Pritesh Patel

• MB, ChB
• Professor (Associate) at University of Illinois Chicago

Purpose Overuse of opioids has been associated with a significant public health crisis, yet remain critical as adjunctive treatment in multiple myeloma (MM). Questions remain about the balance between the benefits to risks of ongoing opioid use, especially when the patient’s myeloma is in remission. This retrospective review focuses on the associat...

Background: Autologous transplant remains standard first line treatment in multiple myeloma (MM) yet melphalan 200 mg/m2 leads to 500% variation in systemic exposure (Nath CE et al, 2010, PMID 20573084), as measured by area under the curve (AUC). Unfortunately, PK-targeted melphalan dosing has been unsuccessful with test dose strategies failing to...

Introduction: Cannabis use among cancer patients is increasing, supported by studies demonstrating its efficacy in alleviating cancer- and treatment-related symptoms such as pain and nausea, while offering a reduced risk of developing physiological dependence compared to opioid options. Despite this, provider implicit bias and lack of knowledge, ab...

Background: Pain is one of the most frequent and distressing symptoms in multiple myeloma (MM). Opioids are the gold standard in the management of moderate to severe pain; however, overuse has been associated with a significant public health crisis. High rates of opioid use independent of bony disease have been reported, with a negative impact of c...

Objectives Based on a previous phase 1 study, total marrow irradiation (TMI) at 9Gy was added to a myeloablative FluBu4 conditioning regimen in allogeneic hematopoietic stem cell transplantation (HSCT) for myeloid malignancies. Here, we report on the long‐term toxicity of TMI combined with FluBu4 and compare it to patients who received only FluBu4....

Overuse of opioid analgesics has been associated with a significant public health crisis, but at the same time, these medications are critical as an adjunctive treatment for bone pain in multiple myeloma (MM). Despite this, opioid use patterns in MM have not been well studied. Given the prolonged survival after autologous stem cell transplant (ASCT...

Background Eligibility assessment of patients with sickle cell disease (SCD) for allogeneic hematopoietic stem cell transplant (HSCT) is a complex yet vital component of pre-transplant evaluation. Psychosocial assessment tools have been modeled after those completed in solid organ transplantation but no studies have validated these tools in this po...

Background Chemokine receptor CXCR4 antagonist plerixafor (Px) as well as high volume (HV) leukapheresis have been shown to reduce hematopoietic stem progenitor cell (HSPC) mobilization failure rates. However, no direct comparisons of such methods currently exists. Methods and Materials We compared the HSPC collection yield based on basal peripher...

Blood & Marrow Transplantation (BMT) is rarely available in many low-middle-income countries (LMIC). In 2012, Civil Service Hospital, a government hospital in Kathmandu (Nepal) partnered with the University of Illinois at Chicago (USA) to consult on the establishment of BMT in their hospital, train staff and promote educational activities. The impl...

This cohort study examines the risk of skeletal-related events associated with the frequency of bisphosphonate treatment in patients with multiple myeloma.

Background:AML is predominantly a disease of the elderly, yet outcomes remain dismal, particularly for relapsed/refractory (R/R) AML patients (pts). Gemtuzumab Ozogamicin (GO) is a monoclonal antibody targeting CD33–commonly expressed on AML blasts, and, critically, AML stem cells (LSC)–linked to the cytotoxin calicheamicin. GO resistance mechanism...

p>Background: Multiple myeloma (MM) incidence and outcomes differ across racial/ethnic groups in the United States. Interactions between socioeconomic status (SES) with ethnicity in MM incidence and survival outcomes are not well understood. Our objective was to evaluate disparities in cancer-specific survival of patients diagnosed with MM by race/...

PURPOSE Treatment of chronic myelogenous leukemia (CML) with tyrosine kinase inhibitors (TKIs) has improved survival but is associated with significant financial burden. We measured the annual trend in TKI utilization, Medicare gross payment, and patient out-of-pocket (OOP) expenditure from 2007 to 2016. METHODS We used SEER linked to Medicare par...

