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Sandeep Soni, MD

  • Sandeep Soni

Specialties

Hematology/Oncology

Work and Education

Professional Education

Maulana Azad Medical College, New Delhi, Delhi 110002, India, 4/17/1988

Internship

Maulana Azad Medical College, New Delhi, Delhi 110002, India, 12/31/1987

Residency

Childrens Hospital at Montefiore Pediatric Residency, Bronx, NY, 6/30/2002

Fellowship

Albert Einstein College of Medicine Montefiore, Bronx, NY, 6/30/2000

UT MD Anderson Cancer Center, Houston, TX, 8/28/2003

Board Certifications

Hematology/Oncology, American Board of Pediatrics

Conditions Treated

Neuroblastoma

Stem Cell Transplant

All Publications

Unrelated Donor Transplantation in Children with Thalassemia using Reduced-Intensity Conditioning: The URTH Trial BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Shenoy, S., Walters, M. C., Ngwube, A., Soni, S., Jacobsohn, D., Chaudhury, S., Grimley, M., Chan, K., Haight, A., Kasow, K. A., Parikh, S., Andreansky, M., Connelly, J., Delgado, D., Godder, K., Hale, G., Nieder, M., Pulsipher, M. A., Trachtenberg, F., Neufeld, E., Kwiatkowski, J. L., Thompson, A. A. 2018; 24 (6): 121622

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) can cure transfusion-dependent thalassemia (TDT). In a multicenter trial we investigated the efficacy of reduced-intensity conditioning (RIC) before unrelated donor (URD) HSCT in children with TDT. Thirty-three children, ages 1 to 17 years, received bone marrow (BM) or umbilical cord blood (UCB) allografts. Median time to neutrophil engraftment was 13 days (range, 10 to 25) and 24 days (range, 18 to 49) and platelet engraftment 23 days (range, 12 to 46) and 50 days (range, 31 to 234) after BM and UCB allografts, respectively. With a median follow-up of 58 months (range, 7 to 79), overall and thalassemia-free survival was 82% (95% CI, .64% to .92%) and 79% (95% CI, .6% to .9%), respectively. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) after BM and UCB allografts was 24% and 44%; the 2-year cumulative incidence of chronic extensive GVHD was 29% and 21%, respectively; 71% of BM and 91% of UCB recipients discontinued systemic immunosuppression by 2 years. Six patients who had Pesaro risk class 2 (n=5) and class 3 (n=1) died of GVHD (n=3), viral pneumonitis (n=2) and pulmonary hemorrhage (n=1). Outcomes after this RIC compared favorably with URD HSCT outcomes for TDT and supported engraftment in 32 of 33 patients. Efforts to reduce GVHD and infectious complications are being pursued further.

View details for DOI 10.1016/j.bbmt.2018.01.023

View details for Web of Science ID 000436056000016

View details for PubMedID 29374585

View details for PubMedCentralID PMC5993578

Gene Therapy in Patients with Transfusion-Dependent beta-Thalassemia NEW ENGLAND JOURNAL OF MEDICINE Thompson, A. A., Walters, M. C., Kwiatkowski, J., Rasko, J. J., Ribeil, J., Hongeng, S., Magrin, E., Schiller, G. J., Payen, E., Semeraro, M., Moshous, D., Lefrere, F., Puy, H., Bourget, P., Magnani, A., Caccavelli, L., Diana, J., Suarez, F., Monpoux, F., Brousse, V., Poirot, C., Brouzes, C., Meritet, J., Pondarre, C., Beuzard, Y., Chretien, S., Lefebvre, T., Teachey, D. T., Anurathapan, U., Ho, P. J., von Kalle, C., Kletzel, M., Vichinsky, E., Soni, S., Veres, G., Negre, O., Ross, R. W., Davidson, D., Petrusich, A., Sandler, L., Asmal, M., Hermine, O., De Montalembert, M., Hacein-Bey-Abina, S., Blanche, S., Leboulch, P., Cavazzana, M. 2018; 378 (16): 147993

