Stuart A Grossman

Johns Hopkins Medicine, Baltimore, Maryland, United States

Are you Stuart A Grossman?

Claim your profile

Publications (201)1122.89 Total impact

  • Susannah Ellsworth · Stuart A Grossman
    British Journal of Cancer 09/2015; DOI:10.1038/bjc.2015.317 · 4.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Iniparib is a prodrug that converts to highly reactive cytotoxic metabolites intracellularly with activity in preclinical glioma models. We investigated the maximum tolerated dose (MTD) of iniparib with monthly (m) and continuous (c) temozolomide (TMZ) dosing schedules in patients with malignant gliomas (MG). Adults with newly diagnosed MG who had successfully completed ≥80 % of radiation (RT) and TMZ without toxicity received mTMZ dosing (150-200 mg/m(2) days 1-5/28 days) or cTMZ dosing (75 mg/m(2)/days × 6 weeks) in conjunction with iniparib (i.v. 2 days/week) in the adjuvant setting. Iniparib was dose escalated using a modified continual reassessment method (mCRM). 43 patients (32 male; 34 GBM, 8 AA, 1 gliosarcoma; median age 54 years; median KPS 90) were enrolled across 4 dose levels. In the mTMZ group, 2/4 patients had dose limiting toxicities (DLT) at 19 mg/kg/week (rash/hypersensitivity). At 17.2 mg/kg/week, 1/9 patients had a DLT (grade 3 fatigue). Additional grade 3 toxicities were neutropenia, lymphopenia, and nausea. In the cTMZ group, one DLT (thromboembolic event) occurred at 10.2 mg/kg/week. Dose escalation stopped at 16 mg/kg/week based on mCRM. The mean maximum plasma concentration of iniparib increased with dose. Concentration of the two major circulating metabolites, 4-iodo-3-aminobenzamide and 4-iodo-3-aminobenzoic acid, was ≤5 % of the corresponding iniparib concentration. Iniparib is well tolerated, at doses higher than previously investigated, in combination with TMZ after completion of RT + TMZ in patients with MG. Recommended phase 2 dosing of iniparib based on mCRM is 17.2 mg/kg/week with mTMZ and 16 mg/kg/week with cTMZ. An efficacy study of TMZ/RT + iniparib followed by TMZ + iniparib in newly diagnosed GBM using these doses has completed enrollment. Survival assessment is ongoing.
    Journal of Neuro-Oncology 08/2015; DOI:10.1007/s11060-015-1876-0 · 3.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with high-grade gliomas (HGG) are frequently excluded from first-in-human solid tumor trials because of perceived poor prognosis, excessive toxicities, concomitant drug interactions, and poor efficacy. We conducted an analysis of outcomes from select, single-agent phase I studies in patients with HGG. We compared outcomes to pooled analysis of published studies in solid tumors with various molecular and cytotoxic drugs evaluated as single agents or as combinations. Individual records of patients with recurrent HGG enrolled onto Adult Brain Tumor Consortium trials of single-agent, cytotoxic or molecular agents from 2000 to 2008 were analyzed for baseline characteristics, toxicities, responses, and survival. Our analysis included 327 patients with advanced, refractory HGG who were enrolled onto eight trials involving targeted molecular (n = 5) and cytotoxic (n = 3) therapies. At enrollment, patients had a median Karnofsky performance score of 90 and median age of 52 years; 62% were men, 63% had glioblastoma, and the median number of prior systemic chemotherapies was one. Baseline laboratory values were in an acceptable range to meet eligibility criteria. Patients were on the study for a median of two cycles (range, < one to 56 cycles), and 96% were evaluable for primary end points. During cycle 1, grade ≥ 3 nonhematologic and grade ≥ 4 hematologic toxicities were 5% (28 of 565 adverse events) and 0.9% (five of 565 adverse events), respectively, and 66% of these occurred at the highest dose level. There was one death attributed to drug. Overall response rate (complete and partial response) was 5.5%. Median progression-free and overall survival times were 1.8 and 6 months, respectively. Patients with HGG who meet standard eligibility criteria may be good candidates for solid tumor phase I studies with single-agent molecular or cytotoxic drugs with favorable preclinical rationale and pharmacokinetic properties in this population. © 2015 by American Society of Clinical Oncology.
