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Papers by Kirk Schultz

IC impaired tumor growth and improved survival (P < .001). Survival was dependent on the donor T ... more IC impaired tumor growth and improved survival (P < .001). Survival was dependent on the donor T cell inoculum in the donor graft: 10^4-10^6 T cells caused lethal GVHD (P < .01), and no T cells did not cause GVHD but only attenuated tumor growth, leading to eventual lethality (P < .05). Having 10^2 or 10^3 T cells in the graft did not lead to GVHD and controlled tumor growth (P < .001), but tumors eventually overtook the mice. Higher T cell doses led to impaired B and NK cell reconstitution (P < .05). Ex vivo expanded NK cells showed higher surface expression of Ly49C/I (P < .05), produced higher levels of TNF-α (P < .01), and lysed tumors better than unexpanded NK cells in vitro (P < .05). Infusing ex vivo expanded B6 wild type NK cells with, or without, IC actually exacerbated GVHD lethality (P < .05), whereas ex vivo expanded NK cells from B6 TNF-α −/− donors with IC improved GVT effects, but not as well as using IC alone. These studies provide the first evidence that IC can be safely administered after alloBMT, can be tolerated with lower T cell doses in the donor graft and contribute to potent GVT effects against NBL. Ex vivo expanded, donor-derived NK cells paradoxically exacerbate GVHD, but targeting TNF-α production may improve GVT.

Background: While HCT provides the best chance for cure for eligible patients with AML, barriers ... more Background: While HCT provides the best chance for cure for eligible patients with AML, barriers limit the number able to receive HCT. Virginia (VA) has some of the wealthiest and poorest counties in the country. We hypothesize that there are geographic variations in the rate and estimated unmet need of HCT for patients with AML in VA. Understanding geographic differences may help improve access to HCT. Methods: All patients aged 20-74 years diagnosed with AML in 2013-2015 were identified by the VA Department of Health and classified by residence into 8 regions: Southwest, Southside, Valley, Central, Northern, Richmond, Eastern, and Hampton Roads. Socioeconomic (SES) factors including sex, age, race, marital status, education, employment, income, and health insurance were examined by region. Number of patients receiving first HCT by region were obtained from CIBMTR data. Unmet need was calculated by estimating the number of potential patients for HCT and subtracting the actual number of HCTs (Besse et al., 2015). Results: 690 patients were diagnosed with AML in VA between 2013 and 2015; 153 first HCTs were reported to CIBMTR during the same time period. The rate of HCT and unmet need varied among the different geographic regions (Figure 1). The only SES factor that correlated with HCT rate was race/ethnicity (P=0.0334). The Southside, which had a higher percentage of non-Hispanic Black or African American population (31%), had a lower HCT rate (8%) compared to the Northern region, which had a Black or African American population of 12%, but a HCT rate of 29% (Figure 2). The Northern region had the highest median income ($105,000) and one of the highest rates of proceeding to HCT (29%) (Figure 3). In contrast, the Southside, which had the lowest median income ($40,000), had only 8% of patients proceeding to HCT and an estimated unmet need of 88%. Private vs public insurance, marital status, education, and gender did not correlate with HCT rates. Conclusions: There are geographic differences in rates of HCT for patients with AML in VA. Regions with a higher non-Hispanic Black or African American population had lower rates of receiving HCT. Further study is needed to determine if the decreased rates in regions with a higher non-Hispanic Black or African American population are related to donor availability or SES barriers. Future steps to eliminate these SES barriers will be vital to increase the access of patients receiving a potentially curative HCT in VA.

