Short Chemotherapy-Phased Imatinib (IM) Pulses Improve Long-Term Outcome of Adult Patients with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia (Ph+ ALL).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2029-2029
Author(s):  
Renato Bassan ◽  
Giuseppe Rossi ◽  
Enrico Maria Pogliani ◽  
Eros Di Bona ◽  
Emanuele Angelucci ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Observation Interval ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Pcr Analysis ◽  
Remission Induction ◽  
Term Survival ◽  
Multicentric Study ◽  
Long Term Outcome

Abstract Abstract 2029 Poster Board II-6 In a prospective NILG (Northern Italy Leukemia Group) study, short IM pulses were added to chemotherapy in order to 1) reduce incidence of early failures, 2) obtain higher transfer rates to stem cell transplantation (SCT), and 3) improve survival in comparison with a prior patient cohort treated with the same chemotherapy program without IM. IM 600 mg/d was given orally for 7 consecutive dd. with each chemotherapy block, starting from day 15 of induction (IDR/VCR/PDN±ASP) and day –3 of the following consolidation courses (5x IDR/VCR/CY/DEXA; 2x HD-MTX/ARA-C). All pts. received CNS chemoradioprophylaxis and were eligible to allogeneic SCT, or alternatively to HD therapy with autologous SCT and long-term maintenance with 6MP/MTX and intermittent IM. Between April '00 and November '08, 100 out of 404 pts. registered in NILG study 09/00 had Ph+ ALL (Ph chromosome and/or BCR-ABL rearrangement). M/F ratio was 1.17 and median age 46 years (range 19-66). 35 pts. constituted the control cohort (IM-) while, starting December '02, 59 pts. were included in the modified protocol (IM+), and 6 were excluded from analysis because treated on a continuous IM schedule. Of 59 IM+ pts., 53 received IM during induction/consolidation as planned and 6 during consolidation only (included in IM- group for remission induction analysis). Outcome to induction therapy of IM+ vs. IM- group was: CR 49/53 (92%) vs. 33/41 (80%), NR 2 (3.7%) vs. 5 (12%), ED 2 (3.7%) vs. 3 (7%) (P=NS). With a median observation interval from diagnosis of 5 years (range 0.6-9.2 years), 21 IM+ vs. 6 IM- pts. are alive in remission (CR1 pts.: 43% vs. 18%, P=0.02), and both OS (Figure) and DFS (0.39 vs. 0.21, P=0.044) rates at 5 years are significantly improved in IM+ group, especially when IM was administered from the induction cycle. The ability to perform a SCT increased from 53%(n=15: 11 allogeneic, 4 autologous) to 68%(n=37: 22 allogeneic, 5 autologous), partly owing to lower incidence of early relapse (26% vs. 56% at 1 year, P=0.005). SCT-related mortality was not different (P=0.58) and postgraft survival probability at 5 years was 0.45 overall, again with no difference related to SCT source or IM. Use of IM was not associated with greater reduction of BCR-ABL transcripts: by PCR analysis of BM samples taken at weeks 10, 16 and 22 in pretransplantation pts., a major response (absent/<10-4 PCR signals) was documented in 13/27 (48%) determinations from 13 evaluable IM- pts. vs. 16/49 (33%) from 25 IM+ pts.(P=NS). The short IM schedule used in this multicentric study demonstrated synergy with chemotherapy, resulting for the first time in NILG studies in improved long-term survival for this adverse subset. Problems of SCT-related toxicity and postgraft relapse need to be addressed further, to confirm curability of Ph+ ALL in a greater proportion of cases. Disclosures: No relevant conflicts of interest to declare.

In Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia (Ph+ ALL) Imatinib (IM) and Chemotherapy in Combination Improve Remission Rate, Stem Cell Transplantation Rate and Long-Term Outcome

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 662-662
Author(s):  
Tamara Intermesoli ◽  
Chiara Cattaneo ◽  
Enrico Maria Pogliani ◽  
Eros Di Bona ◽  
Claudio Romani ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Long Term Results ◽  
Remission Induction ◽  
Long Term Outcome ◽  
Relapse Risk ◽  
Number Of Patients ◽  
Early Failures

Abstract Abstract 662 Introduction: In the last 10 years IM was added to chemotherapy to improve outcome of adult patients (pts.) with Ph+ ALL, with encouraging results. The Northern Italy Leukemia Group (NILG) designed a clinical trial with chemotherapy plus short IM pulses (Bassan et al, JCO 2010; 28:3644–52) aiming to increase the CR rate, limit incidence of early failures and increase the number of patients proceeding to SCT with subsequent improvement of survival. Aim: To analyze the long-term results in Ph+ ALL pts. treated with chemotherapy plus IM, in comparison to a prior cohort treated without IM. Patients and Methods: IM 600 mg/d was given orally for 7 consecutive dd. with each chemotherapy block, starting from day 15 of induction (IDR/VCR/PDN±ASP) and day –3 of consolidation courses (5x IDR/VCR/CY/DEXA; 2x HD-MTX/ARA-C). All pts. received CNS chemo-radioprophylaxis and were eligible to allogeneic SCT, or alternatively to HD therapy with autologous SCT and long-term maintenance with 6MP/MTX and intermittent IM. Between April '00 and November '08, 100 out of 404 pts. enrolled into NILG trial 09/00 had Ph+ ALL (median age 46 years, range 19–66; male 54). The pts. belonged to two subsequent treatment groups: control arm (IM-, n=35) and IM+ arm (n=65), of whom 59 received IM during induction/consolidation and 6 during consolidation only (pts. included in IM- cohort for remission induction analysis and in IM+ cohort afterwards). From March 2005 ASP was omitted during induction due to increased toxicity, so that in the IM+ group 20 pts. received ASP and 39 did not. Results: The complete remission (CR) rate was: 33/41 (80.5%) in IM- vs. 55/59 (93%) in IM+ pts. (p=0.05). With regard to the use of ASP in IM+ group, CR rate was: 16/20 (80%) with ASP vs. 39/39 (100%) without ASP (p=0.004). With a median follow-up of 1,6 years (maximum 11.3), 24/60 (40%) IM+ pts. are alive in 1st CR compared to 5/28 (18%) IM- pts., (p=0.04). Estimated 5-year OS, DFS and early relapse rates were significantly improved and reduced (relapse risk within 6 mos.), respectively, in IM+ vs. IM- group: OS 0.38 vs. 0.23 (p=0.012), DFS 0.40 vs. 0.25 (p=0.015) and relapse risk 0.05 vs. 0.24 (p=0.003). The probability to receive a SCT (autologous or allogeneic) was increased in IM+ pts. (72% vs. 54%), a difference that was statistically significant for allogeneic SCT (63% vs. 39%, p=0.04). In a cumulative analysis, patients receiving a SCT had the best outcome regardless of prior IM use (n=58; 5-years OS 0.49 and DFS 0.50), while in pts. unable to reach SCT outcome was slightly better in those exposed to IM (Figure). Forty CR pts. (28 IM+ and 12 IM-), were evaluable for minimal residual disease (MRD) response at weeks 10–22. PCR-negativity at weeks 10 and 16 was tendentially higher in IM+ group (32% and 37,5%) rather than IM- pts. (25% and 12,5%, p=ns). Conclusion: This long-term update confirms that short IM pulses in combination with chemotherapy increased the rate of CR, reduced incidence of early failures, and allowed to increase the feasibility of SCT, with a marked outcome improvement. An allogeneic SCT appears the best consolidation option for Ph+ ALL. Disclosures: No relevant conflicts of interest to declare.

