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361 citation(s) found for "Núñez, Julio".

Diagnostic value of plasma P‐tau217 in frontotemporal dementia spectrum disorders
Heuer, Hilary W. , Toller, Gianina , Thijssen, Elisabeth H. , Proctor, Nicholas K. , Forsberg, Leah K. , Brushaber, Danielle , Ramos, Eliana Marisa , Coppola, Giovanni , Bordelon, Yvette , Dickerson, Brad C., Fagan, Anne M. , Fields, Julie A. , Foroud, Tatiana M., Galasko, Doug, Gavrilova, Ralitza H. , Geschwind, Daniel H. , Ghoshal, Nupur , Graff‐Radford, Neill R. , Graff‐Radford, Jonathan , Grant, Ian , Huey, Edward D. , Kornak, John , Ljubenkov, Peter A. , Lucente, Diane , Mackenzie, Ian R. , Masdeu, Joseph C. , Mendez, Mario F. , Miyagawa, Toji , Onyike, Chiadi U. , Pedraza, Otto , Petrucelli, Leonard , Rademakers, Rosa , Rankin, Katherine P. , Rascovsky, Katya, Ritter, Aaron, Savica, Rodolfo , Staffaroni, Adam M. , Trataglia, Maria Carmela, Weıntraub, Sandra , Rosen, Howard J. , Boxer, Adam L. , Rojas, Julio C. , VandeVrede, Lawren , Appleby, Brian S. , Botha, Hugo , Dickson, Dennis W. , Domoto‐Reilly, Kimiko , Fong, Jamie , Goldman, Jill , Grossman, Murray , Hsiung, Ging‐Yuek Robin , Huang, Eric J. , Irwin, David J. , Jones, David T. , Kantarci, Kejal , Knopman, David S. , Kremers, Walter K. , Lapid, Maria I. , Léger, Gabriel C. , Litvan, Irene , Masdeu, Joseph C , McMillan, Corey T. , Miller, Bruce L. , Pascual, Belén , Rexach, Jessica E. , Roberson, Erik D. , Seeley, William W. , Toga, Arthur W. , Wong, Bonnie , Wszołek, Zbigniew K. , Dage, Jeffrey L. , Boeve, Bradley F.

Alzheimer's & Dementia | February 1, 2022 | Volume: 17 | Issue: S4 | Pages: No page available

10.1002/alz.055763 Get It

AbstractBackgroundFrontotemporal dementia spectrum disorders (FTD) display complex neuropathological substrates and poor clinicopathological correlations, which hinders therapy development. Plasma P‐tau217 is an emerging tool to screen for Alzheimer’s disease (AD) pathology and may have diagnostic value in FTD.MethodPlasma P‐tau217 was measured cross‐sectionally by electrochemiluminescence in FTD patients referred to ALLFTD from ARTFL (n = 628, 45.7% female, median age 66 ± 12 years). P‐tau217 differences by baseline phenotype, disease severity and genotype were determined with non‐parametric tests and general linear models. Associations between P‐tau217 and measures of disease severity and neuropsychological performance were determined with linear regressions corrected for age, sex, phenotype and APOE.ResultThe sample included 33% behavioral variant FTD, 23.6% primary progressive aphasia (PPA), 28.5% atypical parkinsonism, 1.6% amnestic dementia (AmDem), 2.8% FTD/motoneuron disease, 3% mild cognitive/behavioral impairment and 7.5% healthy controls. Only 1.6% carried FTD‐causing mutations. P‐tau217 was not related to age (r = 0.034, 95%CI ‐0.03 – 0.12, p = 0.4). Compared to controls (0.18 ± 0.07 pg/mL), P‐tau217 was elevated only in AmDem (0.58 ± 0.9 pg/mL, p = 0.001) and logopenic PPA (lvPPA, 0.71 ± 0.62 pg/mL p < 0.001). P‐tau217 ≥ 0.42 pg/mL effectively discriminated AmDem and lvPPA from all other phenotypes (AUC 0.87, 95%CI 0.77 – 0.96, p = 0.001, 77% sensitivity, 92% specificity). AmDem (60%) and lvPPA (91.7%) had the highest prevalence of high (≥ 0.42 pg/mL) P‐tau217, and the highest prevalence of APOE4 (AmDem 40%, lvPPA 63.6%). APOE4 carriers (0.23 ± 0.22 pg/mL) had higher P‐tau217, than non‐carriers (0.19 ± 0.09 pg/mL), regardless of phenotype (APOE effect p = .002, APOE x phenotype, p = 0.44). P‐tau217 was associated with worse clinical severity, mood, memory and executive function, but not with worse motor symptoms or social cognition.ConclusionWhen FTD is suspected, high plasma P‐tau217 is strongly associated with amnestic dementia and logopenic PPA phenotypes. Pending completion of ongoing neuropathological, CSF and molecular neuroimaging analyses, the data support the use of plasma P‐tau217 to identify atypical AD as a cause or AD as a co‐pathology contributing to FTD clinical presentation.
Complement and NfL associations with brain structure and functional connectivity alterations in presymptomatic and symptomatic GRN mutation carriers
Flagan, Taru , Chu, Stephanie A. , Häkkinen, Suvi , McFall, David , Heller, Carolin , Brown, Jesse A. , Lee, Alex J. , Mandelli, Maria Luisa , Gorno‐Tempini, Marilu, Dickerson, Brad C., Geschwind, Daniel H. , Ghoshal, Nupur , Graff‐Radford, Neill R. , Huey, Edward D. , Karydas, Anna M., Kaufer, Daniel , Mackenzie, Ian R. , Mendez, Mario F. , Onyike, Chiadi U. , Petrucelli, Leonard , Ramos, Eliana Marisa , Weıntraub, Sandra , Forsberg, Leah K. , Heuer, Hilary W. , Boxer, Adam L. , Rosen, Howard J. , Lee, Suzee E. , Consortia, ARTFL/LEFFTDS, Rohrer, Jonathan D. , Pasquini, Lorenzo , Appleby, Brian S. , Domoto‐Reilly, Kimiko , Foroud, Tatiana , Grossman, Murray , Hsiung, Ging‐Yuek Robin , Huang, Eric J. , Kantarci, Kejal , Knopman, David S. , Litvan, Irene , Roberson, Erik D. , Rojas, Julio C. , Tartaglia, Maria Carmela , Toga, Arthur W. , Boeve, Bradley F. , Miller, Bruce L. , Moreno, Fermín , Seeley, William W. , Consortia, ARTFL/LEFFTDS

Alzheimer's & Dementia | February 1, 2022 | Volume: 17 | Issue: S4 | Pages: No page available

