Navneet S Majhail

National Marrow Donor Program, Minneapolis, Minnesota, United States

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Publications (131)432.34 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Variation in Medicaid policies among states may lead to differences in coverage for complex treatments. This article uses hematopoietic cell transplantation (HCT), an established treatment for patients with hematologic cancers, as a case study to highlight state variation in Medicaid coverage of complex oncology treatments. Information on HCT coverage benefits for 2012 was collected from state Medicaid Web sites and was compared with recommended HCT benefits developed by multiple stakeholders. Coverage was reviewed for five categories: one, transplantation procedure; two, donor search; three, prescriptions; four, clinical trials; and five, patient food, lodging, and transportation. Coverage was coded on a three-point scale for each category for each state. States were ranked by the number of variables for which they met recommended benefits criteria (maximum rank score, 5). Detailed information on Medicaid coverage was available for 47 states. No state provided the recommended coverage benefits in all five categories. Prescription coverage most often met the recommended criteria, whereas only a small number of states provided clinical trial coverage for HCT. There was substantial variation in Medicaid coverage for HCT by state. Findings highlight substantial variation in Medicaid coverage for HCT by state, which may increase disparities in access for already medically underserved populations.
    Journal of Oncology Practice 04/2014;
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    ABSTRACT: Adolescents and young adults (AYAs, ages 15-40 years) with cancer have not experienced survival improvements to the same extent as younger and older patients. We compared changes in survival following myeloablative allogeneic hematopoietic cell transplantation (HCT) for acute lymphoblastic leukemia (ALL) among children (N=981), AYAs (N=1218) and older adults (N=469) who were transplanted over three time periods: 1990-1995, 1996-2001 and 2002-2007. Five-year survival varied inversely with age group. Survival improved over time in AYAs and paralleled that seen in children; however, overall survival did not change over time forolder adults. Survival improvements were primarily related to lower rates of early treatment related mortality in the most recent era. For all cohorts, relapse rates did not change over time. A subset of 222 AYAs between the ages of 15-25 at 46 pediatric or 49 adult centers werealso analyzed to describe differences by center type. In this subgroup, there were differences in transplant practices among pediatric and adult centers, although HCT outcomes did not differ by center type. Survival for AYAs undergoing myeloablative allogeneic HCT for ALL improved at a similar rate as survival for children.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 03/2014; · 3.15 Impact Factor
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    ABSTRACT: Hematopoietic cell transplantation (HCT) remains the only known curative therapy for many patients with hematologic, metabolic and immunologic disorders. Furthermore, the use of HCT has increased with the emergence of HCT as a viable therapeutic option for older patients, those with significant co-morbidities, and, with the demonstrated clinical effectiveness of alternative allogeneic donor sources, for those patients without a suitable sibling donor. The National Marrow Donor Program® (NMDP) estimates that by 2020 it will facilitate 10,000 transplants per year, double the number in 2010. To understand the HCT infrastructure needs to facilitate this number of transplants, the NMDP organized the System Capacity Initiative 2020, centered on 6 working groups representing a diverse group of stakeholders. The Physician Workforce Group was tasked with addressing issues relating to recruitment and retention of transplant physicians. We report here the results of our efforts and future initiatives.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 02/2014; · 3.15 Impact Factor
  • ASBMT; 02/2014
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    ABSTRACT: Hematopoietic stem cell transplantation (HCT) is a potentially life-saving therapy for patients with malignant and non-malignant disease states. This article reviews the current published literature on the dosing of pharmacologic agents used for HCT-preparative regimens with specific focus on the obese patient population. The review found that dose adjustments for obesity have, to date, been based empirically or extrapolated from published data in the non-transplant patient population. As a result, the Committee determined that clear standards or dosing guidelines are unable to be made for the obese population because Level I and II evidence is unavailable at this time. Instead, the Committee provides a current published literature review to serve as a platform for conditioning agent dose selection in the setting of obesity. A necessary goal should be to encourage future prospective trials in this patient population because further information is needed to enhance our knowledge of the pharmacokinetics and pharmacodynamics of conditioning agents in the setting of obesity.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 01/2014; · 3.15 Impact Factor
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    ABSTRACT: With broadening indications, more options for hematopoietic cell transplantation (HCT) and improvement in survival, the number of long-term HCT survivors is expected to increase steadily. Infertility is a frequent problem that long-term HCT survivors and their partners face and it can negatively impact on the quality of life. The most optimal time to address fertility issues is before the onset of therapy for the underlying disease; however, fertility preservation should also be addressed before HCT in all children and patients of reproductive age, with referral to a reproductive specialist for patients interested in fertility preservation. In vitro fertilization (IVF) and embryo cryopreservation, oocyte cryopreservation and ovarian tissue banking are acceptable methods for fertility preservation in adult women/pubertal females. Sperm banking is the preferred method for adult men/pubertal males. Frequent barriers to fertility preservation in HCT recipients may include the perception of lack of time to preserve fertility given an urgency to move ahead with transplant, lack of patient-physician discussion because of several factors (for example, time constraints, lack of knowledge), inadequate access to reproductive specialists, and costs and lack of insurance coverage for fertility preservation. There is a need to raise awareness in the medical community about fertility preservation in HCT recipients.Bone Marrow Transplantation advance online publication, 13 January 2014; doi:10.1038/bmt.2013.211.
