Joseph Moore

Overview:

· Clinical research in the diagnosis and treatment of acute myeloid and lymphoid leukemias
· Malignant lymphoma
· Chronic myeloid and lymphoid leukemias
· Patient care and support programs and protocols
· Drug development and evaluation
· Soft tissue sarcoma
· Neuroendocrine tumors, carcinoid
· Delivery of continuing medical education
· Telemedicine
Research Program in Malignant Lymphoma and the Lymphocytic Leukemias (Acute and Chronic).

Duke has a long history of contribution to basic research and to clinical research programs which advance the understanding and treatment of the malignant lymphomas and the lymphocytic leukemias.
Currently, I am Duke principal investigator on a protocol for the investigation of Acute Lymphocytic Leukemia (CLL) designed to effect the first major change in induction therapy of this disease in the last twenty years. This is in cooperation with the overall PI at Memorial Sloan-Kettering Cancer Center. Additionally, we currently participate in a CALGB protocol for the primary treatment of Acute Lymphocytic Leukemia.

Chronic Lymphocytic Leukemia (CLL) represents a group of usually low-grade lymphoproliferative disorders. Duke's study of these disorders began with Dr. R. Wayne Rundles in the 1950s and 1960s, and proceeded on to current studies of both local initiative and participation and cooperative group protocols. Cancer and leukemic group B (CALGB) protocols currently investigate the use of rituximab and Fludarabine in CLL, and explore treatment with the investigative agent flavopiridol. Several other programs are currently being written in this cooperative group and will be participating in all of these. Additionally, we are currently extending the basic research and pharmacologic studies begun by Dr. Robert Silber (deceased) with The Clinical Pharmacology Section under the direction of Dr. Michael Colvin and his colleagues

Dr. Brice Weinberg has a long track record of innovative basic research in leukemias. He currently has initiated studies with several chemicals which inhibit nitric oxide (NO), a critical chemical transmitter in CLL and other cells. Initial pilot studies have demonstrated CLL cells are almost completely destroyed by inhibition of this enzyme. This work has the potential for bringing to the clinic an entirely new class
of chemical medications for the treatment of CLL.

In concert with the Duke Bone Marrow Transplant Program (DBMT), we are beginning to extend transplantation for Chronic Lymphocytic Leukemia to patients in all age groups, employing both standard allogeneic transplants, unrelated cord blood (UCBT) transplantation, and "mini-allo" transplants employing related donors. These studies are ongoing at this time and initial results are quite encouraging.

The Malignant Lymphomas represent an extremely varied group of diseases occurring in all age groups. These studies also encompass all of the cooperative efforts described above for CLL. We are currently participating in CALGB studies treating all levels of malignant lymphoma, and I am currently principal investigator (PI) on a program which is exploring the use of erythropoietin alpha (a growth factor stimulating the growth of red blood cells) in patients with malignant lymphomas and Hodgkin's disease. Likewise, I am principal investigator (PI) of another study using a white cell growth factor (SD-
to maintain white blood cell function in patients being treated with the aggressive program ESHAP, as a prelude to treatment with high dose chemotherapy and transplantation.

Dr. Jon P. Gockerman of our group is principal investigator employing the use of BEXXAR, a monoclonal antibody targeting CD20 and employed as a carrier for local radiation with I-131. These studies will facilitate the transfer of this particular very encouraging drug from the laboratory to general use in the clinic

Currently, Dr. Nelson Chao and his colleagues have developed, with our clinical help, a very comprehensive program for the transplantation of appropriate patients with malignant lymphoma, and with the malignant non-Hodgkin's lymphomas, and with Hodgkin's disease. Innovative programs are underway for treatment of mantle zone lymphoma and we are currently participating in a National Cancer Institute-generated study to treat intermediate grade malignant lymphoma with both chemotherapy and a unique immune treatment with anti-idiotypic antibody uniquely generated for each individual patient. Duke will be one of only three sites in the country responsible for this trial, but will also extend eligibility to other Duke cooperative sites under the Duke Oncology Consortium, of which I am the Medical Director.

In addition to the above transplantation studies, we are currently activating transplantation protocols employing allogeneic (sibling) donors, unrelated cord blood (UCB) donors, and matched unrelated donors (MUD).

Positions:

Professor of Medicine

Medicine, Hematological Malignancies
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1970

Johns Hopkins University

Grants:

Cancer And Leukemia Group B

Administered By
Medicine, Medical Oncology
Awarded By
National Institutes of Health
Role
Co-Principal Investigator
Start Date
End Date

A Randomized Open-label, Phase 2 Trial of Ponatinib in Patients with Resistant Chronic Phase Chronic Myeloid Leukemia to Characterize the Efficacy and Safety of a Range of Doses

Administered By
Duke Cancer Institute
Awarded By
Ariad Pharmaceuticals
Role
Principal Investigator
Start Date
End Date

Nimh Clinical Training

Administered By
Medicine, Medical Oncology
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

Follicular mucinosis as a presenting sign of acute myeloblastic leukemia.