10.1002/alz.050737 Get It

AbstractBackgroundProgranulin (GRN) mutations cause autosomal dominant frontotemporal lobar degeneration. Clinical trials for GRN‐targeted therapies are underway, yet reliable biomarkers to predict onset and track disease progression remain elusive. Task‐free functional MRI (tf‐fMRI) connectivity may be more sensitive than structural measures for detecting presymptomatic changes (Dopper, 2014; Premi, 2016). Presymptomatic GRN feature tf‐fMRI hyperconnectivity that is more pronounced in older carriers presumably closer to symptom onset, suggesting hyperconnectivity may be a harbinger of disease (Lee, 2019). To aid the interpretation of hyperconnectivity, we explored relationships of structural and tf‐fMRI measures with candidate fluid biomarkers for GRN: CSF complement proteins C3b and C1q, which drive neurodegeneration in GRN ‐/‐ mice (Lui, 2016) and plasma neurofilament light chain (NfL), a marker of axonal injury.MethodWe studied 20 symptomatic GRN (Sx), 39 presymptomatic GRN (preSx), and 67 healthy‐controls (HC). Cross‐sectional CSF C3b, C1q, and plasma NfL concentrations were compared between groups. Correlations controlling for age assessed relationships between fluid biomarkers and symptom severity (CDR®+NACC‐FTLD box score). Voxelwise multiple regression models examined interactions between fluid biomarkers and gene status on grey matter probability maps (GM) and voxelwise tf‐fMRI whole‐brain weighted degree (WBD) maps.ResultComplement concentrations were similar between Sx, preSx, and HC. Across all GRN, C3b concentrations increased with symptom severity (r=0.34, p=0.04). In Sx, but not preSx, higher C3b was associated with increased WBD in medial‐frontal regions, left insula, and thalamus compared to HC. Sx had higher NfL concentrations compared to preSx and HC. Across all GRN and in Sx, higher NfL was associated with greater symptom severity (r=0.60, p<0.001; r=0.72, p<0.001). In Sx, higher NfL was associated with lower GM in precuneus and bilateral frontoinsular cortices, but not WBD, compared to HC. In preSx, higher NfL was associated with increased WBD in thalamus and right temporal regions, but not GM, compared to HC.ConclusionC3b and NfL concentrations correlated with symptom severity. C3b concentrations were associated with tf‐fMRI connectivity alterations in Sx while NfL concentrations were associated with connectivity alterations in preSx. Longitudinal studies are needed to determine temporal relationships between altered connectivity, atrophy, complement, NfL rise, and symptom onset.
Clinical value of CSF tau, p‐tau181, neurogranin and neurofilaments in familial frontotemporal lobar degeneration
Heuer, Hilary W. , Chen, Weiping , Czerkowicz, Julie, Graham, Danielle , Forsberg, Leah K. , Brushaber, Danielle , Ramos, Eliana Marisa , Coppolla, Giovanni, Bordelon, Yvette , Dickerson, Brad C., Fagan, Anne M. , Fields, Julie A. , Galasko, Doug, Gavrilova, Ralitza H. , Geschwind, Daniel H. , Ghoshal, Nupur , Graff‐Radford, Neill R. , Graff‐Radford, Jonathan , Grant, Ian , Huey, Edward D. , Kornak, John , Ljubenkov, Peter A. , Lucente, Diane , Mackenzie, Ian R. , Masdeu, Joseph C. , Mendez, Mario F. , Miyagawa, Toji , Onyike, Chiadi U. , Pedraza, Otto , Petrucelli, Leonard , Rademakers, Rosa , Rankin, Katherine P. , Rascovsky, Katya, Ritter, Aaron, Savica, Rodolfo , Staffaroni, Adam M. , Toga, Arthur W. , Weıntraub, Sandra , Rosen, Howard J. , Boxer, Adam L. , Rojas, Julio C. , Appleby, Brian S. , Botha, Hugo , Dickson, Dennis W. , Domoto‐Reilly, Kimiko , Fong, Jamie , Foroud, Tatiana , Goldman, Jill , Grossman, Murray , Hsiung, Ging‐Yuek Robin , Huang, Eric J. , Irwin, David J. , Jones, David T. , Kantarci, Kejal , Knopman, David S. , Kremers, Walter K. , Lapid, Maria I. , Léger, Gabriel C. , Litvan, Irene , Masdeu, Joseph C , McMillan, Corey T. , Miller, Bruce L. , Pascual, Belén , Rexach, Jessica E. , Roberson, Erik D. , Seeley, William W. , Tartaglia, Maria Carmela , Wong, Bonnie , Wszołek, Zbigniew K. , VandeVrede, Lawren , Boeve, Bradley F.

Alzheimer's & Dementia | February 1, 2022 | Volume: 17 | Issue: S4 | Pages: No page available

10.1002/alz.052993 Get It

AbstractBackgroundBlood neurofilament light chain (NfL) is a robust predictor of phenoconversion in familial frontotemporal lobar degeneration (fFTLD). The comparative value of CSF NfL and other CSF markers of degeneration in fFTLD remains unexplored.MethodFLTD‐causing mutation carriers were recruited through ALLFTD (n = 113, 56.6% female, mean age 48.1 ± 13 years; 29 C9orf72, 16 GRN, 34 MAPT, 34 mutation non‐carriers) and prospectively evaluated for 3 years. Baseline CSF was analyzed for NfL, phosphorylated neurofilament heavy chain (p‐NfH), tau, phosphorylated tau181 (p‐tau) and neurogranin using fit‐for‐purpose immunoassays. Mixed effect linear models, with random slopes, corrected for age, sex, genotype and total intracranial volume related CSF biomarkers to longitudinal clinical variables.ResultNfL (β = 0.64, p < 0.001), p‐NfH (β = 0.68, p < 0.001) and tau (β = 0.46, p < 0.001) correlated with age. There were no differences in biomarker concentrations by phenotype or severity, except for higher NfL and p‐NfH in full phenotype, compared to prodromal disease and asymptomatic carriers. Low neurogranin (β = ‐0.39, p < 0.001), low p‐tau (β = ‐0.33, p < 0.001) and high NfL (β = 0.42, p < 0.001) correlated with worse baseline disease severity measured by the CDR® Dementia Staging Instrument plus behavior and language domains from the National Alzheimer’s Disease Coordinating Center FTLD module sum of boxes (CDR®+NACC‐FTLDsb), and with other measures of global cognition, instrumental and daily function, and frontal and temporal brain volumes. Regardless of genotype, the predicted annualized rate of CDR®+NACC‐FTLDsb score worsenings per higher baseline CSF biomarker Log pg/mL were tau: 3.0 ± 0.2, NfL: 2.8 ± 0.2 and p‐NfH: 2.8 ± 0.2. High tau, NfL and p‐NfH also predicted worsening in other measures of global cognition and instrumental and daily function. Neurogranin and p‐tau did not predict clinical decline.ConclusionCSF tau, p‐tau, neurogranin, NfL and p‐NfH reflect important aspects of disease severity in fFTLD. In contrast to Alzheimer’s disease, low p‐tau and neurogranin are inversely related to clinical severity, which suggests a distinctive pathophysiological process and has implications for therapeutic development. CSF NfL, p‐NfH and tau have strong prognostic value in fFTLD.
Demographic and psychosocial factors associated with the decision to learn mutation status in familial frontotemporal dementia and the impact of disclosure on mood
Bajorek, Lynn, Kiekhofer, Rachel, Hall, Matthew J. , Taylor, Joanne, Lucente, Diane , Brushaber, Danielle , Coppolla, Giovanni, Bordelon, Yvette , Dickerson, Brad C., Fagan, Anne M. , Fields, Julie A. , Forsberg, Leah K. , Galasko, Doug, Gavrilova, Ralitza H. , Geschwind, Daniel H. , Ghoshal, Nupur , Graff‐Radford, Neill R. , Graff‐Radford, Jonathan, Grant, Ian , Heuer, Hilary W. , Huey, Edward D. , Kornak, John , Ljubenkov, Peter A. , Mackenzie, Ian R. , Masdeu, Joseph C. , Mendez, Mario F. , Miyagawa, Toji , Onyike, Chiadi U. , Pedraza, Otto , Petrucelli, Leonard , Rademakers, Rosa , Ramos, Eliana Marisa , Rankin, Katherine P. , Rascovsky, Katya, Ritter, Aaron, Savica, Rodolfo , Toga, Arthur W. , Weıntraub, Sandra , Boxer, Adam L. , Rosen, Howard J. , Staffaroni, Adam M. , Hall, Matthew, Appleby, Brian S. , Botha, Hugo , Dickson, Dennis W. , Domoto‐Reilly, Kimiko , Fong, Jamie , Foroud, Tatiana , Goldman, Jill , Graff‐Radford, Jonathan , Grossman, Murray , Hsiung, Ging‐Yuek Robin , Huang, Eric J. , Irwin, David J. , Jones, David T. , Kantarci, Kejal , Kremers, Walter K. , Lapid, Maria I. , Léger, Gabriel C. , Litvan, Irene , Masdeu, Joseph C , McMillan, Corey T. , Miller, Bruce L. , Pascual, Belén , Rexach, Jessica E. , Roberson, Erik D. , Rojas, Julio C. , Seeley, William W. , Tartaglia, Maria Carmela , Wong, Bonnie , Wszołek, Zbigniew K. , VandeVrede, Lawren , Boeve, Bradley F.

