Tulio Rodriguez

Loyola University, New Orleans, Louisiana, United States

Are you Tulio Rodriguez?

Claim your profile

Publications (23)69.29 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Allogeneic transplant using reduced intensity conditioning is a therapeutic option for patients with Hodgkin lymphoma (HL) who relapse after an autograft. This was a prospective study of 31 consecutive eligible patients with HL who relapsed after an autograft and underwent an allograft using BEAM (BCNU, etoposide, cytarabine, melphalan) conditioning. At a median follow-up of 7 years the progression-free survival (PFS) was 36% (95% confidence interval [CI] 19–54%) and overall survival (OS) was 42% (95% CI 23–59%). In multivariate analysis only residual disease at the time of transplant predicted outcome, with a 4-year PFS and OS of 62% and 75% for patients with minimal residual disease versus 8% and 8% for patients with gross residual disease, respectively (p = 0.005 and p = 0.001, respectively). This benefit seemed to be irrespective of chemosensitivity, with an OS for patients with chemorefractory yet minimal disease of 71% at 4 years. BEAM allogeneic transplant is effective in producing long-term remissions after autograft failure. Regardless of chemosensitivity, minimizing tumor burden pre-transplant may improve long-term outcome.
    Leukemia and Lymphoma 06/2014; 55(6). DOI:10.3109/10428194.2013.838233 · 2.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective. To describe characteristics of Clostridium difficile infection (CDI) and markers of severe CDI among patients with hematologic malignancies. Design. Case-control study. Setting. Tertiary care teaching hospital. Patients and Methods. Inpatients with hematologic malignancies and CDI were age and time matched with 2 control inpatients without hematologic malignancies. Chart reviews were performed, and C. difficile isolates were strain typed. Results. Case patients ([Formula: see text]) and control patients ([Formula: see text]) patients were different in respect to receipt of immunosuppressive agents within 2 months (92.7% vs 25.6%; [Formula: see text]); neutropenia within 2 months (75.6% vs 3.7%; [Formula: see text]) and mean (± standard deviation) white blood cell (WBC) count at diagnosis ([Formula: see text] vs [Formula: see text] cells/mL; [Formula: see text]); baseline mean creatinine level ([Formula: see text] vs [Formula: see text] mg/dL; [Formula: see text]), mean creatinine level at diagnosis ([Formula: see text] vs [Formula: see text] mg/dL; [Formula: see text]), and creatinine increases of 1.5 times over baseline (2.4% vs 15.1%; [Formula: see text]). Immunosuppressive agents and creatinine level remained significant in multivariable analysis ([Formula: see text] for both variables). Severity correlated with mortality when measured by alternate severity criteria but not when measured by the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America criteria, which are based solely on WBC count and creatinine elevation. The prevalence of the epidemic BI/NAP1/027 strain was similar in both groups. Conclusions. Patients with hematologic malignancies had lower creatinine levels at the time of CDI diagnosis compared with control patients. WBC counts also tended to be lower in case patients. CDI severity criteria based on WBC count and creatinine level may not be applicable to patients with hematologic malignancies.
    Infection Control and Hospital Epidemiology 02/2013; 34(2):127-32. DOI:10.1086/669081 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Uncontrolled delayed nausea and vomiting remains a problem after high-dose preparative regimens used for autologous and allogeneic hematopoietic stem cell transplant. Recently, aprepitant was approved for highly and moderately emetogenic chemotherapy, and, in particular, is effective for decreasing delayed emesis. To evaluate its safety and efficacy in the transplantation setting, we performed a randomized, placebo-controlled, phase 3 trial of aprepitant in combination with ondansetron and dexamethasone in patients treated with ablative preparative regimens. Patients were randomized to receive oral aprepitant or placebo daily with oral ondansetron and dexamethasone during and for 3 days after the completion of the preparative regimen in this prospective randomized, double-blind study. The primary objective was complete response (CR) rate, defined as no emesis with no or mild nausea. Other endpoints included number of emetic episodes, nausea severity assessed using a 100 mm visual analog scale (VAS), the need for rescue antiemetics and transplantation outcome, including regimen-related toxicity (RRT). One hundred eighty-one patients were randomized and 179 patients were eligible for analysis. Overall, CR rates were 81.9% for the aprepitant and 65.8% for the placebo arms (P < .001). Percentage of patients with no emesis all days were 73.3% for aprepitant and 22.5% placebo (P < .001). Mean VAS scores were 16.6 mm aprepitant and 16.9 mm placebo (NS) and there were no differences in the amount of rescue antiemetics used, RRT, engraftment, or transplantation outcome. Aprepitant in combination with dexamethasone and ondansetron significantly decreased emesis and significant nausea, whereas not increasing RRT or affecting short-term survival but had no significant impact on the use of PRN antiemetics, or overall VAS nausea scores.