Abstract

Donor availability and transplantation-related risks limit the broad use of allogeneic hematopoietic-cell transplantation in patients with transfusion-dependent -thalassemia. After previously establishing that lentiviral transfer of a marked -globin (A-T87Q) gene could substitute for long-term red-cell transfusions in a patient with -thalassemia, we wanted to evaluate the safety and efficacy of such gene therapy in patients with transfusion-dependent -thalassemia.In two phase 1-2 studies, we obtained mobilized autologous CD34+ cells from 22 patients (12 to 35 years of age) with transfusion-dependent -thalassemia and transduced the cells ex vivo with LentiGlobin BB305 vector, which encodes adult hemoglobin (HbA) with a T87Q amino acid substitution (HbAT87Q). The cells were then reinfused after the patients had undergone myeloablative busulfan conditioning. We subsequently monitored adverse events, vector integration, and levels of replication-competent lentivirus. Efficacy assessments included levels of total hemoglobin and HbAT87Q, transfusion requirements, and average vector copy number.At a median of 26 months (range, 15 to 42) after infusion of the gene-modified cells, all but 1 of the 13 patients who had a non-0/0 genotype had stopped receiving red-cell transfusions; the levels of HbAT87Q ranged from 3.4 to 10.0 g per deciliter, and the levels of total hemoglobin ranged from 8.2 to 13.7 g per deciliter. Correction of biologic markers of dyserythropoiesis was achieved in evaluated patients with hemoglobin levels near normal ranges. In 9 patients with a 0/0 genotype or two copies of the IVS1-110 mutation, the median annualized transfusion volume was decreased by 73%, and red-cell transfusions were discontinued in 3 patients. Treatment-related adverse events were typical of those associated with autologous stem-cell transplantation. No clonal dominance related to vector integration was observed.Gene therapy with autologous CD34+ cells transduced with the BB305 vector reduced or eliminated the need for long-term red-cell transfusions in 22 patients with severe -thalassemia without serious adverse events related to the drug product. (Funded by Bluebird Bio and others; HGB-204 and HGB-205 ClinicalTrials.gov numbers, NCT01745120 and NCT02151526 .).

View details for DOI 10.1056/NEJMoa1705342

View details for Web of Science ID 000430312500004

View details for PubMedID 29669226

Outcomes of Unrelated Donor Stem Cell Transplantion with Post-Transplant Cyclophosphamide for Graft-versus-Host Disease Prophylaxis in Patients with Severe Sickle Cell Disease BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Rangarajan, H. G., Abu-Arja, R., Pai, V., Guilcher, G. T., Soni, S. 2018; 24 (2): 41317

Abstract

Unrelated donor (URD) hematopoietic cell transplantation (HCT) in children with sickle cell disease (SCD) is associated with a high incidence of rejection and graft-versus-host disease (GVHD). We report on the first 4 patients with severe SCD who underwent URD HCT using a novel myeloablative and immunosuppressive regimen composed of busulfan, fludarabine, and antithymocyte globulin with a single dose of post-transplant cyclophosphamide along with tacrolimus and mycophenolate mofetil for GVHD prophylaxis. Three patients engrafted and remain disease-free after a median follow-up period of 2.5 years. One patient had primary graft failure attributed to low stem cell content of the graft. Of interest, none of the engrafted patients developed acute or chronic GVHD. This preparative regimen along with the use of post-transplant cyclophosphamide offers a promising approach for unrelated donor transplants in patients with SCD and needs further corroboration in larger number of patients.

