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Hypofractionation and Concomitant Boost in Ductal Carcinoma In Situ (DCIS): Analysis of a Prospective Case Series with Long-Term Follow-Up. LIFE (BASEL, SWITZERLAND) 2022; 12:life12060889. [PMID: 35743920 PMCID: PMC9225308 DOI: 10.3390/life12060889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022]
Abstract
We previously reported on a cohort of breast cancer patients affected with ductal carcinoma in situ (DCIS) that were treated with breast conservative surgery and hypofractionated whole-breast radiotherapy with a concomitant boost to the lumpectomy cavity. We now report on the long-term results of the oncological and toxicity outcomes, at a median follow-up of 11.2 years. We also include an analysis of the predictive factors for local recurrence (LR). Eighty-two patients with long-term observation were considered for this report. All received hypofractionated post-operative radiotherapy with a concomitant boost (45 Gy/20 fractions to the whole breast and 50 Gy/20 fractions to the lumpectomy cavity). We report on LC rates at 5 and 10 years, overall survival (OS), and breast-cancer-specific survival (BCSS), employing the Kaplan–Meier method. Cox proportional regression analysis was used to determine the role of selected clinical parameters on the risk of local recurrence, by the univariate and multivariate models. After a median follow-up of 11.2 years (range 5–15 years), 9 pts (11%) developed LR. The LR rates at 5 years and 10 years were 2.4% and 8.2%, respectively. The 5- and 10-year overall survival rates were 98.8% and 91.6%, respectively. The 5- and 10-year breast-cancer-specific survival rates were 100.0% and 99.0%. Late skin and subcutaneous toxicities were generally mild, and cosmetic results were good–excellent for most patients. For the univariate regression analysis, ER positive status (HR; 95% CI, p = 0.021), PgR positive status (HR; 95% CI, p = 0.012), and the aggregate data of positive hormonal status (HR; 95% CI, p = 0.021) were inversely correlated to LR risk. Conversely, a high tumor grade (G3) was directly correlated with the risk of LR (HR; 95% CI, p = 0.048). For the multivariate regression analysis, a high tumor grade (G3) confirmed its negative impact on LR (HR 0.40; 95% CI 0.19–0.75, p = 0.047). Our long-term data demonstrate hypofractionated whole-breast radiotherapy with a concomitant boost to be feasable, effective, and tolerable. Our experience suggests positive hormonal status to be protective with respect to LR risk. A high tumor grade is a risk factor for LR.
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Yang Y, Zhao X, Wang X, Jin K, Luo J, Yang Z, Mei X, Ma J, Shao Z, Zhang Z, Chen X, Guo X, Yu X. Molecular subtypes predict second breast events of ductal carcinoma in situ after breast‐conserving surgery. Cancer Med 2022; 11:2755-2766. [PMID: 35598318 PMCID: PMC9302274 DOI: 10.1002/cam4.4651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/20/2022] [Accepted: 02/20/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Currently, the prognostic value of molecular subtypes in ductal carcinoma in situ (DCIS) remains unclear. In this study, we explored whether molecular subtypes could predict second breast events (SBEs) in patients after breast‐conserving surgery (BCS). Methods From January 2008 to December 2016, 291 DCIS patients treated with BCS were retrospectively analyzed. Patients were classified into four molecular subtypes: luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) overexpression, and triple‐negative breast cancer (TNBC). The SBE incidence was calculated by the competing risk model and compared by Gray's test. The disease‐free survival rates were estimated by the Kaplan–Meier method and compared by the log‐rank test. Prognostic factors were evaluated by univariate and multivariate COX proportional hazards regression model. Results With a median follow‐up of 66 months, 12 SBEs were identified. The 5‐year overall SBE incidence of luminal A, luminal B, HER2 overexpression, and TNBC was 2.18%, 4.25%, 15.15%, and 0.00%, respectively. In the univariate analysis, the HER2 overexpression subtype was the predictor of overall (p = 0.005), in situ (p = 0.004), and ipsilateral SBEs (p = 0.008). Patients with endocrine therapy were less likely to develop in situ SBEs (p = 0.039). Additionally, patients with closed (<2 mm) or involved margins were related to a higher risk of contralateral SBEs (p = 0.029). In the multivariate analysis, the HER2 overexpression subtype remained of prognostic values for overall (p = 0.006), in situ (p = 0.029), and ipsilateral SBEs (p = 0.012). Conclusions The molecular subtype, especially the HER2 overexpression subtype, was the independent prognostic factor for DCIS patients who underwent BCS.
