Anthony Sung

Overview:

I am dedicated to the treatment of hematologic malignancies through cellular therapies such as hematopoietic stem cell transplantation (HCT). My research focuses on strategies to reduce complications of HCT and ranges from preclinical studies using murine models of HCT to Phase 1 and Phase 2 clinical trials. Areas of interest include the role of the microbiota (the trillions of bacteria living in and on our bodies), nutrition, and exercise in modulating HCT outcomes such as graft-versus-host disease (GVHD) and infections. In addition to advancing new pharmacological and cellular immunotherapies in support of these goals, we also are developing mobile health technologies (mHealth) to monitor patients at home, both as part of our innovative home transplant program as well as to improve follow up care of all our patients when they return home after transplant.

Positions:

Assistant Professor of Medicine

Medicine, Hematologic Malignancies and Cellular Therapy
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Senior Fellow in the Duke Center for the Study of Aging and Human Development

Center for the Study of Aging and Human Development
School of Medicine

Education:

M.D. 2008

Harvard University

Residency, Osler Medical Housestaff Training Program

Johns Hopkins University School of Medicine

Fellowship, Hematology Oncology

Duke University School of Medicine

Grants:

Patient-centered home-based hematopoietic stem cell transplantation

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

AZD9668 and Neutrophil Elastase Inhibition to Prevent Graft-versus-Host Disease

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

Keratinocyte targeted strategies for treatment of cutaneous GVHD

Administered By
Dermatology
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Mitigators of Radiation-Induced Endovascular Injury: Targeting Tie2 and Thrombocytopenia

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

Home Transplant to Preserve the Microbiota and Decrease GVHD

Administered By
Medicine, Hematologic Malignancies and Cellular Therapy
Awarded By
American Society of Hematology
Role
Principal Investigator
Start Date
End Date

Publications:

Incidence, Risk Factors, and Outcomes of Patients Who Develop Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infections in the First 100 Days After Allogeneic Hematopoietic Stem Cell Transplant.

Importance: Patients undergoing hematopoietic stem cell transplant (HSCT) are at risk for bloodstream infection (BSI) secondary to translocation of bacteria through the injured mucosa, termed mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI), in addition to BSI secondary to indwelling catheters and infection at other sites (BSI-other). Objective: To determine the incidence, timing, risk factors, and outcomes of patients who develop MBI-LCBI in the first 100 days after HSCT. Design, Setting, and Participants: A case-cohort retrospective analysis was performed using data from the Center for International Blood and Marrow Transplant Research database on 16 875 consecutive pediatric and adult patients receiving a first allogeneic HSCT from January 1, 2009, to December 31, 2016. Patients were classified into 4 categories: MBI-LCBI (1481 [8.8%]), MBI-LCBI and BSI-other (698 [4.1%]), BSI-other only (2928 [17.4%]), and controls with no BSI (11 768 [69.7%]). Statistical analysis was performed from April 5 to July 17, 2018. Main Outcomes and Measures: Demographic characteristics and outcomes, including overall survival, chronic graft-vs-host disease, and transplant-related mortality (only for patients with malignant disease), were compared among groups. Results: Of the 16 875 patients in the study (9737 [57.7%] male; median [range] age, 47 [0.04-82] years) 13 686 (81.1%) underwent HSCT for a malignant neoplasm, and 3189 (18.9%) underwent HSCT for a nonmalignant condition. The cumulative incidence of MBI-LCBI was 13% (99% CI, 12%-13%) by day 100, and the cumulative incidence of BSI-other was 21% (99% CI, 21%-22%) by day 100. Median (range) time from transplant to first MBI-LCBI was 8 (<1 to 98) days vs 29 (<1 to 100) days for BSI-other. Multivariable analysis revealed an increased risk of MBI-LCBI with poor Karnofsky/Lansky performance status (hazard ratio [HR], 1.21 [99% CI, 1.04-1.41]), cord blood grafts (HR, 2.89 [99% CI, 1.97-4.24]), myeloablative conditioning (HR, 1.46 [99% CI, 1.19-1.78]), and posttransplant cyclophosphamide graft-vs-host disease prophylaxis (HR, 1.85 [99% CI, 1.38-2.48]). One-year mortality was significantly higher for patients with MBI-LCBI (HR, 1.81 [99% CI, 1.56-2.12]), BSI-other (HR, 1.81 [99% CI, 1.60-2.06]), and MBI-LCBI plus BSI-other (HR, 2.65 [99% CI, 2.17-3.24]) compared with controls. Infection was more commonly reported as a cause of death for patients with MBI-LCBI (139 of 740 [18.8%]), BSI (251 of 1537 [16.3%]), and MBI-LCBI plus BSI (94 of 435 [21.6%]) than for controls (566 of 4740 [11.9%]). Conclusions and Relevance: In this cohort study, MBI-LCBI, in addition to any BSIs, were associated with significant morbidity and mortality after HSCT. Further investigation into risk reduction should be a clinical and scientific priority in this patient population.
Authors
Dandoy, CE; Kim, S; Chen, M; Ahn, KW; Ardura, MI; Brown, V; Chhabra, S; Diaz, MA; Dvorak, C; Farhadfar, N; Flagg, A; Ganguly, S; Hale, GA; Hashmi, SK; Hematti, P; Martino, R; Nishihori, T; Nusrat, R; Olsson, RF; Rotz, SJ; Sung, AD; Perales, M-A; Lindemans, CA; Komanduri, KV; Riches, ML
MLA Citation
Dandoy, Christopher E., et al. “Incidence, Risk Factors, and Outcomes of Patients Who Develop Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infections in the First 100 Days After Allogeneic Hematopoietic Stem Cell Transplant.Jama Netw Open, vol. 3, no. 1, Jan. 2020, p. e1918668. Pubmed, doi:10.1001/jamanetworkopen.2019.18668.
URI
https://scholars.duke.edu/individual/pub1426934
PMID
31913492
Source
pubmed
Published In
Jama Network Open
Volume
3
Published Date
Start Page
e1918668
DOI
10.1001/jamanetworkopen.2019.18668