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 07/2012; 19(1). DOI:10.1016/j.bbmt.2012.07.019 · 3.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Graft-versus-host disease (GVHD) causes most non-relapse mortality (NRM) after alternative donor (unrelated and mismatched related) hematopoietic cell transplant (HCT). We previously showed that increases in day +7 TNF-receptor-1 (TNFR1) ratios (posttransplantation day +7/pretransplantation baseline) after myeloablative HCT correlate with outcomes including GVHD, NRM, and survival. Therefore, we conducted a phase II trial at 2 centers, testing whether the addition of the TNF-inhibitor etanercept (25 mg twice weekly from start of conditioning to day +56) to standard GVHD prophylaxis would lower TNFR1 levels, reduce GVHD rates, and improve NRM and survival. Patients underwent myeloablative HCT from a matched unrelated donor (URD; N = 71), 1-antigen mismatched URD (N = 26), or 1-antigen mismatched related donor (N = 3) using either total body irradiation (TBI)-based conditioning (N = 29) or non-TBI-based conditioning (N = 71). Compared to historical controls, the increase in posttransplantation day +7 TNFR1 ratios was not altered in patients who received TBI-based conditioning, but was 40% lower in patients receiving non-TBI-based conditioning. The latter group experienced relatively low rates of severe grade 3 to 4 GVHD (14%), 1-year NRM (16%), and high 1-year survival (69%). These findings suggest that (1) the effectiveness of TNF-inhibition with etanercept may depend on the conditioning regimen, and (2) attenuating the expected rise in TNFR1 levels early posttransplantation correlates with good outcomes.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 03/2012; 18(10):1525-32. DOI:10.1016/j.bbmt.2012.03.013 · 3.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nonrandomized trials suggest that pegfilgrastim, a pegylated granulocyte colony-stimulating factor, could be used in lieu of filgrastim after autologus peripheral blood stem cell transplantation. This phase III, randomized, double-blinded, placebo-controlled trial compared the efficacy, costs, and safety of single-dose pegfilgrastim (single 6 mg dose) versus daily filgrastim (5 microg/kg/day) for this indication. Seventy-eight patients, matched for age, sex, underlying disease, stage, and CD34/kg transplant dose were enrolled. Cytokines were started on day +1 posttransplant and continued to an absolute neutrophil count (ANC) of 5x10(9)/L for 3 days or 10x10(9)/L for 1 day. The median time to neutrophil engraftment (ANC >1.5x10(9)/L for 3 days or 5x10(9)/L for 1 day) was the same in both groups (12 days). No differences in platelet engraftment (11 versus 13 days), number of platelet transfusions (5 versus 4), percent with positive cultures for bacterial pathogens (23% versus 15%), days of fever (1 versus 2), deaths prior to engraftment (1 versus 1), or duration of hospital stay (19 versus 19 days) were seen between the pegfilgrastim and filgrastim groups, respectively. Using the average wholesale price for doses used in this trial, there was a per-patient savings of $961 for the pegfilgrastim group (P < .001). This phase III study failed to demonstrate a difference in time to neutrophil engraftment or any clinical sequelae between pegfilgrastim and filgrastim when given post-APBSCT, with pegfilgrastim achieving a cost savings over filgrastim.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 05/2010; 16(5):678-85. DOI:10.1016/j.bbmt.2009.12.531 · 3.35 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2010; 16(2). DOI:10.1016/j.bbmt.2009.12.017 · 3.35 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2009; 15(2):61-61. DOI:10.1016/j.bbmt.2008.12.190 · 3.35 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2009; 15(2):110-110. DOI:10.1016/j.bbmt.2008.12.339 · 3.35 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Murine studies using anti-T-cell antibodies for conditioning in allogeneic SCT demonstrate engraftment with low rates of GVHD. On the basis of this preclinical model, we conditioned 30 patients with advanced hematologic malignancies with rabbit antithymocyte globulin (ATG) and TBI, to reduce rates of fatal acute GVHD. Patients were enrolled in two sequential groups: cohort 1 received ATG 10 mg/kg in divided doses (days -4 to -1)+200 cGy TBI (n=16), and cohort 2 received ATG (days -10 to -7)+450 cGy TBI (n=14). Median donor blood chimerism for the combined group was 94, 93 and 93% in the first, second and third months after transplant. Only three developed grade II acute GVHD despite 43% of patients receiving unrelated donor transplants. One-year survival was 71+/-11 and 54+/-14%, respectively, in recipients of related and unrelated donor SCT. Donor lymphocyte infusions were needed in 12 patients for the management of relapse and for mixed donor-recipient chimerism in 4 patients. We conclude that 10 mg/kg ATG and TBI allows engraftment with a low risk of acute GVHD; however, further dose optimization of ATG is required to achieve a balance between GVHD and disease relapse.