Chemotherapy-Phased Imatinib Pulses Improve Long-Term Outcome of Adult Patients With Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia: Northern Italy Leukemia Group Protocol 09/00

2010 ◽  
Vol 28 (22) ◽  
pp. 3644-3652 ◽  
Author(s):  
Renato Bassan ◽  
Giuseppe Rossi ◽  
Enrico M. Pogliani ◽  
Eros Di Bona ◽  
Emanuele Angelucci ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Adult Patients ◽  
Negative Group ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Positive Group ◽  
Disease Free

Purpose Short imatinib pulses were added to chemotherapy to improve the long-term survival of adult patients with Philadelphia chromosome (Ph) –positive acute lymphoblastic leukemia (ALL), to optimize complete remission (CR) and stem-cell transplantation (SCT) rates. Patients and Methods Of 94 total patients (age range, 19 to 66 years), 35 represented the control cohort (ie, imatinib-negative [IM-negative] group), and 59 received imatinib 600 mg/d orally for 7 consecutive days (ie, imatinib-positive [IM-positive] group), starting from day 15 of chemotherapy course 1 and from 3 days before chemotherapy during courses 2 to 8. Patients in CR were eligible for allogeneic SCT or, alternatively, for high-dose therapy with autologous SCT followed by long-term maintenance with intermittent imatinib. Results CR and SCT rates were greater in the IM-positive group (CR: 92% v 80.5%; P = .08; allogeneic SCT: 63% v 39%; P = .041). At a median observation time of 5 years (range, 0.6 to 9.2 years), 22 patients in the IM-positive group versus five patients in the IM-negative group were alive in first CR (P = .037). Patients in the IM-positive group had significantly greater overall and disease-free survival probabilities (overall: 0.38 v 0.23; P = .009; disease free: 0.39 v 0.25; P = .044) and a lower incidence of relapse (P = .005). SCT-related mortality was 28% (ie, 15 of 54 patients), and postgraft survival probability was 0.46 overall. Conclusion This imatinib-based protocol improved long-term outcome of adult patients with Ph-positive ALL. With SCT, post-transplantation mortality and relapse remain the major hindrance to additional therapeutic improvement. Additional intensification of imatinib therapy should warrant a better molecular response and clinical outcome, both in patients selected for SCT and in those unable to undergo this procedure.

Thirty Percent Long Term Survival In Children with Acute Leukemia and Complications Requiring Mechanical Ventilation

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3243-3243
Author(s):  
Daniel Steinbach ◽  
Bernhard Wilhelm ◽  
Hans-Rudolf Kiermaier ◽  
Ursula Creutzig ◽  
Martin Schrappe ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Acute Leukemia ◽  
Conflicts Of Interest ◽  
Lymphoblastic Leukemia ◽  
Serious Adverse Events ◽  
Term Survival ◽  
Long Term Survival ◽  
Cardiac Resuscitation

Abstract Abstract 3243 Objective: Previous reports indicated that short term prognosis for patients with malignant diseases and serious adverse events requiring mechanical ventilation (SAEV) is not dismal any more. The purpose of this study was to determine whether patients who survive such complications can also achieve long term cure from leukemia. It might influence end-of-live decisions on the intensive care unit if patients with an SEAV only survive intensive care to succumb to relapse. Patients and Methods: We report the outcome of children with SAEV treated in the multicenter studies ALL-BFM 95 and AML-BFM 98. Data from 1182 patients with acute lymphoblastic leukemia (ALL) and 332 patients with acute myeloid leukemia (AML) were analyzed. 88 patients (51 ALL; 37 AML) developed an SAEV. Results: The prognosis was almost identical in ALL and AML (50% survival of SAEV; 30% overall survival after 5 years). This was independent from the time between diagnosis of leukemia and SAEV. Even children who required hemodialysis (n=14) or cardiac resuscitation (n=16) achieved 20% long term survival but no patient survived (n=16) who fulfilled more than 3 out of 6 identified risk factors: age≥10 years, high risk leukemia, C-reactive Protein≥150mg/l, administration of inotropic infusion, cardiac resuscitation, and hemodialysis. Conclusions: To our knowledge, this is the first report about cure rates in a malignant disease after successful treatment of SAEV. Our results show that intensive care medicine contributes to short and long term survival of children with leukemia. Sixty percent of all children with acute leukemia who survive an SAEV achieve long term cure. However, we could also identify risk features that still indicate a devastating prognosis. Disclosures: No relevant conflicts of interest to declare.