    Journal of Clinical Oncology 08/2015; DOI:10.1200/JCO.2015.61.1525 · 18.43 Impact Factor
  • Roy E Strowd · Stuart A Grossman
    [Show abstract] [Hide abstract]
    ABSTRACT: Opinion statement: Central nervous system gliomas are the most common primary brain tumor, and these are most often high-grade gliomas. Standard therapy includes a combination of surgery, radiation, and chemotherapy which provides a modest increase in survival, but virtually, no patients are cured, the overall prognosis remains poor, and new therapies are desperately needed. Tumor metabolism is a well-recognized but understudied therapeutic approach to treating cancers. Dietary and nondietary modulation of glucose homeostasis and the incorporation of dietary supplements and other natural substances are potentially important interventions to affect cancer cell growth, palliate symptoms, reduce treatment-associated side effects, and improve the quality and quantity of life in patients with cancer. These approaches are highly desired by patients. However, they can be financially burdensome, associated with toxicities, and have, on occasion, reduced the efficacy of proven therapies and negatively impacted patient outcomes. The lack of rigorous scientific data evaluating almost all diet and supplement-based therapies currently limits their incorporation into standard oncologic practice. Rigorous studies are needed to document and improve these potentially useful approaches in patients with brain and other malignancies.
    Current Treatment Options in Oncology 08/2015; 16(8):356. DOI:10.1007/s11864-015-0356-2 · 3.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Venous thromboembolism (VTE) is a common complication in patients with high-grade gliomas. The purpose of this prospective multicenter study was to determine the hazard rate of first symptomatic VTE in newly-diagnosed glioma patients and identify clinical and laboratory risk factors. On enrollment, demographic and clinical information were recorded and a comprehensive coagulation evaluation was performed. Patients were followed until death. The study end point was objectively-documented symptomatic VTE. One hundred seven patients were enrolled with a median age of 57 years (range 29-85) between June 2005 and April 2008. Ninety-one (85 %) had glioblastoma multiforme (GBM). During an average survival of 17.7 months, 26 patients (24 %) (95 % CI 17-34 %) developed VTE (hazard rate 0.15 per person-year) and 94 patients (88 %) died. Median time to VTE was 14.2 weeks post-operation (range 3-126). Patients with an initial tumor biopsy were 3.0 fold more likely to suffer VTE (p = 0.02). Patients with an elevated factor VIII activity (>147 %) were 2.1-fold more likely to develop VTE. ABO blood group, D dimer and thrombin generation were not associated with VTE. No fatal VTE occurred. VTE is a common complication in patients with newly-diagnosed high grade gliomas, particularly in the first six months after diagnosis. Patients with an initial tumor biopsy and elevated factor VIII levels are at increased risk. However, VTE was not judged to be primarily responsible for any patient deaths. Therefore, outpatient primary VTE prophylaxis remains investigational until more effective primary prophylaxis strategies and therapies for glioma are identified.
    Journal of Neuro-Oncology 06/2015; DOI:10.1007/s11060-015-1840-z · 3.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Radiation (RT), temozolomide (TMZ), and dexamethasone in newly diagnosed high grade gliomas (HGG) produces severe treatment-related lymphopenia (TRL) that is associated with early cancer-related deaths. This TRL may result from inadvertent radiation to circulating lymphocytes. This study reinfused lymphocytes, harvested before chemo-radiation, and assessed safety, feasibility, and trends in lymphocyte counts. Patients with newly diagnosed HGG and total lymphocyte counts (TLC) ≥ 1000 cells/mm(3) underwent apheresis. Cryopreserved autologous lymphocytes were reinfused once radiation was completed. Safety, feasibility, and trends in TLC, T cell subsets and cytokines were studied. Serial TLC were also compared with an unreinfused matched control group. Ten patients were harvested (median values: age 56 years, dexamethasone 3 mg/day, TLC/CD4 1980/772 cells/mm(3)). After 6 weeks of RT/TMZ, TLC fell 69 % (p < 0.0001) with similar reductions in CD4, CD8 and NK cells but not Tregs. Eight patients received lymphocyte reinfusions (median = 7.0 × 10(7) lymphocytes/kg) without adverse events. A post-reinfusion TLC rise of ≥300 cells/mm(3) was noted in 3/8 patients at 4 weeks and 7/8 at 14 weeks which was similar to 23 matched controls. The reduced CD4/CD8 ratio was not restored by lymphocyte reinfusion. Severe lymphopenia was not accompanied by elevated serum interleukin-7 (IL-7) levels. This study confirms that severe TRL is common in HGG and is not associated with high plasma IL-7 levels. Although lymphocyte harvesting/reinfusion is feasible and safe, serial lymphocyte counts are similar to unreinfused matched controls. Studies administering higher lymphocyte doses and/or IL-7 should be considered to restore severe treatment-related lymphopenia in HGG.