Background Whether race/ethnicity plays a role in hematopoietic stem/progenitor cells (HSPC) mobilization in autologous donors has not been studied. We hypothesize that donor characteristic including race/ethnicity, age, sex, body mass index, and diagnostic groups influences HSPC mobilization. Diagnostic groups include healthy allogeneic donors, au...

PURPOSE Intravenous (IV) bisphosphonates reduce the risk of skeletal-related events in patients with multiple myeloma (MM). However, data describing racial differences in IV bisphosphonate utilization outside of clinical trial settings are limited. We evaluated population-level IV bisphosphonate initiation and discontinuation among patients of age...

High dose melphalan and autologous stem cell transplantation is standard of care for the upfront treatment of multiple myeloma (MM). Several studies have shown upregulation of single DNA repair genes and whole DNA repair pathways as associated with melphalan resistance and poor outcomes after ASCT. Here we set out to identify the most important DNA...

Although myeloablative fludarabine/busulfan (FluBu4) has been widely adopted in clinical practice, considerable interpatient variability exists in systemic busulfan exposure (AUC) when using body weight or body surface area based-dosing, leading to decreased efficacy (i.e. relapse) or increased toxicity (i.e., mucositis, veno-occlusive disease). Th...

Background Presently, acute myeloid leukemia (AML) risk stratification is estimated prior to treatment by incorporating patient and disease characteristics. However, apart from the limited use of minimal residual disease measurement, few methodologies assess AML relapse risk post-treatment. In attempts to correlate pre- and post-treatment blood cel...

Multiple myeloma (MM) patients are predisposed to high rate of infectious complications, with viral infections and in particular varicella zoster virus infection having a more than 10-fold increased incidence compared to the general population. This risk increases with use of autologous stem cell transplant (ASCT), multiple lines of therapy for rel...

Purpose To examine the impact of pre-diagnosis depressive symptoms and mental health-related quality of life (HRQOL) on survival among older patients with multiple myeloma (MM). Methods We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data resource. Patients aged 65 yea...

Background: The diagnosis of cancer and its treatment have meaningful impacts on health-related quality of life (HRQOL). Although advances in novel therapy and stem cell transplantation have increased survival in patients with hematologic malignancies (HM), less evidence exists on the subsequent impacts of HM on HRQOL. The objective of this study w...

PurposePatient-reported outcomes such as self-reported health (SRH) are important in understanding quality cancer care, yet little is known about links between SRH and outcomes in older patients with multiple myeloma (MM). We evaluated associations between SRH and mortality among older patients with MM.Methods We analyzed a retrospective cohort of...

Classic Hodgkin lymphoma (CHL) is a clonal lymphoid neoplasm derived from B cells. CHL usually involves the lymph nodes. Although cases with extranodal involvement by CHL have been reported, the involvement of the uterine cervix by CHL is an extremely uncommon phenomenon. Herein, we report an unusual case of a 51-year-old female with nodular sclero...

The reduced-intensity conditioning regimen, fludarabine and melphalan 140 mg/m ² (FM140), is widely adopted in practice. Pharmacokinetic studies report 10-fold interpatient variability in melphalan exposure. We identified low hemoglobin (Hb) and/or creatinine clearance (CrCl), determinants of melphalan pharmacokinetic, as strong predictors of outco...

Introduction: Lack of health insurance is an important determinant of cancer health disparities in the United States. For patients with hematologic malignancies, breakthroughs in novel chemotherapeutics, targeted therapies, and stem cell transplantation are counterbalanced with concerns for financial toxicity and lack of access without adequate hea...

p>Introduction: Human immunodeficiency virus (HIV)-related lymphomas are more frequently diagnosed at advanced stages and HIV is associated with lower survival in Hodgkin and non-Hodgkin lymphoma. Less is documented on how the impacts of HIV on lymphoma outcomes differ between racial groups in the United States. Methods: We conducted a hospital-bas...