Outcomes Of Relapse Of AML Post Allogeneic Transplantation In The Era Of Hypomethylating Agents: An Analysis Of 162 Allogeneic Transplants From a Single Center

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2086-2086
Author(s):  
Justin LaPorte ◽  
Xu Zhang ◽  
Zaamin Hussain ◽  
Stacey Brown ◽  
Connie A. Sizemore ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Patient Characteristics ◽  
Hypomethylating Agents ◽  
Term Survival ◽  
Long Term Outcome ◽  
Post Transplant ◽  
Hypomethylating Agent ◽  
One Year ◽  
Relapse Therapy

Abstract Allogeneic hematopoietic cell transplantation (allo-HCT) can be curative in many patients with intermediate and high risk AML. However, post-transplant relapse remains an important cause of treatment failure. Patients with AML who relapse post allo-HCT typically have a dismal prognosis with limited therapeutic options. Hypomethylating agents alone are increasingly being used to treat AML in patients who are elderly or otherwise unfit for chemotherapy. They may also be used for maintenance/consolidation following induction chemotherapy. The activity and minimal toxicity associated with hypomethylating agents makes them potentially useful in the management of AML patients who relapse following allo-HCT. However, their use in this setting has not been well studied. We assessed one hundred and sixty two consecutive patients who underwent a first allo-HCT for AML at our center during a period when hypomethylating agent therapy was widely available (February 2005 through May 2013). Patient characteristics were: median age, 53 (range18-74); M=75, F=87; donor-matched-sibling (MRD) =59, matched-unrelated (MUD) =67, HLA-haploidentical (Haplo) =36; ablative conditioning=98, RICT/NST=64; PBSC=142, BM=20; CIBMTR risk category- high=53, intermediate=28, low=74, unknown=7. Post-relapse therapy was determined by the attending physician and patient preference. Patient characteristics, post-relapse therapy, GVHD and survival were prospectively collected as part of our comprehensive HCT database. With a median follow-up for surviving patients of 22.4 months, relapse of AML post-allo-HCT was experienced by fifty-five patients (22 MRD, 24 MUD, 9 Haplo; cytogenetic risk 23 poor, 31 intermediate, 1 unknown) at a median of 113 days (range 25-1106) post-transplant. Thirty-four patients (62%) were treated with a hypomethylating agent post-relapse (17 azacitidine, 10 decitabine, 7 both) (12 hypomethylating agent alone, 11 combined with chemotherapy, 11 sequentially with chemotherapy). Median number of cycles of hypomethylating agent therapy was 2 (range 1-9). Of the 23 patients that received at least 2 cycles of hypomethylating agents, 14 achieved CR or CRi. Donor lymphocyte infusions (DLI) were administered in 15 of the 55 relapsed patients and 16 patients received a second allo-HCT. Estimated Kaplan-Meier probability of post-relapse survival (PRS) at 6, 12 and 24 months post-relapse for all patients was 53%, 36% and 19% and was not significantly different for patients who developed any versus no GVHD following post-relapse therapy. However, PRS at 6 and 12 months was 62% (95% CI 43-76%) and 38% (95% CI 22-54%) in patients who received hypomethylating agent therapy post-relapse versus 38% (95% CI 18-58%) and 33% (95% CI 15-53%) in patients who did not (p=0.063 Gehan’s test). PRS was not different between the two groups at 24 months. Survival > 1 year post relapse was achieved in 19 of 55 relapsing patients (35%). Of these patients, 9 received a second allo-HCT, 9 received DLI and 12 were treated with a hypomethylating agent. At the time of writing 6 patients are alive and in complete remission at a median of 49 months (10-72) following relapse. Of the 6 patients (5 MRD, 1 MUD; cytogenetic risk 2 poor, 4 intermediate), 4 received hypomethylating agents, 3 received a second transplant, 1 received DLI, and 4 have active GVHD. These data demonstrate that relapse post allo-HCT remains a major obstacle to long-term survival in patients transplanted for AML. Hypomethylating agents can be used in the majority of relapsed patients in this setting and appear effective in inducing responses. The use of hypomethylating agents may be associated with a prolongation of early post-relapse survival although it does not appear to increase survival beyond one year post-relapse. Survival beyond one year post-relapse can be achieved even without a second allogeneic transplant, but is only achieved in a minority of relapsing patients. Combination of therapy with hypomethylating agents and novel agents may be necessary to impact long-term outcome. Disclosures: No relevant conflicts of interest to declare.