Alzheimer's & Dementia | February 1, 2022 | Volume: 17 | Issue: S7 | Pages: No page available

10.1002/alz.050692 Get It

AbstractBackgroundUp to 30% of frontotemporal dementia (FTD) cases are due to known pathogenic mutations (f‐FTD). Little is known about the factors that predict who will choose to learn their results. Upcoming clinical trials in f‐FTD may require disclosure prior to enrollment, even before symptom onset, and thus characterizing this sample is important. Furthermore, understanding the mood impacts of genetic disclosure may guide genetic counseling practice.MethodF‐FTD participants (n=568) from families with a known pathogenic mutation (MAPT, C9orf72, GRN) were enrolled through the ARTFL/LEFFTDS Longitudinal FTD Study (ALLFTD) and provided the opportunity for disclosure. Independent‐sample t‐tests compared demographic and psychosocial factors between participants who did and did not receive their results. In participants who were asymptomatic at baseline and follow up (n=199,177 with follow‐up), linear mixed effects modeling was used to investigate pre‐ to post‐disclosure changes in the 15‐item Geriatric Depression Scale (GDS).ResultOf participants from families with a known pathogenic genetic mutation, 47% received genetic disclosure. Of the asymptomatic subset (n=386), 36% know their mutation status. Of these asymptomatic learners, 46% received disclosure through the study, and the remainder learned their genetic status prior to study enrollment. None of the analyzed demographic or psychosocial factors (i.e., sex, age, education, having children) differed between learners and non‐learners (p’s > 0.05). In the longitudinal analysis of asymptomatic participants, learners showed a pre‐ to post‐increase of 0.31 GDS points/year (95%CI: ‐0.08, 0.69, p = 0.12), whereas non‐learners showed a slight decline (‐0.15 points/year, 95%CI: ‐0.36, 0.06, p = 0.16). This difference between slopes was statistically significant (0.46, 95%CI: 0.02, 0.89, p=0.04) but represents a small clinical effect. In asymptomatic learners, slopes did not differ based on mutation status (0.28, 95%CI: ‐0.66, 1.20, p=0.55). Conclusions were based on the estimates and full range of confidence intervals.ConclusionThe majority of asymptomatic research participants do not know their genetic status, which will be a consideration for clinical trials that require disclosure. No considered demographic factors were strongly associated with the decision to receive disclosure. The findings suggest that disclosure in asymptomatic participants has minimal impact on depressive symptoms regardless of genetic results.
Gearing up for the future: Exploring facilitators and barriers to inform clinical trial design in frontotemporal lobar degeneration
Banga, Yasmin B, Lai, Yujung, Kim, Priscilla , Boxer, Adam L. , Rosen, Howard J. , Forsberg, Leah K. , Heuer, Hilary W. , Brushaber, Danielle , Bordelon, Yvette , Dickerson, Brad C., Dickinson, Susan, Faber, Kelley , Fagan, Anne M. , Fields, Julie A. , Fishman, Ann, Galasko, Doug, Gavrilova, Ralitza H. , Geschwind, Daniel H. , Ghoshal, Nupur , Graff‐Radford, Jonathan, Graff‐Radford, Neill R. , Grant, Ian , Huey, Edward D. , Karydas, Anna M., Kaufer, Daniel , Kramer, Joel H. , Kornak, John , Lagone, Emma, Ljubenkov, Peter A. , Lucente, Diane , Mackenzie, Ian R. , Manoochehri, Masood , Masdeu, Joseph C. , McGinnis, Scott, Mendez, Mario F, Miyagawa, Toji , Nelson, K. , Onyike, Chiadi U. , Pantelyat, Alex, Pearlman, Rodney , Petrucelli, Leonard , Rademakers, Rosa , Ramos, Eliana Marisa , Rankin, Katherine P. , Rascovsky, Katya, Ritter, Aaron, Sabbagh, Marwan N. , Salmon, David P. , Savica, Rodolfo , Staffaroni, Adam M. , Syrjanen, Jeremy A. , Tatton, Nadine , Taylor, Jack C. , Weıntraub, Sandra , Wheaton, Diana, Wong, Benjamin , Boeve, Bradley F. , Appleby, Brian S. , Biernacka, Joanna M. , Botha, Hugo , Bozoki, Andrea C , Brannelly, Patrick , Dickson, Dennis W. , Domoto‐Reilly, Kimiko , Foroud, Tatiana , Gendron, Tania F. , Goldman, Jill , Graff‐Radford, Jonathan , Grossman, Murray , Hsiung, Ging‐Yuek Robin , Huang, Eric J. , Irwin, David J. , Jones, David T. , Kantarci, Kejal , Knopman, David S. , Kremers, Walter K. , Kukull, Walter A. , Léger, Gabriel C. , Litvan, Irene , Masdeu, Joseph C , Mendez, Mario F, Miller, Bruce L. , Nelson, Kevin M, Pascual, Belén , Pottier, Cyril , Rexach, Jessica E. , Roberson, Erik D. , Rojas, Julio C. , Seeley, William W. , Tartaglia, Maria Carmela , Toga, Arthur W. , Wszołek, Zbigniew K.

Alzheimer's & Dementia | February 1, 2022 | Volume: 17 | Issue: S7 | Pages: No page available

10.1002/alz.052495 Get It

AbstractBackgroundFrontotemporal lobar degeneration (FTLD) refers to a group of neurodegenerative conditions, affecting the frontal and/or temporal lobes. Ongoing research has provided insight into developing clinical trials for FTLD and key clinical measures such as structural MRI. To inform clinical trial design and optimize participation, it is imperative to explore facilitators and barriers for potential candidates.ObjectiveThe objective of this study is to explore facilitators and barriers to participating in future clinical trials for FTLD.MethodsAdvancing Research and Treatment for Frontotemporal Lobar Degeneration (ARTFL) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS) are observational studies focused on characterizing FTLD syndromes in preparation for clinical trials. The 584 participants enrolled across 18 research sites in the United States and Canada completed a survey assessing interest in clinical trial participation.Results29% of respondents self‐reported as patients (63±10 years), 26% self‐reported as caregivers answering on behalf of patients (65±10 years), and 45% self‐reported as healthy but at risk for FTLD (48±14 years). Travel reimbursement was the most common factor reported to positively influence participation (≧66%), with the healthy but at risk group showing the strongest endorsement (83%). Cost and time involved in travel were possible barriers for about half of the patients (48%) and healthy but at risk respondents (53%). The respondents value receiving feedback on the study findings (≧80%) and being informed of their individual disease progression (≧75%). Particularly, keeping participation confidential was very important for the healthy but at risk group (62%). In regard to research assessments, most participants demonstrated a high interest in physical and neurological exams at a research center (≧87%) whereas only half were interested in doing more invasive procedures such as the lumbar puncture (≧52%). Overall, respondents showed a positive attitude and support for research participation (≧77%) and trusted that their health information would remain confidential in a clinical trial (≧53%).ConclusionsFavorable attitudes and interest towards medical research exist among participants. To optimize participation, clinical trials should allocate funding for travel and involve participants in feedback about study results and their disease progression. Alternatives to invasive assessments may increase participation.
Impact of a Multidisciplinary Tumor Board on the Care of Patients with Histiocytic Disorders: The Histiocytosis Working Group experience
Goyal, Gaurav , Abeykoon, Jithma P. , Sartori‐Valinotti, Julio C. , Vassallo, Robert , Ryu, Jay H. , Davidge‐Pitts, Caroline , Ravindran, Aishwarya , Sartori-Valinotti, Julio C., Goyal, Guarav , Vassallo, Robert , Ravindran, Aishwarya , Ryu, Jay H , Young, Jason R. , Shah, Meera , Bennani, N. Nora , Tobin, W. Oliver , Koster, Matthew J. , Rech, Karen L. , Go, Ronald S.