TPS7566 Background: AML is predominantly a disease of the elderly, yet outcomes remain dismal, especially for relapsed/refractory (R/R) AML patients (pts). Gemtuzumab Ozogamicin (GO) is a monoclonal antibody targeting CD33–commonly expressed on AML blasts, and, critically, AML stem cells (LSC)–that is linked to the cytotoxin calicheamicin. Recogniz...

Relapsed or refractory acute myeloid leukemia (R/R AML) has a poor prognosis and is best treated with salvage chemotherapy as a bridge to allogeneic stem cell transplant (alloSCT). However, the optimal salvage therapy remains unknown. Here we compared two salvage regimens; mitoxantrone, etoposide, and cytarabine (MEC) and mitoxantrone and high‐dose...

Aims High dose melphalan (HDM) and autologous stem cell transplant (ASCT) is standard of care for multiple myeloma (MM), but there is significant variability in melphalan exposure (area under the plasma drug concentration–time curve, AUC) when using body surface area‐based dosing. Our aim was to establish a method of pharmacokinetic (PK) testing fo...

High dose melphalan (MEL) and autologous stem cell transplant (ASCT) is the standard of care in the treatment of multiple myeloma (MM). Resistance to MEL has been linked to increased DNA repair. Here we sought to identify which DNA repair pathways lead to MEL resistance. As inhibitors of the single strand DNA repair enzyme PARP1 are clinically avai...

The reduced-intensity conditioning (RIC) regimen consisting of fludarabine and melphalan 140 mg/m² (Flu/Mel140) has been widely adopted in clinical practice. Pharmacokinetic (PK) studies report up to 10-fold interpatient variability in melphalan exposure. We previously identified low Hgb and/or creatinine clearance (CrCl), both determinants of melp...

High dose melphalan (HDM) and autologous stem cell transplantation (ASCT) is standard of care for multiple myeloma (MM). However, ∼40% of patients fail to achieve complete remission, in part due to variability in melphalan exposure (AUC) when using body-surface-area (BSA)-based dosing, which results in suboptimal exposure and response. HDM, 100mg/m...

High dose melphalan (MEL) and autologous stem cell transplant (ASCT) is the standard of care in the treatment of multiple myeloma (MM). Resistance to MEL has been linked to increased DNA repair. Here we sought to identify whether inhibition of PARP1 (PARPi) synergizes with MEL and can overcome resistance. We tested the synergistic cytotoxicity of P...

Patients with sickle cell disease (SCD) have access to fewer health care resources and therapies compared to other diseases, which contributes to increased morbidity and health care utilization. We compared health care utilization (inpatient hospital days, emergency care visits) and health care-related costs between SCD adults that underwent hemato...

Several commonly used immune‐suppressing biologic drugs target proteins and cytokines involved in myeloma pathogenesis. Our objective was to determine whether targeted biologic disease‐modifying antirheumatic drugs (DMARDs) are associated with risk of multiple myeloma (MM). We conducted a nested case–control study within a retrospective cohort of 5...

Outcomes after ASCT are highly variable making it difficult to predict risk of disease progression. We analyzed the impact of clinically available immune-related biomarkers on treatment-free survival (TFS) in 130 patients receiving Mel200 and ASCT. Absolute lymphocyte count (ALC), monocyte count (AMC), neutrophil count (ANC), and immunoglobulin (Ig...

Melphalan is given at a dose of 200 mg/m2 (Mel200) prior to ASCT for multiple myeloma (MM). Pharmacokinetic (PK) studies show a high degree of interpatient variability. We aimed to test the impact of clinical factors previously shown to affect melphalan PK such as hemoglobin (Hgb), fat-free mass (FFM), and creatinine clearance (CrCl) on outcomes. M...

