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Chang L, Wei Y, Qu Y, Zhao M, Zhou X, Long Y, Hashimoto K. Role of oxidative phosphorylation in the antidepressant effects of arketamine via the vagus nerve-dependent spleen-brain axis. Neurobiol Dis 2024; 199:106573. [PMID: 38901783 DOI: 10.1016/j.nbd.2024.106573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 06/22/2024] Open
Abstract
Arketamine, the (R)-enantiomer of ketamine, exhibits antidepressant-like effects in mice, though the precise molecular mechanisms remain elusive. It has been shown to reduce splenomegaly and depression-like behaviors in the chronic social defeat stress (CSDS) model of depression. This study investigated whether the spleen contributes to the antidepressant-like effects of arketamine in the CSDS model. We found that splenectomy significantly inhibited arketamine's antidepressant-like effects in CSDS-susceptible mice. RNA-sequencing analysis identified the oxidative phosphorylation (OXPHOS) pathway in the prefrontal cortex (PFC) as a key mediator of splenectomy's impact on arketamine's effects. Furthermore, oligomycin A, an inhibitor of the OXPHOS pathway, reversed the suppressive effects of splenectomy on arketamine's antidepressant-like effects. Specific genes within the OXPHOS pathways, such as COX11, UQCR11 and ATP5e, may contribute to these inhibitory effects. Notably, transforming growth factor (TGF)-β1, along with COX11, appears to modulate the suppressive effects of splenectomy and contribute to arketamine's antidepressant-like effects. Additionally, SRI-01138, an agonist of the TGF-β1 receptor, alleviated the inhibitory effects of splenectomy on arketamine's antidepressant-like effects. Subdiaphragmatic vagotomy also counteracted the inhibitory effects of splenectomy on arketamine's antidepressant-like effects in CSDS-susceptible mice. These findings suggest that the OXPHOS pathway and TGF-β1 in the PFC play significant roles in the antidepressant-like effects of arketamine, mediated through the spleen-brain axis via the vagus nerve.
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Affiliation(s)
- Lijia Chang
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba 260-8670, Japan; Basic Medicine Research Innovation Center for Cardiometabolic Diseases, Ministry of Education, Southwest Medical University, Luzhou, 646000, China
| | - Yan Wei
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba 260-8670, Japan; Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Youge Qu
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba 260-8670, Japan
| | - Mingming Zhao
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba 260-8670, Japan
| | - Xiangyu Zhou
- Basic Medicine Research Innovation Center for Cardiometabolic Diseases, Ministry of Education, Southwest Medical University, Luzhou, 646000, China; Department of Thyroid and Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China
| | - Yang Long
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, Sichuan 646000, China; Experimental Medicine Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba 260-8670, Japan.
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Primary Arterial Hypertension and Drug-Induced Hypertension in Philadelphia-Negative Classical Myeloproliferative Neoplasms: A Systematic Review. Biomedicines 2023; 11:biomedicines11020388. [PMID: 36830925 PMCID: PMC9952891 DOI: 10.3390/biomedicines11020388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
The impact of primary arterial hypertension (HTN) in myeloproliferative neoplasms (MPNs) remains unclear, with scant literature available, mostly focusing on cardiovascular risk factors as a singular entity or on organ-specific HTN. Furthermore, available studies reporting findings on drug-induced HTN in MPNs report varying and contradictory findings. In consideration of the above, this study set out to systematically review the available literature and shed light on the occurrence of HTN in MPNs, its association with thrombosis, as well as the drugs used in MPN management that could increase blood pressure. The literature search yielded 598 potentially relevant records of which 315 remained after the duplicates (n = 283) were removed. After we screened the titles and the abstracts of these publications, we removed irrelevant papers (n = 228) and evaluated the full texts of 87 papers. Furthermore, 13 records did not meet the inclusion criteria and were excluded from the systematic review. Finally, a total of 74 manuscripts were entered into the qualitative synthesis and included in the present systematic review. Our systematic review highlights that HTN is the most common comorbidity encountered in MPNs, with an impact on both the occurrence of thrombosis and survival. Moreover, drug-induced HTN remains a challenge in the management of MPNs. Further research should investigate the characteristics of patients with MPNs and HTN, as well as clarify the contribution of HTN to the development of thrombotic complications, survival and management in MPNs. In addition, the relationship between clonal hematopoiesis of indeterminate potential, HTN, cardiovascular disease and MPNs requires examination in upcoming assessments.
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Ritchie E, Al-Janadi A, Kessler C, Scherber R, Kalafut T, Ren H, Mesa R. Patient-reported outcomes of patients with myelofibrosis or essential thrombocythemia enrolled in the MOST study. Leuk Lymphoma 2022; 63:3138-3153. [PMID: 36205505 DOI: 10.1080/10428194.2022.2113531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The Myelofibrosis and Essential Thrombocythemia Observational STudy (MOST; NCT02953704) is an ongoing, noninterventional study assessing clinical characteristics and patient-reported outcomes (PROs) of patients with myelofibrosis (MF) or essential thrombocythemia (ET). This analysis assessed PROs at enrollment; symptom burden and quality of life (QoL), work productivity, and activity were assessed using validated questionnaires in patients with low- or intermediate-1-risk (age-alone) MF, or high- or low-risk ET (receiving ET-directed therapy) at enrollment. In MF and ET cohorts, fatigue had highest mean symptom score. Women had higher mean total symptom scores (TSS), mean symptom scores, and reduced QoL versus men. In patients with MF, mean TSS and symptom scores were similar between risk groups. Patients with low-risk ET had higher mean TSS and symptom scores than patients with high-risk ET. In conclusion, patients with lower risk MF and low- or high-risk ET experience significant symptom burden affecting QoL and ability to work.