Follicular mucinosis is often associated with mycosis fungoides and has been rarely observed to occur with other neoplastic and inflammatory conditions. We describe a 60-year-old patient with follicular mucinosis who later developed acute myelogenous leukemia. This is the first reported case of follicular mucinosis as a presenting sign of acute myeloblastic leukemia in the absence of mycosis fungoides or leukemia cutis.
Authors
Sumner, WT; Grichnik, JM; Shea, CR; Moore, JO; Miller, WS; Burton, CS
MLA Citation
Sumner, W. T., et al. “Follicular mucinosis as a presenting sign of acute myeloblastic leukemia.J Am Acad Dermatol, vol. 38, no. 5 Pt 2, May 1998, pp. 803–05. Pubmed, doi:10.1016/s0190-9622(98)70462-1.
URI
https://scholars.duke.edu/individual/pub867844
PMID
9591790
Source
pubmed
Published In
Journal of the American Academy of Dermatology
Volume
38
Published Date
Start Page
803
End Page
805
DOI
10.1016/s0190-9622(98)70462-1

Ten-year outcome of patients with acute myeloid leukemia not treated with allogeneic transplantation in first complete remission.

The probability that adult patients with de novo acute myeloid leukemia (AML) receiving intensive chemotherapy in the absence of allogeneic hematopoietic stem cell transplantation (Allo-HCT) in first complete remission (CR1) will be disease-free at 10 years after diagnosis, a long-term surrogate of cure, is unknown. To address this question, we examined 2551 AML patients (1607 aged <60 years, and 944 aged ≥60 years) enrolled in Cancer and Leukemia Group B treatment protocols and the cytogenetics companion protocol 8461 between 1983 and 2004. At 10 years, 267 (16.6%) of patients aged <60 years and 23 (2.4%) of those aged ≥60 years were alive and disease-free. This disease-free AML group consisted predominantly of patients with core-binding factor AML with t(8;21)(q22;q22) or inv(16)(p13q22)/t(16;16)(p13;q22) and those with a normal karyotype. Occurrences of AML beyond 10 years were infrequent and associated with cytogenetic findings different from those at diagnosis. These data provide evidence that the frequency of long-term cure of AML is low among younger and especially older patients in the absence of Allo-HCT in CR1. In older patients not appropriate for Allo-HCT, these data provide further justification for early use of alternative treatments outside of intensive chemotherapy.
Authors
Vasu, S; Kohlschmidt, J; Mrózek, K; Eisfeld, A-K; Nicolet, D; Sterling, LJ; Becker, H; Metzeler, KH; Papaioannou, D; Powell, BL; Kolitz, JE; Moore, JO; Baer, MR; Roboz, GJ; Stone, RM; Byrd, JC; Carroll, AJ; Bloomfield, CD
MLA Citation
Vasu, Sumithira, et al. “Ten-year outcome of patients with acute myeloid leukemia not treated with allogeneic transplantation in first complete remission.Blood Adv, vol. 2, no. 13, July 2018, pp. 1645–50. Pubmed, doi:10.1182/bloodadvances.2017015222.
URI
https://scholars.duke.edu/individual/pub1331230
PMID
29991495
Source
pubmed
Published In
Blood Adv
Volume
2
Published Date
Start Page
1645
End Page
1650
DOI
10.1182/bloodadvances.2017015222

Chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is the commonest type of leukemia seen in Western countries. It affects an older group of individuals than most other varieties of leukemia, and men more often than women, in a ratio of 2:1. The incidence of CLL is significantly increased in some families. In most instances, CLL is due to the overgrowth or accumulation of immunoglobulin producing B lymphocytes. Hypogammaglobulinemia is a common feature, and anomalous immunoglobulin components occur in 3 to 5% of patients. The early symptoms and signs of CLL include fatigue, reduced exercise tolerance, enlarged lymph nodes, and splenomegaly. Fever, weight loss, and impairment of bone marrow function, with anemia, bleeding and susceptibility to infection are characteristic of severe or advanced disease. In the great majority of patients, the disease can be controlled for 6 to 10 or more years with simple regimens using chlorambucil or cyclophosphamide, often in combination with prednisone. Radiotherapy and splenectomy are useful in some instances. The terminal phase of the disease is characterized by exacerbation or increasing severity of the leukemia and the development of opportunistic infections associated with immunodeficiency.
Authors
Rundles, RW; Moore, JO
MLA Citation
Rundles, R. W., and J. O. Moore. “Chronic lymphocytic leukemia.Cancer, vol. 42, no. 2 Suppl, Aug. 1978, pp. 941–45. Pubmed, doi:10.1002/1097-0142(197808)42:2+<941::aid-cncr2820420717>3.0.co;2-1.
URI
https://scholars.duke.edu/individual/pub899923
PMID
688176
Source
pubmed
Published In
Cancer
Volume
42
Published Date
Start Page
941
End Page
945
DOI
10.1002/1097-0142(197808)42:2+<941::aid-cncr2820420717>3.0.co;2-1

Comparison of the efficacy of a two-day and a five-day schedule for infusing intravenous gamma globulin in the treatment of immune thrombocytopenic purpura in adults.