High dose melphalan (HDM) followed by autologous stem cell transplantation (ASCT) is standard of care after induction therapy for eligible patients with multiple myeloma (MM). However, ~40% of patients fail to achieve complete remission (CR), largely due to interpatient variability (~10-fold) in melphalan exposure (AUC). Thus, many patients experie...

The reduced-intensity conditioning (RIC) regimen consisting of fludarabine and melphalan 140 mg/m2 (Flu/Mel140) prior to allogeneic hematopoietic stem cell transplant (HSCT) has been widely adopted in clinical practice. However, pharmacokinetic (PK) studies report up to a 10-fold interpatient variability in melphalan exposure (AUC). Specifically, m...

Cryopreservation of hematopoietic stem/progenitor cell (HPC) grafts and other cell based products to be infused in the future is a common practice. However, cryopreservation and conditions of storage can influence post thaw recovery of cellular products. HPC graft is composed of heterogeneous blood cells. Various assays detect viability based on di...

Multiple myeloma (MM) patients are at higher risk for infectious complications, with viral infections having a 10-fold increased incidence compared to the general population. In particular, the risk of varicella zoster virus (VZV) reactivation increases with use of autologous stem cell transplant (ASCT), multiple lines of therapy for relapsed/refra...

Despite near universal health coverage under Medicare, racial disparities persist in the treatment of diffuse large B-cell lymphoma (DLBCL) among older patients in the United States. Studies evaluating DLBCL outcomes often treat socioeconomic status (SES) measures as confounders, potentially introducing biases when SES factors are mediators of disp...

Cytogenetic changes in multiple myeloma (MM) have emerged as one of the most important prognostic factors. Translocations of chromosomes 4 and 14 [t(4;14)], chromosomes 14 and 16 [t(14;16)] and deletion of chromosome 17p [del(17p)] have been incorporated in the Revised International Staging System as a measure of adverse disease biology. Ongoing re...

Myeloablative conditioning regimens with significant extramedullary toxicity result in high rates of renal dysfunction including acute kidney injury (AKI). Here we examine the incidence and impact of a reduced creatinine clearance (below 60 ml/min) before day 90 (early renal dysfunction, ERD) in patients receiving the reduced toxicity fludarabine/i...

Study objective: Bevacizumab is used in the treatment of recurrent glioblastoma, but evidence is limited on the incidence of thromboembolic complications regarding the use of this drug in real-world settings. We aimed to evaluate the risk of arterial thromboembolism (ATE) and venous thromboembolism (VTE) associated with the use of bevacizumab amon...

Objective: To compare polypharmacy and potentially inappropriate medication use in multiple myeloma patients receiving care under a traditional, physician-managed, or collaborative physician-pharmacist clinic. Design: Retrospective chart review. Setting: Urban academic cancer center. Data source: Computerized electronic record. Patients: F...

6582 Background: The strength of associations between pre-diagnosis self-reported health (SRH) and mortality differ by medical condition, with a moderately strong association reported among cancer patients. Less is known about the impact of SRH on survival among patients diagnosed with multiple myeloma (MM). We aimed to evaluate pre-diagnosis SRH i...

e18250 Background: Adjuvant intravenous bisphosphonates (IV BP) reduce the risk of skeletal-related events (SRE) in patients with multiple myeloma (MM). We examined the effects of bisphosphonate utilization patterns (adherence, cumulative dose and frequency) on risk of SRE. Methods: Patients aged 65 years or older and diagnosed with first primary M...

e18232 Background: Few studies have evaluated the impacts of depressive symptoms and mental health on patients diagnosed with multiple myeloma (MM). The aim of this study was to examine associations between depressive symptoms and poor mental health-related quality of life in relation to survival in a cohort of older MM patients. Methods: We conduc...

e18165 Background: Intravenous bisphosphonates (IV BP) reduce the risk of skeletal-related events in patients with multiple myeloma (MM). However, data describing racial differences in utilization of IV BP in non-clinical trial settings is limited. In this study, we evaluated population-level IV BP utilization and factors associated with initiation...