Results of Treatment with Tyrosine Kinase Inhibitors(TKIs) in Combination with Intensive Chemotherapy in Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia(Ph+ALL)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1503-1503
Author(s):  
Taiichi Kyo ◽  
Takeshi Okatani ◽  
Kouhei Kyo ◽  
Ryouta Imanaka ◽  
Mitsuhiro Itagaki ◽  
...  
Keyword(s):  
Present Report ◽  
Lymphoblastic Leukemia ◽  
Remission Induction ◽  
High Dose ◽  
Term Survival ◽  
Long Term Survival ◽  
Chemotherapy Group ◽  
First Choice ◽  
Induction Regimen

Abstract Abstract 1503 (Objective) The treatment outcome of patients with Ph+ ALL has significantly improved since the advent of TKIs such as imatinib and dasatinib. However, the long-term survival of these patients is not necessarily high when bone marrow transplantation (BMT) is not performed. The present study was aimed at developing an effective combination of a TKI and chemotherapy for long-term survival of patients with Ph+ ALL but ineligible for BMT. (Subjects and Methods) Forty-three consecutive patients (18 men, 25 women) with previously untreated Ph+ ALL who visited our hospital between June 2001 and February 2011 were treated. The age range was 13 to 84 years (median: 57), and 21 were 60 years or older. Measurement of BCR-ABL fusion transcript levels was performed immediately in these patients, and imatinib (IM) was started at 600 mg/body/day (given daily as a rule) as soon as the patient tested positive. A remission induction regimen (chemotherapy) used commonly in acute myeloblastic leukemia (AML) patients at our hospital was combined with TKIs in the first 14 patients. Another remission induction regimen often used in ALL patients at our hospital was then combined with TKIs in the subsequent 29 patients. The AML remission induction regimen used idarubicin (IDR) at 12 mg/m2 for 4 days, behenoyl-ara-C (BH-AC) at 350 mg/m2 for 10 days, and prednisolone (PSL) at 40 mg/body (P.O.) for 10 days. PSL was initially given at 100 mg/body (P.O.) and then gradually reduced in the ALL remission induction regimen. Vincristine (VCR) at 1.3 mg/m2 (Days 1, 8, 15, and 22), daunorubicin at 60 mg/m2 (Days 1, 2, and 3), cyclophosphamide at 1200 mg/m2 (Day 2), and L-asparaginase at 3000 μ/m2 (Days 11, 13, 16, 18, and 20) were administered. The remission induction therapies were given in a sterile room. Macrophage colony-stimulating factor was given for 7 days from Day 11 and granulocyte colony-simulating factor from Day 19. A post-remission therapy commonly administered to AML patients at our hospital was given after remission for 1 year (ASH, 2009, abstract, no. 1052). High-dose cytarabine (at 2 g/m2 BID for 5 days but at 1 g/m2 BID in patients aged 60 years or older) (HD-AC) and mitoxantrone (MIT) at 7 mg/m2 × 3 were initially administered after remission. Maintenance/consolidation therapy was given by alternating BH-AC at 350 mg/m2 × 4 + aclarubicin at 20 mg/body × 6 and BH-AC at 350 mg/m2 × 4 + IDR at 10 mg/m2 × 1 + VCR at 1.3 mg/m2 (each for 35 days). IM was given daily at 600 mg/day simultaneously with the post-remission therapy. Dasatinib was used in the post-remission therapy of 8 patients at 140 mg/day. All of the TKIs were given to patients for 3 years after completion of chemotherapy. (Results) Complete remission (CR) was achieved in 41/43 (95%). CR was achieved in 13 out of 14 (93%) patients treated with the AML regimen and 28 out of 29 (97%) treated with the ALL regimen. DIC occurred in 31/41 (76%) during remission induction therapy. The follow-ups of patients achieving CR lasted for 5 to 128 months (median: 24 months). Ten patients (aged 25 to 54 years [median: 37]) underwent BMT at first CR. Thirty-one patients (aged 13 to 84 years [median: 63]) were assigned to the chemotherapy group. The 10-year overall survival (OS) calculated by the Kaplan-Meier method was 57% for 41 patients who achieved CR, 66% for 20 patients younger than 60 years, and 49% for 21 patients aged 60 years or older. The OS was 80% for 10 patients who underwent BMT at first CR and 47% for 31 patients in the chemotherapy group. The 50% OS of the chemotherapy group was 36 months. The 10-year event-free survival (EFS) was 50% for patients who achieved CR, 80% for patients who underwent BMT at first CR, and 43% for the chemotherapy group. The 50% EFS of the chemotherapy group was 33 months. Fifteen patients have relapsed, and a new chromosomal aberration was observed at relapse in 11/13 (85%). (Discussion) The results of the present report indicate that BMT is the first choice for post-remission therapy of Ph+ ALL. Fifty percent of patients aged 60 years or older, who account for about half of the patients with Ph+ ALL, have achieved long-term survival with the prolonged TKI + chemotherapy used in the present report. Relapse was also rare among patients who received the combination and maintained CR for 3 years or longer. A combination of an appropriate TKI and a chemotherapy regimen as well as careful monitoring for complications is likely to further extend the survival of patients with Ph+ ALL. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Long Term Results for Childhood Acute Lymphoblastic Leukemia: An Institutional Review