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Affiliation(s)
- Yilan Yang
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Xu Zhao
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Xuanyi Wang
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Kairui Jin
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Jurui Luo
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Zhaozhi Yang
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Xin Mei
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Jinli Ma
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Zhimin Shao
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Department of Breast Surgery Fudan University Shanghai Cancer Center Shanghai China
| | - Zhen Zhang
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Xingxing Chen
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Xiaomao Guo
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Xiaoli Yu
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology, Shanghai Medical College Fudan University Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
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Wang Z, Zhang X, Ren H, Zhang L, Chen B. Multiple Metastases of the Liver and Lung After Breast-Conserving Surgery for Ductal Carcinoma In Situ Without Microinvasion of the Breast: A Case Report and Literature Review. Front Oncol 2022; 12:855899. [PMID: 35480092 PMCID: PMC9035873 DOI: 10.3389/fonc.2022.855899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
BackgroundDuctal carcinoma in situ (DCIS) is a non-invasive disease that rarely causes distant metastasis. It is extremely rare for patients diagnosed with DCIS without microinvasion to develop distant metastasis in the absence of ipsilateral or contralateral breast recurrence. This is the first case report of multiple liver and lung metastases from DCIS after breast-conserving surgery and radiotherapy.Case PresentationA 45-year-old woman who was diagnosed with DCIS and received breast-conserving surgery, radiotherapy, and sequential endocrine therapy developed multiple metastases in the liver and lung despite not having bilateral breast recurrence at the 62-month follow-up. Comprehensive advanced breast cancer therapy was administered but did not prevent the progression of metastatic foci in the liver.ConclusionsThis case shows the poor potential outcome in DCIS. Further research should be conducted on metastasis in DCIS; reexamination and monitoring are indispensable for patients diagnosed with DCIS.
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Affiliation(s)
| | | | | | - Lei Zhang
- *Correspondence: Bo Chen, ; Lei Zhang,
| | - Bo Chen
- *Correspondence: Bo Chen, ; Lei Zhang,
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Leonard CE, Tole SP, Turner MP, Bennett JP, Howell KT, Carter DL. Association of the 12-Gene Breast DCIS Score ® Assay With Local Recurrence in Patients With Ductal Carcinoma In Situ Treated on Accelerated Partial Breast Radiotherapy Protocols. Front Oncol 2021; 11:671047. [PMID: 34221987 PMCID: PMC8247917 DOI: 10.3389/fonc.2021.671047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background The following analysis explores clinicopathologic factors and the 12-gene Breast DCIS Score test result in order to better define an appropriate DCIS (ductal carcinoma in situ) population eligible for APBI (accelerated partial breast radiotherapy). Methods This exploratory analysis aimed to retrospectively measure the association between the 12-gene Oncotype DX Breast DCIS Score® assay (Redwood City, CA) and relevant clinicopathologic factors with locoregional recurrence in a pooled cohort of women treated with local excision and APBI on prospective phase II (NCT01185145) and phase III (NCT01185132) clinical trials. Univariable Cox proportional hazards regression was used to determine whether there was an association between local recurrence and DCIS Score result risk group (≥ 39 vs < 39) and clinicopathologic factors. Results This analysis included 104 evaluable patients (n = 18 from NCT01185145 and n = 86 from NCT01185132). The median age was 60 years (range: 40-79). Seventy-nine percent of patients were postmenopausal. The median span of DCIS was 10 mm (range 2-45 mm). Two-thirds of the cohort presented with necrosis (71%). The distribution of DCIS Score® results ranged from 0 to 82, with 69% of patients having a DCIS Score result < 39. The median follow-up time was 8.2 years in NCT01185145 versus 3.0 years in NCT01185132. There were 6 local ipsilateral breast recurrences. DCIS Score result was significantly associated with local recurrence in univariable modeling, hazard ratio = 10.3 (95% CI 1.7, 198.4); p = 0.010. None of the clinicopathologic characteristics resulted in any significant association with locoregional recurrence. Conclusion The Breast DCIS Score assay demonstrated risk stratification in this cohort of patients treated with local excision and APBI pooled from two clinical trials. These results are consistent with those recently published utilizing whole breast radiotherapy. Due to the small number of local recurrence events and limited follow-up time, further investigations are needed to confirm findings.