House calls for stem cell transplant patients during the COVID-19 pandemic.

Authors
Sung, AD; Nichols, KR; Chao, NJ
MLA Citation
Sung, Anthony D., et al. “House calls for stem cell transplant patients during the COVID-19 pandemic.Blood, vol. 136, no. 3, July 2020, pp. 370–71. Pubmed, doi:10.1182/blood.2020006573.
URI
https://scholars.duke.edu/individual/pub1446962
PMID
32488235
Source
pubmed
Published In
Blood
Volume
136
Published Date
Start Page
370
End Page
371
DOI
10.1182/blood.2020006573

Phase I dose escalation study of naive T-cell depleted donor lymphocyte infusion following allogeneic stem cell transplantation.

Prophylactic donor lymphocyte infusions (DLI) are used to augment post-transplant immune recovery to reduce both infectious complications and disease recurrence. Preclinical studies implicate the naive T-cell subset as the primary driver of graft-versus-host disease (GvHD). In this phase I dose escalation study, we assessed the safety of a DLI that was depleted of CD45RA+ naive T cells. Sixteen adult patients received a prophylactic DLI at a median of 113 days (range 76-280 days) following an HLA-identical, non-myeloablative allogeneic hematopoietic stem cell transplantation. Three patients each received the naive T-cell depleted DLI with a CD3+ dose of 1 × 105/kg, 1 × 106/kg, and 5 × 106/kg. The maximum dose of 1 × 107/kg was expanded to 7 patients. No dose-limiting grade III/IV acute GvHD or adverse events attributable to the DLI were observed at any dose level. One patient developed grade 2 acute GvHD of skin and upper intestines, and another developed moderate chronic GvHD of the lungs following the DLI. With a median follow-up of 2.8 years, 2-year progression-free and overall survival is 50.0% and 68.8%, respectively. In conclusion, these data suggest that a DLI that has been depleted of CD45RA+ naive T cells is feasible and carries a low risk of acute or chronic GvHD.
Authors
Maung, KK; Chen, BJ; Barak, I; Li, Z; Rizzieri, DA; Gasparetto, C; Sullivan, KM; Long, GD; Engemann, AM; Waters-Pick, B; Nichols, KR; Lopez, R; Kang, Y; Sarantopoulos, S; Sung, AD; Chao, NJ; Horwitz, ME
MLA Citation
Maung, Ko K., et al. “Phase I dose escalation study of naive T-cell depleted donor lymphocyte infusion following allogeneic stem cell transplantation.Bone Marrow Transplant, July 2020. Pubmed, doi:10.1038/s41409-020-0991-5.
URI
https://scholars.duke.edu/individual/pub1450672
PMID
32624583
Source
pubmed
Published In
Bone Marrow Transplant
Published Date
DOI
10.1038/s41409-020-0991-5

