Ajay Major

Ajay Major
University of Colorado | UCD · Division of Hematology

MD, MBA

About

67
Publications
7,430
Reads
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267
Citations
Citations since 2017
61 Research Items
262 Citations
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Introduction
Ajay Major is an assistant professor at the University of Colorado School of Medicine specializing in lymphoma. His outcomes and health services research focuses on patient-reported outcomes in lymphoma and myeloma, short- and long-term toxicities of therapy, and survivorship. He is also a physician-publisher in the medical education and narrative medicine spaces.
Education
July 2019 - July 2022
University of Chicago
Field of study
  • Chief Fellow in Hematology and Oncology and T32 Awardee
June 2016 - June 2019
University of Colorado
Field of study
  • Residency in Internal Medicine
August 2012 - May 2016
Albany Medical College
Field of study
  • Medicine, with Distinctions in Advocacy and Health Systems Analysis

Publications

Publications (67)
Article
Full-text available
Elderly patients with classical Hodgkin lymphoma (cHL) are understudied and poorly defined. The National Cancer Data Base was queried for adults with cHL diagnosed 2004-2013: 22,547 age 18-39, 12,841 age 40-59, and 10,873 age >60 were identified. Two-year overall survival (OS) was 97%, 91%, and 65% for the three age cohorts, respectively (p < .0001...
Article
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Background: Previous studies have shown an increased risk of secondary primary malignancies (SPMs) after diffuse large B-cell lymphoma (DLBCL) treatment. Whether stage of DLBCL at diagnosis affects the subtypes of SPMs that occur has not been previously described. Methods: The Surveillance, Epidemiology, and End Results database was queried for...
Article
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The PI3K/Akt/mTOR (PAM) axis is constitutively activated in multiple lymphoma subtypes and is a promising therapeutic target. The mTOR inhibitor temsirolimus (TEM) and the immunomodulatory agent lenalidomide (LEN) have overlapping effects within the PAM axis with synergistic potential. This multicenter phase I/II study evaluated combination therapy...
Article
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There are limited data describing the impact of active surveillance on longitudinal health-related quality of life (HRQoL) in patients with indolent non-Hodgkin lymphomas (NHL). A cohort of untreated indolent NHL patients completed FACT-LYM questionnaires at 6, 12, 18, 24, and 36 months after diagnosis. Longitudinal FACT-LYM scores were analyzed by...
Article
Peripheral neuropathy is a common treatment-emergent side effect during the treatment of newly-diagnosed multiple myeloma. Although bortezomib is most commonly implicated, real-world data suggest that lenalidomide and dexamethasone (VRd) and autologous stem cell transplantation (ASCT) may also contribute to neuropathy and health-related quality of...
Article
Background: Lenalidomide is a cornerstone of maintenance therapy in patients with newly diagnosed multiple myeloma after autologous stem-cell transplantation. We aimed to compare the efficacy and safety of maintenance therapy with carfilzomib, lenalidomide, and dexamethasone versus lenalidomide alone in this patient population. Methods: This stu...
Chapter
Full-text available
Narrative analysis, creative writing, and interactive reflective writing have been identified as valuable for professional identity formation and resilience among medical and premedical students alike. This study proposes that medical student blogs are novel pedagogical tools for fostering peer-to-peer learning in academic medicine and are currentl...
Article
Context: Relapses involving the central nervous system (CNS) are uncommon among patients with diffuse large B-cell lymphoma (DLBCL) but carry very poor prognosis. Prophylaxis is heterogeneously prescribed around the time of frontline therapy, with no clear standard of care in terms of recipient selection or route of administration. Design: We re...
Article
Importance: Treatment of newly diagnosed multiple myeloma (NDMM) with a quadruplet regimen consisting of a monoclonal antibody, proteasome inhibitor, immunomodulatory imide, and corticosteroid has been associated with improved progression-free survival (PFS) compared with triplet regimens. The optimal quadruplet combination, and whether this obvia...