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Affiliation(s)
- Charles E Leonard
- Radiation Oncology, Rocky Mountain Cancer Centers, Littleton, CO, United States
| | - Shannon P Tole
- Radiation Oncology, Rocky Mountain Cancer Centers, Littleton, CO, United States
| | - Michelle P Turner
- Biostatistics, Exact Sciences Corporation, Redwood City, CA, United States
| | - John P Bennett
- Biostatistics, Exact Sciences Corporation, Redwood City, CA, United States
| | - Kathryn T Howell
- Radiation Oncology, Rocky Mountain Cancer Centers, Littleton, CO, United States
| | - Dennis L Carter
- Radiation Oncology, Rocky Mountain Cancer Centers, Aurora, CO, United States
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Comparing hypofractionated and conventionally fractionated whole breast irradiation for patients with ductal carcinoma in situ after breast conservation: a propensity score-matched analysis from a national multicenter cohort (COBCG-02 study). J Cancer Res Clin Oncol 2021; 147:2069-2077. [PMID: 33387035 DOI: 10.1007/s00432-020-03483-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/22/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Randomized trials confirmed the efficacy and the safety of hypofractionated whole breast irradiation (HF-WBI) in patients with early-stage breast cancer. However, the role of HF-WBI in patients with DCIS after breast conserving surgery has not yet been clearly established in prospective randomized trials. The aim of this study was to evaluate if HF-WBI can be considered comparable to conventionally fractionated (CF)-WBI in DCIS patients. MATERIALS AND METHODS The analysis included DCIS patients from four Italian centers treated with CF-WBI 50 Gy/25 fractions or HFRT 40.5 Gy/15 fractions, without tumor bed boost. A propensity score matching (PSM) analysis was performed using a logistic regression that considered age, grading, presence of necrosis, resection margin status and adjuvant endocrine therapy. RESULTS Five hundred twenty-seven patients was included (367 in the CF-WBI-group and 160 in the HR-WBI group). After 1:1 matching, 101 patients were allocated to the CF-WBI-group and 104 to the HF-WBI group. No correlation was observed between the type of RT schedule and LRFS (HR 1.68, 95% CI 0.82-3.45; p = 0.152). After PSM, no statistical difference was observed between the two RT group (HR 1.11, 95% CI 0.40-3.04; p = 0.833), with 3- and 5-years LRFS rates of 100% and 97.9% for CF-WBI and 95.6% and 94% for HF-WBI. CONCLUSION A short course of radiation therapy seems to be comparable to CF-WBI in terms of clinical outcomes. These data support the use of hypofractionated schedules in DCIS patients, but considering the remaining uncertainties.
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Cutuli B. [Ductal carcinoma in situ in 2019: Diagnosis, treatment, prognosis]. Presse Med 2019; 48:1112-1122. [PMID: 31653542 DOI: 10.1016/j.lpm.2019.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 08/28/2019] [Indexed: 12/27/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) currently represents up to 15% of the newly diagnosed breast cancers, and are almost always detected by microcalcifications. Global prognosis is good (3% of 15-year specific mortality) but invasive local recurrences (LR) can lead to metastasis in 12-15% of the cases. Breast conserving surgery with whole breast irradiation is the main treatment (reducing LR by 50%), but mastectomy (with or without reconstruction) is performed in about 30% of the cases due to wide lesion size and/or multicentricity. The role of tamoxifen remains unclear. Axillary dissection is needless but sentinel node biopsy is proposed in case of micro-invasion suspicion (large lesions with high grade). The main factors of LR are young age (≤40 years) incomplete excision, and high nuclear grade with comedonecrosis. Several studies on "therapeutic descalation" are still ongoing in order to identify the "low risk" DCIS (about 10% of the cases) in which radiotherapy could be safely omitted.