The microbe-derived short-chain fatty acids butyrate and propionate are associated with protection from chronic GVHD.

Studies of the relationship between the gastrointestinal microbiota and outcomes in allogeneic hematopoietic stem cell transplantation (allo-HCT) have thus far largely focused on early complications, predominantly infection and acute graft-versus-host disease (GVHD). We examined the potential relationship of the microbiome with chronic GVHD (cGVHD) by analyzing stool and plasma samples collected late after allo-HCT using a case-control study design. We found lower circulating concentrations of the microbe-derived short-chain fatty acids (SCFAs) propionate and butyrate in day 100 plasma samples from patients who developed cGVHD, compared with those who remained free of this complication, in the initial case-control cohort of transplant patients and in a further cross-sectional cohort from an independent transplant center. An additional cross-sectional patient cohort from a third transplant center was analyzed; however, serum (rather than plasma) was available, and the differences in SCFAs observed in the plasma samples were not recapitulated. In sum, our findings from the primary case-control cohort and 1 of 2 cross-sectional cohorts explored suggest that the gastrointestinal microbiome may exert immunomodulatory effects in allo-HCT patients at least in part due to control of systemic concentrations of microbe-derived SCFAs.
Authors
Markey, KA; Schluter, J; Gomes, ALC; Littmann, ER; Pickard, AJ; Taylor, BP; Giardina, PA; Weber, D; Dai, A; Docampo, MD; Armijo, GK; Slingerland, AE; Slingerland, JB; Nichols, KB; Brereton, DG; Clurman, AG; Ramos, RJ; Rao, A; Bush, A; Bohannon, L; Covington, M; Lew, MV; Rizzieri, DA; Chao, N; Maloy, M; Cho, C; Politikos, I; Giralt, S; Taur, Y; Pamer, EG; Holler, E; Perales, M-A; Ponce, DM; Devlin, SM; Xavier, J; Sung, AD; Peled, JU; Cross, JR; van den Brink, MRM
MLA Citation
Markey, Kate A., et al. “The microbe-derived short-chain fatty acids butyrate and propionate are associated with protection from chronic GVHD.Blood, vol. 136, no. 1, July 2020, pp. 130–36. Pubmed, doi:10.1182/blood.2019003369.
URI
https://scholars.duke.edu/individual/pub1441380
PMID
32430495
Source
pubmed
Published In
Blood
Volume
136
Published Date
Start Page
130
End Page
136
DOI
10.1182/blood.2019003369

Financial Incentives to Increase Stool Collection Rates for Microbiome Studies in Adult Bone Marrow Transplant Patients

Authors
Thompson, J; Ren, Y; Romero, K; Lew, M; Bush, A; Messina, J; Jung, S-H; Miller, J; Zenko, Z; Jenq, RR; Peled, JU; van den Brink, MRM; Chao, NJ; Sung, AD
MLA Citation
Thompson, Jillian, et al. “Financial Incentives to Increase Stool Collection Rates for Microbiome Studies in Adult Bone Marrow Transplant Patients.” Biology of Blood and Marrow Transplantation, vol. 26, no. 3, ELSEVIER SCIENCE INC, 2020, pp. S371–S371.
URI
https://scholars.duke.edu/individual/pub1435056
Source
wos
Published In
Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation
Volume
26
Published Date
Start Page
S371
End Page
S371