Kristin Page

Overview:

Stem cell transplantation and/or cellular therapies can be used to treat a variety of pediatric diseases including malignancies such as leukemia, lymphoma and myelodysplastic syndrome in addition to certain non-malignant conditions (such as immune deficiencies, inherited metabolic diseases, hemoglobinopathies, and bone marrow failure syndromes). As the Director of the Pediatric Transplant and Cellular Therapy Survivorship Clinic, my goal is optimize the care of survivors of pediatric stem cell transplantation, cellular therapies and chemotherapy. To further support this goal, my research interests include improving patient-reported health related quality of life, access to survivorship care, and further understanding the pathophysiology of certain late effects with the ultimate goal of identifying treatments.

Positions:

Assistant Professor of Pediatrics

Pediatrics, Blood and Marrow Transplantation
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2002

University of Vermont

M.H.S. 2016

Duke University School of Medicine

Pediatric Internship & Residency, Pediatrics

University of Vermont

Pediatric Hem-Onc Fellowship, Pediatrics

Duke University

Grants:

An Open-Label, Single-Arm, Phase 1/2 Study Evaluating the Safety and Efficacy of Itacitinib in Combination With Corticosteroids for the Treatment of Steroid-Naive Acute Graft-Versus-Host Disease in Pediatric Subjects

Administered By
Pediatrics, Blood and Marrow Transplantation
Awarded By
Incyte Corporation
Role
Principal Investigator
Start Date
End Date

Publications:

Subsequent neoplasms and late mortality in children undergoing allogeneic transplantation for nonmalignant diseases.

We examined the risk of subsequent neoplasms (SNs) and late mortality in children and adolescents undergoing allogeneic hematopoietic cell transplantation (HCT) for nonmalignant diseases (NMDs). We included 6028 patients (median age, 6 years; interquartile range, 1-11; range, <1 to 20) from the Center for International Blood and Marrow Transplant Research (1995-2012) registry. Standardized mortality ratios (SMRs) in 2-year survivors and standardized incidence ratios (SIRs) were calculated to compare mortality and SN rates with expected rates in the general population. Median follow-up of survivors was 7.8 years. Diagnoses included severe aplastic anemia (SAA; 24%), Fanconi anemia (FA; 10%), other marrow failure (6%), hemoglobinopathy (15%), immunodeficiency (23%), and metabolic/leukodystrophy syndrome (22%). Ten-year survival was 93% (95% confidence interval [95% CI], 92% to 94%; SMR, 4.2; 95% CI, 3.7-4.8). Seventy-one patients developed SNs (1.2%). Incidence was highest in FA (5.5%), SAA (1.1%), and other marrow failure syndromes (1.7%); for other NMDs, incidence was <1%. Hematologic (27%), oropharyngeal (25%), and skin cancers (13%) were most common. Leukemia risk was highest in the first 5 years posttransplantation; oropharyngeal, skin, liver, and thyroid tumors primarily occurred after 5 years. Despite a low number of SNs, patients had an 11-fold increased SN risk (SIR, 11; 95% CI, 8.9-13.9) compared with the general population. We report excellent long-term survival and low SN incidence in an international cohort of children undergoing HCT for NMDs. The risk of SN development was highest in patients with FA and marrow failure syndromes, highlighting the need for long-term posttransplantation surveillance in this population.
Authors
Kahn, JM; Brazauskas, R; Tecca, HR; Bo-Subait, S; Buchbinder, D; Battiwala, M; Flowers, MED; Savani, BN; Phelan, R; Broglie, L; Abraham, AA; Keating, AK; Daly, A; Wirk, B; George, B; Alter, BP; Ustun, C; Freytes, CO; Beitinjaneh, AM; Duncan, C; Copelan, E; Hildebrandt, GC; Murthy, HS; Lazarus, HM; Auletta, JJ; Myers, KC; Williams, KM; Page, KM; Vrooman, LM; Norkin, M; Byrne, M; Diaz, MA; Kamani, N; Bhatt, NS; Rezvani, A; Farhadfar, N; Mehta, PA; Hematti, P; Shaw, PJ; Kamble, RT; Schears, R; Olsson, RF; Hayashi, RJ; Gale, RP; Mayo, SJ; Chhabra, S; Rotz, SJ; Badawy, SM; Ganguly, S; Pavletic, S; Nishihori, T; Prestidge, T; Agrawal, V; Hogan, WJ; Inamoto, Y; Shaw, BE; Satwani, P
MLA Citation
Kahn, Justine M., et al. “Subsequent neoplasms and late mortality in children undergoing allogeneic transplantation for nonmalignant diseases.Blood Adv, vol. 4, no. 9, May 2020, pp. 2084–94. Pubmed, doi:10.1182/bloodadvances.2019000839.
URI
https://scholars.duke.edu/individual/pub1440945
PMID
32396620
Source
pubmed
Published In
Blood Adv
Volume
4
Published Date
Start Page
2084
End Page
2094
DOI
10.1182/bloodadvances.2019000839