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Affiliation(s)
- Ellen Ritchie
- Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, USA
| | | | - Craig Kessler
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Robyn Scherber
- Incyte Corporation, Wilmington, DE, USA.,UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | | | - Haobo Ren
- Incyte Corporation, Wilmington, DE, USA
| | - Ruben Mesa
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
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Gerds AT, Lyons RM, Colucci P, Kalafut P, Paranagama D, Verstovsek S. Disease and Clinical Characteristics of Patients With a Clinical Diagnosis of Myelofibrosis Enrolled in the MOST Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e532-e540. [PMID: 35256316 DOI: 10.1016/j.clml.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Clinical characteristics and treatment patterns of patients with lower-risk myelofibrosis (MF) are not well described. This analysis from the MOST (NCT02953704) assessed the demographic and clinical characteristics and treatment patterns of patients with the clinical diagnosis of lower-risk MF at enrollment. PATIENTS AND METHODS MOST is an ongoing, prospective, observational study in patients with clinical diagnoses of MF or essential thrombocythemia enrolled at clinical practices throughout the United States. Patients included in the MF cohort (≥18 years of age) had low-risk MF by the Dynamic International Prognostic Scoring System or intermediate-1 (INT-1) risk MF (by age >65 years only) at enrollment. Patient data were entered into an electronic case report form during usual-care visits over a planned 36 month observation period. RESULTS Two hundred five patients were eligible for this analysis (low risk, n = 85; INT-1 risk, n = 120; median age, 68 years [range, 35-88]); 166 patients (81.0%) had mutation testing results available. The median time from MF diagnosis to enrollment was 1.8 years. Hemoglobin and hematocrit levels were below the normal range in 50.5% and 48.7% of patients, respectively. Nearly all (98.0%) patients had comorbid conditions, most commonly hypertension (49.8%). Fatigue was the most common physician-reported MF symptom (30.7%). At enrollment, 55.6% of patients were receiving MF-directed monotherapy, most frequently hydroxyurea (46.5%) or ruxolitinib (40.4%). CONCLUSION Future longitudinal analyses of data from MOST will help identify unmet needs and characterize how patients with lower-risk MF are managed throughout the disease course.
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Affiliation(s)
- Aaron T Gerds
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH.
| | - Roger M Lyons
- Texas Oncology and US Oncology Research, San Antonio, TX
| | | | | | | | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bradford A, Young K, Whitechurch A, Burbury K, Pearson EJM. Disabled, invisible and dismissed-The lived experience of fatigue in people with myeloproliferative neoplasms. Cancer Rep (Hoboken) 2022; 6:e1655. [PMID: 35705529 PMCID: PMC9875604 DOI: 10.1002/cnr2.1655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 05/03/2022] [Accepted: 05/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myeloproliferative neoplasms (MPNs) are rare haematological cancers. Several studies report the most common MPN symptom leading to reduced quality of life is fatigue. Yet, how fatigue affects the lives of people with MPN is not well described. AIMS The purpose of this qualitative study is to better understand the lived experience of fatigue associated with MPN. METHODS AND RESULTS People with MPN who had experienced fatigue were invited to complete an online survey and if eligible, then to participate in semi-structured interviews and focus groups, exploring their experiences of fatigue. Thematic analysis of interview transcripts by two researchers produced themes describing the lived experience of fatigue. Twenty-three people with MPN participated in seven interviews and four focus groups. Qualitative data revealed how fatigue significantly affected participants' experiences of functional, social, family and emotional wellbeing. Participants reported that fatigue was infrequently acknowledged or addressed by health professionals, and a lack of information or support to manage their fatigue. Four themes including 12 sub-themes describe the experience of fatigue in MPN: (1) the distress of the MPN diagnosis, (2) sensations of fatigue, (3) daily life and emotional burden with fatigue and (4) how people managed their fatigue with limited guidance. CONCLUSION Fatigue in MPN is common, debilitating and distressing. It affects all aspects of health, wellbeing and life. Health professionals could affect patients' lives substantially by acknowledging and understanding fatigue in MPN, including contributing factors and potential opportunities for management. More systematic data describing the causes and management of MPN fatigue is needed.
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Affiliation(s)
- Ashleigh Bradford
- Department of Health Services and Implementation Research | Department of Nursing | Department of Clinical HematologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Clinical Pathology | The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Ken Young
- MPN Alliance AustraliaSandringhamVictoriaAustralia
| | - Ashley Whitechurch
- Department of Health Services and Implementation Research | Department of Nursing | Department of Clinical HematologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Kate Burbury
- Department of Health Services and Implementation Research | Department of Nursing | Department of Clinical HematologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Clinical Pathology | The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Elizabeth Jane M. Pearson
- Department of Health Services and Implementation Research | Department of Nursing | Department of Clinical HematologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Clinical Pathology | The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
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Lee MW, Yeon SH, Ryu H, Song IC, Lee HJ, Yun HJ, Kim SY, Lee JE, Shin KS, Jo DY. Volumetric Splenomegaly in Patients With Polycythemia Vera. J Korean Med Sci 2022; 37:e87. [PMID: 35315598 PMCID: PMC8938613 DOI: 10.3346/jkms.2022.37.e87] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Non-palpable splenomegaly in patients with polycythemia vera (PV) has seldom been addressed. In this retrospective study, we evaluated non-palpable, volumetric splenomegaly defined based on age- and body surface area (BSA)-matched criteria in patients with PV diagnosed according to the 2016 World Health Organization diagnostic criteria. METHODS Patients with PV who underwent abdominal computed tomography (CT) and who had palpable splenomegaly at diagnosis from January 1991 to December 2020 at Chungnam National University Hospital were enrolled. The spleen volume of each patient was determined by volumetric analysis of abdominal CT and adjusted for the patient's age and BSA. Then the degree of splenomegaly was classified as no splenomegaly, borderline volumetric splenomegaly, overt volumetric splenomegaly, or palpable splenomegaly. RESULTS Of the 87 PV patients enrolled, 15 (17.2%) had no splenomegaly, whereas 17 (19.5%), 45 (51.7%), and 10 (11.5%) had borderline volumetric, overt volumetric, and palpable splenomegaly, respectively. The degree of splenomegaly did not affect the cumulative incidence of thrombotic vascular events (10-year incidence: 7.7%, 0%, 22.3%, and 50.7%, respectively, P = 0.414). By contrast, splenomegaly tended to adversely affect myelofibrotic transformation (10-year cumulative incidence: 0%, 0%, 7.1%, and 30.3%, respectively, P = 0.062). Moreover, the cumulative incidence of myelofibrotic transformation was significantly higher in patients with overt volumetric or palpable splenomegaly than those with no or borderline volumetric splenomegaly (10-year incidence: 0% vs. 10.3%, respectively; 15-year incidence: 0% vs. 26.3%, respectively, P = 0.020). Overall survival (OS) differed among patients with different degrees of splenomegaly (15-year OS: 100%, 78.6%, 71.7%, and 51.9%, respectively, P = 0.021). CONCLUSION The degree of splenomegaly, including volumetric splenomegaly, based on age- and BSA-matched reference spleen volumes at diagnosis reflects disease progression in PV patients. Therefore, volumetric splenomegaly should be evaluated at the time of diagnosis and taken into consideration when predicting the prognosis of patients with PV.
