In this month’s Pharmacy SIG Literature Update: tumor-infiltrating lymphocytes for metastatic melanoma, post-transplant cyclophosphamide in pediatric allogeneic HCT, auto vs. allo first-line therapy in poor-risk T-NHL, and more!
Literature summaries are provided as information only. Please refer to the original published articles for complete details on study methodology, results and discussion.
*** Must read. Landmark publication that affects practice
** Recommend reading. Secondary paper that adds to literature
* Consider reading. Cursory importance to the practice
*Ahmed S, Bashir Q, Bassett R, et al. Eltrombopag for post-transplantation thrombocytopenia: Results of a phase II randomized, double-blind, placebo-controlled trial. Transplantation and Cellular Therapy. 2021 May; 27(5):430e1-e7. https://pubmed.ncbi.nlm.nih.gov/33965187/.
- A randomized, double-blind, placebo controlled phase II trial to evaluate the impact of eltrombopag on post-HCT thrombocytopenia. Patients were required to be ≥35 days post-HCT, had a platelet count ≤20,000 sustained for 7 days or were transfusion-dependent with an ANC ≥1500 with or without receipt of GCSF in the last 7 days.
- Eltrombopag was started at 50 mg once daily and escalated every 2 weeks to 75 mg, 125 mg, and 150 mg if the platelets were 10,000/uL and hemoglobin >8 mg/dL. Treatment was planned for a total of 8 weeks.
- Platelet counts ≥30,000/uL were achieved in 36% of patients in the eltromobopag arm and 5% in the placebo arm, however the difference was not statistically significant.
- The secondary endpoint of achieving a platelet count of ≥50,000/uL was reached in 21% of the eltrombopag arm and 0% in the placebo arm (p=0.046). There was no difference in the other secondary endpoints of OS, PFS, NRM, relapse rate, and or independence of platelet transfusions.
- The authors concluded that, compared to placebo, eltrombopag lead to an increased percentage of patients who achieved a platelet count ≥50,000/uL, although this did not lead to increased transfusion independence.
**Farhadfar N, Dias A, Wang T, et al. Impact of pretransplantation renal dysfunction on outcomes after allogeneic hematopoietic cell transplantation. Transplantation and Cellular Therapy. 2021 May; 27(5):410-422. https://pubmed.ncbi.nlm.nih.gov/33775617/
- Review of CIBMTR database of patients aged ≥40 years with hematologic malignancy who underwent alloHCT from January 2008 to December 2016. Main exclusion criteria included age<40 years old were if they received ex vivo T-cell depletion or CD34+ selected grafts. (N=13,505)
- Patients were grouped into 4 categories based on eGFR (mL/min): ≥90 (group A; n=7062), 60-89 (group B; n=5264), 45-59 (group C; n=897), and <45 (group D; n=282). Dialysis patients were included in their own cohort (n=46).
- NRM was higher in groups C and D compared to A and B. Compared to group A, the hazard ratios for groups C and D were 1.46 (p=0.0001) and 1.74 (p=0.004) for NRM, respectively. Group C and D also had an increased risk of overall mortality compared to arms A and B, with hazard ratios of 1.17 (p=0.03) and 1.63 (p<0.001), respectively.
- In patients on dialysis, the 1-year OS was 20% and NRM was 67%.
- The authors concluded that poor preHCT renal function > 40 years.
*Lulla PA, Naik S, Vasileiou S, et al. Clinical effects of administer leukemia-specific donor T cells to patients with AML/MDS after allogeneic transplant. Blood. 2021;137(19):2585-2597. https://pubmed.ncbi.nlm.nih.gov/33270816/
- Single-center, single-arm study of the infusion of selectively activated and expanded donor leukemia-specific T cells (reactive to multiple antigens expressed by AML/MDS) in escalating doses (0.5 to 10 x 107 cells/m2 ) to 24 patients with either high-risk for relapse (n=17) or relapsed disease (n=8)
- 2 patients (8%) developed aGVHD which both resolved within 2 weeks. 4 patients (16%) developed cGVHD, but all were of mild severity and did not require systemic treatment. Hepatitis occurred in 6 patients (25%) and was temporally associated with the infusions. Except for one case of hepatitis treated with systemic steroids, all others were grade <2.