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5161-5161
Author(s):  
Huirong Mai ◽  
Ximin Fang ◽  
Xiuli Yuan ◽  
Xiaodong Wang ◽  
Sixi Liu ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
Conflicts Of Interest ◽  
Lymphoblastic Leukemia ◽  
Severe Infection ◽  
Long Term Results ◽  
Term Survival ◽  
Institutional Review ◽  
Pediatric All

Abstract Objective s: To exam the outcomes of children with acute lymphoblastic leukemia (ALL) treated on Berlin-Frankfürt-Münster (BFM) International ALL- based protocol, GD 2008ALL protocol. Method s : In total, 274 patients with newly diagnosed ALL age 1 to 16 years were enrolled onto GD2008ALL protocol from July 1, 2008 to June 30, 2016. Five-year overall survival (OS) rates and even-free survival (EFS) rates were examined with additional analyses of causes of relapse and death. Results:The 5-year probabilities of OS and EFS were 90.8% and 86.9%. The 5-year EFS were 91.7% in SR group, 86.5% in IR group and 82.6% in HR group, respectively. Twenty-five patients were died. Reasons for mortality included 8 cases due to relapse of leukemia, seven cases due to severe infection, one case due to hepatic failure, one case due to intracranial hemorrhage from accident, eight cases abandoned after relapse. There were 29 cases relapsed, including 22 cases (75%) relapsed of the bone marrow alone, 1 case (3.6%) CNS relapsed alone, 2 cases (7.1%) testicular relapsed and 4 cases (14.3%) relapsed of bone marrow and extramedullary. Eleven patients survived after therapy for relapse, of which 7 had received HSCT, two out of the 7 had relapsed after HSCT, and continued on CART therapy. Four out of the 11 relapsed patients received relapsed ALLR3 protocol for treatment. All 11 patients remained in remission status. Conclusion:Our single institutional review of pediatric ALL treated on GD 2008ALL Protocol was tolerated and has good long term outcomes. Although relapse is a major factor affecting long term survival, there are still have options such as HSCT or immunotherapy available for these patients. Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document