The Oncologist | January 1, 2022 | Volume: 27 | Issue: 2 | Pages: 144-148

10.1093/oncolo/oyab031 | PMID 35641201 Get It

Abstract Introduction Histiocytic disorders pose significant diagnostic and management challenges for the clinicians due to diverse clinical manifestations and often non-specific histopathologic findings. Herein, we report the tumor board experience from the first-of-its-kind Histiocytosis Working Group (HWG). Materials and Methods The HWG was established in June 2017 and consists of experts from 10 subspecialties that discuss cases in a multidisciplinary format. We present the outcome of tumor board case discussions during the first 2 years since its inception (June 2017-June 2019). Results Forty cases with a suspected histiocytic disorder were reviewed at HWG during this time period. Average number of subspecialties involved in HWG case discussion was 5 (range, 2-9). Histiocytosis Working Group tumor board recommendations led to significant changes in the care of 24 (60%) patients. These included change in diagnosis (n = 11, 27%) and change in treatment (n = 13, 33%). Conclusion Our report highlights the feasibility of a multidisciplinary tumor board and its impact on outcomes of patients with histiocytic disorders.
Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19
Gillet, A.S. , Zu, Yuanhao, Brown, Margo, Pham, Thaidan , Yoshida, Yilin , Douglas, Ivor S. , Moore, Mathew, Tea, Kevin, Wetherbie, Andrew, Stevens, Rachael, Lefante, John J., Shaffer, Jeffrey G. , Armaignac, Donna Lee , Belden, Katherine A. , Kaufman, Margit, Heavner, Smith F. , Danesh, Valerie , Hill, Catherine A. St., Boman, Karen , Bansal, Vikas , Kumar, Vishakha K. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Mesland, Jean-Baptiste , Henin, Pierre , Petre, Hélène, Buelens, Isabelle, Gérard, A , Granado, Rolando Claure-Del, Vega-Terraza, Esdenka, Iturricha-Cáceres, Maria F., Garza, Rubén , Chan, Victoria , Gavidia, Oscar Y., Pachon, Felipe, Tawheed, Ahmed , Pineda, Estela , Guillen, Gabina María Reyes, Soto, Helin Archaga, Lizardo, Ana Karen Vallecillo, Segu, Smitha, Chakraborty, T., Joyce, Epcebha, Kasumalla, Phani Sreeharsha, Vadgaonkar, Girish, Ediga, Rekha, Basety, Shilpa, Dammareddy, Shwetha, Raju, Umamaheswara, Manduva, Janaki, Kolakani, Naresh, Sripathi, Shreeja , Chaitanya, Sheetal, Parameswaran, Sreejith , Parthiban, Magesh, Menu, P., Daga, Mardul Kumar, Agarwal, Munisha , Rohtagi, Ishan, Papani, Sridhar, Kamuram, Mahesh, Agrawal, Kamlesh Kumar , Baghel, Vijendra, Patel, K, Mohan, Surapaneni Krishna, Jyothisree, Ekambaram, Dalili, Nooshin , Nafa, Mohsen, Matsuda, Wataru , Suzuki, Reina , Horikita, Sho, Kodate, Akira, Takahashi, Yuki , Moriki, Koyo, Iwasaki, Yudai , Rodríguez‐Gutiérrez, René , Gonzale, Jose Gerardo, Salcido‐Montenegro, Alejandro , Hassan-Hanga, Fatimah , Gezawa, Abubakar Shehu, Kabir, Halima , Amole, Taiwo Gboluwaga , Haliru, Dalha Gwarzo, Ibrahim, Abdullahi S., Asghar, Muhammad Sohaib , Syed, Mashaal , Naqvi, Syed Anosh Ali, Заболотских, И. Б. , Alamoudi, Razan K., Alsharif, Hassan, Almazwaghi, Sarah A., Elsakran, Mohammed S., Aid, M., Darwich, Mouaz A., Hagag, Omnia M., Ali, Salah A., Rocacorba, Alona, Supeña, Kathrine, Juane, Efren Ray, Medina, Jenalyn, Baduria, Jowany, Amer, Marwa , Dahhan, Talal, Kseibi, Eiad, Butt, Abid Shahzad, Khurshid, Syed Moazzum, Rabee, Muath, Abujazar, Mohammed, Alghunaim, Razan K, Abualkhair, Maal, AlFirm, Abeer Turki, Alarifi, Mohammed I, Macarambon, Jara Mia, Bukhari, Ahmad Abdullah, Albahrani, Hussian A, Aldossary, Kaltham M., Zoran, Marija Zdravkovic, Popadic, Viseslaz, Bojicic, Jovana, Predrag, Stevanović, Stojakov, Dejan , Ignjatovic, Duska K., Bojicic, Suzana C, Bobos, Mariana M, Nenadić, Irina , Zaric, Milica S., Djuric, Marko , Djukic, Vladimir R., Teruel, Santiago, Martin, Belen C., Bilgin, Huseyin, Dodd, Kenneth W. , Goodmanson, Nicholas, Hesse, Kathleen, Bird, P. H., Weinert, Chauncey, Schoenrade, Nathan, Altaher, Abdulrahman, Mayar, Esmael, Aronson, Matthew, Cooper, Tyler, Logan, Monica, Miner, Brianna, Papo, Gisele, Siegal, Eric M., Runningen, Phyllis, Patel, Love , Melamed, Roman , Tierney, David M. , Raj, Vino S., Mazumder, Narayana, Hill, Catherine St., Kirkland, Lisa L., Schmitz, Nova J., Sigman, Alena, Hall, Joan, Raval, Abhijit, Franks, Andrea S. , Jarvis, Jennifer M., Kharbanda, Anmol, Jhajhria, Sunil, Fyffe, Zachary, Capizzi, Stephen A., Alicie, Bethany, Green, Martha, Corckarell, Lori, Drennan, A. M., Dubuque, Kathleen, Fambrough, Tonya, Gasaway, Nikole, Krantz, Briana, Nebi, Peiman, Orga, Jan, Serfass, Margaret, Simion, Alina, Warren, Kimberly R., Wheeler, Cassie, Woolman, C. J., Christie, Amy B. , Adiga, Rajani, Moyer, A, Verghese, George M., Forehand, Chirsty C, Sabov, Moldovan, Zaidi, Fatema, Tissavirasingham, Fiona, Malipeddi, Dhatri , Campbell, Beth Salvagio , Wilson, Cathleen, Rivers, Patrick , Brinks, Jonathan, Mongoh, Mokenge Ndiva, Gilson, Boris, Armaignac, Donaa Lee, Parris, Don, Zuniga, Maria Pilar, Vargas, Ilea, Boronat, Viviana, Hutton, Anneka, Kaur, Navneet , Neupane, Prashank, Sadule-Rios, Nohemi, Rojas, Lourdes M. , Neupane, Aashish, Rivera, Priscilla, Carlos, Carlos Valle, Amin, Mahesh, Schelle, Mary E, Steadham, Amanda, McBride, Cameron , Abraham, Jocelyn, Richards, Katherine , Collins, Keegan, Antony, Preethi, Dubrocq, Gueorgui , Davis, Amber, Hammers, Marissa