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Affiliation(s)
- Myung-Won Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sang-Hoon Yeon
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyewon Ryu
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ik-Chan Song
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyo-Jin Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hwan-Jung Yun
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seon Young Kim
- Department of Laboratory Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jeong Eun Lee
- Department of Radiology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyung Sook Shin
- Department of Radiology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Deog-Yeon Jo
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
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Cheung V, Siddiq N, Devlin R, McNamara C, Gupta V. Modèle de soins partagés pour les hémopathies malignes chroniques complexes. Can Oncol Nurs J 2021; 31:175-185. [PMID: 34036156 DOI: 10.5737/23688076312175185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Les néoplasies myéloprolifératives (NMP) sont des leucémies chroniques rares sans chromosome Philadelphie. L’expertise de cette maladie peu commune est limitée et concentrée dans des centres spécialisés où les patients doivent se rendre pour obtenir confirmation du diagnostic, prendre des décisions complexes, recevoir des soins de soutien et accéder à de nouveaux médicaments par la participation à des essais cliniques. Toutefois, les nombreux déplacements nécessaires pour ces rendez-vous représentent un poids pour les patients; ils augmentent le fardeau financier, accroissent le stress des proches aidants et nuisent à la qualité de vie. Pour s’attaquer à ce problème, le programme du Centre de cancérologie Princess Margaret (PM) dédié aux NMP a mis en place un modèle de soins partagés et a misé sur la collaboration avec les équipes soignantes locales afin d’offrir aux patients atteints de NMP une prise en charge continue et des soins de soutien plus accessibles. Ainsi, les patients se déplacent moins et reçoivent des soins de qualité axés sur leurs besoins. Le présent article décrit l’expérience de mise en œuvre du modèle de soins partagés au Centre Princess Margaret, expérience qui pourrait s’étendre à d’autres hémopathies malignes chroniques et maladies chroniques rares. L’objectif ultime des soins partagés n’est pas de centraliser les services, mais plutôt de bâtir une communauté de soins accessibles pour le patient.
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Affiliation(s)
- Verna Cheung
- infirmière clinicienne spécialisée, Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
| | - Nancy Siddiq
- en éducation, infirmière praticienne (adultes), Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
| | - Rebecca Devlin
- collaboratrice scientifique, programme des NMP Elizabeth and Tony Comper, Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
| | - Caroline McNamara
- hématologue titulaire, Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
| | - Vikas Gupta
- professeur de médecine, Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
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Cheung V, Siddiq N, Devlin R, McNamara C, Gupta V. Shared-care model for complex chronic haematological malignancies. Can Oncol Nurs J 2021; 31:165-174. [PMID: 34036155 DOI: 10.5737/23688076312165174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Myeloproliferative neoplasms (MPNs) are a group of rare Philadelphia-negative chronic leukemias. Disease rarity has resulted in limited expertise concentrated in specialist centres. Patients are often referred to such expert centres for diagnostic issues, complex decision-making, access to novel drugs through clinical trials, and supportive care. Attending such appointments may increase financial and travel burden, increase caregiver stress, and negatively impact quality of life. To address this, the MPN program at Princess Margaret (PM) Cancer Centre has implemented a shared-care model, working with local healthcare providers to provide ongoing management, and supportive care for MPN patients closer to home. This decreases patient travel burden, while maintaining high-quality patient-centered care. In this article we share our experience implementing the shared-care model. This model is potentially applicable to other chronic hematological malignancies and rare chronic diseases. The ultimate goal of shared-care is not to centralize care, but instead to build a community of accessible care for the patient.
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Affiliation(s)
- Verna Cheung
- Clinical Nurse Specialist, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Nancy Siddiq
- MSN in Education Nurse Practitioner (Adult), Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Rebecca Devlin
- Scientific Associate, The Elizabeth and Tony Comper MPN Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Caroline McNamara
- Staff Hematologist, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Vikas Gupta
- Professor of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
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Patient-reported Effects of Fedratinib, an Oral, Selective Inhibitor of Janus Kinase 2, on Myelofibrosis-related Symptoms and Health-related Quality of Life in the Randomized, Placebo-controlled, Phase III JAKARTA Trial. Hemasphere 2021; 5:e553. [PMID: 33969273 PMCID: PMC8096463 DOI: 10.1097/hs9.0000000000000553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022] Open
Abstract
Patients with myelofibrosis (MF) experience an array of symptoms that impair health-related quality of life (HRQoL). Fedratinib, an oral, selective Janus-kinase 2 (JAK2) inhibitor, was investigated in the randomized, placebo-controlled, phase III JAKARTA study in adult patients with intermediate- or high-risk JAK-inhibitor-naïve MF. The effect of fedratinib 400 mg/d on patient-reported MF symptoms and HRQoL in JAKARTA was assessed. Participants completed the modified Myelofibrosis Symptom Assessment Form (MFSAF v2.0), which evaluates 6 key MF symptoms (night sweats, early satiety, pruritus, pain under ribs on the left side, abdominal discomfort, bone/muscle pain). The modified MFSAF v2.0 was completed during the first 6 treatment cycles and at end of cycle 6 (EOC6). Symptom response was a ≥50% improvement from baseline in total symptom score (TSS). Overall HRQoL was assessed by EQ-5D-3L health utility index (HUI) score. The MFSAF-evaluable population comprised 91/96 patients randomized to fedratinib 400 mg and 85/96 patients randomized to placebo. Mean baseline TSS was 17.6 and 14.7 for fedratinib and placebo, respectively, and mean EQ-5D-3L HUI was 0.70 and 0.72. Fedratinib elicited statistically significant and clinically meaningful improvements in TSS from baseline versus placebo at all postbaseline visits. Symptom response rates at EOC6 were 40.4% with fedratinib and 8.6% with placebo (OR 7.0 [95% CI, 2.9-16.9]; P < 0.001), and a significantly higher proportion of fedratinib-treated patients achieved clinically meaningful improvement from baseline on the EQ-5D-3L HUI at EOC6 (23.2% versus 6.5%; P = 0.002). Fedratinib provided clinically meaningful improvements in MF symptoms and overall HRQoL versus placebo in patients with JAK-inhibitor-naïve MF.