View details for DOI 10.1016/j.bbmt.2017.10.030

View details for Web of Science ID 000425475800031

View details for PubMedID 29061531

Phase I Study of Clofarabine and 2-Gy Total Body Irradiation as a Nonmyeloablative Preparative Regimen for Hematopoietic Stem Cell Transplantation in Pediatric Patients with Hematologic Malignancies: A Therapeutic Advances in Childhood Leukemia Consortium Study. Biology of blood and marrow transplantation Soni, S., Abdel-Azim, H., McManus, M., Nemecek, E., Sposto, R., Woolfrey, A., Frangoul, H. 2017

Abstract

Clofarabine is a purine nucleoside analog with immunosuppressive and antileukemic activity and its inclusion in reduced-intensity regimens could potentially improve outcomes. We performed a prospective phase I study of clofarabine combined with 2Gy total body irradiation (TBI) as a nonmyeloablative preparative regimen for allogeneic stem cell transplantation in pediatric patients who were considered at high risk of mortality from standard myeloablative regimens. The main goal of the study was to delineate the maximum feasible dose (MFD) of clofarabine in combination with 2Gy TBI. Eighteen patients, 1 to 21 years of age and in complete remission, were enrolled in 2 strata (matched related donor and unrelated donor) and evaluated for day100 dose-limiting events (DLE) (nonengraftment, nonrelapse mortality [NRM], and severe renal insufficiency) after receiving clofarabine at the starting dose level of 40mg/m(2). All 6 patients (3 in each stratum) engrafted with no day 100 DLE seen in the first cohort. The dose was increased to 52mg/m(2) in the next and an expanded cohort (total of 12 patients) and no DLE were observed at day 100 and at the 1-year study endpoint. The regimen was well tolerated with transient transaminitis and gastrointestinal and skin reactions as the common reversible toxicities observed with clofarabine. The dose of 52mg/m(2) of clofarabine was deemed the MFD. Disease relapse led to mortality in 6 (33%) patients during follow-up with 1-year event-free survival and overall survival of 60% (95% confidence interval [CI], 34 to 79) and 71% (95% CI, 44 to 87), respectively. This regimen leads to successful engraftment using both related and unrelated donors with exceptionally low rates of NRM.

View details for DOI 10.1016/j.bbmt.2017.03.037

View details for PubMedID 28396162

Gene Therapy in a Patient with Sickle Cell Disease. The New England journal of medicine Ribeil, J. A., Hacein-Bey-Abina, S., Payen, E., Magnani, A., Semeraro, M., Magrin, E., Caccavelli, L., Neven, B., Bourget, P., El Nemer, W., Bartolucci, P., Weber, L., Puy, H., Meritet, J. F., Grevent, D., Beuzard, Y., Chrtien, S., Lefebvre, T., Ross, R. W., Negre, O., Veres, G., Sandler, L., Soni, S., de Montalembert, M., Blanche, S., Leboulch, P., Cavazzana, M. 2017; 376 (9): 84855

Abstract

Sickle cell disease results from a homozygous missense mutation in the -globin gene that causes polymerization of hemoglobin S. Gene therapy for patients with this disorder is complicated by the complex cellular abnormalities and challenges in achieving effective, persistent inhibition of polymerization of hemoglobin S. We describe our first patient treated with lentiviral vector-mediated addition of an antisickling -globin gene into autologous hematopoietic stem cells. Adverse events were consistent with busulfan conditioning. Fifteen months after treatment, the level of therapeutic antisickling -globin remained high (approximately 50% of -like-globin chains) without recurrence of sickle crises and with correction of the biologic hallmarks of the disease. (Funded by Bluebird Bio and others; HGB-205 ClinicalTrials.gov number, NCT02151526 .).

View details for DOI 10.1056/NEJMoa1609677

View details for PubMedID 28249145

Combined Umbilical Cord Blood and Bone Marrow from HLA-Identical Sibling Donors for Hematopoietic Stem Cell Transplantation in Children With Hemoglobinopathies PEDIATRIC BLOOD & CANCER Soni, S., Boulad, F., Cowan, M. J., Scaradavou, A., Dahake, J., Edwards, S., Walters, M. C. 2014; 61 (9): 1690-1694

