Stefanie Sarantopoulos

Positions:

Professor of Medicine

Medicine, Hematologic Malignancies and Cellular Therapy
School of Medicine

Professor of Immunology

Immunology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1998

Boston University

Ph.D. 1998

Boston University School of Medicine

Intern, Internal Medicine

Boston University School of Medicine

Resident, Internal Medicine

Boston University School of Medicine

Chief Resident, Internal Medicine

Boston University School of Medicine

Fellowship, Hematology/ Oncology

Dana-Farber Cancer Institute

Grants:

BAFF Pathology: Novel Therapeutic Targets in Chronic Graft versus Host Disease

Administered By
Medicine, Hematologic Malignancies and Cellular Therapy
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Breaking B-Cell Tolerance to Produce Antibodies that Eradicate Leukemias and Lymphomas

Administered By
Medicine, Hematologic Malignancies and Cellular Therapy
Awarded By
Department of Defense
Role
Principal Investigator
Start Date
End Date

The Notch2-BCR Axis: Targeting Drivers of B cell Fate in Chronic GVHD

Administered By
Medicine, Hematologic Malignancies and Cellular Therapy
Awarded By
Leukemia & Lymphoma Society
Role
Principal Investigator
Start Date
End Date

Understanding Aberrant TLR7 Signaling in B Cells from Patients with Chronic GVHD

Administered By
Medicine, Hematologic Malignancies and Cellular Therapy
Awarded By
American Society for Blood and Marrow Transplantation
Role
Principal Investigator
Start Date
End Date

A Phase II of Entospletinib, a SYK Inhibitor, First line cGVHD patients

Administered By
Duke Cancer Institute
Awarded By
Gilead Sciences, Inc.
Role
Principal Investigator
Start Date
End Date

Publications:

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IIa. The 2020 Clinical Implementation and Early Diagnosis Working Group Report.

Recognition of the earliest signs and symptoms of chronic graft-versus-host disease (GVHD) that lead to severe manifestations remains a challenge. The standardization provided by the National Institutes of Health (NIH) 2005 and 2014 consensus projects has helped improve diagnostic accuracy and severity scoring for clinical trials, but utilization of these tools in routine clinical practice is variable. Additionally, when patients meet the NIH diagnostic criteria, many already have significant morbidity and possibly irreversible organ damage. The goals of this early diagnosis project are 2-fold. First, we provide consensus recommendations regarding implementation of the current NIH diagnostic guidelines into routine transplant care, outside of clinical trials, aiming to enhance early clinical recognition of chronic GVHD. Second, we propose directions for future research efforts to enable discovery of new, early laboratory as well as clinical indicators of chronic GVHD, both globally and for highly morbid organ-specific manifestations. Identification of early features of chronic GVHD that have high positive predictive value for progression to more severe manifestations of the disease could potentially allow for future pre-emptive clinical trials.
Authors
Kitko, CL; Pidala, J; Schoemans, HM; Lawitschka, A; Flowers, ME; Cowen, EW; Tkaczyk, E; Farhadfar, N; Jain, S; Steven, P; Luo, ZK; Ogawa, Y; Stern, M; Yanik, GA; Cuvelier, GDE; Cheng, G-S; Holtan, SG; Schultz, KR; Martin, PJ; Lee, SJ; Pavletic, SZ; Wolff, D; Paczesny, S; Blazar, BR; Sarantopoulos, S; Socie, G; Greinix, H; Cutler, C
MLA Citation
URI
https://scholars.duke.edu/individual/pub1478246
PMID
33839317
Source
pubmed
Published In
Transplant Cell Ther
Volume
27
Published Date
Start Page
545
End Page
557
DOI
10.1016/j.jtct.2021.03.033

Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years.

Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for both malignant and nonmalignant hematologic diseases; however, reported rates of treatment-related mortality approach 30%. Outcomes are worse in patients who begin HCT with functional impairments. To detect such impairments, a geriatric assessment (GA) is recommended in adults age ≥65 years. Younger HCT candidates also may be impaired because of chemotherapy regimens pre-HCT. Therefore, we hypothesized that GA can be beneficial for adult patients of all ages and subsequently created a clinical pretransplantation optimization program to assess all HCT candidates using a modified GA. One-hundred fifty-seven patients were evaluated in 4 functional domains- physical, cognitive, nutritional, and psychological-at 2 time points prior to HCT-new patient evaluation (NPE) and sign-off (SO)-between October 2017 and January 2020. At NPE, 80.9% of the patients had at least 1 domain with a functional impairment, and physical (P = .006), cognitive (P = .04), and psychological (P = .04) impairments were associated with an increased likelihood of not proceeding to HCT. In addition, patients age 18 to 39 years were more likely than older patients to have a physical function impairment (P = .001). Between NPE and SO, 51.9% of the patients had resolution of 1 or more impairments, and nutritional impairment at SO was predictive of worse overall survival (P = .01). Our study shows that GA can identify functional impairments in patients of all ages. Early identification of impairments could facilitate referrals to supportive care and resolution of impairments prior to HCT, suggesting that GA could be recommended for HCT candidates of all ages.
Authors
Lew, MV; Ren, Y; Lowder, YP; Siamakpour-Reihani, S; Ramalingam, S; Romero, KM; Thompson, JC; Bohannon, LM; McIntyre, J; Tang, H; Van Opstal, J; Johnson, E; Cohen, HJ; Bartlett, DB; Pastva, AM; Morey, M; Hall, KS; Smith, P; Peters, KB; Somers, TJ; Kelleher, S; Smith, SK; Wischmeyer, PE; Lin, P-H; Wood, WA; Thorpe, G; Minor, K; Wiggins, K; Hennig, T; Helms, T; Welch, R; Matthews, B; Liu, J; Burleson, J; Aberant, T; Engemann, AK; Henshall, B; Darby, M; Proch, C; Dellascio, M; Pittman, A; Suminguit, J; Choi, T; Gasparetto, C; Long, GD; Lopez, RD; Sarantopoulos, S; Horwitz, ME; Chao, NJ; Sung, AD
MLA Citation
Lew, Meagan V., et al. “Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years.Transplant Cell Ther, vol. 28, no. 8, Aug. 2022, pp. 498.e1-498.e9. Pubmed, doi:10.1016/j.jtct.2022.05.018.
URI
https://scholars.duke.edu/individual/pub1521437
PMID
35595226
Source
pubmed
Published In
Transplant Cell Ther
Volume
28
Published Date
Start Page
498.e1
End Page
498.e9
DOI
10.1016/j.jtct.2022.05.018

Home-Based Hematopoietic Cell Transplantation in the United States.

Patients undergoing allogeneic (allo) and autologous (auto) hematopoietic cell transplantation (HCT) require extensive hospitalizations or daily clinic visits for the duration of their transplantation. Home HCT, wherein patients live at home and providers make daily trips to the patient's residence to perform assessments and deliver any necessary interventions, may enhance patient quality of life and improve outcomes. We conducted the first study of home HCT in the United States to evaluate this model in the US healthcare setting and to determine the effect on clinical outcomes and quality of life. This case-control study evaluated patients who received home HCT at Duke University in Durham, North Carolina, from November 2012 to March 2018. Each home HCT patient was matched with 2 controls from the same institution who had received standard treatment based on age, disease, and type of transplant for outcomes comparison. Clinical outcomes were abstracted from electronic health records, and quality of life was assessed via Functional Assessment of Cancer Therapy-Bone Marrow Transplant. Clinical outcomes were compared with Student's t-test or Fisher's exact test (continuous variables) or chi-square test (categorical variables). Quality of life scores were compared using the Student t-test. All analyses used a significance threshold of 0.05. Twenty-five patients received home HCT, including 8 allos and 17 autos. Clinical outcomes were not significantly different between the home HCT patients and their matched controls; home HCT patients had decreased incidence of relapse within 1 year of transplantation. Pre-HCT quality of life was well preserved for autologous home HCT patients. This Phase I study demonstrated that home HCT can be successfully implemented in the United States. There was no evidence that home HCT outcomes were inferior to standard-of-care treatment, and patients undergoing autologous home HCT were able to maintain their quality of life. A Phase II randomized trial of home versus standard HCT is currently underway to better compare outcomes and costs.
Authors
Sung, AD; Giri, VK; Tang, H; Nichols, KR; Lew, MV; Bohannon, L; Ren, Y; Jung, S-H; Dalton, T; Bush, A; Van Opstal, J; Artica, A; Messina, J; Shelby, R; Frith, J; Lassiter, M; Burleson, J; Leonard, K; Potter, AS; Choi, T; Gasparetto, CJ; Horwitz, ME; Long, GD; Lopez, RD; Sarantopoulos, S; Chao, NJ
MLA Citation
Sung, Anthony D., et al. “Home-Based Hematopoietic Cell Transplantation in the United States.Transplant Cell Ther, vol. 28, no. 4, Apr. 2022, pp. 207.e1-207.e8. Pubmed, doi:10.1016/j.jtct.2022.01.015.
URI
https://scholars.duke.edu/individual/pub1506925
PMID
35066211
Source
pubmed
Published In
Transplant Cell Ther
Volume
28
Published Date
Start Page
207.e1
End Page
207.e8
DOI
10.1016/j.jtct.2022.01.015

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. The 2020 Highly morbid forms report.