    Journal of Neuro-Oncology 06/2015; DOI:10.1007/s11060-015-1841-y · 3.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Despite being a highly vascularized tumor, glioblastoma response to anti-vascular endothelial growth factor (VEGF) therapy is transient, possibly because of tumor co-option of preexisting blood vessels and infiltration into surrounding brain. Integrins, which are upregulated after VEGF inhibition, may play a critical role in this resistance mechanism. We designed a study of cediranib, a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor, combined with cilengitide, an integrin inhibitor. Methods: This phase I study was conducted through the Adult Brain Tumor Consortium in patients with recurrent glioblastoma. Once the maximum tolerated dose was determined, 40 patients enrolled in a dose expansion cohort with 20 being exposed to anti-VEGF therapy and 20 being naive. The primary endpoint was safety. Secondary endpoints included overall survival, proportion of participants alive and progression free at 6 months, radiographic response, and exploratory analyses of physiological imaging and blood biomarkers. Results: Forty-five patients enrolled, and no dose toxicities were observed at a dose of cediranib 30 mg daily and cilengitide 2000 mg twice weekly. Complete response was seen in 2 participants, partial response in 2, stable disease in 13, and progression in 21; 7 participants were not evaluable. Median overall survival was 6.5 months, median progression-free survival was 1.9 months, and progression-free survival at 6 months was 4.4%. Plasma-soluble VEGFR2 decreased with treatment and placental growth factor, carbonic anhydrase IX, and SDF1α, and cerebral blood flow increased. Conclusions: The combination of cediranib with cilengitide was well tolerated and associated with changes in pharmacodynamic blood and imaging biomarkers. However, the survival and response rates do not warrant further development of this combination.
    Neuro-Oncology 05/2015; DOI:10.1093/neuonc/nov085 · 5.56 Impact Factor
  • Roy E Strowd · Inas A Abuali · Stuart A Grossman
    [Show abstract] [Hide abstract]
    ABSTRACT: SUMMARY Indolent CNS lymphomas (CNSLs) are rare and no guidelines exist for management. Recent literature highlights the potential for safe and tolerable intrathecal (IT) delivery of rituximab, a large anti-CD20 monoclonal antibody, for aggressive CNSL. We report a patient with relapsed indolent CNSL who failed systemic rituximab and could not tolerate IT chemotherapies, but had an objective response of 6 months duration to IT rituximab.
    04/2015; 4(3):1-5. DOI:10.2217/cns.15.3
  • Carmen Kut · Stuart A Grossman · Jaishri Blakeley
    JAMA Neurology 02/2015; 72(4). DOI:10.1001/jamaneurol.2014.3736 · 7.42 Impact Factor
  • Roy E Strowd · Matthias Holdhoff · Stuart A Grossman
    [Show abstract] [Hide abstract]
    ABSTRACT: Gliomas classified as grade II by the World Health Organization (WHO) include astrocytomas, oligodendrogliomas, and mixed oligoastrocytomas. This heterogeneous group of conditions is associated with a more favorable prognosis and longer-term survival than high-grade gliomas (HGGs). Neurosurgical resection and radiation therapy improve survival in symptomatic, progressive, or high-risk grade II gliomas. Until recently, the role of chemotherapy has been less clear. This review draws on insights from the management of HGGs and emerging data on the addition of PCV (procarbazine, lomustine [CCNU], and vincristine) to radiation for these neoplasms. Specifically, this review focuses on the current status of chemotherapeutic management of grade II gliomas, including optimal timing of treatment, and management of 1p19q codeleted and non-codeleted tumors.
