David Iberri

All Publications

• Venetoclax and hypomethylating agent therapy in high risk myelodysplastic syndromes: a retrospective evaluation of a real-world experience. Leukemia & lymphoma Azizi, A., Ediriwickrema, A., Dutta, R., Patel, S. A., Shomali, W., Medeiros, B., Iberri, D., Gotlib, J., Mannis, G., Greenberg, P., Majeti, R., Zhang, T. 2020: 1?8

  Abstract

  Treatment with hypomethylating agents (HMAs) azacitidine or decitabine is the current standard of care for high risk myelodysplastic syndromes (MDSs) but is associated with low rates of response. The limited number of treatment options for patients with high risk MDS highlights a need for new therapeutic options. Venetoclax is an inhibitor of the BCL-2 protein which, when combined with an HMA, has shown high response rates in unfit and previously untreated acute myeloid leukemia. We performed a retrospective study of high risk MDS patients receiving combination HMA plus venetoclax in order to determine their effectiveness in this context. We show that in our cohort, the combination results in high response rates but is associated with a high frequency of myelosuppression. These data highlight the efficacy of combination HMA plus venetoclax in high risk MDS, warranting further prospective evaluation in clinical trials.

  View details for DOI 10.1080/10428194.2020.1775214

  View details for PubMedID 32543932

• Clinical and laboratory features of autoimmune hemolytic anemia associated with immune checkpoint inhibitors AMERICAN JOURNAL OF HEMATOLOGY Leaf, R., Ferreri, C., Rangachari, D., Mier, J., Witteles, W., Ansstas, G., Anagnostou, T., Zubiri, L., Piotrowska, Z., Oo, T. H., Iberri, D., Yarchoan, M., Salama, A. S., Johnson, D. B., Leavitt, A. D., Rahma, O. E., Reynolds, K. L., Leaf, D. E. 2019; 94 (5): 563?74

  View details for DOI 10.1002/ajh.25448

  View details for Web of Science ID 000468303900007

• Clinical and Laboratory Features of Autoimmune Hemolytic Anemia Associated with Immune Checkpoint Inhibitors. American journal of hematology Leaf, R. K., Ferreri, C., Rangachari, D., Mier, J., Witteles, W., Ansstas, G., Anagnostou, T., Zubiri, L., Piotrowska, Z., Oo, T. H., Iberri, D., Yarchoan, M., Salama, A., Johnson, D. B., Leavitt, A. D., Rahma, O., Reynolds, K. L., Leaf, D. E. 2019

  Abstract

  Immune checkpoint inhibitors (ICPis) are a novel class of immunotherapeutic agents that have revolutionized the treatment of cancer; however, these drugs can also cause a unique spectrum of autoimmune toxicity. Autoimmune hemolytic anemia (AIHA) is a rare but often severe complication of ICPis. We identified 14 patients from 9 institutions across the US who developed ICPi-AIHA. The median interval from ICPi initiation to development of AIHA was 55 days (interquartile range [IQR], 22-110 days). Direct antiglobulin test (DAT) results were available for 13 of 14 patients: eight patients (62%) had a positive DAT and five (38%) had a negative DAT. The median pre-treatment and nadir hemoglobin concentrations were 11.8 g/dL (IQR, 10.2-12.9 g/dL) and 6.3 g/dL (IQR, 6.1-8.0 g/dL), respectively. Four patients (29%) had a pre-existing lymphoproliferative disorder, and two (14%) had a positive DAT prior to initiation of ICPi therapy. All patients were treated with glucocorticoids, with 3 requiring additional immunosuppressive therapy. Complete and partial recoveries of hemoglobin were achieved in 12 (86%) and 2 (14%) patients, respectively. Seven patients (50%) were re-challenged with ICPis, and one (14%) developed recurrent AIHA. Clinical and laboratory features of ICPi-AIHA were similar in DAT positive and negative patients. ICPi-AIHA shares many clinical features with primary AIHA; however, a unique aspect of ICPi-AIHA is a high incidence of DAT negativity. Glucocorticoids are an effective first-line treatment in the majority of patients with ICPi-AIHA, and most patients who are re-challenged with an ICPi do not appear to develop recurrence of AIHA. This article is protected by copyright. All rights reserved.