Most children with sickle cell disease (SCD) who might otherwise be considered for curative hemat... more Most children with sickle cell disease (SCD) who might otherwise be considered for curative hematopoietic cell transplantation (HCT) lack a healthy matched related donor. Barriers to alternative donor HCT for SCD include graft rejection, graft-versus-host disease(GVHD) and regimen-related toxicities. To address these problems, we initiated a phase II trial of unrelated bone marrow or cord blood transplantation (CBT) using a novel, alemtuzumabbased, reduced intensity conditioning (RIC) regimen in children with severe SCD. Here we report the results for the 8 children who received unrelated CBT on this study. Patients were prepared for HCT following alemtuzumab(10, 15 and 20 mg on day-21,-20 and-19 respectively), fludarabine(30 mg/m 2 day-8 to-4) and melphalan(140 mg/m 2 day-3). Cyclosporine or tacrolimus and mycophenolate were administered for GVHD prophylaxis. Donor/recipient HLA match status was 5/6 in all patients based on low/ intermediate resolution molecular typing at HLA-A,-B, and high resolution typing at-DRB1. Median recipient age was 13.7 years (range 7.4 to 16.2 years). The median pre-cryopreservation total nucleated cell dose was 6.4x10 7 /kg (range 3.1 to 7.6) and the median post-thaw infused CD34 cell dose was 1.5x10 5 /kg (range 0.2 to 2.3). The conditioning regimen demonstrated a favorable safety profile. All patients achieved an absolute neutrophil count.500/mm 3 by day 33 (median 22 days). Six of eight patients had a platelet recovery to. 50,000/mm 3 by day 100. Five patients had autologous hematopoietic recovery and three patients had sustained full donor engraftment. Two of 3 engrafted patients developed grade II acute GVHD. Of these, one developed extensive chronic GVHD that was fatal 14 months post-transplant. With a median follow up of 1.8 years (range 1-2.6), 7 patients are alive with a 1-year survival of 100% and 2 are alive without graft failure or disease recurrence. Total nucleated or CD 34+ cell dose, HLA mismatch or ABO mismatch were not correlated with graft rejection in this small series. Conclusion: This RIC regimen was associated with a high rate of graft rejection after unrelated CBT. The CBT arm has been closed, but the trial remains open to enrollment for eligible patients with 8/8 HLA allele matched unrelated bone marrow donors. Novel approaches aimed at reducing graft rejection while minimizing toxicity will be needed before RIC unrelated donor CBT can be widely adopted for transplanting children with severe SCD.

Frontiers in Pediatrics, Feb 2, 2022

Blood Advances, Jan 27, 2022

will include the protocol with all amendments, informed consent forms, complete de-identified pat... more will include the protocol with all amendments, informed consent forms, complete de-identified patient data sets, and analytic/ statistical code. Data will be available indefinitely at http://www.keanlab.com. Some of these data have been presented in Watkins B, Qayed M, McCracken C, et al. Phase II trial of costimulation blockade with abatacept for prevention of acute GVHD.

Biology of Blood and Marrow Transplantation, Mar 1, 2019

Previous studies have reported single B cell-related chronic graft-versus-host disease diagnostic... more Previous studies have reported single B cell-related chronic graft-versus-host disease diagnostic (cGVHD) biomarkers, such as B cell-activating factor (BAFF), CD21 low , and immature B cells, but research on the performance of biomarker combinations and the covariate effect of steroids is lacking. The primary objective of this study was to determine the most accurate combination of B cell populations using cell surface staining flow cytometry in an independent cohort of patients with cGVHD. Secondary objectives included assessing the effect of corticosteroid use at sample collection on the makeup and accuracy of the diagnostic panel and identifying the mechanism underlying low surface expression of BAFF receptor (BAFF-R) on B cells in cGVHD. Flow cytometry analysis was performed in an adult cohort of post-HCT patients with cGVHD onset (n = 44) and time-matched recipients without cGVHD (n = 63). We confirmed that the onset of cGVHD was associated with higher soluble BAFF (sBAFF) levels, elevated CD27 ¡ CD10 ¡ CD21 low CD19 + B cell and classical switched memory B cell counts, and reduced transitional and na€ ıve B cell counts. The highest single B cell population area under the receiver operating characteristic (ROC) curve (AUC) was .72 for transitional type 1 CD21 low B cells. We also showed a significant inverse relationship between sBAFF and surface BAFF-R expression caused by sBAFF modulation of BAFF-R. Steroid use at sample collection influenced the significance of the sBAFF:B cell ratio, na€ ıve and marginal zone-like B cells. The optimal combination of B cell subsets most significantly associated with cGVHD onset with or without concurrent corticosteroid use resulted in ROC AUCs of .87 and .84, respectively. Transitional and CD21 low B cells were the only populations present in both panels; however, analyzing only these populations resulted in ROC AUCs of .79 and .78, respectively. This suggests that the inclusion of other populations and use of different panels depending on steroid use is necessary to achieve better accuracy. sBAFF was not a component of either panel. These novel B cell profiles could be tested prospectively in patients post-HSCT and could lead to focused mechanistic studies.