Abstract

It is well established that umbilical cord blood and bone marrow are biologically different stem cell sources.We analyzed the feasibility and outcome of hematopoietic stem cell transplantation (HSCT) in 13 children (median age 5.9 years) with hemoglobinopathies after the co- infusion of cord blood (CB) and bone marrow (BM) from the same human leucocyte antigen (HLA) identical sibling donor. We also compared outcomes of children with co-transplantation to outcomes in children with hemoglobinopathies who had received a BM (n = 21) or CB (n = 22) transplant alone.Compared to CB transplant (CBT) recipients, the co-transplant group had more rapid neutrophil (17 vs. 25 days, P = 0.013) and platelet (29 vs. 48 days, P = 0.009) recovery and less transplant related mortality. Patients who received a co-transplant had a lower incidence of grade II acute (0% vs. 26.3%) and chronic (0% vs. 21%) graft versus host disease (GVHD) compared to BM transplant (BMT) recipients (P = 0.055 and 0.045, respectively). With a median follow-up of >60 months in each treatment group, the 5-year probability of event free survival (EFS) was 100% in the co-transplant group, 90% after BMT and 86% after CBT (P = 0.42).Co-transplantation of CB and BM from HLA-identical sibling donors appears to be a feasible and effective strategy to further optimize outcomes of HSCT for hemoglobinopathies.

View details for DOI 10.1002/pbc.25085

View details for Web of Science ID 000340540600026

View details for PubMedID 24803091

Outcomes of Matched Sibling Donor Hematopoietic Stem Cell Transplantation for Severe Sickle Cell Disease with Myeloablative Conditioning and Intermediate-Dose of Rabbit Anti-Thymocyte Globulin PEDIATRIC BLOOD & CANCER Soni, S., Gross, T. G., Rangarajan, H., Baker, K. S., Sturm, M., Rhodes, M. 2014; 61 (9): 1685-1689

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative therapy for sickle cell disease (SCD) in children. Despite excellent outcomes of matched sibling donor (MSD) HSCT, there is still 5-10% chance of rejection and transplant related mortality (TRM) with 12-23% incidence of graft versus host disease (GVHD). We postulated that an intermediate dose of rabbit anti-thymocyte globulin (r-ATG, 10 mg/kg cumulative) would be effective in preventing both rejection and GVHD.Fifteen patients, median age 5 (range 1.5-18) years, underwent MSD HSCT using busulfan ( 12.8 mg/kg with first dose pharmacokinetics), cyclophosphamide (total 200 mg/kg) and r-ATG. Bone marrow was the stem cell source; tacrolimus and methotrexate were given for GVHD prophylaxis.All patients achieved donor engraftment and there was no TRM. One patient rejected donor cells at 2 months post-transplant. Majority of the patients had high and sustained level of donor chimerism. None of the patients developed Grade II GVHD. Incidence of CMV (10%) and EBV (9%) reactivations was low with rapid immune-reconstitution. Overall survival was 100% with event free survival of 93%.Eliminating the risks of TRM and GVHD by optimizing the regimen may lead to further acceptance of HSCT for SCD.

View details for DOI 10.1002/pbc.25059

View details for Web of Science ID 000340540600025

View details for PubMedID 24740582

Successful unrelated umbilical cord blood transplantation for class 3 beta-thalassemia major using a reduced-toxicity regimen PEDIATRIC TRANSPLANTATION Soni, S., Breslin, N., Cheerva, A. 2014; 18 (2): E41-E43

Abstract

Unrelated umbilical CB transplant for class 3 -thalassemia major is associated with an increased risk of mortality and non-engraftment. We describe two patients who underwent successful unrelated umbilical CB transplant using a novel reduced-toxicity preparative regimen. This regimen may be sufficiently immunosuppressive and myeloablative to ensure engraftment with reduced risks of toxicity and mortality. Close monitoring of HHV-6 viral load is advised for patients undergoing transplant with this regimen.

