Dr. Lekha Mikkilineni is a board-certified medical oncologist. She is also an Assistant Professor in the Department of Medicine, Division of Blood & Marrow Transplant and Cellular Therapy.
Dr. Mikkilineni has extensive experience treating blood and bone marrow cancers. She currently provides care through the Bone Marrow Transplant & Cellular Therapy Program at Stanford Health Care. Her clinical focus is multiple myeloma, plasma-cell leukemia, Extramedullary myeloma, high-risk myeloma, CAR T cell therapy, bispecific therapy, amyloidosis, POEMS syndrome, and Waldenstrom’s macroglobunemia.
Dr. Mikkilineni’s research centers on exploring novel CAR T-cell therapies to treat multiple myeloma and to define mechanisms of resistance to immunotherapy. She is particularly focused on understanding how to improve therapies for multiple myeloma patients who have extramedullary disease or high-risk features. Prior to coming to Stanford, she ran phase 1 CAR T-cell trials for multiple myeloma targeting BCMA and SLAMF7 at the National Cancer Institute.
Dr. Mikkilineni received the Conquer Cancer Foundation Young Investigator Award from the American Society of Clinical Oncology for her research focusing on SLAMF7 as a potential target for multiple myeloma. She has received honors and awards for her work at the NCI. She has completed fellowships in hematology/oncology and immunotherapy at the National Heart, Lung, and Blood Institute/National Cancer Institute. She finished her residency in internal medicine at Thomas Jefferson University Hospital. She holds a Master of Science in medical sciences from Boston University and a medical degree from Tulane University.
Dr. Mikkilineni has authored book chapters and published research in numerous high-impact academic journals. She has presented her findings through oral and poster presentations at national and international conferences.
Assistant Professor - University Medical Line, Medicine - Blood & Marrow Transplantation
Board Certification: American Board of Internal Medicine, Oncology (2020)
Fellowship: National Cancer Institute - Center Cancer Research (2019) MD
Board Certification: American Board of Internal Medicine, Internal Medicine (2017)
Residency: Thomas Jefferson University Hospital Internal Medicine Residency (2016) PA
Medical Education: Tulane University School of Medicine Registrar (2013) LA
Additional Clinical Info
Early and Late Toxicities of Chimeric Antigen Receptor T-Cells.
Hematology/oncology clinics of North America
As chimeric antigen receptor (CAR) T-cell therapy is increasingly integrated into clinical practice across a range of malignancies, identifying and treating inflammatory toxicities will be vital to success. Early experiences with CD19-targeted CAR T-cell therapy identified cytokine release syndrome and neurotoxicity as key acute toxicities and led to unified initiatives to mitigate the influence of these complications. In this section, we provide an update on the current state of CAR T-cell-related toxicities, with an emphasis on emerging acute toxicities affecting additional organ systems and considerations for delayed toxicities and late effects.
View details for DOI 10.1016/j.hoc.2023.05.010
View details for PubMedID 37349152
The impact of race, ethnicity, and obesity on CAR T-cell therapy outcomes.
2022; 6 (23): 6040-6050
Cancer outcomes with chemotherapy are inferior in patients of minority racial/ethnic groups and those with obesity. Chimeric antigen receptor (CAR) T-cell therapy has transformed outcomes for relapsed/refractory hematologic malignancies, but whether its benefits extend commensurately to racial/ethnic minorities and patients with obesity is poorly understood. With a primary focus on patients with B-cell acute lymphoblastic leukemia (B-ALL), we retrospectively evaluated the impact of demographics and obesity on CAR T-cell therapy outcomes in adult and pediatric patients with hematologic malignancies treated with CAR T-cell therapy across 5 phase 1 clinical trials at the National Cancer Institute from 2012 to 2021. Among 139 B-ALL CAR T-cell infusions, 28.8% of patients were Hispanic, 3.6% were Black, and 29.5% were overweight/obese. No significant associations were found between race, ethnicity, or body mass index (BMI) and complete remission rates, neurotoxicity, or overall survival. Hispanic patients were more likely to experience severe cytokine release syndrome compared with White non-Hispanic patients even after adjusting for leukemia disease burden and age (odds ratio, 4.5; P = .001). A descriptive analysis of patients with multiple myeloma (n = 24) and non-Hodgkin lymphoma (n = 23) displayed a similar pattern to the B-ALL cohort. Our findings suggest CAR T-cell therapy may provide substantial benefit across a range of demographics characteristics, including for those populations who are at higher risk for chemotherapy resistance and relapse. However, toxicity profiles may vary. Therefore, efforts to improve access to CAR therapy for underrepresented populations and elucidate mechanisms of differential toxicity among demographic groups should be prioritized.
View details for DOI 10.1182/bloodadvances.2022007676
View details for PubMedID 35939781
Infectious Complications of CAR T-Cell Therapy Across Novel Antigen Targets in the first 30 days.
Infections are a known complication of chimeric antigen receptor (CAR) T-cell therapy with data largely emerging from CD19 CAR T-cell targeting. As CAR T-cell therapy continues to evolve, infection risks and management thereof will become increasingly important to optimize outcomes across the spectrum of antigens and disease targeted. We retrospectively characterized infectious complications occurring in 162 children and adults treated amongst five phase 1 CAR T-cell clinical trials. Trials included targeting of CD19, CD22, disialoganglioside (GD2) or B-cell maturation antigen (BCMA). Fifty-three patients (32.7%) had 76 infections between lymphocyte depleting (LD) chemotherapy and day 30; with the majority (80.5%) occurring between day 0 (D0) and day 30 (D30). By trial, the highest proportion of infections was seen with CD22 CAR T-cells (n=23/53; 43.4%), followed by BCMA CAR T-cells(n=9/24; 37.5%). By disease, patients with multiple myeloma, had the highest proportion of infections (9 of 24, 37.5%) followed by acute lymphoblastic leukemia (36 of 102, 35.3%). Grade 4 infections were rare (n=4, 2.5%). Between D0 and D30, bacteremia and bacterial site infections were the most common infection type. In univariate analysis, increasing prior lines of therapy, recent infection within 100 days of LD chemotherapy, corticosteroid or tocilizumab use and fever and neutropenia (F&N) were associated with a higher risk of infection. In a multivariable analysis, only prior lines of therapy and recent infection were associated with higher risk of infection. In conclusion, we provide a broad overview of infection risk within the first 30 days post infusion across a host of multiple targets and diseases, elucidating both unique characteristics and commonalities highlighting aspects important to improving patient outcomes.
View details for DOI 10.1182/bloodadvances.2021004896
View details for PubMedID 34619768
- Infectious Complications Associated with CAR T-Cell Therapy AMER SOC HEMATOLOGY. 2019