Leukemia, Oct 10, 2012

Chronic graft-versus-host disease (CGVHD) is one of the most debilitating complications post hema... more Chronic graft-versus-host disease (CGVHD) is one of the most debilitating complications post hematopoietic cell transplant (HCT). Several studies have evaluated factors affecting survival in CGVHD, 1-8 most utilizing the older definition of CGVHD where patients with any symptoms of GVHD (acute or chronic) may be classified as CGVHD if symptomatic beyond day 100 post HCT. However, the new NIH consensus guidelines have redefined criteria for CGVHD diagnosis and staging 9 based on actual symptoms at presentation and excludes patients with persistent, recurrent or late AGVHD who were previously considered to have CGVHD. The CGVHD consortium follows a large multi-center prospectively enrolled cohort of CGVHD patients utilizing NIH consensus guidelines for assessments. 10 Several reports from this consortium have identified factors affecting survival including global severity, thrombocytopenia, KPS and the overlap syndrome. 11,12 Prior AGVHD has been associated with a higher mortality in patients who develop CGVHD, 1,3 indicating that these patients may be more debilitated and hence suffer worse outcome. However, the clinical and prognostic importance of prior AGVHD on subsequent CGVHD in the current era using NIH diagnostic and staging criteria is unknown. We evaluated the significance of prior AGVHD on CGVHD presentation, overall response and survival in a contemporary cohort of CGVHD patients prospectively enrolled by the CGVHD consortium. Cases enrolled in the consortium could be incident (enrollment < 3 months after diagnosis) or prevalent (enrollment ≥3 months after diagnosis). 10 Detailed CGVHD assessments were performed reflecting the recommendations of the NIH Consensus Conference, 9,13 and are

Journal of Clinical Oncology, Apr 1, 2019

PURPOSE Children and young adults with hypodiploid B-lymphoblastic leukemia (B-ALL) fare poorly a... more PURPOSE Children and young adults with hypodiploid B-lymphoblastic leukemia (B-ALL) fare poorly and hematopoietic stem-cell transplantation (HSCT) is often pursued in first complete remission (CR1). We retrospectively reviewed the outcomes of children and young adults with hypodiploid BALL who were enrolled in recent Children's Oncology Group (COG) trials to evaluate the impact of HSCT on outcome. PATIENTS AND METHODS Cytogenetic analyses and DNA index were performed at COG-approved laboratories, and hypodiploidy was defined as modal chromosome number less than 44 and/or DNA index less than 0.81. Minimal residual disease (MRD) was determined centrally using flow cytometry at two reference laboratories. Patients with hypodiploid ALL came off protocol therapy postinduction and we retrospectively collected details on their subsequent therapy and outcomes. Event-free survival (EFS) and overall survival (OS) were estimated for the cohort. RESULTS Between 2003 and 2011, 8,522 patients with National Cancer Institute standard-risk and high-risk BALL were enrolled in COG AALL03B1 (ClinicalTrials.gov identifier: NCT00482352). Hypodiploidy occurred in 1.5% of patients (n = 131), 98.3% of whom achieved CR after induction therapy. Five-year EFS and OS were 52.2% 6 4.9% and 58.9% 6 4.8%, respectively. Outcomes for patients undergoing CR1 HSCT were not significantly improved: 5-year EFS and OS were 57.4% 6 7.0% and 66.2% 6 6.6% compared with 47.8% 6 7.5% and 53.8% 6 7.6%, respectively (P = .49 and .34, respectively) for those who did not undergo transplantation. Patients with MRD of 0.01% or greater at the end of induction had 5-year EFS and OS of 26.7% 6 9.3% and 29.3% 6 10.1%, respectively, and HSCT had no significant impact on outcomes. CONCLUSION Children and young adults with hypodiploid BALL continue to fare poorly and do not seem to benefit from CR1 HSCT. This is especially true for patients with MRD of 0.01% or greater at the end of induction. New treatment strategies are urgently needed for these patients.