  View details for PubMedID 30790338

• Dynamic BH3 Profiling Predicts for Clinical Response to Lenalidomide Plus Chemotherapy in Relapsed Acute Myeloid Leukemia Garcia, J. S., Bhatt, S., Fell, G., Blonquist, T. M., Taw, J., Iberri, D., Letai, A., Medeiros, B. C. AMER SOC HEMATOLOGY. 2018

  View details for DOI 10.1182/blood-2018-99-117428

  View details for Web of Science ID 000454842803094

• Postibrutinib outcomes in patients with mantle cell lymphoma BLOOD Martin, P., Maddocks, K., Leonard, J. P., Ruan, J., Goy, A., Wagner-Johnston, N., Rule, S., Advani, R., Iberri, D., Phillips, T., Spurgeon, S., Kozin, E., Noto, K., Chen, Z., Jurczak, W., Auer, R., Chmielowska, E., Stilgenbauer, S., Bloehdorn, J., Portell, C., Williams, M. E., Dreyling, M., Barr, P. M., Chen-Kiang, S., DiLiberto, M., Furman, R. R., Blum, K. A. 2016; 127 (12): 1559-1563

  Abstract

  Despite unprecedented clinical activity in mantle cell lymphoma (MCL), primary and acquired resistance to ibrutinib is common. The outcomes and ideal management of patients that experience ibrutinib failure are unclear. We performed a retrospective cohort study of all patients with MCL that experienced disease progression while receiving ibrutinib across 15 international sites. Medical records were evaluated for clinical characteristics, pathological, and radiological data, and therapies used pre and post ibrutinib. A total of 114 subjects met eligibility criteria. The median number of prior therapies was 3 (range 0-10). The MIPI scores at start of ibrutinib were low, intermediate, and high in 46%, 31%, and 23%, respectively. Of patients with available data prior to ibrutinib and post-ibrutinib, 34/47 and 11/12 had a Ki67>30%. The median time on ibrutinib was 4.7 months (range 0.7-43.6). The median overall survival (OS) following cessation of ibrutinib was 2.9 months (95% CI 1.6-4.9 months). Of the 104 patients with data available, 73 underwent subsequent treatment an average of 0.3 months after stopping ibrutinib with a median OS of 5.8 months (95% C.I. 3.7 to 10.4 months). Multivariate Cox regression analysis of MIPI prior to post-ibrutinib treatment, and subsequent treatment with bendamustine, cytarabine, or lenalidomide failed to reveal any association with OS. Poor clinical outcomes were noted in the majority of patients with primary or secondary ibrutinib resistance. We could not identify treatments that clearly improved outcomes. Future trials should focus on understanding the mechanisms of ibrutinib resistance and on treatment following ibrutinib.

  View details for DOI 10.1182/blood-2015-10-673145

  View details for PubMedID 26764355

• Ibrutinib-associated rash: a single-centre experience of clinicopathological features and management. British journal of haematology 2016

  View details for PubMedID 27539794

• Ibrutinib-Associated Rash: Single-Center Experience of Clinicopathologic Features and Management Iberri, D. J., Kwong, B., Stevens, L., Coutre, S. E., Kim, J., Sabile, J., Advani, R. H. AMER SOC HEMATOLOGY. 2015

  View details for Web of Science ID 000368021803163

• Balancing Safety and Efficacy of Epidermal Growth Factor Receptor Inhibitors in Patients With Squamous Cell Carcinoma of the Head and Neck ONCOLOGIST Iberri, D. J., Colevas, A. D. 2015; 20 (12): 1393-1403

  Abstract

  : The epidermal growth factor receptor (EGFR) is overexpressed in more than 80% of squamous cell cancers of the head and neck (SCCHN). An evolving understanding of the role of EGFR in tumorigenesis has made the receptor an important therapeutic target in SCCHN. Several EGFR inhibitors (EGFRIs) are active in SCCHN, and their use is associated with improvement in progression-free survival and overall survival in various treatment settings. Nevertheless, EGFR inhibition is associated with significant mucocutaneous toxicity that must be balanced against its anticipated efficacy. This review summarizes the relevant clinical trial experience with EGFRIs, with attention to efficacy, toxicity, and methods of selecting patients most likely to benefit from therapy.Cetuximab and other inhibitors of the epidermal growth factor receptor (EGFR) have entered the medical oncologist's arsenal against squamous cell carcinoma of the head and neck (SCCHN). They are modestly active as single agents and in combination with chemotherapy and radiotherapy. Despite their efficacy across multiple treatment settings, cetuximab and other EGFR inhibitors (EGFRIs) have not supplanted platinum-based therapies, which remain a standard of care for SCCHN. The modest benefits of EGFRI therapy must take into consideration patient, disease, and treatment characteristics and must be balanced against potential treatment toxicity.