    Bone marrow transplantation 01/2014; · 3.00 Impact Factor
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    ABSTRACT: Peripheral blood stem cell (PBSC) products have traditionally been transported from the collection center to a transplant center using validated volunteer courier-based procedures. Evolving airline service strategies and security policies have complicated this model of product transport. This study was designed to evaluate the feasibility of transporting PBSC products using commercial overnight shipping services, while maintaining product quality, compared to courier-transported products. Five PBSC products were collected from healthy volunteer donors and divided to evaluate product quality when transported either by volunteer courier or by commercial overnight shipping service. Products were evaluated on the day of collection and at 24, 48, and 72 hours postcollection for total nucleated cell (TNC) count, cell viability, progenitor cell numbers, and progenitor cell lineage growth potential (colony-forming units [CFUs]) to assess product composition and quality associated with each cohort. No delivery delays were encountered and all products were received intact. Measurements of product composition and quality demonstrated no differences in TNC count (p = 0.893), cell viability (p = 0.409), CD34+ progenitor cell content (p = 0.509), or CFU-granulocyte-macrophage growth potential (p = 0.827). We found no difference in product viability, progenitor cell content, or product potency in PBSC products transported either by volunteer courier or by commercial overnight shipping.
    Transfusion 01/2014; · 3.53 Impact Factor
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    ABSTRACT: We conducted a nested case-control study within a cohort of 6,244 patients to assess risk factors for avascular necrosis (AVN) of bone in children and adolescents following allogeneic transplantation. Eligible patients were ≤21 years of age, received their first allogeneic transplant between 1990 and 2008 in the United States and had survived ≥ 6 months from transplantation. Overall, 160 cases with AVN and 478 controls matched by year of transplant, length of followup and transplant center were identified. Cases and controls were confirmed via central review of radiology, pathology and/or surgical procedure reports. Median time from transplant to diagnosis of AVN was 14 months. On conditional logistic regression, increasing age at transplant (≥5 years), female gender and chronic graft-versus-host disease (GVHD) were significantly associated with increased risks of AVN. Compared to patients receiving myeloablative regimens for malignant diseases, lower risks of AVN were seen in patients with non-malignant diseases and those who had received reduced intensity conditioning regimens for malignant diseases. Children at high risk for AVN include those within the age group where rapid bone growth occurs as well as those who experience exposure to myeloablative conditioning regimens and immunosuppression post-HCT for the treatment of GVHD. More research is needed to determine whether screening strategies specifically for patients at high risk for developing AVN with early interventions may mitigate the morbidity associated with this complication.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 01/2014; · 3.15 Impact Factor
  • 01/2014; 20(2):S27–S28.
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    ABSTRACT: Adolescents and young adults (AYAs, ages 15-40 years) with cancer have not experienced survival improvements to the same extent as younger and older patients. We compared changes in survival following myeloablative allogeneic hematopoietic cell transplantation (HCT) for acute lymphoblastic leukemia (ALL) among children (N=981), AYAs (N=1218) and older adults (N=469) who were transplanted over three time periods: 1990-1995, 1996-2001 and 2002-2007. Five-year survival varied inversely with age group. Survival improved over time in AYAs and paralleled that seen in children; however, overall survival did not change over time forolder adults. Survival improvements were primarily related to lower rates of early treatment related mortality in the most recent era. For all cohorts, relapse rates did not change over time. A subset of 222 AYAs between the ages of 15-25 at 46 pediatric or 49 adult centers werealso analyzed to describe differences by center type. In this subgroup, there were differences in transplant practices among pediatric and adult centers, although HCT outcomes did not differ by center type. Survival for AYAs undergoing myeloablative allogeneic HCT for ALL improved at a similar rate as survival for children.