J, McGahey, Ill M, Farris, Amanda C., Priest, Elisa L. , Korsmo, Robyn, Fares, Lorie, Skiles, Kathy, Shor, Susan M, Burns, Kenya, Flores, Melody, Newman, Lindsay, Wilk, Debora A., Ettlinger, Jason, Bomar, Jaccallene, Darji, Himani, Arroliga, Alejandro C. , Dowell, Corrie A., Gonzales, Gabriela “ Hope”, Garcia, Michael A. , Colona, Mia R., Kibbelaar, Zoé A. , Leong, Michael S. , Wallman, Daniel , Soni, Kanupriya , Maccarone, Jennifer , Gilman, Joshua, Devis, Ycar, Chung, Joseph, Paracha, Munizay , Lumelsky, David , DiLorenzo, Madeline A. , Abdurrahman, Najla, Johnson, Shelsey W. , Hersh, Maj Andrew M., Wachs, Stephanie, Swigger, Brittany S., Sattler, L, Moulton, Michael N., Zammit, Kimberly, Loeffler, William, Tirupathi, Raghavendra , Tang, Alymer, Safi, Arshad M., Green, Cindy, Newell, J.D., Ramani, Naga, Ganti, Bhavani Harika, Ihle, R , Davis, Elaine , Martin, Shelda A, Sayed, Imran A., Strom, Larisa, Lee, Giyoung , Burnett, Ryan H., Sydney, Guy I. , Traynor, Danielle M., White, Joshua, Khan, Aftab, Dhahwal, Rahul, Ahmed, Farzin, Deonarine, Chrispoter, Jones, Ashley, Shaikh, Mohammad Ali, Preston, David A. , Chin, Jeanette, Duggal, Abhijit, Rajendram, Prabalini , Mehkri, Omar , Biehl, Michelle, Houltham, Stuart, Kind, Alexander, Ashok, Kiran, Poynter, Bryan, Beukemann, Mary, Rice, Richard, Gole, Susan, Shaner, Valerie , Conjeevaram, Adarsh, Ferrari, Michlelle, Alappan, Narendrakumar, Minear, Steven , Hernández-Montfort, Jaime , Nasim, Syed Sohaib, Sunderkrishnan, Ravi, Sahoo, Debasis , Milligan, Patrick S., Koglin, Joy M., Gibson, Regina, Johnson, Lana, Preston, Felicia, Scott, Crimson, Nungester, Bethany, Byrne, Dana , Grant, Katie, Doktar, Katherine L, Porto, Maura C, Kaplan, Olgo, Schonewald, Brian, Woodford, Ashley L., Tsai, Alan , Reid, Savina, Bhowmick, Kuntal, Daneshpooy, Saba , Mowdawalla, Cyrus , Dave, Trishna Akshay, Crudeli, Wilhemina Kennedy Connor, Ferry, Chirstopher, Nguyen, Long , Modi, Sneha, Padala, Niharika, Patel, Pavan Jitendra, Lin, Belle, Qiuyun, Jamie, Liu, Fan Mandi, Kota, Rasagna, Banerjee, Annesha , Daugherty, Steven K., Atkinson, Sam, Shrimpton, Kelly, Ontai, Sidney , Contreras, Brian, Obinwanko, Uzoma, Amamasi, Nneka, Sharafi, Amir, Lee, Sarah , Esber, Zahia , Jinjvadia, Chetna, Krishnamoorthy, Vijay , Kraft, Bryan , Pulsipher, Aaron, Friedman, Eugene, Mehta, Sachin , Kaufman, Margit, Lobel, G, Gandhi, Nisha, AbdelAty, Amr M. , Shaji, Elizabeth, Lim, Kiana, Marte, Juan M., Sosa, Dani Ashley, Benjenk, Ivy , Prasanna, Nivedita, Perkins, Nicholas , Roth, Prera J, Litwin, Alain H. , Pariyadath, Ananda, Moschella, Phillip , Llano, Trayson, Waller, Christine, Kallies, Kara J. , Thorsen, Jonean , Fitzsimmons, Alec , Olsen, H. L., Smalls, Normal, Davis, S., Jovic, Valentina, Masuda, M, Hayes, Amanda, Nault, Katharine, Snow, William G., Liptak, Riley, Durant, Hannah, Pendleton, Valerie, Nanavati, Alay, Mrozowsk, Risa, Doubleday, Erica, Liu, Yuk Min, Zavala, Sarah , Shim, Esther, Reilkoff, Ronald A., Eichen, Sarah, Goertzen, Lexie, Rajala, Scott, Feussom, Ghislaine, Junia, Christine, Lichtenberg, Robert, Sidhu, Hasrat, Espinoza, Diana , Rodrigues, Shelden , Zabala, Marai Jose, Susheela, Ammu , Hatharaliyadda, Buddhi, Rameshkumar, Naveen, Kasireddy, Amulya, Beltran, Lisseth, Chaugule, Akshata, Patil, Namrata, Patil, Ruhi, Cartin‐Ceba, Rodrigo , Sen, Ayan , Talaei, Fahimeh , Domecq, Juan Pablo , Gajic, Ognjen, Sharma, Mayank , Qamar, Shahraz , Morales, Diana J. Valencia , Nou, Abigail T. La, Bogojevic, Marija , Sanghavi, Devang , Franco, Pablo Morno, Ganaphadithan, Karthik, Saunders, Hollie , Fleissner, Zachary, Mateus, Alejandra Yu Lee, Kaur, Nirmaljot , Giri, Abhisekh, Hasan, Mohammed Mustafa, Donepudi, Ashrita , Khan, Syed Anjum , Jain, Nitesh , Koritala, Thoyaja , Nanchal, Rahul , Peterson, Jennifer , Yamanaka, Travis, Barreras, Nicholas A., Markos, Michael, Fareeduddin, Anita, Mehta, Rohan, Venkata, Chakradhar , Engemann, Miriam, Mantese, Annamarie, Tarabichi, Yasir , Wang, Christine, Kotekal, Dhatri, Bierwirth, Adriana C. Briceno, Orellana, Gabriela, Catalasan, Gerardo , Ahmed, Shohana, Salinas, Ivania, Nogal, Genesis Del, Tejada, Ángel Morales-Martínez de, Chen, Jen‐Ting , Hope, Aluko A. , Tsagaris, Zoe, Ruen, Elise, Hambardzumyan, Aram, Siddiqi, Nasar A, Jurado, Lesly, Tincher, Lindsey, Brown, Carolyn , Aulakh, Bhagat , Bandy, Jennifer A., Kreps, Lisa M., Bollinger, Dwan R, Stienecker, Roger Scott , Melendez, Andre G, Brunner, Tressa A., Budzon, Sue M., Heffernan, J., Souder, Janelle M., Miller, Tracy L., Maisonneuve, A., Redfern, Roberta E. , Shoemaker, Jessica, Micham, Jennifer, Kenney, Lynn, Naimy, Gabriela, Pulver, Kerry P J, Yehle, Jennifer, Weeks, Alicia, Inman, T., Delmonaco, Brain L, Franklin, Anthony , Heath, Mitchell, Vilella, Antonia L. , Kutner, Sara B., Clark, Kacie , Anderson, Harry L, Rajkumar, Dixy, Abunayla, Ali, Heiter, Jerrilyn, Zaren, Howard A. , Smith, Stephanie J., Lewis, Grant C., Seames, Lauren, Farlow, Cheryl, Miller, Judy, Broadstreet, Gloria, Martinez, Anthony , Allison, Micheal, Mittal, Aniket, Ruíz, Rafael Azuar , Skaanland, Aleta, Patel, Umang, Hodge, Jordesha, Patel, Krunal Kumar, Dalal, Shivani , Kavani, Himanshu , Joseph, Sam W. , Bernstein, Michael, Goff, Ian K., Naftilan, Matthew, Mathew, Amal , Williams, Debora, Murdock, Sue, Ducey, Maryanne, Nelson, Kerianne, Mitchel, James, Cox, Sylvan, Amzuta, Ioana, Shah, Amish , Modi, Ritu, Al-Khalisy, Hassan, Masuta, Pradeep, Schafer, Melissa , Wratney, Angela, Carter, K., Olmos, M. A. Martinez, Parker, Brittany M, Quintanilla, Julio, Craig, Tara A, Clough, B., Jameson, J, Jones, Tacy L, Ayers, Shonda C., Harrell, Amy B., Brown, Brent R., Darby, Caleb, Page, Kristy, Brown, Amanda, McAbee, Jessie, Baram, Michael , Weber, Devin , DePaola, Rosalie, Xia, Yuwei , Carter, Hudson, Tolley, A. E., Ferranti, Mary, Steele, Mark P., Kemble, Laurie, Sethi, Joshua, Han, Chung Cheng, Pagliaro, Jaclyn , Husian, Abdurrahman, Zawaydeh, Qais , Sines, B. , Markotić, Dragana, Bošnjak, Ivana, Nicholson, Susannah E. , Jonas, Rachelle B., Dement, AnnaRose E, Tang, William , DeRose, Mark, Villarreal, Robert E, Dy, Rajany , Lardino, Alfredo, Sharma, Jill H., Czieki, Richard, Christopher, Julia, Lacey, Ryan, Mashina, Marwan , Patel, Kushal, Gomaa, Dina , Goodman, Micahel, Spuzzillo, Anthony , Shinn, John O., Baslanti, Tezcan Ozrazgat, Omalay, George, Hashemighouchani, Haleh , Cupka, Julie S , Galet, Colette , Hubbard, Janice, Nazir, Usman, Rampon, Garrett , Riggle, Jake, Dismag, Nathan, Lenhardt, Rainer, Cavallazzi, Rodrigo , Jerde, Ann, Black, Alexa, Polidori, A., Griffey, Haily, Winkler, J., Brenzel, Thomas, Alvarez, Rodger A, Alarocon-Calderon, Amarilys, Sosa, Marie Anne , Mahabir, Sunita, Patel, Mausam , Parker, Pauline, Admon, Andre, Hanna, Sinan, Pliakas, Maria , Wolski, Ann, Cirino, Jennifer, Geiger, Grant , Njai, Abdoulie , Saad, Baraa M., Chuan, Byron, Rawal, Sagar L, Piracha, Manal, Levin, Nicholas M. , Suslavich, Kayte , Tsolinas, Rachel , Fica, Zachary , Skidmore, Chloe R., Stapleton, Renee D., Dixon, Anne E. , Johnson, Olivia, Ardren, Sara S., Burns, Stephanie, Raymond, Anna, Gonyaw, Erika, Hodgdon, Kevin , Houseger, Chole, Lin, Benjamin R. , McQuesten, Karen, Grimm, Heidi Pecott-, Sweet, Julie, Ventrone, Sebastian, Khandelwal, Nita , Lovelace-Macon, Lara, Garimella, Navya, Dow, Denisse Bazan, Rahman, Rania Abdul, Mulrow, Mary, Wilfong, Erin M. , Vela, Kelsi, Harris, Lynne, Cusson, Bruce, Fowler, Jacob , VanEenenaam, David P., Mckinney, Glen , Udoh, Imoh, Johnson, Kathleen N. , Michelson, Andrew P. , Haulf, Sara S, Lynch, Lauren, Steinbery, Aaron, Braus, Nicholas, Pattan, Vishwanath , Papke, J, Jimada, Ismail, Mhid, Nida, Chakola, Samuel, Sheth, Kevin N., Ammar, Abdalla , Lopez, Victor Torres , Khosla, Akhil , Gautam, Samir C. , Lee‐Mateus, Alejandra Yu , Bansal, Vikas , Yu Lee-Mateus, Alejandra , Kaur, Nirmaljot , Asghar, Muhammad S , Redfern, Roberta E , Denson, Joshua L. , Mauvais‐Jarvis, Franck , Cheruku, Sreekanth , Deo, Neha , Walkey, Allan J. , Kashyap, Rahul , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Clevenbergh, Philippe Albert , Granado, Rolando Claure‐Del , Mercado, Jose A, Garza, Ruben, Chu, Eric, Chan, Victoria, El‐Kassas, Mohamed , Chakraborty, Tuhin, Cherian, Anusha , Menu, Priya A, Sanui, Masamitsu , Itagaki, Yuki , Shiga, Takuya , Camacho-Ortíz, Adrián , Galadanci, Hadiza , Syed, Mashaal, Musaeva, Tatiana Sergeevna , Bawazeer, Mohammed Abdullah , Alghunaim, Razan K, Almazyad, Mohammed , Asfina, Kazi Nur , Klašnja, Slobodan , Kovačević, Bojan , Teruel, Santiago Y, Sili, Uluhan , Ay, Pınar , Bird, Paige, Schoenrade, Nathan, Hall, Joan, Franks, Andrea, Drennan, Amelia, Warren, Kimberly, Ashley, Dennis W. , Sikora, Andrea , Bruning, Rebecca, Jones, Timothy W, Mosier, Jarrod , Lutrick, Karen , Vincent, Gregory, Howard, Christopher M. , Garner, Orlando , Mathew, Sindhu, Dubrocq, Gueorgui , Waikar, Sushrut S. , Leong, Michael, McGrath, Patrick J, Chilbert, Maya R. , Green, Cindy, Ihle, Rayan E, Martin, Shelda A., Gist, Katja M. , Chiotos, Kathleen , Blatz, Allison M. , Surani, Salim , White, Joshua, Khan, Aftab, Preston, David, Vachharajani, Vidula , Dugar, Siddharth , Sacha, Gretchen , Kind, Alexander, Gole, Susan, Gupta, Sandeep , Schorr, Christa , Siegler, James E. , Bartz, Raquel R. , Mehta, Sachin, Kaufman, Margit, Abdelaty, Amr, Yamane, David , Pariyadath, Anand, Olsen, Haley, Smith, Michael A. , Snow, William, Heneghan, Julia A. , Tang, Ben, Goyes, Daniela , Maldonado, Génessis , Khan, Hassan, Gajic, Ognjen , Tekin, Aysun , Lal, Amos , O’Horo, John C. , Singh, Romil , Nou, Abigail La, Zec, Simon , Guru, Pramod , Garcia, Juan, Yarrarapu, Siva Naga S. , Bergl, Paul A. , Peterson, Jennifer L, Perzynski, Adam T. , Wang, Christine, Matute, Carlos , Hamdan, Ahmad, Tejada, Angel, Tripathi, Sandeep , Inman, Terra, Moore, Danielle, Anderson, Harry L, Miller, Judy, Ruiz, Rafael, Ross, Robert, Joseph, Sam, Block, Jason, O’Brien, Connor , Carter, Kristina L, Olmos, Michael, Gupta, Neha , Darby, Caleb, Tolley, Aaron, Malhotra, Atul , Bice, Thomas J. , Bosnjak, Ivana, Vail, Emily A. , Tang, William, Villarreal, Roberto E., Patel, Kushal, Wakefield, Devin, Bihorac, Azra , Ruppert, Matthew M. , McGonagill, Patrick W. , Wang, David , Allan, Lauren , Badheka, Aditya V. , Chegondi, Madhuradhar , Akça, Ozan , Polidori, Allison, Winkler, Justin, Chanderraj, Rishi , Dandachi, Dima , Regunath, Hariharan , Camazine, Maraya , Saad, Baraa, Shah, Faraaz A , Tonna, Joseph E. , Lin, Benjamin, Pecott-Grimm, Heidi, West, T. Eoin , Caldwell, Ellen , Akhter, Murtaza , Khanna, Ashish , Lyons, Patrick G. , Lynch, Lauren M, Nguyen, Nguyet Minh , Papke, Jessica, Ammar, Mahmoud A , Dela Cruz, Charles S