Article
Full-text available
Measurable residual disease (MRD) as assessed by next generation sequencing (NGS) using bone marrow (BM) aspirate carries prognostic significance in multiple myeloma (MM). Though its analytical sensitivity reaches 10-6, MRD assessed from BM may be vulnerable to false negatives due to patchy or extramedullary disease, or due to inadequate aspirate s...
Article
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In the POLARIX trial, pola‐R‐CHP demonstrated improved progression‐free survival (PFS) compared to R‐CHOP in untreated intermediate‐ to high‐risk DLBCL. We surveyed practicing clinicians regarding their interpretation of POLARIX, including impressions of efficacy, safety, and cost. Of 174 respondents, most from academic centers (82%) in the United...
Article
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Treatment following autologous stem cell transplantation (ASCT) for multiple myeloma (MM) remains an area of active investigation. We have shown that extended post-ASCT treatment with carfilzomib, lenalidomide, and dexamethasone (KRd) after KRd induction improved the depth and duration of response (Jasielec et al, Blood 2020), suggesting a benefit...
Article
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Rare cases of COVID‐19 vaccinated individuals develop anti‐platelet factor 4 (PF4) antibodies that cause thrombocytopenia and thrombotic complications, a syndrome referred to as vaccine‐induced immune thrombotic thrombocytopenia (VITT). Currently, information on the characteristics and persistence of anti‐PF4 antibodies that cause VITT after Ad26.C...
Article
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Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma (HL) in both children and adults. In contrast to classic HL, NLPHL nearly always expresses CD20, has a mostly indolent clinical course with high overall survival despite frequent relapses, and may undergo aggressive transformation. To build a framework for...
Article
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PURPOSE The global pediatric oncology clinical research landscape, particularly in Central and South America, Africa, and Asia, which bear the highest burden of global childhood cancer cases, is less characterized in the literature. Review of how existing pediatric cancer clinical trial groups internationally have been formed and how their research...
Article
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A 65-year-old man without past medical history presented with two weeks of progressive weakness and lethargy, edema, and short-term memory difficulties. Review of systems revealed a 40-pound unintentional weight loss over the previous six months.
Article
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Purpose: The COVID-19 pandemic led to unprecedented challenges in medical training, and we sought to assess the specific impact of COVID-19 on hematology-oncology (HO) fellowship programs. Methods: We conducted a cross-sectional anonymous online survey of 103 HO program directors (PDs) in conjunction with the American Society of Hematology (ASH)...
Article
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Purpose: Graduate medical and research training has drastically changed during the COVID-19 pandemic, with widespread implementation of virtual learning, redeployment from core rotations to the care of patients with COVID-19, and significant emotional and physical stressors. The specific experience of hematology-oncology (HO) fellows during the CO...
Article
Full-text available
Purpose: There is a need for an improved understanding of clinical and biologic risk factors in pediatric cancer to improve patient outcomes. Machine learning (ML) represents the application of computational inference from advanced statistical methods that can be applied to increasing amount of data available for study in pediatric oncology. The g...
Article
Full-text available
Narrative analysis, creative writing, and interactive reflective writing have been identified as valuable for professional identity formation and resilience among medical and premedical students alike. This study proposes that medical student blogs are novel pedagogical tools for fostering peer-to-peer learning in academic medicine and are currentl...
Article
Full-text available
The emerging molecular and prognostic characterization of diffuse large B-cell lymphoma (DLBCL) has challenged the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) treatment paradigm in recent years, with the identification of several DLBCL subtypes associated with significantly inferior survival after standard R-CHOP...
Article
Full-text available
Background Rituximab induction (RI) and bendamustine-rituximab (BR) induction are both options for the frontline management of indolent non-Hodgkin lymphomas (NHLs). Although BR induces longer progression-free survival than RI, BR confers more toxicity and a longer duration of initial induction than RI. The effects of RI versus BR on health-related...