    01/2014;
  • Brian L McClune, Navneet S Majhail
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    ABSTRACT: With long-term survival for recipients of autologous and allogeneic hematopoietic cell transplantation (HCT) increasing, the recognition of late complications such as decreased bone mineral density leading to osteoporosis (OP) has also increased. With an incidence that is reported to affect as many 50 % of allo HCT recipients, studies continue to mount supporting the need and success in treatment of this HCT complication. In this review, we highlight the major pathological mechanisms behind the development of OP, its diagnosis, and the literature supporting consensus treatment recommendations while noting areas of uncertainty that need further research.
    Current Osteoporosis Reports 11/2013;
  • Navneet S Majhail, Hillard M Lazarus
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 08/2013; · 3.15 Impact Factor
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    ABSTRACT: Advances in hematopoietic cell transplantation (HCT) have led to an increasing number of transplant survivors. In order to adequately support their healthcare needs, there is a need to know the prevalence of HCT survivors. We used data on 170,628 recipients of autologous and allogeneic HCT reported to the Center for International Blood and Marrow Transplant Research from 1968 to 2009 to estimate the current and future number of HCT survivors in the United States. Stacked cohort simulation models were used to estimate the number of HCT survivors in the US in 2009 and make projections for HCT survivors by the year 2030. There were 108,900 (range, 100,500-115,200) HCT survivors in the United States in 2009. This included 67,000 autologous HCT and 41,900 allogeneic HCT survivors. The number of HCT survivors is estimated to increase by 2.5 times by the year 2020 (242,000 survivors) and 5 times by the year 2030 (502,000 survivors). By 2030, the age at transplant will be <18 years for 14% of all survivors (N=64,000), 18-59 years for 61% survivors (N=276,000) and 60 years and older for 25% of survivors (N=113,000). In coming decades, a large number of individuals will be HCT survivors. Transplant center providers, hematologists, oncologists, primary care physicians and other specialty providers will need to be familiar with the unique and complex health issues faced by this population.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 07/2013; · 3.15 Impact Factor
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    ABSTRACT: Autologous hematopoietic cell transplantation (auto-HCT) is performed to treat relapsed and recurrent malignant disorders and as part of initial therapy for selected malignancies. This study evaluated changes in use, techniques, and survival in a population-based cohort of 68,404 patients who underwent first auto-HCT in a US or Canadian center between 1994 and 2005 and were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). The mean annual number of auto-HCTs performed was highest during 1996-1999 (6948), and decreased subsequently 2000-2003 (4783), owing mainly to fewer auto-HCTs done to treat breast cancer. However, the mean annual number of auto-HCTs increased from 5278 annually in 1994-1995 to 5459 annually in 2004-2005, reflecting increased use for multiple myeloma, non-Hodgkin lymphoma, and Hodgkin lymphoma. Despite an increase in the median recipient age from 44 to 53 years, there has been a significant improvement in overall survival (OS) from 1994 to 2005 in patients with chemotherapy-sensitive relapsed non-Hodgkin lymphoma (day +100 OS, from 85% to 96%; 1-year OS, from 68% to 80%; P < .001) and chemotherapy-sensitive multiple myeloma (day +100 OS, from 96% to 98%; 1-year OS, from 83% to 92%; P < .001). This improvement in OS was most pronounced in middle-aged (>40 years) and older (>60 years) individuals.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 07/2013; 19(7):1116–1123. · 3.15 Impact Factor
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    ABSTRACT: Using liver magnetic resonance imaging (R2-MRI) to quantify liver iron content (LIC), we conducted a prospective cohort study to determine the association of iron-overload and adult allogeneic hematopoietic cell transplant (HCT) outcomes. Patients received pre-transplant ferritin measurements; patients with ferritin >500 ng/ml underwent R2-MRI. Patients were defined as no iron-overload (N=28) and iron-overload (LIC >1.8 mg/g; N=60). Median LIC in iron-overload group was 4.3 mg/g (range, 1.9-25.4). There was no difference in the 1-year probability of overall survival, non-relapse mortality, relapse, acute or chronic graft-versus-host disease, organ failure, infections or hepatic veno-occlusive disease between the two groups. We also found no difference in the cumulative incidence of a composite endpoint of non-relapse mortality, any infection, organ failure or hepatic veno-occlusive disease (1-year cumulative incidence: 71% vs. 80%, P=0.44). In multivariate analyses, iron-overload status did not impact risks of overall mortality (relative risk 2.3, 95% confidence intervals 0.9-5.9, P=0.08). Recovery of absolute lymphocyte count, absolute NK-cells, total T-cells, and CD4(+), CD8(+) and regulatory T-cells was not delayed in patients with iron-overload. In conclusion, we found no association between pre-transplant iron-overload and allogeneic HCT outcomes. Future studies in this population should use LIC to define iron-overload instead of ferritin. This study has been registered at www.ClinicalTrials.gov (Identifier: NCT00888316).