Late effects after ablative allogeneic stem cell transplantation for adolescent and young adult acute myeloid leukemia.

There is marked paucity of data regarding late effects in adolescents and young adults (AYAs) who undergo myeloablative conditioning (MAC) allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML). We evaluated late effects and survival in 826 1-year disease-free survivors of MAC HCT for AYA AML, with an additional focus on comparing late effects based upon MAC type (total body irradiation [TBI] vs high-dose chemotherapy only). The estimated 10-year cumulative incidence of subsequent neoplasms was 4% (95% confidence interval [CI], 2%-6%); 10-year cumulative incidence of nonmalignant late effects included gonadal dysfunction (10%; 95% CI, 8%-13%), cataracts (10%; 95% CI, 7%-13%), avascular necrosis (8%; 95% CI, 5%-10%), diabetes mellitus (5%; 95% CI, 3%-7%), and hypothyroidism (3%; 95% CI, 2%-5%). Receipt of TBI was independently associated with a higher risk of cataracts only (hazard ratio [HR], 4.98; P < .0001) whereas chronic graft-versus-host disease (cGVHD) was associated with an increased risk of cataracts (HR, 3.22; P = .0006), avascular necrosis (HR, 2.49; P = .006), and diabetes mellitus (HR, 3.36; P = .03). Estimated 10-year overall survival and leukemia-free survival were 73% and 70%, respectively, and did not differ on the basis of conditioning type. In conclusion, late effects among survivors of MAC HCT for AYA AML are frequent and are more closely linked to cGVHD than type of conditioning.
Authors
Lee, CJ; Kim, S; Tecca, HR; Bo-Subait, S; Phelan, R; Brazauskas, R; Buchbinder, D; Hamilton, BK; Battiwalla, M; Majhail, NS; Lazarus, HM; Shaw, PJ; Marks, DI; Litzow, MR; Chhabra, S; Inamoto, Y; DeFilipp, Z; Hildebrandt, GC; Olsson, RF; Kasow, KA; Liesveld, JL; Rotz, SJ; Badawy, SM; Bhatt, NS; Yared, JA; Page, KM; Arellano, ML; Kent, M; Farhadfar, N; Seo, S; Hematti, P; Freytes, CO; Rovó, A; Ganguly, S; Nathan, S; Burns, L; Shaw, BE; Muffly, LS
MLA Citation
Lee, Catherine J., et al. “Late effects after ablative allogeneic stem cell transplantation for adolescent and young adult acute myeloid leukemia.Blood Adv, vol. 4, no. 6, Mar. 2020, pp. 983–92. Pubmed, doi:10.1182/bloodadvances.2019001126.
URI
https://scholars.duke.edu/individual/pub1435469
PMID
32168378
Source
pubmed
Published In
Blood Adv
Volume
4
Published Date
Start Page
983
End Page
992
DOI
10.1182/bloodadvances.2019001126

Bloodstream Infection Due to Vancomycin-resistant Enterococcus Is Associated With Increased Mortality After Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndrome: A Multicenter, Retrospective Cohort Study.