- Of the 17 enrollees with high-risk AML/MDS, 6 (35%) relapsed at a median of 9.5 months. Of the 8 enrollees with relapsed disease refractory to salvage therapy, 2 (25%) achieved an objective response.
- Authors conclude that leukemia-specific T-cells are safe and promising for the prevention and treatment of AML/MDS after HCT
**Shaw B, Jimenez-Jimenez A, Burns L, et al. National marrow donor program-sponsored multicenter, phase II trial of HLA-mismatched unrelated donor bone marrow transplantation using post-transplant cyclophosphamide. J Clin Oncol 2021 (epub ahead of print). PMID: 33905264
- Prospective, phase II, NMDP-sponsored study of MMUD bone marrow HCT with PTCy in patients with hematologic malignancies (n= 80; 40 received MAC, 40 received RIC; 48% of patients were an ethnic minority)3
- Eligible patients were ages 15-71 having AML, MDS, or lymphoma. Patients were also required to have a KPS ≥ 60% and adequate organ function. Any patient with a suitable HLA-identical sibling or MUD was excluded.
- Patients received MAC (investigator choice of TBI/Cy, Bu/Cy, or Bu/Flu) or RIC (flu/Cy/TBI) followed by bone marrow infusion on day 0, then PTCy on days +3 and +4 and sirolimus + MMF starting on day +5.
- The primary endpoint was met with a 1-year OS of 76% (90% CI, 67.3-83.3%) in the entire cohort and 72% and 79% in the MAC and RIC strata, respectively.
- OS was not influenced by HLA match grade (75% in 7 of 8 and 77% in 4-6 of 8).
- Incidences of grades 2-4 and 3-4 aGVHD at day +100 were 43% and 18%, respectively among patients receiving MAC and 33% and 0% among patients receiving RIC.
- cGVHD rates at 1 year were 36% and 18% among the MAC and RIC strata, respectively.
- The most common cause of death was relapse. Rates of clinically meaningful viral infection were ≤11% at 1 year except for BK, adenovirus, and HHV6.
- Authors conclude that this study demonstrates the feasibility and effectiveness of HCT with an MMUD in the setting of PTCy.
*Leonard A, Sharma A, Uchida A, et al. Disease severity impacts plerixafor-mobilized stem cell collection in patients with sickle cell disease. Blood Adv. 2021;5(9):2403-2411. https://pubmed.ncbi.nlm.nih.gov/33956057/
- Phase 1 safety and efficacy study of 23 patients with sickle cell disease (HbSS=20, HbSC=1, HbSβ+=2) who underwent plerixafor mobilization (240 mcg/kg) followed by apheresis at St. Jude and the National Institutes of Health
- 20 patients (87%) successfully met the target CD34+ cells/kg yield (2.0 x 106 CD34+ cells/kg) within 1-2 mobilization and apheresis procedures. Median collection was 4.0 x 106 CD34+ cells/kg. Patients 30 years (6.4 x 106 vs 2.3 x 106 CD34+ cells/kg, respectively).
- Number of hospitalizations within the preceding year was inversely correlated with total CD34+ yield (r2=0.2535, p=0.01) and patients requiring multiple agents for chronic pain demonstrated a lower yield (r2=0.3511, p=0.002). Patients who discontinued hydroxyurea for a longer time demonstrated a greater CD34+ yield (r2=0.2747, p=0.01).
- Authors recommend that 1) hydroxyurea be discontinued at least 30 days prior to stem cell collection, and 2) banking for future consideration of autologous therapy before age 30 be discussed
**Schmitz N, Truemper L, Bouabdallah K, et al. A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk T-NHL. Blood. 2021;137(19):2646-2657. https://pubmed.ncbi.nlm.nih.gov/33512419/
- Phase 3 trial of 104 patients with peripheral T-cell NHL (18-60 years, poor prognosis) who were randomized to CHOEP x4 cycles followed by either high-dose therapy (BEAM) with an autoHCT (n=41) vs myeloablative conditioning (FBC) with an alloHCT (n=26)
- 3-year EFS was comparable between the groups at 43% in the alloHCT group and 38% in the autoHCT group (p=0.583), PFS was 43% vs. 39% (p =0.611), and OS was 57% and 70%, respectively (p=0.408). None of the responding patients in the alloHCT group relapsed, as opposed to 13 patients (36%) of the responding patients in the autoHCT group.