  View details for DOI 10.1634/theoncologist.2015-0177

  View details for Web of Science ID 000368416400007

• Hodgkin Lymphoma: the Changing Role of Radiation Therapy in Early-Stage Disease?the Role of Functional Imaging. Current treatment options in oncology Iberri, D. J., Hoppe, R. T., Advani, R. H. 2015; 16 (9): 45-?

  Abstract

  Early-stage classical Hodgkin lymphoma (CHL) is a highly curable malignancy. Historically, extended-field radiotherapy (EFRT) alone showed excellent cure rates, but the risk of radiotherapy (RT)-associated toxicities led to combined modality therapy (CMT) replacing RT alone. RT has subsequently evolved further with significant reductions of dose and field size, and is currently restricted to involved sites only (ISRT). Contemporary CMT yields cure rates in excess of 85 %, and most studies do not have adequate follow-up required to evaluate the risk reduction in late effects. In an effort to avoid RT altogether, response-adapted treatment approaches utilizing results of interim [(18)F]fluorodeoxyglucose (FDG) positron emission tomography with fused computed tomography (PET/CT) imaging have been studied. Results from two studies in favorable-risk (UK RAPID and EORTC H10F) and one in unfavorable-risk patients (EORTC H10U) suggest that omission of RT in patients with a negative interim PET/CT response (Deauville score ?2) yields slightly inferior progression-free survival (PFS) compared to conventional CMT, but with no difference in overall survival (OS) albeit with short-term follow-up. In order to extrapolate results to daily practice, it is critical to understand the selection of patients entered on trials since definitions of favorable and unfavorable disease vary between study groups. Currently, CMT continues to be the standard of care for the vast majority of patients with early-stage CHL and RT is an integral part of therapy in patients with bulky disease. However, for selected patients with favorable characteristics, emerging data suggest that a chemotherapy-alone approach is reasonable.

  View details for DOI 10.1007/s11864-015-0360-6

  View details for PubMedID 26187795

• Building a Modern Journal Club: The Wiki Journal Club Experience. Journal of graduate medical education Plante, T. B., Iberri, D. J., Coderre, E. L. 2015; 7 (3): 341?43

  View details for DOI 10.4300/JGME-D-14-00488.1

  View details for PubMedID 26457137

• Balancing Safety and Efficacy of Epidermal Growth Factor Receptor Inhibitors in Patients With Squamous Cell Carcinoma of the Head and Neck. The oncologist Iberri, D. J., Colevas, A. D. 2015

  Abstract

  : The epidermal growth factor receptor (EGFR) is overexpressed in more than 80% of squamous cell cancers of the head and neck (SCCHN). An evolving understanding of the role of EGFR in tumorigenesis has made the receptor an important therapeutic target in SCCHN. Several EGFR inhibitors (EGFRIs) are active in SCCHN, and their use is associated with improvement in progression-free survival and overall survival in various treatment settings. Nevertheless, EGFR inhibition is associated with significant mucocutaneous toxicity that must be balanced against its anticipated efficacy. This review summarizes the relevant clinical trial experience with EGFRIs, with attention to efficacy, toxicity, and methods of selecting patients most likely to benefit from therapy.Cetuximab and other inhibitors of the epidermal growth factor receptor (EGFR) have entered the medical oncologist's arsenal against squamous cell carcinoma of the head and neck (SCCHN). They are modestly active as single agents and in combination with chemotherapy and radiotherapy. Despite their efficacy across multiple treatment settings, cetuximab and other EGFR inhibitors (EGFRIs) have not supplanted platinum-based therapies, which remain a standard of care for SCCHN. The modest benefits of EGFRI therapy must take into consideration patient, disease, and treatment characteristics and must be balanced against potential treatment toxicity.