View details for DOI 10.1111/petr.12201

View details for Web of Science ID 000330740100001

View details for PubMedID 24330091

Busulfan and melphalan as consolidation therapy with autologous peripheral blood stem cell transplantation following Children's Oncology Group (COG) induction platform for high-risk neuroblastoma: Early results from a single institution PEDIATRIC TRANSPLANTATION Soni, S., Pai, V., Gross, T. G., Ranalli, M. 2014; 18 (2): 217-220

Abstract

Bu-Mel as preparative therapy prior to autologous stem cell rescue was recently shown to be superior to the conventional CEM regimen for HR NBL in Europe. There are no data available on the feasibility and toxicity of Bu-Mel as consolidation therapy following the COG-type induction regimens used in North America. We report early complications and outcomes of patients with HR NBL who received Bu-Mel for consolidation following COG-based induction. Retrospective analysis of all patients who had received Bu-Mel as preparative regimen prior to stem cell rescue for HR NBL was carried out. Toxicity, outcomes, and any delays to receiving radiation or anti-GD2 antibody therapy were analyzed. Six patients undergoing PBSCT had received Bu-Mel. The treatment was well tolerated. Mucositis was the main toxicity; three patients had developed neutropenia fever and none developed pulmonary toxicity. One patient had developed moderate SOS that responded to conservative management. All patients were able to receive and tolerate post-transplant local radiotherapy and ch.14.18 anti-GD2 antibody therapy without any delays. All patients are alive with no disease recurrence. The Bu-Mel regimen is well tolerated and is feasible post-COG-type induction platform.

View details for DOI 10.1111/petr.12202

View details for Web of Science ID 000330740100021

View details for PubMedID 24341617

Outcome of children who experience disease relapse following allogeneic hematopoietic SCT for hematologic malignancies BONE MARROW TRANSPLANTATION Bajwa, R., Schechter, T., Soni, S., Gassas, A., Doyle, J., Sisler, I., Godder, K., Tatman, D., Rumelhart, S., Domm, J., Miao, Y., Frangoul, H. 2013; 48 (5): 661-665

Abstract

Relapse after allogeneic hematopoietic SCT (HSCT) carries a poor prognosis and is a common cause of death. Outcomes of children who relapse post HSCT are not well known. In this retrospective multicenter study we included 532 patients who underwent allogeneic HSCT and examined the outcomes of 160 patients (30%) who relapsed. Treatment options after relapse included (i) palliative therapy with non-curative intent (n=43), (ii) salvage chemotherapy (without a second HSCT, n=55) or (iii) salvage chemotherapy followed by a second HSCT (n=62). Sixty two patients underwent a second HSCT. The 1-year disease-free survival (DFS) for those given palliative therapy, chemotherapy alone and who underwent a second transplant was <1%, 9% and 50% (P=<0.0001), respectively. The DFS at 1 and 2 year was 50% and 35%, respectively, among the patients who received a second transplant versus 9% and 2% in those who did not (P=<0.0001). In multivariable analysis longer time to relapse (P=0.04) and undergoing a second HSCT (P<0.001) were associated with improved outcome. Withdrawal of immunosuppressive therapy, followed by curative intent chemotherapy should be offered to all patients who relapse after an allogeneic HSCT. A second HSCT should be considered, especially in patients who respond to salvage chemotherapy.

View details for DOI 10.1038/bmt.2012.209

View details for Web of Science ID 000318699800007

View details for PubMedID 23128573

Twice daily i.v. bolus tacrolimus infusion for GVHD prophylaxis in children undergoing stem cell transplantation BONE MARROW TRANSPLANTATION Skeens, M., Pai, V., Garee, A., Termuhlen, A. M., Bajwa, R. P., Gross, T. G., Soni, S. 2012; 47 (11): 1415-1418