Chronic graft-versus-host disease (GVHD) can be associated with significant morbidity, in part because of nonreversible fibrosis, which impacts physical functioning (eye, skin, lung manifestations) and mortality (lung, gastrointestinal manifestations). Progress in preventing severe morbidity and mortality associated with chronic GVHD is limited by a complex and incompletely understood disease biology and a lack of prognostic biomarkers. Likewise, treatment advances for highly morbid manifestations remain hindered by the absence of effective organ-specific approaches targeting "irreversible" fibrotic sequelae and difficulties in conducting clinical trials in a heterogeneous disease with small patient numbers. The purpose of this document is to identify current gaps, to outline a roadmap of research goals for highly morbid forms of chronic GVHD including advanced skin sclerosis, fasciitis, lung, ocular and gastrointestinal involvement, and to propose strategies for effective trial design. The working group made the following recommendations: (1) Phenotype chronic GVHD clinically and biologically in future cohorts, to describe the incidence, prognostic factors, mechanisms of organ damage, and clinical evolution of highly morbid conditions including long-term effects in children; (2) Conduct longitudinal multicenter studies with common definitions and research sample collections; (3) Develop new approaches for early identification and treatment of highly morbid forms of chronic GVHD, especially biologically targeted treatments, with a special focus on fibrotic changes; and (4) Establish primary endpoints for clinical trials addressing each highly morbid manifestation in relationship to the time point of intervention (early versus late). Alternative endpoints, such as lack of progression and improvement in physical functioning or quality of life, may be suitable for clinical trials in patients with highly morbid manifestations. Finally, new approaches for objective response assessment and exploration of novel trial designs for small populations are required.
Authors
Wolff, D; Radojcic, V; Lafyatis, R; Cinar, R; Rosenstein, RK; Cowen, EW; Cheng, G-S; Sheshadri, A; Bergeron, A; Williams, KM; Todd, JL; Teshima, T; Cuvelier, GDE; Holler, E; McCurdy, SR; Jenq, RR; Hanash, AM; Jacobsohn, D; Santomasso, BD; Jain, S; Ogawa, Y; Steven, P; Luo, ZK; Dietrich-Ntoukas, T; Saban, D; Bilic, E; Penack, O; Griffith, LM; Cowden, M; Martin, PJ; Greinix, HT; Sarantopoulos, S; Socie, G; Blazar, BR; Pidala, J; Kitko, CL; Couriel, DR; Cutler, C; Schultz, KR; Pavletic, SZ; Lee, SJ; Paczesny, S
MLA Citation
Wolff, Daniel, et al. “National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. The 2020 Highly morbid forms report.Transplant Cell Ther, vol. 27, no. 10, Oct. 2021, pp. 817–35. Pubmed, doi:10.1016/j.jtct.2021.06.001.
URI
https://scholars.duke.edu/individual/pub1488122
PMID
34217703
Source
pubmed
Published In
Transplant Cell Ther
Volume
27
Published Date
Start Page
817
End Page
835
DOI
10.1016/j.jtct.2021.06.001

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: III. The 2020 Treatment of Chronic GVHD Report.

Positive results from recent clinical trials have significantly expanded current therapeutic options for patients with chronic graft-versus-host disease (GVHD). However, new insights into the associations between clinical characteristics of chronic GVHD, pathophysiologic mechanisms of disease, and the clinical and biological effects of novel therapeutic agents are required to allow for a more individualized approach to treatment. The current report is focused on setting research priorities and direction in the treatment of chronic GVHD. Detailed correlative scientific studies should be conducted in the context of clinical trials to evaluate associations between clinical outcomes and the biological effect of systemic therapeutics. For patients who require systemic therapy but not urgent initiation of glucocorticoids, clinical trials for initial systemic treatment of chronic GVHD should investigate novel agents as monotherapy without concurrently starting glucocorticoids, to avoid confounding biological, pathological, and clinical assessments. Clinical trials for treatment-refractory disease should specifically target patients with incomplete or suboptimal responses to most recent therapy who are early in their disease course. Close collaboration between academic medical centers, medical societies, and industry is needed to support an individualized, biology-based strategic approach to chronic GVHD therapy.
Authors
DeFilipp, Z; Couriel, DR; Lazaryan, A; Bhatt, VR; Buxbaum, NP; Alousi, AM; Olivieri, A; Pulanic, D; Halter, JP; Henderson, LA; Zeiser, R; Gooley, TA; MacDonald, KPA; Wolff, D; Schultz, KR; Paczesny, S; Inamoto, Y; Cutler, CS; Kitko, CL; Pidala, JA; Lee, SJ; Socie, G; Sarantopoulos, S; Pavletic, SZ; Martin, PJ; Blazar, BR; Greinix, HT
MLA Citation
DeFilipp, Zachariah, et al. “National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: III. The 2020 Treatment of Chronic GVHD Report.Transplant Cell Ther, vol. 27, no. 9, Sept. 2021, pp. 729–37. Pubmed, doi:10.1016/j.jtct.2021.05.004.
URI
https://scholars.duke.edu/individual/pub1486126
PMID
34147469
Source
pubmed
Published In
Transplant Cell Ther
Volume
27
Published Date
Start Page
729
End Page
737
DOI
10.1016/j.jtct.2021.05.004