- Transplant-related mortality occurred in 31% of the alloHCT patients vs none in the autoHCT ptients, mostly attributed to acute or chronic GVHD
- Authors conclude that the strong graft-versus-lymphoma effect after alloHCT was counterbalanced by TRM
**Trujillo AM, Karduss AJ, Suarez G, et al. Haploidentical Hematopoietic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide in Children with High-Risk Leukemia Using a Reduced-Intensity Conditioning Regimen and Peripheral Blood as the Stem Cell Source. Transplantation and Cellular Therapy. 2021 May; 27(5):427e1-e7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543223/
- Retrospective review of 42 patients 1-17 years old with high-risk leukemia who underwent haploHCT with PTCy were included. Stem-cells were derived from peripheral blood. Conditioning consisted of either FluBuTBI or FluMelTBI.
- The median time to neutrophil recovery was 14 days, and time to platelet recovery was 12 days.
- 86% of patients developed cytokine release syndrome (CRS), of which all cases consisted only of fever without the need for oxygen or hemodynamic support.
- Grade II-IV aGVHD and III-IV aGVHD occurred in 43% and 17%, respectively. 1-year moderatesevere cGVHD occurred in 15 (29%) patients. Of these patients, 47% had prior grade II-IV aGVHD.
- The 36-month OS and EFS was 56% and 46%, respectively, for the entire cohort. In patients in CR1, these numbers were 71% and 58%; in CR2, these numbers were 52% and 42%; in CR3, these numbers were 43% and 40%. There were no differences in survival between patients with AML and ALL.
- The authors concluded that haploHCT with RIC and PTCy in high-risk pediatric patients is feasible. The high-rates of grade III-IV aGVHD was worrisome, and further research is needed to prevent this outcome.
**Ruggeri A, Galimard JE, Paina O, et al. Outcomes of Unmanipulated Haploidentical Transplantation Using Post-Transplant Cyclophosphamide (PT-Cy) in Pediatric Patients With Acute Lymphoblastic Leukemia. Transplantation and Cellular Therapy. 2021 May; 27(5):424e1-e9. https://pubmed.ncbi.nlm.nih.gov/33965182/
- Review of the Pediatric Disease Working Party (PDWP) of the EBMT transplant database. Patients received MAC or RIC with PTCy and CNI for GVHD prophylaxis. Patients were <18 years 5 old and had a diagnosis of ALL in any disease status (CR1, CR2, CR3+, or active disease). Graft source was either marrow or peripheral blood. 180 patients were included in the analysis
- The majority of patients were in CR2 (45%), followed by CR1 (23.9%), active disease (18.9%), and CR3+ (12.2%).
- Conditioning consisted mostly of MAC utilizing chemotherapy (51.7%), followed by MAC utilizing TBI (25.6%) and RIC (22.8%).
- 2-year NRM was 19.6% for the entire group, 9.8% in patients in CR1, 19.1% in CR2. NRM was higher in patients who received peripheral blood compared to bone marrow grafts (26.5% vs 7.8%; p<0.001).
- 2-year leukemia-free survival (LFS) was 38.5% (65% in CR1, 44% in CR2, and 18.8% in CR3). 2- year OS was 76.5% for CR1 and 61.2% for CR2.
- The authors concluded that outcomes for pediatric patients in CR3+ or active disease remain poor, although PTCy appears to be a feasible option for GVHD prophylaxis in children with ALL.
**Freyer CW, Gier S, Moyer ME, et al. Leucovorin rescue after methotrexate graft-versus-host disease prophylaxis shortens the duration of mucositis, time to neutrophil engraftment, and hospital length of stay. Transplantation and Cellular Therapy. 2021 May; 27(5):431-438. https://pubmed.ncbi.nlm.nih.gov/33965188/
- Retrospective pre/post intervention study of adults who received myeloablative conditioning with MRD/MUD alloHCT and methotrexate prophylaxis for GVHD (MTX dosed 15 mg/m2 day +1 and 10 mg/m2 days +3, +6, +11).
- Leucovorin was dosed at 15 mg PO or IV every 6 hours for 4 doses after each dose of MTX, starting 12 hours post-MTX on days +3, +6, and +11. No leucovorin was given on day +1 due to concern for inhibiting the effect of MTX on day +3, due to the short time between doses.