Article
Full-text available
Introduction: The combination of carfilzomib, lenalidomide, and dexamethasone (KRd), with and without autologous stem cell transplantation (ASCT) is an effective regimen for newly diagnosed multiple myeloma (NDMM) (Jakubowiak et al., Blood 2012 and Jasielec et al., Blood 2020). The addition of daratumumab to KRd (Dara-KRd) for 8 cycles led to a mea...
Article
Full-text available
Background Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma that typically presents with early-stage favorable disease and exhibits an indolent clinical course with long-term remissions and eventual relapse. Histopathologic variants of NLPHL have recently been described and may have poorer outcomes compa...
Article
Full-text available
Treatment of older patients (pts) with PCNSL is challenging due to the prevalence of comorbidities, frailty, and complexities with effective delivery of chemotherapy (CT). Optimal induction CT or consolidation for older PCNSL pts are unknown. Moreover, there are a paucity of large-scale prognostication studies available. We analyzed post-induction...
Article
Full-text available
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a newly described hematologic disorder, which presents as acute thrombocytopenia and thrombosis after administration of the ChAdOx1 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson & Johnson) adenovirus-based vaccines against COVID-19. Due to positive assays for antibodies against platelet...
Article
Full-text available
Prophylaxis is commonly used to prevent central nervous system (CNS) relapse in diffuse large B cell lymphoma, with no clear standard of care. We retrospectively evaluated 1162 adult patients across 21 US academic centers with DLBCL or similar histologies who received single-route CNS prophylaxis as part of frontline therapy between 2013-2019. Prop...
Article
Full-text available
Treatment of older patients (pts) with PCNSL is challenging due to the prevalence of comorbidities, frailty, and effective delivery of chemotherapy (CT). Optimal induction CT or consolidation for older PCNSL pts are unknown. Moreover, there are a paucity of large-scale prognostication studies available. We analyzed post-induction treatment patterns...
Poster
Treatment of older patients (pts) with PCNSL is challenging due to the prevalence of comorbidities, frailty, and effective delivery of chemotherapy (CT). Optimal induction CT and consolidation for older PCNSL pts are unknown. Moreover, there are a paucity of large-scale prognostication studies available. We analyzed post-induction treatment pattern...
Article
Full-text available
Oncology health-care workers (HCWs) are facing substantial stressors during the current coronavirus disease 2019 (COVID-19) pandemic, resulting in a wide range of acute stress responses. To appropriately meet the growing mental health needs of HCWs, it is imperative to differentiate expectable stress responses from post-traumatic stress disorder an...
Article
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We present the following illustrative case of a patient with relapsed B-ALL who developed HLH/MAS after treatment with a commercial CAR-T product and was successfully managed with anakinra, interleukin-6 (IL-6) inhibitors, and corticosteroids. Our case highlights several key challenges surrounding the presentation, diagnosis, and management of CAR-...
Article
Full-text available
Problem: There are significant barriers for resident physicians seeking mental health care, including lack of time, cost, and concerns about confidentiality. The authors sought to improve access to mental health resources by addressing these barriers through the development of a confidential opt-out mental health pilot program for interns, and to a...
Preprint
Full-text available
Background: The ongoing COVID-19 pandemic has profoundly affected the mental health of health care workers (HCWs), and optimal strategies to provide psychological support for HCWs are not currently established. Aims: To rapidly review recently-published literature on the mental health of HCWs during the COVID-19 pandemic. Methods: Query of all quan...
Article
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Background: The traditional model of promotion and tenure in the health professions relies heavily on formal scholarship through teaching, research, and service. Institutions consider how much weight to give activities in each of these areas and determine a threshold for advancement. With the emergence of social media, scholars can engage wider aud...
Article
Full-text available
Background Targeting the PI3K/Akt/mTOR axis in relapsed lymphomas is of interest based on constitutive activation in many lymphoma subtypes, and has had varying degrees of success. We previously showed that the first generation mTOR inhibitor, temsirolimus (TEM), has activity across histologies with an acceptable toxicity profile (Smith, et al., JC...