JAMA Network Open | December 22, 2021 | Volume: 4 | Issue: 12 | Pages: e2140568

10.1001/jamanetworkopen.2021.40568 | PMID 34935924 Get It

126. Outpatient Antimicrobial Stewardship Utilizing a Decentralized Model
McMullan, Stephen, Anderson, Therese , Boeff, Deborah, Bonner, William F., Epps, Kevin , LaCouture, Jacqueline, Leak, Michelle A. , Leybeg, Angelica, Riffe, Izabela, Schnusenberg, Lynda, Mendez, Julio, Anderson, Therese F , Powers, Harry, Bonner, William, Harris, Dana M.

Open Forum Infectious Diseases | December 5, 2021 | Volume: 8 | Issue: Supplement_1 | Pages: S176-S176

10.1093/ofid/ofab466.328 Get It

Abstract Background The majority of human antimicrobial utilization occurs in the outpatient setting. Despite being mainly viral in etiology, upper respiratory tract infections (URIs) were the most common indication for outpatient antimicrobial prescriptions at our institution. Methods Through our electronic health record (EHR), we were able to determine our rate of antibiotic prescriptions for inappropriate URI diagnosis at our primary care practice sites. We selected staff volunteers from each our primary care practice sites to serve as stewardship champions. They were given training in stewardship best practices, and an URI stewardship toolkit which included viral URI prescription pad, EHR order panel, and patient education signage. They were tasked with providing education and feedback to their practice sites. We meet with them on a monthly basis to disseminate prescribing data and education. They also provided feedback from practice sites to the stewardship committee. Results Our decentralized model was put in place in November 2020. In the 6 months prior to the intervention, the average prescribing rate was 29.1%. In the 6 months after the intervention, the average prescribing rate decreased by 15% to 24.8%. During the intervention phase, there was an increase in number of non-COVID URIs diagnosed at our primary care sites. Temporal Trend in Inappropriate Antibiotics Prescribing Rates for Viral URIs Pre- and Post- Intervention Inappropriate antibiotic prescribing rate for viral upper respiratory tract infections from May 2020 until May 2021. Intervention started in December 2021 (arrow). Pre-intervention average was 29.1%. Post-intervention age was 24.8% which is a 15% decline in prescribing rate. Viral Upper Respiratory Infections Visits The total number of visits for presumed viral upper respiratory infections to primary care sites from May 2020 until May 2021. The majority of COVID-19 precautions in the area expired at the end of March 2021. Conclusion We have been able to lower our inappropriate prescriptions for URIs utilizing a decentralized model of stewardship champions. This result was especially notable as the intervention phase corresponded with the end of COVID-19 precautions and an increase in non-COVID URIs diagnosed. The advantage of this approach includes an advocate embedded at each practice site who is familiar with the opportunities and challenges of the site, and a two-way flow of information from practice sites to the stewardship committee. This model provided additional benefit during the COVID-19 pandemic as the ability of centralized staff to travel to off campus clinic sites was curtailed. Disclosures All Authors: No reported disclosures
Primary Analysis of ZUMA-12: A Phase 2 Study of Axicabtagene Ciloleucel (Axi-Cel) As First-Line Therapy in Patients with High-Risk Large B-Cell Lymphoma (LBCL)
Neelapu, Sattva S. , Ulrickson, Matthew L. , Thiéblemont, Catherine , Oluwole, Olalekan O. , Herrera, Alex F. , Ujjani, Chaitra S. , Kekre, Natasha , Vos, Sven de , Lui, Christine, Milletti, Francesca, Dong, Jinghui , Xu, Hairong , Oluwole, Olalekan O , Dickinson, Michael , Muñoz, Javier , Lin, Yi , Riedell, Peter A. , Chavez, Julio C