Patients with high-risk myeloproliferative neoplasms (MPNs), and in particular myelofibrosis (MF), can be cured only with allogeneic hematopoietic stem cell transplantation (HSCT). Because MPNs and JAK2 V617F -mutated cells show genomic instability, stalled replication forks, and baseline DNA double-strand breaks, DNA repair inhibition with poly(AD...

Introduction/background: African American (AA) individuals have a twofold higher incidence of multiple myeloma (MM) compared with other racial groups. Outcomes are affected by factors such as disparate access to care as well as differences in disease biology. Patients and methods: We conducted a single-institution analysis to evaluate the effect...

Background & Aim Both chemokine receptor CXCR4 antagonist plerixafor (P) as well as high volume (HV) leukapheresis have been shown to reduce mobilization failure rates. However, no direct comparisons of such collection methods currently exist. In this single center retrospective study, we compared the collection efficiency in adult patients diagnos...

Introduction Although autologous stem cell transplant (ASCT) prolongs progression free survival (PFS) in multiple myeloma (MM), prediction of outcomes is challenging due to wide variability in post-transplant survival. MM is an immune suppressive disease characterized by the development of a microenvironment that promotes disease progression and re...

The Hermanos Ameijeiras Hospital (HAH) (Havana) is the primary center performing allogeneic hematopoietic stem cell transplantation (HSCT) in adult patients in Cuba, but has no access to donor registries because of the economic embargo. To implement HSCT from haploidentical donors in Cuba, in 2016 HAH and University of Illinois at Chicago (UIC) sta...

Introduction Melphalan 200 mg/m² (Mel200) and autologous stem cell transplant (ASCT) prolongs progression free survival (PFS) in multiple myeloma (MM). Pharmacokinetic (PK) studies report a 5-fold interpatient variability in melphalan exposure with increased exposure leading to increased toxicity yet superior survival. Clinical factors including re...

The impact of race/ethnicity on hematopoietic stem/progenitor cell (HSPC) mobilization remains controversial. Past studies have concluded Black healthy donors as more robust mobilizers or comparable mobilizers with Whites in response to granulocyte colony-stimulating factor (G-CSF). Whether ethnicity plays any role in HSPC mobilization in autologou...

Early release of TNFα after hematopoietic stem cell transplantation (HSCT) correlates with development of acute graft-vs.-host disease (GVHD). Here we tested the effect of TNFα and alloreactive T cells on early hematopoietic HSC genotype and function. Addition of TNFα (10 ng/ml) in liquid cultures with CD34+ cells for 6–72 h resulted in the downreg...

Background Granulocyte colony‐stimulating factors (G‐CSFs), which are used for the prevention of complications from chemotherapy‐related neutropenia, are linked to the risk of developing second primary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). The objective of this study was to examine the correlation between using a specific...

In this study we utilized a large animal model to identify a dose of intravenous busulfan that can cause reversible myelosuppression. Nine baboons (Papio anubis) were treated with IV busulfan at 6.4 (Group A), 8 (Group B), or 9.6 mg/kg (Group C). Peripheral blood counts were measured up to 90 days after treatment and serial bone marrow samples were...

ARRIVE Checklist 2014 Mahmud et al August 2018. (PDF)

Bone marrow CD3+ T lymphocyte count following busulfan administration. Bone marrow CD3+ lymphocytes was measured prior to and following busulfan administration in all three groups of baboons (Group A, Group B and Group C). The data (mean ± SEM) is expressed as absolute number of CD3+ cells per microliter bone marrow. The CD3+ T cell number pre and...