Article
Full-text available
Background: With the incorporation of positron emission tomography (PET) imaging as part of the standard staging evaluation of follicular lymphoma (FL), it is generally recommended to obtain the diagnostic biopsy from a lesion with the highest standardized uptake value (SUV) to rule out de novo histologic transformation (HT). In some cases such an...
Article
Full-text available
Introduction: Treatment of older patients (pts) with PCNSL is challenging due to the prevalence of comorbidities, frailty, and complexities with delivery of chemotherapy (CT). The optimal induction CT and consolidation regimens for older PCNSL pts is unknown. Moreover, there are few large scale prognostication studies available, including analysis...
Article
Full-text available
Introduction Relapses involving the central nervous system (CNSrel) occur in ~5% of patients (pts) with aggressive non-Hodgkin lymphoma (NHL) in the rituximab era (Ghose et al, Clin LML 2015) with rates exceeding 10% in high risk groups (Villa et al, Ann Onc 2010; Schmitz et al, JCO 2016). CNSrel are generally thought to occur in the first 4-6 mont...
Article
Full-text available
Background Primary CNS lymphoma (PCNSL) is a rare non-Hodgkin lymphoma that is often associated with immunosuppressed states. The Epstein-Barr Virus (EBV) may play a role in tumor pathogenicity in some cases. The objective of this study was to examine the patient characteristics, tumor pathology, and survival outcomes associated with EBV tumor stat...
Article
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The highest rates of burnout syndrome, defined as emotional exhaustion, depersonalization, and reduced personal accomplishment, are found in residents and fellows, and burnout may lead to increased medical errors. Although there have been campaigns to create residency curricula that promote resilience, improvement of burnout metrics with curricular...
Article
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There is increasing consensus that comprehensive reforms are needed to curb the rising costs of specialty drugs and growing bipartisan agreement on the basic principles that these reforms must address (1) constraints on yearly inflation of drug prices, (2) limits on practices to extend patents and restrict generic competition, (3) increased transpa...
Article
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Vincristine- or vinblastine-induced peripheral neuropathy (VIPN) is a common adverse event during lymphoma treatment that can profoundly impact quality of life and survivorship. VIPN often leads to dose-reduction or discontinuation of these agents. However, there is limited data (Annals of Hematology, Utsu 2016; Annals of Hematology, Morth 2018) ev...
Article
Full-text available
A 26-year-old man with history of chronic hepatitis C presented to the emergency department (ED) with a week-long history of shortness of breath, difficulty swallowing, and weakness of his shoulders and legs. He had previously been evaluated at 2 different hospitals where his symptoms had been ascribed to gastroesophageal reflux.
Article
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Opinion statement: Post-transplant lymphoproliferative disorder (PTLD) is one of the most common neoplasms seen after solid organ and hematopoietic stem cell transplantation, and is associated with significant morbidity and mortality. The pathogenesis is related to post-transplant immunosuppression and EBV infection. Prevention of PTLD depends upo...
Article
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Fluorodeoxyglucose-positron emission tomography with computed tomography (PET-CT) is the preferred staging modality in patients with follicular lymphoma (FL). PET-CT parameters maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG) and total metabolic tumor volume (TMTV) have been studied to assess prognosis and detect occult tra...
Article
Full-text available
Previous studies have shown increased risk of second primary malignancies (SPM) after DLBCL treatment. Risk factors for and types of SPM that occur, stratified by stage of DLBCL at diagnosis, have not been previously described.
Article
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A 32‐year‐old man with recurrent idiopathic pericarditis was admitted with persistent hypotension. Workup revealed elevated ACTH, low DHEA‐S, positive ACTH stimulation test and positive 21‐hydroxylase antibody consistent with autoimmune Addison disease.