BACKGROUND: We examined the impact of vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) on outcomes of allogeneic hematopoietic cell transplantation (HCT) utilizing the Center for International Blood and Marrow Transplant Research database. METHODS: Adult and pediatric patients (N = 7128) who underwent first HCT for acute leukemia or myelodysplastic syndrome from 2008 through 2012 were analyzed as 3 groups-VRE BSI, non-VRE BSI, without BSI-according to BSI status at 100 days (D100) after allogeneic HCT. Multivariable models examined the effect of VRE BSI for overall survival (OS) and nonrelapse mortality (NRM) at 1 year. RESULTS: Of 7128 patients, 258 (3.2%) had VRE BSI, 2398 (33.6%) had non-VRE BSI, and 4472 (63%) had no BSI. The median time to VRE BSI and non-VRE BSI were D11 and D15, respectively. Compared with non-VRE BSI patients, VRE BSI patients were older, had advanced-stage acute leukemia, and received umbilical cord blood (UCB) allografts. In multivariable models, VRE BSI was associated with lower OS (relative risk [RR], 2.9;(99% confidence interval [CI], 2.2-3.7) and increased NRM (RR, 4.7; 99% CI, 3.6-6.2) (P < .0001) for both. Other predictors for worse OS and increased NRM were non-VRE BSI, older age, advanced disease stage, UCB allograft, - mismatch, comorbidity index ≥3, and cytomegalovirus seropositivity (P < .001 for all variables). CONCLUSIONS: VRE BSI is associated with lowest OS and highest NRM compared with patients without BSI or non-VRE BSI. Novel interventions that address the pathophysiology of VRE BSI have the potential of improving survival after HCT.
Authors
Papanicolaou, GA; Ustun, C; Young, J-AH; Chen, M; Kim, S; Woo Ahn, K; Komanduri, K; Lindemans, C; Auletta, JJ; Riches, ML; CIBMTR® Infection and Immune Reconstitution Working Committee,
URI
https://scholars.duke.edu/individual/pub1426891
PMID
30649224
Source
pubmed
Published In
Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Volume
69
Published Date
Start Page
1771
End Page
1779
DOI
10.1093/cid/ciz031

A Phase II Randomized Clinical Trial of the Safety and Efficacy of Intravenous Umbilical Cord Blood Infusion for Treatment of Children with Autism Spectrum Disorder.

