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Ueki Y, Ohshima S, Omata J, Yokoyama Y, Takahashi T, Shodo R, Yamazaki K, Horii A. Role of eosinophilia in patients with recurrent/metastatic head and neck squamous cell carcinoma treated with nivolumab: Prediction of immune-related adverse events and favorable outcome. Cancer Med 2023; 12:20810-20820. [PMID: 37902133 PMCID: PMC10709726 DOI: 10.1002/cam4.6648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Immune-related adverse events (irAEs) are prognostic factors for patients on nivolumab. However, predictors of irAEs have not yet been identified. We aimed to investigate the predictors of irAEs occurrence and nivolumab discontinuation due to irAEs. METHODS Sixty-two patients with recurrent/metastatic head and neck squamous cell carcinoma received nivolumab therapy between June 2017 and December 2020. Treatment outcome was compared between the groups with or without irAEs. The irAE (+) group was further divided by nivolumab discontinuation. Progression-free survival (PFS) and overall survival (OS) were compared between the groups. Predictors of irAE occurrence were analyzed. RESULTS Twenty-one patients (33.9%) developed irAEs, and six (28.6%) discontinued nivolumab due to severe irAEs. The irAE (+) group had significantly longer PFS and OS than the irAE (-) group (median PFS, 12.7 vs. 1.9 months; median OS, 33.1 vs. 12.8 months). The treatment outcomes in the discontinuation group were comparable to those in the non-discontinuation group. The maximum absolute eosinophil count (AEC) during nivolumab therapy was significantly higher in the irAE (+) group than in the irAE (-) group (548.8 vs. 182) and higher in the discontinuation group than in the non-discontinuation group (729.3 vs. 368.6). The receiver operating characteristic curve showed that the maximum AEC had a moderate-to-high accuracy for predicting irAE occurrence (area under the curve [AUC], 0.757) and nivolumab discontinuation (AUC, 0.893). DISCUSSION Monitoring AEC during nivolumab therapy may be useful in predicting irAE occurrence, nivolumab discontinuation, and disease prognosis.
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Affiliation(s)
- Yushi Ueki
- Department of Otolaryngology Head and Neck SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Shusuke Ohshima
- Department of Otolaryngology Head and Neck SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Jo Omata
- Department of Otolaryngology Head and Neck SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Yusuke Yokoyama
- Department of Otolaryngology Head and Neck SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Takeshi Takahashi
- Department of Otolaryngology Head and Neck SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Ryusuke Shodo
- Department of Otolaryngology Head and Neck SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Keisuke Yamazaki
- Department of Otolaryngology Head and Neck SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Arata Horii
- Department of Otolaryngology Head and Neck SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
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Shaikh S, Nagendra L, Shaikh S, Pappachan JM. Adrenal Failure: An Evidence-Based Diagnostic Approach. Diagnostics (Basel) 2023; 13:diagnostics13101812. [PMID: 37238296 DOI: 10.3390/diagnostics13101812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
The diagnosis of adrenal insufficiency (AI) requires a high index of suspicion, detailed clinical assessment including detailed drug history, and appropriate laboratory evaluation. The clinical characteristics of adrenal insufficiency vary according to the cause, and the presentation may be myriad, e.g. insidious onset to a catastrophic adrenal crisis presenting with circulatory shock and coma. Secondary adrenal insufficiency (SAI) often presents with only glucocorticoid deficiency because aldosterone production, which is controlled by the renin angiotensin system, is usually intact, and rarely presents with an adrenal crisis. Measurements of the basal serum cortisol at 8 am (<140 nmol/L or 5 mcg/dL) coupled with adrenocorticotrophin (ACTH) remain the initial tests of choice. The cosyntropin stimulation (short synacthen) test is used for the confirmation of the diagnosis. Newer highly specific cortisol assays have reduced the cut-off points for cortisol in the diagnosis of AI. The salivary cortisol test is increasingly being used in conditions associated with abnormal cortisol binding globulin (CBG) levels such as pregnancy. Children and infants require lower doses of cosyntropin for testing. 21-hydoxylase antibodies are routinely evaluated to rule out autoimmunity, the absence of which would require secondary causes of adrenal insufficiency to be ruled out. Testing the hypothalamic-pituitary-adrenal (HPA) axis, imaging, and ruling out systemic causes are necessary for the diagnosis of AI. Cancer treatment with immune checkpoint inhibitors (ICI) is an emerging cause of both primary AI and SAI and requires close follow up. Several antibodies are being implicated, but more clarity is required. We update the diagnostic evaluation of AI in this evidence-based review.