Abstract

Tacrolimus is routinely administered for GVHD prophylaxis as a 24-h continuous infusion that requires a dedicated i.v. line and thus becomes logistically difficult to administer, especially in young pediatric patients. We investigated the safety and efficacy of twice daily bolus infusions of i.v. tacrolimus in 33 children undergoing hematopoietic stem cell transplantation (HSCT) at our institution. Tacrolimus was started at an initial dose of 0.015mg/kg i.v. bolus administered as a 2-h infusion and then given at every 12h to maintain a trough drug level between 5-15ng/mL. Patients also received short-course MTX (66%) or mycophenolate mofetil (34%) in combination with tacrolimus. No acute infusional toxicities were observed with bolus infusions of i.v. tacrolimus. Nephrotoxicity occurred in 14/33 (42%) patients and 48% developed hypertension (HT). Almost all (94%) patients required magnesium supplements to maintain magnesium (Mg) levels 1.5mg/dL. In all, 3 (9%) patients developed severe sinusoidal obstruction syndrome (SOS). One patient developed posterior reversible leuko-encephalopathy syndrome (PRES) and one additional patient had tremors. The prevelance of these side-effects was similar to those reported for continuous i.v. administration. In all, 28% of the evaluable patients developed acute GVHDgrade II, though the incidence of severe (grade III-IV) GVHD was only 7%. These results suggest that intermittent bolus i.v. tacrolimus administration is a safe and effective method of GVHD prophylaxis in children.

View details for DOI 10.1038/bmt.2012.59

View details for Web of Science ID 000310795500006

View details for PubMedID 22484323

Advancement of Pediatric Blood and Marrow Transplantation Research in North America: Priorities of the Pediatric Blood and Marrow Transplant Consortium BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Pulsipher, M. A., Horwitz, E. M., Haight, A. E., Kadota, R., Chen, A. R., Frangoul, H., Cooper, L. J., Jacobsohn, D. A., Goyal, R. K., Mitchell, D., Nieder, M. L., Yanik, G., Cowan, M. J., Soni, S., Gardner, S., Shenoy, S., Taylor, D., Cairo, M., Schultz, K. R. 2010; 16 (9): 1212-1221

Abstract

Advances in pediatric bone marrow transplantation (BMT) are slowed by the small number of patients with a given disease who undergo transplantation, a lack of sufficient infrastructure to run early-phase oncology protocols and studies of rare nonmalignant disorders, and challenges associated with funding multi-institutional trials. Leadership of the Pediatric Blood and Marrow Transplant Consortium (PBMTC), a large pediatric BMT clinical trials network representing 77 active and 45 affiliated centers worldwide, met in April 2009 to develop strategic plans to address these issues. Key barriers, including infrastructure development and funding, along with scientific initiatives in malignant and nonmalignant disorders, cellular therapeutics, graft-versus-host disease, and supportive care were discussed. The PBMTC's agenda for approaching these issues will result in infrastructure and trials specific to pediatrics that will run through the PBMTC or its partners, the Blood and Marrow Transplant Clinical Trials Network and the Children's Oncology Group.

View details for DOI 10.1016/j.bbmt.2009.12.536

View details for Web of Science ID 000281304000002

View details for PubMedID 20079865

Pre-stem cell transplantation enzyme replacement therapy in Hurler syndrome does not lead to significant antibody formation or delayed recovery of the endogenous enzyme post-transplant: A case report PEDIATRIC TRANSPLANTATION Soni, S., Hente, M., Breslin, N., Hersh, J., Whitley, C., Cheerva, A., Bertolone, S. 2007; 11 (5): 563-567

Abstract

Combined enzyme replacement therapy (ERT) and stem cell transplant (SCT) were done for a two year old boy with severe Hurler syndrome(HS) with the aim to decrease transplant related complications. He tolerated both the procedures well without any major complications. Urine glycosaminoglycans (GAGs) decreased post-transplant and child has improved clinically and neurologically. Insignificant titers of the anti-iduronidase antibodies which developed post-transplant did not affect the transplant outcome or the endogenous recovery of the alpha-L-iduronidase enzyme.

View details for DOI 10.1111/j.1399-3046.2007.00720.x

View details for Web of Science ID 000248177400021

View details for PubMedID 17631030