OBJECTIVE: To evaluate whether umbilical cord blood (CB) infusion is safe and associated with improved social and communication abilities in children with autism spectrum disorder (ASD). STUDY DESIGN: This prospective, randomized, placebo-controlled, double-blind study included 180 children with ASD, aged 2-7 years, who received a single intravenous autologous (n = 56) or allogeneic (n = 63) CB infusion vs placebo (n = 61) and were evaluated at 6 months postinfusion. RESULTS: CB infusion was safe and well tolerated. Analysis of the entire sample showed no evidence that CB was associated with improvements in the primary outcome, social communication (Vineland Adaptive Behavior Scales-3 [VABS-3] Socialization Domain), or the secondary outcomes, autism symptoms (Pervasive Developmental Disorder Behavior Inventory) and vocabulary (Expressive One-Word Picture Vocabulary Test). There was also no overall evidence of differential effects by type of CB infused. In a subanalysis of children without intellectual disability (ID), allogeneic, but not autologous, CB was associated with improvement in a larger percentage of children on the clinician-rated Clinical Global Impression-Improvement scale, but the OR for improvement was not significant. Children without ID treated with CB showed significant improvements in communication skills (VABS-3 Communication Domain), and exploratory measures including attention to toys and sustained attention (eye-tracking) and increased alpha and beta electroencephalographic power. CONCLUSIONS: Overall, a single infusion of CB was not associated with improved socialization skills or reduced autism symptoms. More research is warranted to determine whether CB infusion is an effective treatment for some children with ASD.
Authors
Dawson, G; Sun, JM; Baker, J; Carpenter, K; Compton, S; Deaver, M; Franz, L; Heilbron, N; Herold, B; Horrigan, J; Howard, J; Kosinski, A; Major, S; Murias, M; Page, K; Prasad, VK; Sabatos-DeVito, M; Sanfilippo, F; Sikich, L; Simmons, R; Song, A; Vermeer, S; Waters-Pick, B; Troy, J; Kurtzberg, J
MLA Citation
Dawson, Geraldine, et al. “A Phase II Randomized Clinical Trial of the Safety and Efficacy of Intravenous Umbilical Cord Blood Infusion for Treatment of Children with Autism Spectrum Disorder.J Pediatr, vol. 222, July 2020, pp. 164-173.e5. Pubmed, doi:10.1016/j.jpeds.2020.03.011.
URI
https://scholars.duke.edu/individual/pub1442026
PMID
32444220
Source
pubmed
Published In
J Pediatr
Volume
222
Published Date
Start Page
164
End Page
173.e5
DOI
10.1016/j.jpeds.2020.03.011

The challenge of long-term follow-up of survivors of childhood acute leukemia after hematopoietic stem cell transplantation in resource-limited countries: A single-center report from Brazil.

With the number of long-term HSCT survivors steadily increasing, attention needs to be focused on the late complications and quality of life. We therefore analyzed the outcome of 101 pediatric patients (<18 years old at the time of HSCT) transplanted for acute leukemia between 1981 and 2015 at Complexo Hospital de Clínicas, Federal University of Paraná, Brazil, and who survived at least two years after HSCT. The median follow-up was 5.9 years (2.0-29.0); median age at follow-up was 17.5 years (2.98-39.0). The 5-year cumulative incidence of relapse was 27.5% (95% CI 18.6%-36.4%). Two-year cumulative incidence of chronic GVHD was 21.8% (95% CI 13.7%-29.8%). Of the 101 patients, 72 patients (71.3%) presented with late effects. Those surviving longer after HSCT experienced more complications. Patients who received TBI-based regimen developed more late effects (P = .013) and more endocrinological complications (P = .024). Endocrinological complications were the most common late sequelae found in this study. For childhood survivors, quality of life was not influenced by age (at HSCT or at last visit), time from HSCT, gender, donor, or GVHD. For survivors that no longer were children, only age at last visit impacted financial domain measures, irrespective of gender, donor, or GVHD. The current study confirms the high burden late complications after pediatric HSCT have on the survivors and underlines the importance of extended follow-up.
Authors
Marinho, DH; Ribeiro, LL; Nichele, S; Loth, G; Koliski, A; Mousquer, RTG; Funke, VAM; Page, K; Fasth, A; Pasquini, R; Boguszewski, MCDS; Bonfim, C
MLA Citation
Marinho, Daniela Hespanha, et al. “The challenge of long-term follow-up of survivors of childhood acute leukemia after hematopoietic stem cell transplantation in resource-limited countries: A single-center report from Brazil.Pediatr Transplant, vol. 24, no. 4, June 2020, p. e13691. Pubmed, doi:10.1111/petr.13691.
URI
https://scholars.duke.edu/individual/pub1437215
PMID
32246550
Source
pubmed
Published In
Pediatr Transplant
Volume
24
Published Date
Start Page
e13691
DOI
10.1111/petr.13691

Research Areas:

Cancer Survivors
Cancer in children
Cord Blood Stem Cell Transplantation
Hematopoietic Stem Cell Transplantation
Patient Reported Outcome Measures