Blood | November 23, 2021 | Volume: 138 | Issue: Supplement 1 | Pages: 739-739

10.1182/blood-2021-148009 Get It

Abstract Background: High-risk LBCL is associated with poor prognosis after first-line anti-CD20 mAb-containing regimens, highlighting the need for novel treatments. Axi-cel, an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, is approved for treatment of relapsed/refractory (R/R) LBCL after ≥2 lines of systemic therapy. Here we report the primary analysis of ZUMA-12, a Phase 2, multicenter, single-arm study of axi-cel as part of first-line therapy in patients with high-risk LBCL. Methods: Eligible adults had high-risk LBCL, defined by histology (double- or triple-hit status [MYC and BCL2 and/or BCL6 translocations] per investigator) or an IPI score ≥3, plus a positive interim PET per Lugano Classification (Deauville score [DS] 4/5) after 2 cycles of an anti-CD20 mAb and anthracycline-containing regimen. Patients underwent leukapheresis and received conditioning chemotherapy (cyclophosphamide and fludarabine) followed by a single axi-cel infusion at 2×10 6 CAR T cells/kg. Non-chemotherapy bridging could be administered before conditioning per investigator discretion. The primary endpoint was investigator-assessed complete response (CR) rate per Lugano. Secondary endpoints included objective response rate (ORR; CR + partial response), duration of response (DOR), event-free survival (EFS), progression-free survival (PFS), overall survival (OS), incidence of adverse events (AEs), and levels of CAR T cells in blood and cytokines in serum. The primary analysis occurred after all treated patients had ≥6 months of follow-up. Results: As of May 17, 2021, 42 patients were enrolled and 40 were treated with axi-cel. Median age was 61 years (range, 23-86); 68% of patients were male, 63% had ECOG 1, 95% had stage III/IV disease, 48% had DS4, 53% had DS5, 25% had double- or triple-hit status per central assessment, and 78% had IPI score ≥3. A total of 37 patients had centrally confirmed double- or triple-hit histology or an IPI score ≥3 and were evaluable for response, with 15.9 months of median follow-up (range, 6.0-26.7). The CR rate was 78% (n=29; 95% CI, 62-90); 89% of patients had an objective response, and median time to initial response was 1 month. Among all 40 treated patients, 90% had an objective response (80% CR rate). At data cutoff, 73% of response-evaluable patients had ongoing responses. Medians for DOR, EFS, and PFS were not reached; 12-month estimates were 81%, 73%, and 75%, respectively. The estimated OS at 12 months was 91%. All 40 treated patients had AEs of any grade; 85% of patients had Grade ≥3 AEs, most commonly cytopenias (68%). Grade ≥3 cytokine release syndrome (CRS) and neurologic events (NEs) occurred in 3 patients (8%) and 9 patients (23%), respectively. Median times to onset of CRS and NEs were 4 days (range, 1-10) and 9 days (range, 2-44), with median durations of 6 days and 7 days, respectively. All CRS and most NEs (28/29) of any grade resolved by data cutoff (1 ongoing Grade 1 tremor); 39/40 CRS events resolved by 14 days post-infusion and 19/29 NEs resolved by 21 days post-infusion. Tocilizumab was administered to 63% and 3% of patients for management of CRS or NEs, respectively; corticosteroids were administered to 35% and 33% of patients for CRS and NE management. One Grade 5 event of COVID-19 occurred (Day 350). Median peak CAR T-cell level in all treated patients was 36 cells/µL (range, 7-560), and median expansion by AUC 0-28 was 495 cells/µL × days (range, 74-4288). CAR T-cell levels peaked at a median of 8 days post-infusion (range, 8-37). Higher frequency of CCR7+CD45RA+ T cells in axi-cel product, previously associated with greater expansion of CAR T cells (Locke et al. Blood Adv. 2020), was observed in ZUMA-12, compared with the ZUMA-1 study in R/R LBCL (Neelapu et al. New Engl J Med. 2017). Conclusion: In the primary analysis of ZUMA-12, axi-cel demonstrated a high rate of rapid and complete responses in patients with high-risk LBCL, a population with high unmet need. With 15.9 months of median follow-up, responses were durable as medians for DOR, EFS, and PFS were not yet reached and over 70% of patients remained in response at data cutoff. No new safety signals were reported with axi-cel in an earlier line. Overall, axi-cel may benefit patients exposed to fewer prior therapies, and further trials in first-line high-risk LBCL are warranted to assess axi-cel in this setting. Figure 1 Figure 1. Disclosures Neelapu: Kite, a Gilead Company, Merck, Bristol Myers Squibb, Novartis, Celgene, Pfizer, Allogene, Kuur, Incyte, Precision BioSciences, Legend, Adicet Bio, Calibr, and Unum Therapeutics: Other: personal fees; Kite, a Gilead Company, Bristol Myers Squibb, Merck, Poseida, Cellectis, Celgene, Karus Therapeutics, Unum Therapeutics (Cogent Biosciences), Allogene, Precision BioSciences, Acerta and Adicet Bio: Research Funding; Takeda Pharmaceuticals and related to cell therapy: Patents & Royalties; Kite, a Gilead Company, Merck, Bristol Myers Squibb, Novartis, Celgene, Pfizer, Allogene Therapeutics, Cell Medica/Kuur, Incyte, Precision Biosciences, Legend Biotech, Adicet Bio, Calibr, Unum Therapeutics and Bluebird Bio: Honoraria. Dickinson: Janssen: Consultancy, Honoraria; Takeda: Research Funding; Novartis: Consultancy, Honoraria, Research Funding, Speakers Bureau; Amgen: Honoraria; Celgene: Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria; MSD: Consultancy, Honoraria, Research Funding, Speakers Bureau; Roche: Consultancy, Honoraria, Other: travel, accommodation, expenses, Research Funding, Speakers Bureau; Gilead Sciences: Consultancy, Honoraria, Speakers Bureau. Munoz: Kite, a Gilead Company, Kyowa, Bayer, Pharmacyclics/Janssen, Seagen, Acrotech/Aurobindo, Beigene, Verastem, AstraZeneca, Celgene/BMS, Genentech/Roche.: Speakers Bureau; Bayer, Gilead/Kite Pharma, Celgene, Merck, Portola, Incyte, Genentech, Pharmacyclics, Seattle Genetics, Janssen, and Millennium: Research Funding; Pharmacyclics/Abbvie, Bayer, Kite, a Gilead Company, Pfizer, Janssen, Juno/Celgene, Bristol Myers Squibb, Kyowa Kirin, Alexion, Fosun Kite, Innovent, Seagen, BeiGene, Debiopharm, Epizyme, Karyopharm, ADC Therapeutics, Servier, and Genmab: Consultancy, Other: advisory role; Alexion, AstraZeneca Rare Disease: Other: Study investigator; Targeted Oncology, OncView, Kyowa Kirin, Physicians' Education Resource, and Seagen: Honoraria. Thieblemont: Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Gilead Sciences: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Kyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Bristol Myers Squibb/Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses , Research Funding; Incyte: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Cellectis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses ; Hospira: Research Funding; Bayer: Honoraria; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses . Oluwole: Pfizer: Consultancy; Curio Science: Consultancy; Janssen: Consultancy; Kite, a Gilead Company: Consultancy, Research Funding. Herrera: Takeda: Consultancy; Genentech: Consultancy, Research Funding; Merck: Consultancy, Research Funding; Seagen: Consultancy, Research Funding; AstraZeneca: Consultancy, Research Funding; Kite, a Gilead Company: Research Funding; Gilead Sciences: Research Funding; Tubulis: Consultancy; ADC Therapeutics: Consultancy, Research Funding; Bristol Myers Squibb: Consultancy, Research Funding; Karyopharm: Consultancy. Ujjani: Loxo: Research Funding; AstraZeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Epizyme: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy; TG Therapeutics: Honoraria; Gilead: Honoraria; ACDT: Honoraria; Kite, a Gilead Company: Honoraria; Adaptive Biotechnologies: Research Funding; Atara Bio: Consultancy; AbbVie: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding. Lin: Sorrento: Consultancy; Legend: Consultancy; Novartis: Consultancy; Bluebird Bio: Consultancy, Research Funding; Gamida Cell: Consultancy; Janssen: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Juno: Consultancy; Vineti: Consultancy; Takeda: Research Funding; Merck: Research Funding; Kite, a Gilead Company: Consultancy, Research Funding. Riedell: Bayer: Honoraria; Karyopharm Therapeutics: Consultancy, Honoraria; Morphosys: Research Funding; Celgene/Bristol-Myers Squibb Company: Consultancy, Honoraria, Research Funding; Verastem Oncology: Honoraria; Kite, a Gilead Company: Honoraria, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Research Funding; Takeda: Consultancy; BeiGene: Consultancy; Calibr: Research Funding; Xencor: Research Funding; Tessa Therapeutics: Research Funding. Kekre: Gilead: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Celgene: Consultancy, Honoraria. Lui: Gilead Sciences: Other: stock or other ownership; Kite, a Gilead Company: Current Employment, Other: travel support. Milletti: Kite, a Gilead company: Current Employment; Gilead Sciences: Other: stock or other ownership . Dong: Kite, a Gilead Company: Current Employment; Gilead Sciences: Other: stock or other ownership ; GliaCure/Tufts: Consultancy, Other: advisory role, Patents & Royalties. Xu: Kite, A Gilead Company: Current Employment; Gilead Sciences: Other: stock or other ownership . Chavez: MorphoSys, Bayer, Karyopharm, Kite, a Gilead Company, Novartis, Janssen, AbbVie, TeneoBio, and Pfizer: Consultancy; ADC Therapeutics: Consultancy, Research Funding; Merk: Research Funding; AstraZeneca: Research Funding; MorphoSys, AstraZeneca, BeiGene, Genentech, Kite, a Gilead Company, and Epizyme: Speakers Bureau; BMS: Speakers Bureau.