- Patients who received leucovorin prophylaxis had a shorter duration of grade 2-4 oropharyngeal mucositis (OPM) and hospital LOS compared to control (median 6 vs 10.5 days,p=0.004 and 27.5 vs. 31 days, p = 0.017, respectively).
- Time to neutrophil engraftment was shorter in the leucovorin group (median 18 vs 20 days; p=0.008), although time to platelet engraftment was similar between the groups (median 14 vs 15 days; p=0.25)
- Patients who received leucovorin were less likely to require PCA (35% vs 63%; RR 0.55; p=0.0001) as well as had a shorter duration of total parenteral nutrition (TPN) (median 7 vs 16 days; p=0.001).
- No differences were noted between the groups for the following: grade 2-4 acute GVHD on day +100, grade 3-4 acute GVHD, chronic GVHD by 1 year, relapse at 1 year, and survival at 1 year.
- The authors concluded that leucovorin prophylaxis has the potential to benefit patients in terms of OPM duration and supportive care measures for OPM, although acknowledge the need for a prospective randomized trial to confirm these effects.
**Luo ZK, Domenech-Estarellas EA, Han A, et al. Efficacy and safety of 1% progesterone gel to the forehead for ocular graft-versus-host disease. Transplantation and Cellular Therapy. 2021 May; 27(5):433e1-e8. https://pubmed.ncbi.nlm.nih.gov/33942724/
- Patients were blinded in a randomized in a 2:1 fashion to receive 1% progesterone gel or placebo, applied to cleaned forehead skin twice a day (N=33). Patients were included if they had at least grade 2 NIH score, moderate-severe ocular discomfort, and on stable immunosuppression. The primary endpoint was to assess the efficacy of progesterone on ocular pain and discomfort, as well as clinical signs associated with ocular GVHD (oGVHD)
- Artificial tears were used at baseline in 86.4% and 81.8% of patients in the progesterone and placebo arms, respectively (p=NR). Cyclosporine drops were used in 9.1% and 18.2% of patients, and topical steroids were used in 63.6% and 81.8% of patients in the progesterone and placebo arms, respectively (p=NR for all).
- At 10 weeks, there was a significant reduction in ocular symptoms as assessed by the modified SANDE questionnaire in the progesterone group compared to placebo in symptom frequency (- 30.7 vs -2.2; p<0.001) and symptom severity (-19.8 vs +1.6; p=0.005).
- The authors concluded that, although this was a small population, 1% progesterone applied to the forehead twice daily is effective in alleviating oGVHD symptoms
*Mehta RS, Bassett R, Rondon G, et al. Randomized phase II trial of extracorporeal phototherapy and steroids vs steroids alone for newly diagnosed acute GVHD. BMT 2021;56:1316-24
- Single-center phase II study of 81 patients randomized to either high-dose steroids alone or with ECP. Patients had new onset biopsy proven acute GVHD grades 2-4 following allogeneic HCT from any graft source.
- Patients were enrolled within 72 hours of initiation of 2 mg/kg/day prednisone or methylprednisolone equivalent. Tapering below 1 mg/kg/day was allowed after day 14. The frequency of ECP was 8-9 sessions from enrollment through day 14, 6 sessions between day 15- 28, 8 sessions between week 29-56, and continuation beyond this point by physician discretion.
- The primary endpoint of treatment success at day 56 was defined by patients achieving acute GVHD response between day 28-56 with steroid doses <0.5 mg/kg/day. Treatment success was achieved in 66.7% of the ECP group, compared to 50% in the steroid only arm (p=0.16). Of patients with only skin GVHD, treatment success was seen in 72% of the ECP group, compared to 57% with steroids alone.
- The authors conclude that addition of ECP to steroids may result in higher GVHD response as initial therapy, especially for patients with only skin involvement.
*Kekre N, Kim HT, Hofer J, et al. Phase II trial of natalizumab with corticosteroids as initial treatment of gastrointestinal acute graft-versus-host disease. Bone Marrow Transplantation 2021;56:1006-12. https://pubmed.ncbi.nlm.nih.gov/33398094/
- This is a phase II study of natalizumab, an inhibitor of the alpha-4 subunit of integrin, given to 21 patients for initial treatment of gastrointestinal acute graft-versus-host disease. The majority of patients underwent RIC with MUD. All patients had at least grade II GVHD, including 81% with grade III and no grade IV cases.