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MESH Headings
- Age Factors
- Antineoplastic Agents, Hormonal/therapeutic use
- Biopsy
- Breast/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/etiology
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/etiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Combined Modality Therapy/methods
- Conservative Treatment
- Diagnostic Imaging/methods
- Female
- Humans
- Lymph Node Excision/trends
- Mastectomy
- Neoplasm Recurrence, Local/diagnosis
- Prognosis
- Radiotherapy
- Risk Factors
- Tamoxifen/therapeutic use
- Time Factors
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Affiliation(s)
- Bruno Cutuli
- Institut du cancer Courlancy Reims, 38, rue du Courlancy, 51100 Reims, France.
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Abstract
OBJECTIVE Ductal carcinoma in situ (DCIS) has the potential to progress to invasive carcinoma. The optimal management of DCIS and methods for individualizing treatment of DCIS are still being determined. This evidence map depicts the robustness and topical span of research on DCIS management choice on patient-centered and clinical outcomes. METHODS We searched PubMed, EMBASE, PsycINFO, PubMed Health, PROSPERO, and clinical practice guideline sites to identify systematic reviews of DCIS management options and consulted with topic experts. A bubble plot visualizes the literature volume and research content for patient-centered outcomes. An online decision tree facilitates discussions with patients and guides through the available evidence. RESULTS In total, 40 systematic reviews met inclusion criteria. The research syntheses addressed DCIS management options, including the role of magnetic resonance imaging, axillary surgery/sentinel lymph node biopsy, and excisional biopsy. The map shows existing evidence for mutually exclusive treatment options including active surveillance, breast-conserving surgery, nipple sparing mastectomy, and simple mastectomy. Research findings for intraoperative radiation, adjuvant radiation therapy, adjuvant hormone therapy, hypofractionation radiotherapy, accelerated partial breast irradiation, radiation therapy plus boost, and combined radiation and hormone therapy, as well as for breast reconstruction after mastectomy and surveillance mammography postsurgery are also displayed. The evidence map highlights a scarcity of robust evidence on patient-centered outcomes. CONCLUSIONS The evidence map provides an overview of DCIS research showing the range of management options and remaining decisional dilemmas that follow a diagnosis of DCIS. It maps the evidence in accessible tools to guide practice and future research. : Video Summary:http://links.lww.com/MENO/A448.
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Corradini S, Krug D, Meattini I, Fastner G, Matuschek C, Cutuli B. Challenges in Radiotherapy. Breast Care (Basel) 2019; 14:152-158. [PMID: 31316313 DOI: 10.1159/000500847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 01/06/2023] Open
Affiliation(s)
- Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Tomasson MH, Ali M, De Oliveira V, Xiao Q, Jethava Y, Zhan F, Fitzsimmons AM, Bates ML. Prevention Is the Best Treatment: The Case for Understanding the Transition from Monoclonal Gammopathy of Undetermined Significance to Myeloma. Int J Mol Sci 2018; 19:E3621. [PMID: 30453544 PMCID: PMC6274834 DOI: 10.3390/ijms19113621] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/06/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma is an invariably fatal cancer of plasma cells. Despite tremendous advances in treatment, this malignancy remains incurable in most individuals. We postulate that strategies aimed at prevention have the potential to be more effective in preventing myeloma-related death than additional pharmaceutical strategies aimed at treating advanced disease. Here, we present a rationale for the development of prevention therapy and highlight potential target areas of study.
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Affiliation(s)
- Michael H Tomasson
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Mahmoud Ali
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Vanessa De Oliveira
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Qian Xiao
- Department of Health Human Physiology, University of Iowa, Iowa City, IA 52242, USA.
| | - Yogesh Jethava
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Fenghuang Zhan
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Adam M Fitzsimmons
- Graduate Program in Molecular Medicine, University of Iowa, Iowa City, IA 52242, USA.
| | - Melissa L Bates
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
- Department of Health Human Physiology, University of Iowa, Iowa City, IA 52242, USA.
- Stead Family Department of Pediatrics, University of Iowa, Iowa, IA 52242, USA.
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