Correlation coefficient of bone marrow CFU and CD34+ cell recovery following busulfan administration in baboon. Bone marrow CFU and log transformed CD34+ cell content recovery including all 9 baboons. (TIF)

INTRODUCTION: Biologic disease-modifying antirheumatic drugs (DMARDs) are used more frequently and earlier in the course of rheumatologic conditions in a treat-to-target approach. These medications act on proteins and cytokines with potential pro- and anti-malignancy roles, including tumor necrosis factor-alpha (TNF), human interleukin (IL) recepto...

Multiple myeloma is a complex disease requiring adherence to treatment and supportive care guidelines, patient education, medication management, and timely delivery of anti-myeloma drugs to achieve optimal patient care. Clinical pharmacists play an important role in the management of cancer patients and could potentially assist in several aspects o...

High dose chemotherapy followed by autologous stem cell transplant (ASCT) prolongs progression-free survival (PFS) of patients with multiple myeloma (MM). However, there is wide variability in response and survival after ASCT and therefore prediction of prognosis remains a challenge. Biomarkers of immunologic and inflammatory changes, such as the p...

INTRODUCTION: Multiple myeloma (MM) induces a hypercoagulable state with increased risk of venous thromboembolism (VTE) due to higher blood viscosity, circulating immunoglobin, inflammatory cytokines, procoagulant monoclonal protein and cytotoxic therapies. Thromboprophylaxis is typically indicated for immunomodulator-based treatment or if a patien...

INTRODUCTION Bevacizumab, an angiogenesis inhibitor targeting vascular endothelial growth factor A, is used for the treatment of recurrent glioblastoma, the most common primary brain malignancy in adults. Multiple studies demonstrate the efficacy of bevacizumab on progression-free and overall survival of patients with recurrent glioblastoma. Howeve...

Sickle cell disease (SCD) is an inherited red blood cell disorder that leads to substantial morbidity and a heavy burden on the health care system. Nonmyeloablative allogeneic hematopoietic stem cell transplantation (HSCT) regimens using HLA-matched related donors have recently demonstrated high rates of engraftment and a favorable safety profile i...

Background: Omacetaxine mepesuccinate (OM) is a semi-synthetic form of Homoharringtonine (HH), a cephalotaxine alkaloid. OM induces cell apoptosis by inhibiting peptide bond formation during mRNA translation, with rapid loss of short-lived proteins, such as MCL-1, c-MYC, and Cyclin D1 (Lu, J Hematol Oncol. 2014, 7: 2). Notably, cytarabine synergize...

Despite new targeted therapies, patients with high risk myeloproliferative neoplasms (MPNs) have an increased chance of transforming into acute myeloid leukemia (AML) and can only be cured with allogeneic hematopoietic stem cell transplant (HSCT). JAK2V617F mutation is common in MPNs and is associated with genomic instability, with baseline DNA dou...

Background: Relapsed or refractory acute myeloid leukemia (R/R AML) portends a poor prognosis, thus salvage chemotherapy is commonly used as a bridge to HSCT, however the optimal salvage regimen remains unknown. For decades cytarabine (Ara-C) has served as the backbone of regimens frequently used in the R/R setting. MEC is among the most studied re...

Although melphalan 200mg/m2 (Mel200) and autologous stem cell transplantation (ASCT) significantly prolong progression-free survival for multiple myeloma (MM) patients, clinical outcomes and toxicities vary greatly. Pharmacokinetic studies report a 5-fold interpatient variability in melphalan exposure with increased exposure being associated with h...

Purpose:: We hypothesized that a multidisciplinary collaborative physician-pharmacist multiple myeloma clinic would improve adherence to treatment and supportive care guidelines as well as reduce delays in receiving oral antimyeloma therapy. Methods:: From March 2014 to February 2015, an oncology pharmacist provided consultation for all patients...

Blood and marrow transplantation (BMT) has been performed in Cuba for over 30 years with limited resources and without international relationships. Researchers from University of Illinois at Chicago and Hermanos Ameijeiras Hospital (HAH) in Havana collaborated on retrospectively analyzing 101 consecutive patients with adult acute leukemia who recei...