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2017

A cute graft-versus-host disease remains a major threat to a successful outcome after allogeneic ... more A cute graft-versus-host disease remains a major threat to a successful outcome after allogeneic hematopoietic cell transplantation. While improvements in treatment and supportive care have occurred, it is unknown whether these advances have resulted in

Biology of Blood and Marrow Transplantation, May 1, 2011

We describe long-term disease-free survival (DFS) after unrelated donor bone marrow transplantati... more We describe long-term disease-free survival (DFS) after unrelated donor bone marrow transplantation (BMT) for myelodysplastic syndrome (MDS) in 118 patients aged #18 years. Forty-six patients had refractory cytopenia (RC), 55 refractory anemia with excess blasts (RAEB), and 17 refractory anemia with excess blasts in transformation (RAEB-t). Transplant-related mortality was higher after mismatched BMT (relative risk [RR] 3.29, P 5 .002). Disease recurrence was more likely with advanced stages of MDS at the time of BMT: RAEB (RR 6.50, P 5.01) or RAEB-t (RR 11.00, P 5.004). Treatment failure (recurrent disease or death from any cause; inverse of DFS) occurred in 68 patients. Treatment failure was higher after mismatched BMT (RR 2.79, P 5 .001) and in those with RAEB-t (RR 2.38, P 5.02). Secondary MDS or chemotherapy prior to BMTwas not associated with recurrence or treatment failure. Similarly, cytogenetic abnormalities were not associated with transplant outcomes. Eight-year DFS for patients with RC after matched and mismatched unrelated donor BMT was 65% and 40%, respectively. Corresponding DFS for patients with RAEB and RAEB-t was 48% and 28%, respectively. When a matched adult unrelated donor is available, BMT should be offered as first-line therapy, and children with RC can be expected to have the best outcome.

Transplantation, Feb 1, 2018

Antibody-mediated injury is a major cause of allograft dysfunction and loss. Antibodies to ABH(O)... more Antibody-mediated injury is a major cause of allograft dysfunction and loss. Antibodies to ABH(O) blood group antigens are classic mediators of ABO-incompatible graft rejection, whereas donor-specific anti-HLA antibodies and, more recently, autoantibodies are appreciated as important contributors to allograft inflammation and dysfunction. In August 2016, the International Summit of the Canadian National Transplant Research Program focused on recent advances in the field of antibody-mediated rejection. Here, we describe work presented and discussed at the meeting, with a focus on 3 major themes: the importance of (1) natural antibodies and autoantibodies, (2) tissue injury-derived exosomes and autoimmunity, (3) inflammasome activation and innate immune responses in regulating allograft inflammation and dysfunction. Finally, we explore novel areas of therapeutic intervention that have recently emerged from these 3 major and overlapping fields of transplantation research.

Journal of Clinical Oncology, Aug 10, 2010

Patients with acute leukemia refractory to induction or reinduction chemotherapy have poor progno... more Patients with acute leukemia refractory to induction or reinduction chemotherapy have poor prognoses if they do not undergo hematopoietic stem-cell transplantation (HSCT). However, HSCT when a patient is not in complete remission (CR) is of uncertain benefit. We hypothesized that pretransplantation variables may define subgroups that have a better prognosis. Patients and Methods Overall, 2,255 patients who underwent transplantation for acute leukemia in relapse or with primary induction failure after myeloablative conditioning regimen between 1995 and 2004 were reported to the Center for International Blood and Marrow Transplant Research. The median follow-up of survivors was 61 months. We performed multivariate analysis of pretransplantation variables and developed a predictive scoring system for survival. Results The 3-year overall survival (OS) rates were 19% for acute myeloid leukemia (AML) and 16% for acute lymphoblastic leukemia (ALL). For AML, five adverse pretransplantation variables significantly influenced survival: first CR duration less than 6 months, circulating blasts, donor other than HLA-identical sibling, Karnofsky or Lansky score less than 90, and poor-risk cytogenetics. For ALL, survival was worse with the following: first refractory or second or greater relapse, Ն 25% marrow blasts, cytomegalovirus-seropositive donor, and age of 10 years or older. Patients with AML who had a predictive score of 0 had 42% OS at 3 years, whereas OS was 6% for a score Ն 3. Patients with ALL who had a score of 0 or 1 had 46% 3-year OS but only 10% OS rate for a score Ն 3. Conclusion Pretransplantation variables delineate subgroups with different outcomes. HSCT during relapse can achieve long-term survival in selected patients with acute leukemia.