    Oncology (Williston Park, N.Y.) 12/2014; 28(12). · 2.32 Impact Factor
  • Jian L. Campian · Guneet Sarai · Xiaobu Ye · Shanthi Marur · Stuart A Grossman
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Severe treatment-related lymphopenia occurs commonly in many cancers and is associated with early tumor progression. Data are lacking as to whether this occurs in squamous cell head and neck cancer. Methods Serial total lymphocyte counts were retrospectively reviewed in patients with newly diagnosed squamous head and neck cancer undergoing chemoradiation and associated with treatment outcomes. ResultsThe median baseline total lymphocyte count in 56 patients was 1660 cells/mm(3), which fell by 73% to 445 cells/mm(3) 2 months after initiating chemoradiation (p < .0001). Human papillomavirus negative (HPV-) patients with a total lymphocyte count <500 cells/mm(3) at 2 months had significantly earlier disease progression than those with higher total lymphocyte counts (hazard ratio [HR], 5.75; p = .045). Conclusion Baseline total lymphocyte counts were normal, but at 2 months approximately 60% of patients had severe treatment-related lymphopenia regardless of HPV status. Severe treatment-related lymphopenia in HPV- patients is independently associated with earlier disease progression. Prospective studies are needed to confirm these findings, which suggest that immune preservation is important in this cancer. (c) 2014 Wiley Periodicals, Inc. Head Neck 36: 1747-1753, 2014
    Head & Neck 12/2014; 36(12). DOI:10.1002/hed.23535 · 2.64 Impact Factor
  • I. Abuali · R. Strowd · X. Ye · S. Grossman
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Addition of temozolomide (TMZ) to standard radiation has become common clinical practice in patients with anaplastic astrocytoma (AA). Prospective trials will ultimately inform its utility but results will not be available for years. Three retrospective studies have questioned whether TMZ improves survival over radiation alone but have methodologic limitations to their conclusions. OBJECTIVE: To determine survival trends in patients with AA prior to and following the inclusion of TMZ into standard clinical practice. METHODS: A retrospective single-institution study was conducted of all patients >18 years with newly diagnosed AA treated from Sept 1995 to Dec 2012. Based on an institutional shift toward the incorporation of TMZ into treatment regimens around Jan 2004, patients receiving treatment before (i.e. pre-TMZ) and after (i.e. post-TMZ) this time. Demographic, clinical, radiographic and pathologic data were collected. Median overall survival (OS) was calculated using Kaplan-Meier estimates. RESULTS: A total of 196 patients were identified for inclusion; 74 pre- and 122 post-TMZ; mean age 46.5 + /-14.6 yrs; 57% male; 86% white, 9% black and 5% other ethnicity. Most tumors were supratentorial (69%) though infratentorial (4%), spinal (2%) and other locations (25%) were included. Extent of surgery included biopsy (31%), subtotal (37%) and gross total resection (32%). Chemotherapy was administered in only 12% pre-TMZ (n = 9, TMZ in 1, PCV in 2, and gliadel in 6) and 94% post-TMZ (n = 115, TMZ in all). Of all patients, 88% pre- and 54% post-TMZ were deceased. While median OS was 34.7 months pre-TMZ (95% CI 22.5-62.9) and only 28.1 post-TMZ (95% CI 19.3-40.2), only 56% of those remaining alive post-TMZ have reached median survival. CONCLUSION: The addition of TMZ to radiation for patients with AA is common. While longer OS was observed pre-TMZ, a substantial number of patients post-TMZ have not yet reached median survival and continued follow up is ongoing.
    Neuro-Oncology 11/2014; 16(suppl 5):v159-v159. DOI:10.1093/neuonc/nou265.1 · 5.56 Impact Factor
  • International journal of radiation oncology, biology, physics 09/2014; 90(1):S696-S697. DOI:10.1016/j.ijrobp.2014.05.2044 · 4.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Eight brain-derived proteins were evaluated regarding their potential for further development as a blood-based biomarker for malignant gliomas. Plasma levels for glial fibrillary acidic protein, neurogranin, brain-derived neurotrophic factor, intracellular adhesion molecule 5, metallothionein-3, beta-synuclein, S100 and neuron specific enolase were tested in plasma of 23 patients with high-grade gliomas (WHO grade IV), 11 low-grade gliomas (WHO grade II), and 15 healthy subjects. Compared to the healthy controls, none of the proteins appeared to be specific for glioblastomas. However, the data are suggestive of higher protein levels in gliosarcomas (n = 2), which may deserve further exploration.