- Natalizumab 300mg was given intravenously with corticosteroids (initiated up to 3 days before enrollment) for new onset GI GVHD. A second dose of natalizumab was given 28 days later for patients who did not have a complete response and no grade 3-4 toxicities.
- GVHD-free survival by day 56 was attained in 33.3% of all patients. Overall response rates at day 28 and 56 from study enrollment were 57% and 52%, respectively. Overall survival at 2 years was 43% and NRM was 52%.
- The authors concluded that natalizumab with corticosteroids as initial treatment for acute GI GVHD is safe and effective with durable responses.
*Paviglianiti A, Labopin M, Blaise D, et al. Comparison of mycophenolate mofetil and calcineurin inhibitor versus calcineurin inhibitor-based graft-versus-host-disease prophylaxis for matched unrelated donor transplant in acute myeloid leukemia. A study from the ALWP of the EBMT. Bone Marrow Transplantation 2021; 56(5):1077-1085. https://pubmed.ncbi.nlm.nih.gov/33249424/
- This study included 497 patients with AML who underwent MUD with Bu/Flu RIC conditioning. All patients received anti-thymocyte globulin and CSA, with and without MMF.
- The cumulative incidence of grade II-IV acute GVHD was 27% for CSA and 33% for CSA+MMF (p=0.25). The grade III-IV acute GVHD was 9% vs 11% (p=0.60) and the 2-year chronic GVHD rate was 38% vs 33% (p=0.26).
- On multi-variate analysis there were no statistically significant differences with relapse rate, non-relapse mortality, leukemia free survival, or overall survival between patients having received CSA and CSA + MMF.
- The authors conclude that their results support the need for randomized trials to identify patients who would benefit from the addition of MMF in matched unrelated transplantation.
*Wang D, Wang J, Hu G, et al. A phase 1 study of a novel fully humanized BCMA-targeting CAR (CT103A) in patients with relapsed/refractory multiple myeloma. Blood. 2021;137(21):2890-2901. https://pubmed.ncbi.nlm.nih.gov/33512480/
- Phase 1 open-label, single-arm study of a novel BCMA-targeting CAR construct (CT103A) with a fully humanized scFV in 18 patients with relapsed/refractory multiple myeloma (including 4 with prior murine BCMA CAR exposure) at escalating doses of 1, 3, and 6 x106 CAR-positive T cells (1 x 106 CAR-positive T cells/kg in the expansion phase)8
- ORR was 100% with 13 patients (72.2%) achieving a CR or sCR. Of the 4 murine BCMA-exposed patients, 3 achieved a sCR and 1 achieved a VGPR. Of the 17 patients with MRD, all were MRDnegative within 1 month. Median DOR was 325 days overall, and 412 days in patients who achieved a CR/sCR. At 1 year, the PFS was 58.3%. Median CAR transgene persistence was 307.5 days with detectable CAR transgenes in 77.8% of patients at the cutoff date.
- The most common toxicity was hematologic toxicity occurring in 100% of patients (median neutrophil recovery=14.5 days, median platelet recovery=38 days). 17 (94.4%) patients experienced grade CRS, with 4 (23.5%) at grade 3 and 1 (5.9%) at grade 4. All patient with grade > 3 received the 6 x 106 cells/kg dose. No ICANS was observed.
- Authors conclude that CT103A is safe and highly active in patients with R/R multiple myeloma and still benefit patients who relapsed from prior murine BCMA CAR-T therapy
**Shah N, Lee D, Yates B, et. al. Long-term follow-up of CD19-CAR T-cell therapy in children and young adults with B-ALL. J Clin Oncol 2021;39(15):1650-9. PMID: 33764809
- Single-center, phase I dose-escalation study of CD19.28ζ-CAR T-cells among children and young adults (CAYAs) with B-cell ALL.
- Thirty-one of 50 (62%) patients treated achieved a CR, 28 (90.3%) of whom achieved MRDstatus by flow cytometry.
- Twenty-one of the 28 patients achieving MRD- CR proceeded to consolidative alloHCT (median time 54 days after CAR-T infusion) and had a median OS of 70.2 months (95% CI, 10.4 months to not estimable).
- Cumulative incidence of relapse after alloHCT was 9.5% (95% CI, 1.5 to 26.8) at 24 months.