Article
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Mediastinal gray-zone lymphoma lies intermediate between nodular-sclerosis classic Hodgkin’s lymphoma and primary mediastinal B-cell lymphoma (a subtype of diffuse large B-cell lymphoma), with overlapping clinical, histologic, and molecular features. Genetic characteristics shared among these tumors include frequent 9p24.1 copy-number alterations,...
Article
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It’s my first day on a new rotation—rheumatology clinic, with the attending physician who, I hear, crafts awful puns on the fly and lives for his so-called no-delta visits, his social time with his endless panel of stable arthritis patients. I log in to the health record, with the MS-DOS interface that hearkens back to my days as a 5-year-old booti...
Article
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A 42‐year‐old previously healthy male presented with a six‐month history of B symptoms and new onset fever, nausea, and vomiting. Laboratory evaluation demonstrated anemia (8.0 g/dL), thrombocytopenia (18 × 10^9/L), neutropenia (1.0 × 10^9/L), abnormal liver function (total bilirubin 3.3 mg/dL), coagulopathy (INR 1.9, PTT 111.3 sec, D‐dimer 23,000...
Article
Cutaneous squamous cell carcinoma is the second most common cancer in the United States and has 5-year recurrence and metastasis rates of 8% and 5%, respectively. However, not all cutaneous squamous cell carcinomas are alike, and the size and location of the primary lesion confers a widely variable risk for recurrence and metastasis.
Article
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In 1990, pediatrician Henry K. Silver first documented the rampant problem of medical student mistreatment in a study reported in JAMA, which found that 46.4 percent of students at one medical school had been abused at some point during medical school; by the time they were seniors, that number was 80.6 percent. In the 24 years since that landmark...
Article
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Study of metacaspases in organisms as diverse as Arabadopsis, T. brucei and baker's yeast has provided evidence for the existence of a form of cell death in non-animal systems. Our work focuses on the five metacaspases in the recently-sequenced genome of the filamentous fungus Schizophyllum commune.
Thesis
Full-text available
In plants, fungi, and protists, programmed cell death is controlled by a family of proteases known as metacaspases, which appear to be homologous to aspartate-specific mammalian caspases with high similarity of primary sequence and conservation of the cysteine-histidine catalytic dyad. As proteases, metacaspases also contain N-terminal prodomains t...
Thesis
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The contemporary graffiti movement in Spain evolved spontaneously and independently from other graffiti movements under the influence of la movida counterculture during the post-Franco transition. La movida, which viewed the street as the agora of Spanish society, emphasized the importance of artistry and the need to exist in and connect with the p...
Article
Full-text available
In plants, fungi, and protists, programmed cell death is controlled by a family of proteases known as metacaspases, which appear to be homologous to aspartate-speciic mammalian caspases with high similarity of primary sequence and conservation of the cysteine-histidine catalytic dyad. As proteases, metacaspases also contain N-terminal prodomains th...
Article
Full-text available
Study of metacaspases in organisms as diverse as Arabadopsis and yeast has provided evidence for the existence of a form of cell death in these organisms. Metacaspases have a His-Cys diad similar to that found in caspases, and several have been shown to autoprocess into subunits similar to the p20 and p10 subunits in animal caspases. However, the m...

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Projects (3)
Project
The broad aim of this study is to describe overall and domain-specific health-related quality of life (HRQoL) of adult and pediatric patients with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) by prospective administration of validated patient-reported outcome (PRO) survey instruments. We further aim to elucidate how HRQoL may be affected by different patient, disease, and treatment characteristics.
Project
The broad aim of this study is to understand the quantitative and qualitative relationships between financial toxicity (FT), health-related quality of life (HRQOL), and medication adherence in patients with chronic lymphocytic leukemia (CLL) on first-line oral oncolytic therapy, utilizing a mixed-methods framework with validated patient-reported outcome (PRO) survey instruments.
Project
The aim of this prospective toxicity trial is to examine how changes in endothelial function and cardiovascular physiology are associated with dyspnea and cardiovascular toxicities in patients treated with carfilzomib for multiple myeloma.