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Guaraná M, Soares A, Daumas A, Biasoli I, Solza C. Myeloproliferative Neoplasm Symptom Assessment Form - Total Symptom Score (MPN-SAF TSS) questionnaire: translation, cultural adaptation and validation to Brazilian Portuguese. Hematol Transfus Cell Ther 2021; 44:321-327. [PMID: 33483290 PMCID: PMC9477756 DOI: 10.1016/j.htct.2020.10.966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/03/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Constitutional symptoms and thrombohemorrhagic events are common in patients with myeloproliferative neoplasms (MPNs). Hence, the treatment’s primary goal is to control symptoms and improve the quality of life (QoL). In order to assess response to therapy, symptom burden, and QoL among patients with MPN, the “Myeloproliferative Neoplasm Symptom Assessment Form - Total Symptom Score (MPN-SAF TSS)” questionnaire was developed in the USA in 2012. Herein, we translated and validated the MPN-SAF TSS questionnaire to Brazilian Portuguese. Methods The ten-item questionnaire was translated from the English language and its psychometric properties (reliability, convergent and construct validities) were evaluated in 101 MPN patients. Results There were 41 patients with essential thrombocythemia, 39 with myelofibrosis and 21 with polycythemia vera. The median age of all patients at diagnosis was 68 years and 59% were female. The Cronbach's alpha coefficient for the overall questionnaire was 0.78, ranging from 0.73 to 0.79, if each item was deleted. Validity analyses showed that the strongest item-item correlation were between early satiety and abdominal discomfort. Strong correlations were also found between physician and patient perceptions of itching (r = 0.81) and fatigue (r = 0.70). The Pearson coefficient correlation between the MPN-SAF TSS global score and the EORTC QLQ-C30 functional scales ranged from 0.51 to 0.64. The exploratory factor analysis showed that seven of the ten symptoms loaded into one single factor. Conclusion The Brazilian Portuguese version of the MPN-SAF-TSS showed good psychometric properties and can be an available tool to assess symptom burden in this group of patients.
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Affiliation(s)
- Mariana Guaraná
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Andréa Soares
- Faculdade de Ciências Médicas, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adelmo Daumas
- Faculdade de Medicina, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Irene Biasoli
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Cristiana Solza
- Faculdade de Ciências Médicas, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Health-Related Quality of Life in Patients with Philadelphia-Negative Myeloproliferative Neoplasms: A Nationwide Population-Based Survey in Denmark. Cancers (Basel) 2020; 12:cancers12123565. [PMID: 33260633 PMCID: PMC7760411 DOI: 10.3390/cancers12123565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/04/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The aim of this research was to investigate the health-related quality of life (HRQoL) in patients with Philadelphia-negative myeloproliferative neoplasms (chronic blood cancers) in Denmark. A nationwide questionnaire survey covering functioning, symptom burden, symptom profile, QoL, and lifestyle was performed. Patients registered in the National Patient Register with a diagnosis of Philadelphia-negative myeloproliferative neoplasm were invited. A total of 2228 patients participated in the survey and these could be divided into groups of participants with different subtypes of Phildelphia-negative myeloproliferative neoplasms. The HRQoL across groups of participants with different subtypes of the disease was compared, and the HRQoL of all participants and the general population was compared in order to investigate for a potential difference. The participants reported their HRQoL to be inferior to the general population, but the difference was minor. The differences in HRQoL across groups of participants with different subtypes of the disease were subtle. Fatigue and sexual problems were prevalent and burdensome. Participants reported a slightly healthier lifestyle than the general population. Understanding HRQoL of these patients is a necessity to be able to provide the best treatment and rehabilitation activities. Abstract Previous studies have clarified that many patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) have burdensome symptom profiles and accordingly impaired functioning and quality of life (QoL). In Denmark, all MPN patients are affiliated with public hospitals and because of a healthcare system financed by taxpayers these patients do not have any financial costs related to the hematological disease. Diagnoses are recorded for all patients in hospitals, and diagnosis codes are communicated to the National Patient Register (NPR). Owing to this, it was possible to contribute to the elucidation of Philadelphia-negative MPN patients’ health-related quality of life (HRQoL), by conducting a nationwide, population-based, cross-sectional HRQoL survey of these patients with cost-free access to the best available, suitable medical treatment. The survey contained validated questionnaires covering functioning, symptom burden, symptom profile, QoL, and additional questions on lifestyle. Information on comorbid diagnoses was obtained from the NPR. The participants’ HRQoL was compared to the general population. Moreover, differences in HRQoL across essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN participants were investigated, adjusted for age, sex, comorbidity, and lifestyle. To the best of our knowledge this is the first survey of HRQoL in patients with unclassifiable MPN. A total of 2228 Philadelphia-negative MPN patients participated. The participants reported their HRQoL to be inferior to the general population, but the difference was minor. The differences in HRQoL across groups of participants with different MPN subtypes were subtle. Fatigue and sexual problems were prevalent and burdensome. Overall, participants reported a slightly healthier lifestyle compared to the general population.
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Mendez Luque LF, Blackmon AL, Ramanathan G, Fleischman AG. Key Role of Inflammation in Myeloproliferative Neoplasms: Instigator of Disease Initiation, Progression. and Symptoms. Curr Hematol Malig Rep 2020; 14:145-153. [PMID: 31119475 DOI: 10.1007/s11899-019-00508-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Chronic inflammation is a characteristic feature of myeloproliferative neoplasm (MPN) and impacts many aspects of the disease including initiation, progression, and symptomatology. RECENT FINDINGS The chronic inflammatory state of MPN results from disruption of immune signaling pathways leading to overproduction of inflammatory cytokines by both the neoplastic clones and bystander immune cells. This chronic inflammation may allow for the neoplastic clone to gain a selective advantage. The symptomatic burden felt by MPN patients may be a result of the chronic inflammation associated with MPN, as several cytokines have been linked with different symptoms. Pharmacologic as well as nonpharmacologic treatments of the inflammatory component of this disease may lead to decreased symptomatic burden, prevention of disease progression, and improvement in overall disease trajectory. Inflammation plays a key role in the pathogenesis of MPN and represents an important therapeutic target.