    Blood 06/2013; · 9.06 Impact Factor
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    ABSTRACT: PURPOSEOver the past four decades, allogeneic hematopoietic cell transplantation (alloHCT) has evolved as a curative modality for patients with hematologic diseases. This study describes changes in use, technique, and survival in a population-based cohort. PATIENTS AND METHODS The study included 38,060 patients with hematologic malignancies or disorders who underwent first alloHCT in a US or Canadian center from 1994 to 2005 and were reported to the Center for International Blood and Marrow Transplant Research.ResultsAlloHCT as treatment for acute lymphoblastic (ALL) and myeloid leukemias (AML), myelodysplastic syndrome (MDS), and Hodgkin and non-Hodgkin lymphomas increased by 45%, from 2,520 to 3,668 patients annually. From 1994 to 2005, use of both peripheral (7% to 65%) and cord blood increased (2% to 10%), whereas use of marrow decreased (90% to 27%). Despite a median age increase from 33 to 40 years and 263% increase in unrelated donors for alloHCT, overall survival (OS) at day 100 significantly improved for patients with AML in first complete remission after myeloablative sibling alloHCT (85% to 94%; P < .001) and unrelated alloHCT (63% to 86%; P < .001); 1-year OS improved among those undergoing unrelated alloHCT (48% to 63%; P = .003) but not among those undergoing sibling alloHCT. Similar results were seen for ALL and MDS. Day-100 OS after cord blood alloHCT improved significantly from 60% to 78% (P < .001) for AML, ALL, MDS, and chronic myeloid leukemia. Use of reduced-intensity regimens increased, yielding OS rates similar to those of myeloablative regimens. CONCLUSION Survival for those undergoing alloHCT has significantly improved over time. However, new approaches are needed to further improve 1-year OS.
    Journal of Clinical Oncology 05/2013; · 18.04 Impact Factor
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    ABSTRACT: Donor race matching (both recipients and donors belonging to the same race) might be a factor in outcomes of donor allogeneic hematopoietic cell transplantation (alloHCT). A total of 858 patients who underwent umbilical cord blood (UCB) (475 patients: 202 double UCB and 273 single UCB) or unrelated donor (URD) (383 patients) alloHCT between January 1995 to December 2010 were studied. Most patients were Caucasian (87%), followed by Asians (4%), African Americans (3%), Hispanics (3%), mixed race (3%), and American Indians (<1%). Caucasians comprised 88% of the donor grafts; Caucasians are the most common race of the donor grafts for all races except for Asians. As a result, donor race matching was significantly higher in Caucasian recipients than ethnic minorities (95% vs. 47%, p<0.01). Donor race matching did not affect non-relapse mortality, relapse, acute or chronic graft-versus-host disease or overall survival. Acknowledging the limitations of this study (mainly, self-reported race information and small number of ethnic minorities), at present, there is no data supporting that donor race should be considered a factor in donor selection.
    Leukemia & lymphoma 05/2013; · 2.40 Impact Factor
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    ABSTRACT: African Americans and Blacks have low participation rates in clinical trials and reduced access to aggressive medical therapies. Hematopoietic cell transplantation (HCT) is a high-risk but potentially curative therapy for sickle cell disease (SCD), a disorder predominantly seen in African Americans. We conducted focus groups to better understand participation barriers to HCT clinical trials for SCD. Nine focus groups of youth with SCD (n=10) and parents (n=41) were conducted at 3 sites representing the Midwest, South Atlantic, and West South Central US. Main barriers to clinical trial participation included gaps in knowledge about SCD, limited access to SCD/HCT trial information, and mistrust of medical professionals. For education about SCD/HCT trials, participants highly preferred one-on-one interactions with medical professionals and electronic media as a supplement. Providers can engage with sickle cell camps to provide information on SCD/HCT clinical trials to youth and local health fairs for parents/families. Youth reported learning about SCD through computer games; investigators may find this medium useful for clinical trial/HCT education. African Americans affected by SCD face unique barriers to clinical trial participation and have unmet HCT clinical studies education needs. Greater recognition of these barriers will allow targeted interventions in this community to increase their access to HCT.