    Bone marrow transplantation 09/2008; 42(11):723-31. DOI:10.1038/bmt.2008.244 · 3.47 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2008; 14(2):43-43. DOI:10.1016/j.bbmt.2007.12.121 · 3.35 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We describe the clinical courses of 3 patients with hematologic malignancies (2 with acute myelogenous leukemia and 1 with multiple myeloma) who developed invasive fungal infections due to uncommon molds (Alternaria spp., Paecilomyces lilacinus, and Zygomycetes). Breakthrough invasive fungal infections of the sinus (n=1), lung (n=3), and pericardium (n=1) developed despite fluconazole prophylaxis and failed to respond to treatment with other licensed antifungal therapies, including amphotericin B (n=3), caspofungin (n=2), and voriconazole (n=3), and surgical intervention (n=2). Salvage therapy with posaconazole oral suspension resulted in successful outcomes in all 3 patients, who subsequently underwent allogeneic hematopoietic stem cell transplantation (HSCT) while on continued posaconazole therapy. The median duration of posaconazole treatment before HSCT was 5 months (range: 1.5-6 months). Posaconazole salvage therapy allowed successful allogeneic HSCT in 3 patients with refractory invasive mold infections.
    Transplant Infectious Disease 07/2007; 9(2):89-96. DOI:10.1111/j.1399-3062.2007.00208.x · 1.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although autologous stem cell transplantation (ASCT) for patients with relapsed/refractory Hodgkin lymphoma (HL) appears to offer a survival advantage over conventional therapy, only approximately 25% to 35% of patients with primary progressive or poor-risk recurrent HL can achieve durable remission after ASCT, with disease progressive after transplant accounting for most of the treatment failures. We conducted a pilot study to evaluate the toxicities and efficacy of a tandem transplant approach in this subgroup of patients. Between April 1998 and March 2000, 46 patients were enrolled in the study. Eligibility criteria: primary progressive (n = 28) or recurrent HL (n = 18) with at least 1 of the following poor prognostic factors: first complete remission (CR) <12 months (n = 15) or extra-nodal disease (n = 4) or B symptoms at relapse (n = 4). The first cycle consisted of melphalan (150 mg/m(2)) alone. The second cycle consisted of fractionated total body irradiation (FTBI) 1200 cGy or BCNU (450 mg/m(2)) in combination with etoposide (60 mg/kg) and cyclophosphamide (100 mg/kg). Of the 46 patients, 5 (11%) did not receive the planned tandem transplants because of inadequate stem cell collection for 2 ASCT. After a median of 64 days (25-105), 41 patients received the second ASCT. With a median follow-up of 5.3 years (1.6-8.1), the 5-year estimate of overall survival, progression-free survival, and freedom from progression were 54% (95% confidence interval [CI] 40%-69%), 49% (95% CI, 34%-63%), and 55% (95%CI, 40%-70%), respectively. Our mature results from this study suggest that in patients with primary progressive or poor risk recurrent HL, this tandem ASCT program is effective and well tolerated and compares favorably with the conventional single transplant.
    Biology of Blood and Marrow Transplantation 05/2007; 13(5):594-600. DOI:10.1016/j.bbmt.2007.01.072 · 3.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Steroid refractory graft versus host disease (GVHD) presents a significant therapeutic challenge due to the limited efficacy and safety of second-line treatments. Three patients with extensively pretreated, refractory GVHD were treated with a targeted anti-T-cell agent, alefacept, and demonstrated rapid and clinically significant improvement in their GVHD, facilitating tapering of corticosteroids. The pathological and immunohistochemical findings of GVHD also improved, validating our clinical impression. These preliminary findings indicate that alefacept may have beneficial activity in GVHD warranting further study.
    Journal of Dermatological Treatment 02/2007; 18(1):13-8. DOI:10.1080/09546630601121045 · 1.76 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2007; 13(2):79-79. DOI:10.1016/j.bbmt.2006.12.219 · 3.35 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Outpatient hematopoietic stem cell transplants (HSCT) are usually performed in patients receiving minimally mucotoxic preparative regimens; total body irradiation (TBI)-based regimens typically are excluded. To improve resource utilization and patient satisfaction, we developed a totally outpatient HSCT program for TBI regimens and compared outcomes for our first 100 such transplants to 32 performed as in-patients during the same interval, for caregiver or financial reasons. Symptoms were managed predominately with oral agents; pain management consisted of transdermal fentanyl and oral morphine solution. Except for more unmarried in-patients, the two groups were matched. Time to engraftment, severity of mucositis and transplant duration were identical for the two groups. Twenty-seven of the outpatients were admitted (median-6 days), primarily for progressing infection. Thus 92% of all transplant days were outpatient. There were no septic episodes or hospital admissions for pain management. There were no deaths to day 30 in either group and 100-day survival was identical. There was a mean cost savings of Dollars 16,000 per outpatient transplant and outpatient patient/caregiver quality of life was similar to that reported for in-patients. Patients undergoing severely mucotoxic regimens can be safely transplanted in an outpatient setting with a significant cost saving, with no increase in morbidity or mortality.