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Affiliation(s)
- Laura F Mendez Luque
- Department of Biological Chemistry, University of California Irvine, 839 Medical Sciences Rd, Sprague Hall 126, Irvine, CA, 92617, USA
| | - Amanda L Blackmon
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine, 839 Medical Sciences Rd, Sprague Hall 126, Irvine, CA, 92617, USA
| | - Gajalakshmi Ramanathan
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine, 839 Medical Sciences Rd, Sprague Hall 126, Irvine, CA, 92617, USA
| | - Angela G Fleischman
- Department of Biological Chemistry, University of California Irvine, 839 Medical Sciences Rd, Sprague Hall 126, Irvine, CA, 92617, USA. .,Division of Hematology/Oncology, Department of Medicine, University of California Irvine, 839 Medical Sciences Rd, Sprague Hall 126, Irvine, CA, 92617, USA. .,Chao Family Comprehensive Cancer Center, University of California Irvine, 839 Medical Sciences Rd, Sprague Hall 126, Irvine, CA, 92617, USA.
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Marcellino BK, Verstovsek S, Mascarenhas J. The Myelodepletive Phenotype in Myelofibrosis: Clinical Relevance and Therapeutic Implication. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:415-421. [DOI: 10.1016/j.clml.2020.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/12/2020] [Accepted: 01/17/2020] [Indexed: 12/14/2022]
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Poluben L, Puligandla M, Neuberg D, Bryke CR, Hsu Y, Shumeiko O, Yuan X, Voznesensky O, Pihan G, Adam M, Fraenkel E, Rasnic R, Linial M, Klymenko S, Balk SP, Fraenkel PG. Characteristics of myeloproliferative neoplasms in patients exposed to ionizing radiation following the Chernobyl nuclear accident. Am J Hematol 2019; 94:62-73. [PMID: 30295334 DOI: 10.1002/ajh.25307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022]
Abstract
Myeloproliferative neoplasms (MPNs) driver mutations are usually found in JAK2, MPL, and CALR genes; however, 10%-15% of cases are triple negative (TN). A previous study showed lower rate of JAK2 V617F in primary myelofibrosis patients exposed to low doses of ionizing radiation (IR) from Chernobyl accident. To examine distinct driver mutations, we enrolled 281 Ukrainian IR-exposed and unexposed MPN patients. Genomic DNA was obtained from peripheral blood leukocytes. JAK2 V617F, MPL W515, types 1- and 2-like CALR mutations were identified by Sanger Sequencing and real time polymerase chain reaction. Chromosomal alterations were assessed by oligo-SNP microarray platform. Additional genetic variants were identified by whole exome and targeted sequencing. Statistical significance was evaluated by Fisher's exact test and Wilcoxon's rank sum test (R, version 3.4.2). IR-exposed MPN patients exhibited a different genetic profile vs unexposed: lower rate of JAK2 V617F (58.4% vs 75.4%, P = .0077), higher rate of type 1-like CALR mutation (12.2% vs 3.1%, P = .0056), higher rate of TN cases (27.8% vs 16.2%, P = .0366), higher rate of potentially pathogenic sequence variants (mean numbers: 4.8 vs 3.1, P = .0242). Furthermore, we identified several potential drivers specific to IR-exposed TN MPN patients: ATM p.S1691R with copy-neutral loss of heterozygosity at 11q; EZH2 p.D659G at 7q and SUZ12 p.V71 M at 17q with copy number loss. Thus, IR-exposed MPN patients represent a group with distinct genomic characteristics worthy of further study.
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Affiliation(s)
- Larysa Poluben
- Division of Hematology/Oncology Cancer Research Institute, Beth Israel Deaconess Medical Center Boston Massachusetts
- National Research Center for Radiation Medicine Kyiv Ukraine
| | | | - Donna Neuberg
- Dana‐Farber/Harvard Cancer Center Boston Massachusetts
| | - Christine R. Bryke
- Division of Clinical Pathology Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Yahsuan Hsu
- Division of Clinical Pathology Beth Israel Deaconess Medical Center Boston Massachusetts
| | | | - Xin Yuan
- Division of Hematology/Oncology Cancer Research Institute, Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Olga Voznesensky
- Division of Hematology/Oncology Cancer Research Institute, Beth Israel Deaconess Medical Center Boston Massachusetts
| | - German Pihan
- Division of Clinical Pathology Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Miriam Adam
- Department of Biological Engineering Massachusetts Institute of Technology Cambridge Massachusetts
| | - Ernest Fraenkel
- Department of Biological Engineering Massachusetts Institute of Technology Cambridge Massachusetts
| | - Roni Rasnic
- School of Computer Science and Engineering & Department of Biological Chemistry Hebrew University Jerusalem Israel
| | - Michal Linial
- School of Computer Science and Engineering & Department of Biological Chemistry Hebrew University Jerusalem Israel
| | - Sergiy Klymenko
- National Research Center for Radiation Medicine Kyiv Ukraine
| | - Steven P. Balk
- Division of Hematology/Oncology Cancer Research Institute, Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Paula G. Fraenkel
- Division of Hematology/Oncology Cancer Research Institute, Beth Israel Deaconess Medical Center Boston Massachusetts
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Low-dose splenic irradiation is an alternative therapy for symptomatic splenomegaly in patients with myelofibrosis. Ann Hematol 2018; 98:1037-1040. [DOI: 10.1007/s00277-018-3461-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
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Pedersen KM, Zangger G, Brochmann N, Grønfeldt BM, Zwisler AD, Hasselbalch HC, Tang LH. The effectiveness of exercise-based rehabilitation to patients with myeloproliferative neoplasms-An explorative study. Eur J Cancer Care (Engl) 2018; 27:e12865. [DOI: 10.1111/ecc.12865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/26/2018] [Accepted: 04/21/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Kasper Mønsted Pedersen
- Department of Hematology; Zealand University Hospital; University of Copenhagen; Roskilde Denmark
| | - Graziella Zangger
- Danish Knowledge Centre for Rehabilitation and Palliative Care; University of Southern Denmark; Nyborg Denmark
| | - Nana Brochmann
- Department of Hematology; Zealand University Hospital; University of Copenhagen; Roskilde Denmark
| | - Birk Mygind Grønfeldt
- Danish Knowledge Centre for Rehabilitation and Palliative Care; University of Southern Denmark; Nyborg Denmark
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care; University of Southern Denmark; Nyborg Denmark
| | - Hans Carl Hasselbalch
- Department of Hematology; Zealand University Hospital; University of Copenhagen; Roskilde Denmark
| | - Lars Hermann Tang
- Danish Knowledge Centre for Rehabilitation and Palliative Care; University of Southern Denmark; Nyborg Denmark
- Bachelor’s Degree Program in Physiotherapy; Department of Rehabilitation and Nutrition; Faculty of Health and Technology; Metropolitan University College; Copenhagen Denmark
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Zimran E, Hoffman R, Kremyanskaya M. Current approaches to challenging scenarios in myeloproliferative neoplasms. Expert Rev Anticancer Ther 2018; 18:567-578. [PMID: 29575945 DOI: 10.1080/14737140.2018.1457441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) including polycythemia vera, essential thrombocythemia and primary myelofibrosis are clonal hematological malignancies that originate at the level of the hematopoietic stem cell, and are characterized by excessive proliferation of cells belonging to one or more of the myeloid lineages. Central to the pathogenesis of the MPNs is constitutive activation of the JAK/STAT signaling pathway due to a family of driver mutations affecting JAK2, CALR or MPL. These disorders share common clinical and laboratory features, a significant burden of systemic symptoms, increased risk of developing arterial and venous thrombotic events, and the potential to progress to myelofibrosis and acute leukemia. Areas covered: We identified four clinical situations which represent challenging management dilemmas for patients with MPNs. Our conclusions and recommendations are based on a literature search using MEDLINE and recent meeting abstracts using the keywords, focusing on publications directly addressing these scenarios and on recent contributions to the field. Expert commentary: Multi-center efforts to study large cohorts of MPN patients have led to more uniform and evidence-based approaches to key aspects in MPN management. However, treatment strategies to deal with specific clinical scenarios are lacking.