Bone Marrow Transplantation, Aug 31, 2000

Cyclosporin A (CsA) absorption is highly variable in BMT patients. Neoral, a new microemulsion fo... more Cyclosporin A (CsA) absorption is highly variable in BMT patients. Neoral, a new microemulsion formulation of CsA, permits increased absorption with less variable pharmacokinetic parameters in non-BMT patients. We evaluated the pharmacokinetics of CsA after BMT in patients received microemulsion CsA. Two oral doses of 3 mg/kg were given 48 h apart between 14 and 28 days after allogeneic BMT in 20 adults, and one dose in seven children, while subjects were receiving a continuous i.v. infusion of CsA. Whole blood samples were taken throughout the dosing interval to calculate the incremental CsA exposure using maximum concentration (C max), time to C max (t max), concentration at 12 h after the dose (C12), the area under the concentration-time curve (AUC), and to establish inter-and intra-patient pharmacokinetic variability. Drug exposure was substantially lower in children than in adults, with an AUC of 861 ± 805 vs 2629 ± 1487 mg × h/l (P = 0.001), respectively, and absorption was delayed and diminished in both groups by comparison with solid organ recipients. Intra-patient variability in adults for AUC was high at 0.59 ± 0.34, while inter-patient variability, measured as the coefficient of variation (c.v.), was 0.55 for the first and 0.54 for the second dose. In adults, gastrointestinal (GI) inflammation due to either mucositis or GVHD resulted in a higher AUC of 3077 ± 1551 g × h/l compared to 1795 ± 973 g × h/l (P = 0.02), and a similar trend was observed in children. AUC seemed little affected by the CsA formulation (liquid or capsule), or co-administration with liquids or food. Trough (12 h) CsA levels correlated poorly with incremental AUC. Sparse sample modeling of the AUC using two-point predictors taken at 2.5 and 5 h after dosing accurately approximated AUC in adults (r 2 = 0.94), while 1.5 and 5 h was superior in children (r 2 = 0.98). These data suggest that 12 h postdose trough measurements of CsA may not be the most

Blood Advances

Overall survival after reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transpl... more Overall survival after reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT) using alemtuzumab, fludarabine, and melphalan is associated with high rates of mixed chimerism (MC) and secondary graft failure (GF). We hypothesized that peritransplantation alemtuzumab levels or specific patterns of inflammation would predict these risks. We assessed samples from the Bone Marrow Transplant Clinical Trials Network 1204 (NCT01998633) to study the impact of alemtuzumab levels and cytokine patterns on MC and impending or established secondary GF (defined as donor chimerism <5% after initial engraftment and/or requirement of cellular intervention). Thirty-three patients with hemophagocytic lymphohistiocytosis (n = 25) and other IEIs (n = 8) who underwent HCTs with T-cell–replete grafts were included. Patients with day 0 alemtuzumab levels ≤0.32 μg/mL had a markedly lower incidence of MC, 14.3%, vs 90.9% in patients with levels >0.32 μg/mL (P = .008). Im...

Leukemia

Treatment of chronic myeloid leukemia has improved significantly with the introduction of tyrosin... more Treatment of chronic myeloid leukemia has improved significantly with the introduction of tyrosine kinase inhibitors (TKIs), and treatment guidelines based on numerous clinical trials are available for chronic phase disease. However for CML in the blast phase (CML-BP), prognosis remains poor and treatment options are much more limited. The spectrum of treatment strategies for children and adolescents with CML-BP has largely evolved empirically and includes treatment principles derived from adult CML-BP and pediatric acute leukemia. Given this heterogeneity of treatment approaches, we formed an international panel of pediatric CML experts to develop recommendations for consistent therapy in children and adolescents with this high-risk disease based on the current literature and national standards. Recommendations include detailed information on initial diagnosis and treatment monitoring, differentiation from Philadelphia-positive acute leukemia, subtype-specific selection of inductio...

Blood Advances

The National Institutes of Health Consensus criteria for chronic graft-versus-host disease (cGVHD... more The National Institutes of Health Consensus criteria for chronic graft-versus-host disease (cGVHD) diagnosis can be challenging to apply in children, making pediatric cGVHD diagnosis difficult. We aimed to identify diagnostic pediatric cGVHD biomarkers that would complement the current clinical criteria and help differentiate cGVHD from non-cGVHD. The Applied Biomarkers of Late Effects of Childhood Cancer (ABLE) study, open at 27 transplant centers, prospectively evaluated 302 pediatric patients after hematopoietic cell transplant (234 evaluable). Forty-four patients developed cGVHD. Mixed and fixed effect regression analyses were performed on diagnostic cGVHD onset blood samples for cellular and plasma biomarkers, with individual markers declared relevant if they met 3 criteria: an effect ratio ≥1.3 or ≤0.75; an area under the curve (AUC) of ≥0.60; and a P value <5.814 × 10−4 (Bonferroni correction) (mixed effect) or <.05 (fixed effect). To address the complexity of cGVHD dia...