- Use of fludarabine/cyclophosphamide-based lymphodepletion was associated with improved CR rates (29/42, 69%) vs. non-fludarabine/cyclophosphamide-based lymphodepletion (2/8, 25%; P=0.041).
- Median EFS was not reached in patients with M1 (MRD+, < 5% blasts) vs. a reported median EFS of 0.9 months (95% CI, 0.9 to 2.0 months) in patients with ≥ M2 marrow (P ≤ 0.0001)
- At median follow-up of 4.8 years, median OS was 10.5 months (95% CI, 6.3 to 29.2 months).
- Study provides the longest follow-up data in CAYA population treated with CD-19 CAR T for BALL, and demonstrated that CD19.28ζ-CAR T therapy followed by alloHCT produces durable responses in this patient population
***Sarnaik A, Hamid O, Khushalani N, et al. Lifeleucel, a tumor-infiltrating lymphocyte therapy, in metastatic melanoma. J Clin Oncol 2021 (epub ahead of print). PMID: 33979178
- Phase-II open-label, single-arm, multicenter study in patients with advanced melanoma (stage IIIC or IV with confirmed radiologic progression) who had previously received checkpoint inhibitor(s), and BRAF ± MEK targeted agents, when applicable (n= 66); patients were also required to have had at least one resectable lesion (or aggregate of lesions) with a minimum postresection diameter of 1.5 cm.
- Patients received NMA lymphodepleting chemotherapy with Cy (60 mg/kg) once daily for 2 days followed by Flu (25 mg/m2 ) once daily for 5 days. A single infusion of lifeleucel (1-150 x 109 cells) was administered approximately 24 hours after completion of fludarabine. Patients then 9 received up to 6 doses of IL-2 (600,000 IU/kg) every 8-12 hours starting 3-24 hours after completing lifeleucel infusion.
- Invesitigator-assessed ORR was 36% (95% CI, 25-49%) which included 2 (3%) CR and 22 (33%) PR; disease control rate was 80%.
- Median duration of response was not reached after a median follow-up of 18.7 months (range 0.2-34.1 months); median OS was 17.4 months (95% CI, 11.0-NR).
- 97% of patients experienced a grade >3 TEAE; majority of grade 3-4 TEAEs were hematologic. Febrile neutropenia occurred in 55% of patients and hypophosphatemia occurred in 35%.
- Authors conclude lifileucel demonstrated durable responses and addresses a major unmet need in patients with metastatic melanoma with limited treatment options after approved therapy, including the primary refractory to anti-PD-1 or PD-L1 therapy subset.
aGVHD: acute graft-versus-host disease
ALL: acute lymphoblastic leukemia
AML: acute myeloid leukemia
alloHCT: allogeneic hematopoietic cell transplantation
ANC: absolute neutrophil count
autoHCT: autologous hematopoietic cell transplantation
CAR: chimeric antigen receptor
cGVHD: chronic graft-versus-host disease
CR: complete remission
CSA: cyclosporine A
EFS: event-free survival
ECP: extracorporeal photopheresis
GVHD: graft-versus-host disease
HCT: hematopoietic cell transplantation
HHV6: human herpesvirus 6
KPS: Karnofsky performance status
LFS: leukemia-free survival
MAC: myeloablative conditioning
MDS: myelodysplastic syndrome
MMF: mycophenolate mofetil
MMUD: mismatched unrelated donor
MRD: minimal residual disease
MUD: matched unrelated donor
NHL: non-Hodgkin’s lymphoma
NRM: non-relapse mortality
OPM: oropharyngeal mucositis
ORR: overall response rate
OS: overall survival
PCA: patient-controlled analgesia
PFS: progression-free survival
PTCy: post-transplant cyclophosphamide
RFS: relapse-free survival
RIC: reduced-intensity conditioning
SANDE: Symptom Assessment Questionnaire iN Dry Eye
scFV: single-chain variable fragment
TAAE: treatment-associated adverse event
TBI: total body irradiation
ASTCT Pharmacy SIG Research Working Committee: Jennifer Collins, Kelly Gaffney, Katie Gatwood, Arpita Gandhi, Jitesh Kawedia, Binni Kunvarjee, Andrew Lin, Dennis Marjoncu, Jonathan Ptachcinski, Julianna Roddy, Lily Yan