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Affiliation(s)
- Eran Zimran
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
| | - Ronald Hoffman
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
| | - Marina Kremyanskaya
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
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Bartoszko J, Panzarella T, McNamara CJ, Lau A, Schimmer AD, Schuh AC, Sibai H, Maze D, Yee KWL, Devlin R, Gupta V. Distribution and Impact of Comorbidities on Survival and Leukemic Transformation in Myeloproliferative Neoplasm-Associated Myelofibrosis: A Retrospective Cohort Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:774-781. [PMID: 28711573 DOI: 10.1016/j.clml.2017.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We sought to describe the distribution and impact of comorbidities on outcomes in patients with myelofibrosis, a disease characterized by aberrant bone marrow function with eventual fibrosis. Comorbidities were scored using the Adult Comorbidity Evaluation-27 (ACE-27) and the Hematopoietic Cell Transplant Comorbidity Index (HCT-CI), in which a score ≥ 3 indicates severe comorbidities. PATIENTS AND METHODS We conducted a retrospective study of 306 patients with a confirmed diagnosis of myelofibrosis. Patients were seen from 1999 to 2014 with a median follow-up of 2 years. Multivariable Cox proportional hazards models were constructed to assess the impact of comorbidities on overall survival and leukemic transformation from the date of presentation to our center. A series of descriptive analyses were performed examining the distribution of comorbidities captured by the scales. RESULTS On multivariable survival analysis, an ACE-27 score of 3 was associated with an almost twofold increase in the risk of all-cause death (hazard ratio [HR] 1.95; 95% confidence interval [CI], 1.06-3.58; P = .03) compared with a lower score of 0 to 1. An HCT-CI score ≥ 3 was marginally significantly associated with an increased risk of all-cause death (HR 1.60; 95% CI 0.96-2.68; P = .07). ACE-27 captured a greater spectrum of cardiovascular and venous thrombotic disease. No impact of comorbidities on leukemic transformation was observed. CONCLUSIONS Although the presence of severe comorbidities was lower when assessed by ACE-27 (13%) compared with HCT-CI (23%), and the spectrums of comorbidities captured were different, the overall impact of severe comorbidities as assessed by both scales appears to be similar and associated with a survival disadvantage.
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Affiliation(s)
- Justyna Bartoszko
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tony Panzarella
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Jane McNamara
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthea Lau
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Aaron D Schimmer
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andre C Schuh
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hassan Sibai
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dawn Maze
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Karen W L Yee
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Devlin
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Vikas Gupta
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
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Brochmann N, Flachs EM, Christensen AI, Andersen CL, Juel K, Hasselbalch HC, Zwisler AD. A nationwide population-based cross-sectional survey of health-related quality of life in patients with myeloproliferative neoplasms in Denmark (MPNhealthSurvey): survey design and characteristics of respondents and nonrespondents. Clin Epidemiol 2017; 9:141-150. [PMID: 28280390 PMCID: PMC5338855 DOI: 10.2147/clep.s117587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The Department of Hematology, Zealand University Hospital, Denmark, and the National Institute of Public Health, University of Southern Denmark, created the first nationwide, population-based, and the most comprehensive cross-sectional health-related quality of life (HRQoL) survey of patients with myeloproliferative neoplasms (MPNs). In Denmark, all MPN patients are treated in public hospitals and treatments received are free of charge for these patients. Therefore, MPN patients receive the best available treatment to the extent of its suitability for them and if they wish to receive the treatment. The aims of this article are to describe the survey design and the characteristics of respondents and nonrespondents. MATERIAL AND METHODS Individuals with MPN diagnoses registered in the Danish National Patient Register (NPR) were invited to participate. The registers of the Danish Civil Registration System and Statistics Denmark provided information regarding demographics. The survey contained 120 questions: validated patient-reported outcome (PRO) questionnaires and additional questions addressing lifestyle. RESULTS A total of 4,704 individuals were registered with MPN diagnoses in the NPR of whom 4,236 were eligible for participation and 2,613 (62%) responded. Overall, the respondents covered the broad spectrum of MPN patients, but patients 70-79 years old, living with someone, of a Danish/Western ethnicity, and with a higher level of education exhibited the highest response rate. CONCLUSION A nationwide, population-based, and comprehensive HRQoL survey of MPN patients in Denmark was undertaken (MPNhealthSurvey). We believe that the respondents broadly represent the MPN population in Denmark. However, the differences between respondents and nonrespondents have to be taken into consideration when examining PROs from the respondents. The results of the investigation of the respondents' HRQoL in this survey will follow in future articles.