The standard schedule for treating immune thrombocytopenia purpura in adults with intravenous immunoglobulin G infusion (IVIG), 400 mg/kg per day for five days, was compared with a shorter schedule using 1,000 mg/kg per day for two days. Both schedules were found to be effective in correcting thrombocytopenia. Eleven of the 17 patients treated with the five-day regimen and nine of 10 patients treated with the two-day regimen had significant responses. Patients with an initial platelet count of less than 20,000 platelets/mm3 or with an estimated in vivo platelet survival in excess of 90 hours were less likely to have a response than were other patients. There were no serious side effects in either group, but thrombophlebitis was observed in some patients receiving the five-day regimen when a single intravenous catheter was used for more than three days. Headaches and, less commonly, low-grade fever were noted in some patients receiving the two-day regimen when infusions were given at flow rates in excess of 0.04 ml/kg/minute. Since the two-day regimen requires shorter hospitalization and corrects thrombocytopenia slightly faster than the five-day course, it may be particularly useful in correcting thrombocytopenia in hospitalized patients requiring splenectomy or other surgery.
Authors
Kurlander, R; Coleman, RE; Moore, J; Gockerman, J; Rosse, W; Siegal, R
MLA Citation
Kurlander, R., et al. “Comparison of the efficacy of a two-day and a five-day schedule for infusing intravenous gamma globulin in the treatment of immune thrombocytopenic purpura in adults.Am J Med, vol. 83, no. 4A, Oct. 1987, pp. 17–24. Pubmed, doi:10.1016/0002-9343(87)90546-8.
URI
https://scholars.duke.edu/individual/pub827909
PMID
3118704
Source
pubmed
Published In
The American Journal of Medicine
Volume
83
Published Date
Start Page
17
End Page
24
DOI
10.1016/0002-9343(87)90546-8

The impact of minimally invasive parathyroidectomy on the way endocrinologists treat primary hyperparathyroidism.

BACKGROUND: Minimally-invasive parathyroidectomy (MIP) appears to be changing preoperative treatment and referral patterns for sporadic, nonfamilial, non-multiple endocrine neoplasia, primary hyperparathyroidism (PHPT). METHODS: The American Association of Clinical Endocrinologists membership was surveyed by mail (n=1406 members) regarding physician practices and surgical referral patterns for PHPT. RESULTS: Seven hundred eighty-eight respondents (56%) practiced 17.0+/-0.4 years and referred 63%+/-1% of patients with PHPT for operation. Most endocrinologists (90%) used localizing studies before surgical referral (sestamibi, ultrasound scanning, technetium/thallium scanning, magnetic resonance imaging, computed tomography). Respondents identified symptoms, calcium homeostasis, bone density, health status, age, and general anesthesia risk as the most important considerations for surgical referral. Most respondents (79%) indicated that MIP availability would increase the number of patients who were referred for operation (P<.001), although most of the respondents stated that MIP would change the extent and duration of preoperative evaluations (P<.001). Respondents in practice for fewer years were more likely to refer patients for MIP (P<.001) and minimize preoperative evaluation (P<.05). Endocrinologists who had a patient with a complication after traditional parathyroidectomy were more likely to embrace MIP (P<.05). CONCLUSIONS: MIP availability decreases the extent and duration of preoperative evaluation while decreasing the time from diagnosis to referral. MIP also lowers the endocrinologists' surgical referral threshold for PHPT, although it emphasizes the perceived shortcomings of traditional parathyroidectomy that are held by many physicians.
Authors
Gallagher, SF; Denham, DW; Murr, MM; Norman, JG
MLA Citation
Gallagher, Scott F., et al. “The impact of minimally invasive parathyroidectomy on the way endocrinologists treat primary hyperparathyroidism.Surgery, vol. 134, no. 6, 2003, pp. 910–17. Pubmed, doi:10.1016/s0039-6060(03)00414-8.
URI
https://scholars.duke.edu/individual/pub1352142
PMID
14668722
Source
pubmed
Published In
Surgery
Volume
134
Published Date
Start Page
910
End Page
917
DOI
10.1016/s0039-6060(03)00414-8