  View details for PubMedID 26446236

• Clinical Evidence Summary Apps: Definition, Role, and Unknowns About a Novel Medical Content Delivery Genre. Journal of graduate medical education Plante, T. B., Kane, S. P., Iberri, D. J., Majure, D. T. 2014; 6 (4): 791-?

  View details for DOI 10.4300/JGME-D-14-00407.1

  View details for PubMedID 26140138

• Clinicopathologic Characteristics of HER2 FISH-ambiguous Breast Cancer at a Single Institution AMERICAN JOURNAL OF SURGICAL PATHOLOGY Clay, M. R., Iberri, D. J., Bangs, C. D., Cherry, A., Jensen, K. C. 2013; 37 (1): 120-127

  Abstract

  : The typical algorithm for human epidermal growth factor-2 (HER2) testing is immunohistochemistry (IHC), followed by reflex HER2 fluorescence in situ hybridization (FISH) for HER2 IHC-ambiguous (2+) cases. At our institution, HER2 FISH testing is initially performed as part of routine breast cancer testing, with HER2 FISH-ambiguous (HER2:CEP17 ratio, 1.8 to 2.2) cases reflexed to HER2 IHC. This provides a unique dataset for lesions that may not routinely undergo FISH testing. The clinicopathologic characteristics of HER2 FISH-ambiguous cases are described.: The electronic pathology database in our institution was searched for HER2 FISH-ambiguous cases from 2007 to December 2011. Review of clinical and pathologic characteristics was performed.: Sixty cases from 60 patients were reported as HER2 FISH ambiguous. Reflex HER2 IHC testing was performed on all 60 cases, of which 26 were HER2 IHC negative (0 to 1+), 18 were HER2 IHC ambiguous (2+), and 16 were HER2 IHC positive (3+). Of the 46 HER2 FISH-ambiguous patients with available clinical records, 13 (32%) pursued anti-HER2 treatment (10 IHC 3+, 1 IHC 2+, 2 IHC 0 to 1+). All were grade II or III ductal carcinomas, with 1 grade III metaplastic carcinoma.: Reflex HER2 IHC testing after initially ambiguous HER2 FISH testing provides definitive HER2 status in a majority of cases (70%). However, a substantial percentage (30%) of HER2 FISH-ambiguous cases is also HER2 IHC ambiguous, suggesting an intermediate HER2 biology. Most HER2 FISH-ambiguous patients who received trastuzumab were HER2 IHC 3+, grade III, and had associated high-grade ductal carcinoma in situ. Although not statistically significant and with only minimal follow-up, no recurrences have occurred in those patients treated with trastuzumab (P=0.5754).

  View details for DOI 10.1097/PAS.0b013e31826ab19d

  View details for Web of Science ID 000312486700015

  View details for PubMedID 23108020

• Wikipedia: A Key Tool for Global Public Health Promotion JOURNAL OF MEDICAL INTERNET RESEARCH Heilman, J. M., Kemmann, E., Bonert, M., Chatterjee, A., Ragar, B., Beards, G. M., Iberri, D. J., Harvey, M., Thomas, B., Stomp, W., Martone, M. F., Lodge, D. J., Vondracek, A., de Wolff, J. F., Liber, C., Grover, S. C., Vickers, T. J., Mesko, B., Laurent, M. R. 2011; 13 (1): 153-164

  Abstract

  The Internet has become an important health information resource for patients and the general public. Wikipedia, a collaboratively written Web-based encyclopedia, has become the dominant online reference work. It is usually among the top results of search engine queries, including when medical information is sought. Since April 2004, editors have formed a group called WikiProject Medicine to coordinate and discuss the English-language Wikipedia's medical content. This paper, written by members of the WikiProject Medicine, discusses the intricacies, strengths, and weaknesses of Wikipedia as a source of health information and compares it with other medical wikis. Medical professionals, their societies, patient groups, and institutions can help improve Wikipedia's health-related entries. Several examples of partnerships already show that there is enthusiasm to strengthen Wikipedia's biomedical content. Given its unique global reach, we believe its possibilities for use as a tool for worldwide health promotion are underestimated. We invite the medical community to join in editing Wikipedia, with the goal of providing people with free access to reliable, understandable, and up-to-date health information.

  View details for DOI 10.2196/jmir.1589

  View details for Web of Science ID 000287447100012

  View details for PubMedID 21282098