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Affiliation(s)
- Nana Brochmann
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde
| | | | | | | | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen
| | - Hans Carl Hasselbalch
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
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Mascarenhas JO, Talpaz M, Gupta V, Foltz LM, Savona MR, Paquette R, Turner AR, Coughlin P, Winton E, Burn TC, O'Neill P, Clark J, Hunter D, Assad A, Hoffman R, Verstovsek S. Primary analysis of a phase II open-label trial of INCB039110, a selective JAK1 inhibitor, in patients with myelofibrosis. Haematologica 2016; 102:327-335. [PMID: 27789678 DOI: 10.3324/haematol.2016.151126] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/17/2016] [Indexed: 12/24/2022] Open
Abstract
Combined Janus kinase 1 (JAK1) and JAK2 inhibition therapy effectively reduces splenomegaly and symptom burden related to myelofibrosis but is associated with dose-dependent anemia and thrombocytopenia. In this open-label phase II study, we evaluated the efficacy and safety of three dose levels of INCB039110, a potent and selective oral JAK1 inhibitor, in patients with intermediate- or high-risk myelofibrosis and a platelet count ≥50×109/L. Of 10, 45, and 32 patients enrolled in the 100 mg twice-daily, 200 mg twice-daily, and 600 mg once-daily cohorts, respectively, 50.0%, 64.4%, and 68.8% completed week 24. A ≥50% reduction in total symptom score was achieved by 35.7% and 28.6% of patients in the 200 mg twice-daily cohort and 32.3% and 35.5% in the 600 mg once-daily cohort at week 12 (primary end point) and 24, respectively. By contrast, two patients (20%) in the 100 mg twice-daily cohort had ≥50% total symptom score reduction at weeks 12 and 24. For the 200 mg twice-daily and 600 mg once-daily cohorts, the median spleen volume reductions at week 12 were 14.2% and 17.4%, respectively. Furthermore, 21/39 (53.8%) patients who required red blood cell transfusions during the 12 weeks preceding treatment initiation achieved a ≥50% reduction in the number of red blood cell units transfused during study weeks 1-24. Only one patient discontinued for grade 3 thrombocytopenia. Non-hematologic adverse events were largely grade 1 or 2; the most common was fatigue. Treatment with INCB039110 resulted in clinically meaningful symptom relief, modest spleen volume reduction, and limited myelosuppression.
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Affiliation(s)
| | - Moshe Talpaz
- University of Michigan Cancer Center, Ann Arbor, MI, USA
| | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lynda M Foltz
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Michael R Savona
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Elliott Winton
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | | | | | | | | | - Ronald Hoffman
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Srdan Verstovsek
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Harrison CN, Talpaz M, Mead AJ. Ruxolitinib is effective in patients with intermediate-1 risk myelofibrosis: a summary of recent evidence. Leuk Lymphoma 2016; 57:2259-67. [PMID: 27463690 PMCID: PMC4975083 DOI: 10.1080/10428194.2016.1195501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Ruxolitinib is the only therapy with an approved indication for myelofibrosis (MF), a myeloproliferative neoplasm associated with progressive bone marrow fibrosis and extramedullary hematopoiesis. Although the pivotal phase 3 COMFORT studies included only patients with intermediate-2 or high-risk MF, the US indication includes all patients with intermediate- or high-risk disease. Data from recent nonrandomized studies confirm that the benefits of ruxolitinib established in the COMFORT studies in terms of spleen size reduction and symptom improvement also extend to patients with intermediate-1 risk MF, who tend to have less advanced disease than patients with higher-risk MF. Given the disease-modifying potential of ruxolitinib therapy, timely initiation of ruxolitinib therapy may not only improve patients' current clinical status but also lead to better long-term outcomes. The decision of whether or when to initiate ruxolitinib treatment should be based on the expected benefit-risk ratio for each patient, specifically considering potential adverse effects.
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Affiliation(s)
- Claire N Harrison
- a Department of Haematology , Guy's and St. Thomas' NHS Foundation Trust , London , UK
| | - Moshe Talpaz
- b Comprehensive Cancer Center , University of Michigan , Ann Arbor , MI , USA
| | - Adam J Mead
- c MRC Weatherall Institute of Molecular Medicine and NIHR Biomedical Research Centre , University of Oxford , Oxford , UK
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Sultan S, Irfan SM. Primary Idiopathic Myelofibrosis: Clinico-Epidemiological Profile and Risk Stratification in Pakistani Patients. Asian Pac J Cancer Prev 2016; 16:8629-31. [DOI: 10.7314/apjcp.2015.16.18.8629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Scherber RM, Kosiorek HE, Senyak Z, Dueck AC, Clark MM, Boxer MA, Geyer HL, McCallister A, Cotter M, Van Husen B, Harrison CN, Mesa RA. Comprehensively understanding fatigue in patients with myeloproliferative neoplasms. Cancer 2015; 122:477-85. [DOI: 10.1002/cncr.29753] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/25/2015] [Accepted: 09/04/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Robyn M. Scherber
- Division of Hematology and Medical Oncology, Mayo Clinic; Scottsdale Arizona
- Department of Hematology and Oncology; Oregon Health and Science University; Portland Oregon
| | | | - Zhenya Senyak
- MPN Forum, MPN Research Foundation; Chicago Illinois
| | | | - Matthew M. Clark
- Department of Psychiatry and Psychology; Mayo Clinic; Rochester Minnesota
| | | | - Holly L. Geyer
- Division of Hematology and Medical Oncology, Mayo Clinic; Scottsdale Arizona
| | | | - Mary Cotter
- MPN Forum, MPN Research Foundation; Chicago Illinois
| | | | - Claire N. Harrison
- Guy's and St Thomas' NHS Foundation Trust; London United Kingdom
- MPN Voice; London United Kingdom
| | - Ruben A. Mesa
- Division of Hematology and Medical Oncology, Mayo Clinic; Scottsdale Arizona
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Sultan S, Irfan SM. JAK-2 V617F Mutational Analysis in Primary Idiopathic Myelofibrosis: Experience from Southern Pakistan. Asian Pac J Cancer Prev 2015; 16:7889-92. [PMID: 26625816 DOI: 10.7314/apjcp.2015.16.17.7889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary idiopathic myelofibrosis (PMF) is a clonal Ph-chromosome negative myeloproliferative neoplasm characterized by dysregulated kinase signaling and release of abnormal cytokines. In the recent past, following JAK2 V617F mutation invention, important revolution has been made in the molecular diagnostic biology of this disease. The rational of this study was to determine the mutational status of JAK2 V617F in Pakistan patients with PMF. MATERIALS AND METHODS In this cross sectional study, 20 patients with PMF were enrolled from January 2011 to December 2014. Diagnosis was based on WHO criteria for PMF. All patients were screened for G-T point mutation (V617F) in the JAK2 gene on chromosome 9 by allele specific PCR. RESULTS The mean age was 57.9 ± 16.5 years. The male to female ratio was 3:1. The frequency of JAK2 V617F positivity in our PMF patients was found to be 55%. Positive correlations of JAK2 V617F mutation were established with high TLC count, raised LDH and marked splenomegaly (P<0.05). No correlation of JAK2 V617F could be established with age and gender (P>0.05). CONCLUSIONS The JAK2 V617F mutation frequency in our PMF patients was similar to those reported previously. In our hands JAK2 V617F mutated patients expressed an aggressive disease phenotype. Screening for the mutation in all suspected PMF cases could be beneficial in differentiating patients with reactive and clonal marrow fibrosis.