    Cancer Investigation 07/2014; 32(8). DOI:10.3109/07357907.2014.933237 · 2.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: New therapeutic approaches are urgently needed for recurrent GBM (rGBM). Recent studies suggest that GBM oncogenesis and recurrence are regulated by glioma initiating cells (GIC), a minority population of quiescent cells driven by embryonic signaling pathways and resistant to radiation and chemotherapy. Our hypothesis was that interrupting the sonic hedgehog signaling pathway (SHh), an integral mediator of GIC proliferation, would slow tumor progression and improve six month progression free survival (PFS6) in correlation with decreased GSC proliferation and self-renewal.
    Neuro-Oncology 07/2014; 16 Suppl 3:iii46. DOI:10.1093/neuonc/nou209.17 · 5.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the efficacy of rituximab (R) when added to high-dose methotrexate (HD-MTX) in patients with newly diagnosed immunocompetent primary CNS lymphomas (PCNSLs).METHODS: Immunocompetent adults with newly diagnosed PCNSL treated at The Johns Hopkins Hospital between 1995 and 2012 were investigated. From 1995 to 2008, patients received HD-MTX monotherapy (8 g/m(2) initially every 2 weeks and after complete response [CR] monthly to complete 12 months of therapy). From 2008 to 2012, patients received the same HD-MTX with rituximab (375 mg/m(2)) with each HD-MTX treatment. CR rates and median overall and progression-free survival were analyzed for each patient cohort in this single-institution, retrospective study.RESULTS: A total of 81 patients were identified: 54 received HD-MTX (median age 66 years) while 27 received HD-MTX/R (median age 65 years). CR rates were 36% in the HD-MTX cohort and 73% in the HD-MTX/R cohort (p = 0.0145). Median progression-free survival was 4.5 months in the HD-MTX cohort and 26.7 months in the HD-MTX/R cohort (p = 0.003). Median overall survival was 16.3 months in the HD-MTX cohort and has not yet been reached in the HD-MTX/R cohort (p = 0.01).CONCLUSIONS: The addition of rituximab to HD-MTX appears to improve CR rates as well as overall and progression-free survival in patients with newly diagnosed PCNSL. Comparisons of long-term survival in the 2 cohorts await further maturation of the data.CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in immunocompetent patients with PCNSL, HD-MTX plus rituximab compared with HD-MTX alone improves CR and overall survival rates.
    Neurology 06/2014; 83(3). DOI:10.1212/WNL.0000000000000593 · 8.29 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Preclinical studies indicate autophagy inhibition with hydroxychloroquine (HCQ) can augment the efficacy of DNA-damaging therapy. The primary objective of this trial was to determine the maximum tolerated dose (MTD) and efficacy of HCQ in combination with radiation therapy (RT) and temozolomide (TMZ) for newly diagnosed glioblastoma (GB). A 3+3 phase I trial design followed by a noncomparative phase II study was conducted in GB patients after initial resection. Patients received HCQ (200 to 800 mg oral daily) with RT and concurrent and adjuvant TMZ. Quantitative electron microscopy and immunoblotting were used to assess changes in autophagic vacuoles (AVs) in peripheral blood mononuclear cells (PBMC). Population pharmacokinetic (PK) modeling enabled PK-pharmacodynamic correlations. Sixteen phase I subjects were evaluable for dose-limiting toxicities. At 800 mg HCQ/d, 3/3 subjects experienced Grade 3 and 4 neutropenia and thrombocytopenia, 1 with sepsis. HCQ 600 mg/d was found to be the MTD in this combination. The phase II cohort (n = 76) had a median survival of 15.6 mos with survival rates at 12, 18, and 24 mo of 70%, 36%, and 25%. PK analysis indicated dose-proportional exposure for HCQ. Significant therapy-associated increases in AV and LC3-II were observed in PBMC and correlated with higher HCQ exposure. These data establish that autophagy inhibition is achievable with HCQ, but dose-limiting toxicity prevented escalation to higher doses of HCQ. At HCQ 600 mg/d, autophagy inhibition was not consistently achieved in patients treated with this regimen, and no significant improvement in overall survival was observed. Therefore, a definitive test of the role of autophagy inhibition in the adjuvant setting for glioma patients awaits the development of lower-toxicity compounds that can achieve more consistent inhibition of autophagy than HCQ.