    Bone Marrow Transplantation 01/2007; 38(11):757-64. DOI:10.1038/sj.bmt.1705525 · 3.47 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients referred for hematopoietic stem cell transplantation (HSCT) often have knowledge deficits about their disease and overestimate their prognosis making it difficult initially to discuss potentially life-threatening transplant options. To determine patients' understanding of their disease and the adequacy of a 3-h consultation at our center, we developed a survey that measured perceived knowledge deficits of disease, prognosis, and emotional status before and after their initial consultation. Ninety nine consecutive eligible patients completed the survey. Although 76.7% claimed adequate information about their disease pre-HCST visit, 51.5 and 41.4% respectively lacked knowledge about their 1-year prognosis with and without any therapy. After the visit, 66.7% of the patients had obtained enough information to make an informed decision regarding HSCT versus 23.2% pre-visit, and a significant reduction in the need for further information was reported by 53.5% of patients (P<0.001). Patients were not overwhelmed or confused by the visit and there was a small but significant decrease in negative affect. Measures to increase patients understanding of their disease and its prognosis pre-HSCT consultation visit are warranted; however, a 3-h consultation visit provides the majority of patients with sufficient information to make an informed decision about the risk/benefit ratio of HSCT.
    Bone Marrow Transplantation 03/2006; 37(5):479-84. DOI:10.1038/sj.bmt.1705264 · 3.47 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2006; 12(2):37-37. DOI:10.1016/j.bbmt.2005.11.116 · 3.35 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2006; 12(2):113-113. DOI:10.1016/j.bbmt.2005.11.348 · 3.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A 55-yr-old woman with a history of B-cell lymphoma of the nasopharynx diagnosed in March 1999 eventually underwent submyeloablative allogeneic stem cell transplantation from a sibling donor in December 2002 after conventional treatment options were exhausted. The treatment approach was somewhat altered by the fact that the patient was a practicing Jehovah's Witness and refused blood-blood product transfusion. The course of her treatment was unremarkable until around day 100 posttransplant when she developed graft failure, leading to severe anemia. Blood transfusions were refused. Donor cells were re-infused. During this treatment period, the patient's hemoglobin dropped to a low of 2.7 g/dL, with the patient experiencing severe fatigue, dyspnea on exertion, headaches, and blurred vision. Polymerized human hemoglobin (pyridoxylated) (Poly- Heme, Northfield Laboratories Inc., Evanston, IL) was given under an emergency, compassionate use protocol and successfully bridged the patient's hemoglobin and relieved symptoms during her marrow recovery period.
    Comprehensive Therapy 02/2006; 32(3):172-5. DOI:10.1385/COMP:32:3:172
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A second allogeneic hematopoietic stem cell transplant (HSCT) for relapsed hematologic malignancies is an option in select patients after an initial allograft has failed. If the original donor is not available, a different donor may have to be considered. We report our experience of performing a second allogeneic HSCT using a different donor in patients with relapsed leukemia and lymphoma. In a 5-year period, six patients underwent a second allograft with myeloablative conditioning using a different donor. Four of these were retransplanted using a matched-unrelated donor. Four of the patients (67%) remain progression-free at a median follow-up of 32 months (range 3-72). There were no cases of transplant-related mortality. We conclude that a second allogeneic HSCT using a different donor is a viable option for selected patients relapsing after an allograft if the original donor is not available.
    Bone Marrow Transplantation 03/2005; 35(3):261-4. DOI:10.1038/sj.bmt.1704761 · 3.47 Impact Factor

Publication Stats

167 Citations
69.29 Total Impact Points

Institutions

  • 2004–2014
    • Loyola University
      New Orleans, Louisiana, United States
  • 2004–2012
    • Loyola University Medical Center
      • • Department of Medicine
      • • Department of Internal Medicine
      • • Cardinal Bernardin Cancer Center
      Maywood, Illinois, United States
  • 2007
    • Loyola University Chicago
      • Division of Hospital Medicine
      Chicago, Illinois, United States