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Affiliation(s)
- Sadia Sultan
- Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College, Karachi, Pakistan E-mail :
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Knight EA, Osunsuyi-Fagbemi S, Neely J. Managing Patients With Myelofibrosis in the Era of Janus Kinase Inhibitors. J Adv Pract Oncol 2015; 6:532-50. [PMID: 27648344 PMCID: PMC5017545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Emily A Knight
- 1Mayo Clinic, Scottsdale, Arizona; 2Winship Cancer Institute at Emory University, Atlanta, Georgia
| | - Sylvia Osunsuyi-Fagbemi
- 1Mayo Clinic, Scottsdale, Arizona; 2Winship Cancer Institute at Emory University, Atlanta, Georgia
| | - Jessica Neely
- 1Mayo Clinic, Scottsdale, Arizona; 2Winship Cancer Institute at Emory University, Atlanta, Georgia
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Anderson LA, James G, Duncombe AS, Mesa R, Scherber R, Dueck AC, de Vocht F, Clarke M, McMullin MF. Myeloproliferative neoplasm patient symptom burden and quality of life: evidence of significant impairment compared to controls. Am J Hematol 2015; 90:864-70. [PMID: 26113113 DOI: 10.1002/ajh.24098] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 01/14/2023]
Abstract
The myeloproliferative neoplasms (MPN) including polycythaemia vera (PV), essential thrombocythaemia and primary myelofibrosis (PMF) are rare diseases contributing to significant morbidity. Symptom management is a prime treatment objective but current symptom assessment tools have not been validated compared to the general population. The MPN-symptom assessment form (MPN-SAF), a reliable and validated clinical tool to assess MPN symptom burden, was administered to MPN patients (n = 106) and, for the first time, population controls (n = 124) as part of a UK case-control study. Mean symptom scores were compared between patients and controls adjusting for potential confounders. Mean patient scores were compared to data collected by the Mayo Clinic, USA on 1,446 international MPN patients to determine patient group representativeness. MPN patients had significantly higher mean scores than controls for 25 of the 26 symptoms measured (P < 0.05); fatigue was the most common symptom (92.4% and 78.1%, respectively). Female MPN patients suffered worse symptom burden than male patients (P < 0.001) and substantially worse burden than female controls (P < 0.001). Compared to the Mayo clinic patients, MPN-UK patients reported similar symptom burden but lower satiety (P = 0.046). Patients with PMF reported the worst symptom burden (88.3%); significantly higher than PV patients (P < 0.001). For the first time we report quality of life was worse in MPN-UK patients compared with controls (P < 0.001).
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Affiliation(s)
- Lesley A. Anderson
- Centre for Public Health; Queen's University Belfast; Belfast Northern Ireland
| | - Glen James
- Centre for Public Health; Queen's University Belfast; Belfast Northern Ireland
| | - Andrew S. Duncombe
- Department of Haematology; University Hospitals Southampton NHS Foundation Trust; Hampshire United Kingdom
| | - Ruben Mesa
- Mayo Clinic Cancer Centre; Scottsdale Arizona
| | | | | | - Frank de Vocht
- School of Social and Community Medicine; University of Bristol; Bristol United Kingdom
| | - Mike Clarke
- Centre for Public Health; Queen's University Belfast; Belfast Northern Ireland
| | - Mary F. McMullin
- Centre for Cancer Research and Cell Biology; Queen's University Belfast; Belfast Northern Ireland
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Scherber R, Mesa RA. Survival and new cancers with myeloproliferative neoplasms. Lancet Haematol 2015; 2:e272-e273. [PMID: 26688382 DOI: 10.1016/s2352-3026(15)00109-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Robyn Scherber
- Mayo Clinic, Hematology and Oncology, Scottsdale, AZ 85259, USA
| | - Ruben A Mesa
- Mayo Clinic, Hematology and Oncology, Scottsdale, AZ 85259, USA.
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Mesa RA, Scherber RM, Geyer HL. Reducing symptom burden in patients with myeloproliferative neoplasms in the era of Janus kinase inhibitors. Leuk Lymphoma 2015; 56:1989-99. [PMID: 25644746 DOI: 10.3109/10428194.2014.983098] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) are clonal stem cell-derived malignancies that include primary myelofibrosis, polycythemia vera and essential thrombocythemia and are characterized by dysregulated Janus kinase-signal transducers and activators of transcription (JAK-STAT) signaling. Clinical manifestations include splenomegaly, cytopenias and/or systemic inflammation. Patients have a heterogeneous symptom profile that includes fatigue, loss of appetite, pruritus and night sweats, which significantly impact quality of life (QoL) and lead to poor survival outcomes. With the introduction of JAK inhibitors, improvement in disease-related symptoms has emerged as a realistic expectation of therapy and an integral measure of clinical efficacy. The JAK1/JAK2 inhibitor ruxolitinib is approved for the treatment of myelofibrosis and is currently under clinical development for polycythemia vera. Ruxolitinib has demonstrated significant reductions in symptom burden, with consequent improvements in QoL measures. With the potential to improve QoL, recognition of the impact and burden of symptoms on patients with MPNs is critical.
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