    Autophagy 05/2014; 10(8). DOI:10.4161/auto.28984 · 11.75 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Bone Marrow Transplantation is a high quality, peer-reviewed journal covering all aspects of clinical and basic haemopoietic stem cell transplantation.
    Bone Marrow Transplantation 05/2014; 49(8). DOI:10.1038/bmt.2014.98 · 3.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Prolonged lymphopenia correlating with decreased survival commonly occurs among glioma patients undergoing radiation therapy (RT) and temozolomide (TMZ) treatment. To better understand the pathophysiology of this phenomenon, we prospectively monitored serum cytokine levels and lymphocyte subsets in 15 high-grade glioma patients undergoing combined radiation and TMZ (referred to as RT/TMZ) treatment. Sufficient data for analysis were acquired from 11 of the patients initially enrolled. Lymphocyte phenotyping data were obtained using cytofluorometric analysis and serum cytokine levels were measured using the a multiplex bead-based assays. Total lymphocyte counts (TLCs) were > 1000 cells per μL peripheral blood in 10/11 patients at baseline, but dropped significantly after treatment. Specifically, after RT/TMZ therapy, the TLCs were found to be < 500 cells/μL in 2/11 patients, 500-1000 cells/μL in 7/11 patients, and > 1000 cells/μL in the remaining 2 patients. Among residual mononuclear blood cells, we observed a proportional drop in B and CD4(+) T cells but not in CD8(+) T lymphocytes. Natural killer cells remained to near-to-baseline levels and there was a transient and slight (insignificant) increase in regulatory T cells (Tregs). The circulating levels of IL-7 and IL-15 remained low despite marked drops in both the total and CD4(+) T lymphocyte counts. Thus, patients with malignant glioma undergoing RT/TMZ treatment exhibit a marked decline in TLCs, affecting both CD4(+) T cells and B lymphocytes, in the absence of a compensatory increase in interleukin-7 levels. The failure to mount an appropriate homeostatic cytokine response may be responsible for the prolonged lymphopenia frequently observed in these patients.
    OncoImmunology 01/2014; 3(1):e27357. DOI:10.4161/onci.27357 · 6.27 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S248. DOI:10.1016/j.ijrobp.2013.06.645 · 4.26 Impact Factor

Publication Stats

6k Citations
1,122.89 Total Impact Points


  • 1987–2015
    • Johns Hopkins Medicine
      • • Department of Medicine
      • • Department of Neurology
      • • Johns Hopkins Oncology Center
      Baltimore, Maryland, United States
  • 2014
    • Case Western Reserve University School of Medicine
      Cleveland, Ohio, United States
  • 1992–2014
    • Johns Hopkins University
      • Department of Radiation Oncology and Molecular Radiation Sciences
      Baltimore, Maryland, United States
  • 2002–2013
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States
  • 2012
    • Harvard Medical School
      Boston, Massachusetts, United States
    • University of California, Irvine
      • Division of Hematology/Oncology
      Irvine, CA, United States
  • 2010
    • University of Pennsylvania
      • Department of Neurology
      Philadelphia, PA, United States
  • 2005
    • Moffitt Cancer Center
      Tampa, Florida, United States
  • 2004
    • Royal North Shore Hospital
      Sydney, New South Wales, Australia
  • 2003
    • The Ohio State University
      Columbus, Ohio, United States
    • Wake Forest University
      • Department of Neurosurgery
      Winston-Salem, North Carolina, United States
    • City of Hope National Medical Center
      Duarte, California, United States
  • 1999
    • Wake Forest School of Medicine
      Winston-Salem, North Carolina, United States
  • 1997
    • Columbia University
      • Department of Neurology
      New York, New York, United States