    Journal of Pediatric Hematology/Oncology 05/2013; 35(4):289-298. · 0.97 Impact Factor
  • Source
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    ABSTRACT: Recent advances in allogeneic hematopoietic cell transplant (allo-HCT) have led to an increasing use of alternative donors, including banked umbilical cord blood (UCB). Despite these advances, acute GVHD (aGVHD) and chronic GVHD (cGVHD) continue to be the leading causes of early and late transplant-related mortality. ABO-mismatch has been frequently reported as a risk factor for GVHD, however, data in the UCB recipients are limited. We hypothesized that as the lymphocytes in the cord blood are thought to be naive, they will therefore be less likely to mediate GVHD. Therefore, we analyzed the impact of ABO-mismatch on aGVHD and cGVHD in recipients of single and double UCB-HCT. In both univariate and multivariate analyses, presence of ABO-mismatch did not have an impact on aGVHD or cGVHD. Whereas ABO-compatible donors are preferred in recipients of URD-HCT, ABO compatibility generally need not be considered in recipients of UCB-HCT.Bone Marrow Transplantation advance online publication, 18 February 2013; doi:10.1038/bmt.2013.8.
    Bone marrow transplantation 02/2013; · 3.00 Impact Factor
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    ABSTRACT: Physician practice variation may be a barrier to informing hematopoietic cell transplant (HCT) recipients about fertility preservation (FP) options. We surveyed HCT physicians in the United States to evaluate FP knowledge, practices, perceptions and barriers. Of the 1035 physicians invited, 185 completed a 29-item web-survey. Most respondents demonstrated knowledge of FP issues and discussed and felt comfortable discussing FP. However, only 55% referred patients to an infertility specialist. Most did not provide educational materials to patients and only 35% felt that available materials were relevant for HCT. Notable barriers to discussing FP included perception that patients were too ill to delay transplant (63%), patients were already infertile from prior therapy (92%) and time constraints (41%). Pediatric HCT physicians and physicians with access to an infertility specialist were more likely to discuss FP and to discuss FP even when prognosis was poor. On analyses that considered physician demographics, knowledge and perceptions as predictors of referral for FP, access to an infertility specialist and belief that patients were interested in FP were observed to be significant. We highlight variation in HCT physician perceptions and practices regarding FP. Physicians are generally interested in discussing fertility issues with their patients but lack educational materials.Bone Marrow Transplantation advance online publication, 18 February 2013; doi:10.1038/bmt.2013.13.
    Bone marrow transplantation 02/2013; · 3.00 Impact Factor

Publication Stats

1k Citations
432.34 Total Impact Points

Institutions

  • 2009–2014
    • National Marrow Donor Program
      Minneapolis, Minnesota, United States
    • University of Nebraska at Omaha
      • Department of Internal Medicine
      Omaha, NE, United States
    • Fred Hutchinson Cancer Research Center
      • Division of Clinical Research
      Seattle, Washington, United States
  • 2002–2014
    • Cleveland Clinic
      • Department of Solid Tumor Oncology
      Cleveland, Ohio, United States
  • 2013
    • Roswell Park Cancer Institute
      • Department of Medicine
      Buffalo, New York, United States
  • 2012
    • Children's Hospital of Orange County
      Orange, California, United States
  • 2006–2012
    • University of Minnesota Duluth
      • Medical School
      Duluth, Minnesota, United States
    • Minnesota Oncology
      Saint Paul, Minnesota, United States
  • 2011
    • Massachusetts General Hospital
      Boston, Massachusetts, United States
    • Emory University
      • Department of Health Policy and Management
      Atlanta, GA, United States
    • University of Minnesota Medical Center, Fairview
      Minneapolis, Minnesota, United States
    • University of Pennsylvania
      • "Abramson" Cancer Center
      Philadelphia, PA, United States
  • 2004–2011
    • University of Minnesota Twin Cities
      • • Division of Hematology, Oncology and Transplantation
      • • Department of Pediatrics
      Minneapolis, Minnesota, United States
  • 2010
    • Imperial College London
      Londinium, England, United Kingdom