Frontiers in Pediatrics, 2022

Hematopoietic cell transplant is a curative therapy for many pediatric patients with high risk ac... more Hematopoietic cell transplant is a curative therapy for many pediatric patients with high risk acute lymphoblastic leukemia. Its therapeutic mechanism is primarily based on the generation of an alloreactive graft-versus-leukemia effect that can eliminate residual leukemia cells thus preventing relapse. However its efficacy is diminished by the concurrent emergence of harmful graft-versus-host disease disease which affects healthly tissue leading to significant morbidity and mortality. The purpose of this review is to describe the interventions that have been trialed in order to augment the beneficial graft-versus leukemia effect post-hematopoietic cell transplant while limiting the harmful consequences of graft-versus-host disease. This includes many emerging and promising strategies such as ex vivo and in vivo graft manipulation, targeted cell therapies, T-cell engagers and multiple pharmacologic interventions that stimulate specific donor effector cells.

Blood, 2020

Human graft-versus-host disease (GVHD) biology beyond 3 months after hematopoietic stem cell tran... more Human graft-versus-host disease (GVHD) biology beyond 3 months after hematopoietic stem cell transplantation (HSCT) is complex. The Applied Biomarker in Late Effects of Childhood Cancer study (ABLE/PBMTC1202, NCT02067832) evaluated the immune profiles in chronic GVHD (cGVHD) and late acute GVHD (L-aGVHD). Peripheral blood immune cell and plasma markers were analyzed at day 100 post-HSCT and correlated with GVHD diagnosed according to the National Institutes of Health consensus criteria (NIH-CC) for cGVHD. Of 302 children enrolled, 241 were evaluable as L-aGVHD, cGVHD, active L-aGVHD or cGVHD, and no cGVHD/L-aGVHD. Significant marker differences, adjusted for major clinical factors, were defined as meeting all 3 criteria: receiver-operating characteristic area under the curve ≥0.60, P ≤ .05, and effect ratio ≥1.3 or ≤0.75. Patients with only distinctive features but determined as cGVHD by the adjudication committee (non-NIH-CC) had immune profiles similar to NIH-CC. Both cGVHD and L-...

Blood Advances, 2019

Key Points Low or nondetectable MRD pre-HCT leads to similar outcomes, suggesting that MRD negati... more Key Points Low or nondetectable MRD pre-HCT leads to similar outcomes, suggesting that MRD negativity is not an absolute prerequisite for HCT. MRD post-HCT is more important than pre-HCT, and monitoring with sensitive techniques can detect very high-risk patients early.

Blood, 2019

Chronic graft-versus-host disease (cGVHD) and late acute graft-versus-host disease (L-aGVHD) are ... more Chronic graft-versus-host disease (cGVHD) and late acute graft-versus-host disease (L-aGVHD) are understudied complications of allogeneic hematopoietic stem cell transplantation in children. The National Institutes of Health Consensus Criteria (NIH-CC) were designed to improve the diagnostic accuracy of cGVHD and to better classify graft-versus-host disease (GVHD) syndromes but have not been validated in patients <18 years of age. The objectives of this prospective multi-institution study were to determine: (1) whether the NIH-CC could be used to diagnose pediatric cGVHD and whether the criteria operationalize well in a multi-institution study; (2) the frequency of cGVHD and L-aGVHD in children using the NIH-CC; and (3) the clinical features and risk factors for cGVHD and L-aGVHD using the NIH-CC. Twenty-seven transplant centers enrolled 302 patients <18 years of age before conditioning and prospectively followed them for 1 year posttransplant for development of cGVHD. Centers...

Frontiers in Pediatrics, Feb 2, 2022

Blood Advances, Jan 27, 2022

Biology of Blood and Marrow Transplantation, Mar 1, 2019

Leukemia, Oct 10, 2012

Journal of Clinical Oncology, Apr 1, 2019

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2017

Biology of Blood and Marrow Transplantation, May 1, 2011

Transplantation, Feb 1, 2018

Journal of Clinical Oncology, Aug 10, 2010

Bone Marrow Transplantation, Aug 31, 2000

Blood Advances

Leukemia

Blood Advances

Frontiers in Pediatrics, 2022

Blood, 2020

Blood Advances, 2019

Blood, 2019