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Affiliation(s)
- Salomi Shaikh
- KGN Diabetes and Endocrine Centre, Mumbai 400001, India
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research Center, Mysore 570015, India
| | - Shehla Shaikh
- Department of Endocrinology, Saifee Hospital, Mumbai 400004, India
| | - Joseph M Pappachan
- Department of Endocrinology & Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, UK
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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Mehra T, Dongre K, Boesing M, Frei P, Suenderhauf C, Zippelius A, Leuppi JD, Wicki A, Leuppi-Taegtmeyer AB. Pre-treatment comorbidities, C-reactive protein and eosinophil count, and immune-related adverse events as predictors of survival with checkpoint inhibition for multiple tumour entities. Cancer Med 2023. [PMID: 37084178 DOI: 10.1002/cam4.5919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The development of immune-related adverse events (irAEs) may be associated with clinical efficacy of checkpoint inhibitors (CPIs) in patients with cancer. We therefore investigated the effect of irAEs and pre-treatment parameters on outcome in a large, real-life patient cohort. METHODS We performed a single-centre, retrospective, observational study including patients who received CPIs from 2011 to 2018 and followed until 2021. The primary outcome was overall survival, and the secondary outcome was the development of irAEs. RESULTS In total, 229 patients with different tumour entities (41% non-small cell lung cancer [NSCLC], 29% melanoma) received a total of 282 CPI treatment courses (ipilimumab, nivolumab, pembrolizumab or atezolizumab). Thirty-four percent of patients developed irAEs (of these 17% had CTCAE Grade ≥3). Factors independently associated with mortality were pre-treatment CRP ≥10 mg/L (hazard ratio [HR] 2.064, p = 0.0003), comorbidity measured by Charlson comorbidity index (HR 1.149, p = 0.014) and irAEs (HR 0.644, p = 0.036) (age-adjusted, n = 216). Baseline eosinophil count ≤0.2 × 109 /L was a further independent predictor of mortality (age-, CRP-, CCI- and irAE-adjusted HR = 2.252, p = 0.002, n = 166). Anti-CTLA-4 use (p < 0.001), and pre-treatment CRP <10 mg/L were independently associated with irAE occurrence (p = 0.037). CONCLUSIONS We found an independent association between irAE occurrence and improved overall survival in a real-life cohort spanning multiple tumour entities and treatment regimens. Pre-treatment comorbidities, CRP and eosinophil count represent potential markers for predicting treatment response.
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Affiliation(s)
- Tarun Mehra
- Department of Oncology, Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
- Department of Oncology & Hematology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - Kanchan Dongre
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Patient Safety, University Hospital Basel, Basel, Switzerland
| | - Maria Boesing
- Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
| | - Patricia Frei
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Claudia Suenderhauf
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alfred Zippelius
- Department of Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Joerg D Leuppi
- Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
| | - Andreas Wicki
- Department of Oncology, Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
- Department of Oncology & Hematology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Patient Safety, University Hospital Basel, Basel, Switzerland
- Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
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Predictive Biomarkers for Immune-Related Endocrinopathies following Immune Checkpoint Inhibitors Treatment. Cancers (Basel) 2023; 15:cancers15020375. [PMID: 36672324 PMCID: PMC9856539 DOI: 10.3390/cancers15020375] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
In recent years, in the context of the increase in the life expectancy of cancer patients, special attention has been given to immunotherapy and, indeed, to immune checkpoint inhibitors. The use of immune checkpoint inhibitors has increased rapidly, and approximately 40% of cancer patients are eligible for this treatment. Although their impact is valuable on cancer treatment, immune checkpoint inhibitors come with side effects, known as immune-related adverse effects. These can affect many systems, including cutaneous, musculoskeletal, cardiovascular, gastrointestinal, endocrine, neural, and pulmonary systems. In this review, we focus on immune-related endocrinopathies that affect around 10% of all treated patients. Endocrine dysfunctions can manifest as hypophysitis, thyroid dysfunction, hypoparathyroidism, insulin-deficient diabetes mellitus, and primary adrenal insufficiency. Currently, there are multiple ongoing clinical trials that aim to identify possible predictive biomarkers for immune-related adverse effects. The design of those clinical trials relies on collecting a variety of biological specimens (tissue biopsy, blood, plasma, saliva, and stool) at baseline and regular intervals during treatment. In this review, we present the predictive biomarkers (such as antibodies, hormones, cytokines, human leukocyte antigens, and eosinophils) that could potentially be utilized in clinical practice in order to predict adverse effects and manage them appropriately.
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Zhou J, Du Z, Fu J, Yi X. Blood cell counts can predict adverse events of immune checkpoint inhibitors: A systematic review and meta-analysis. Front Immunol 2023; 14:1117447. [PMID: 36960068 PMCID: PMC10029759 DOI: 10.3389/fimmu.2023.1117447] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
Background Cancer is concerning owing to its high mortality rate. Consequently, methods of prolonging the life of patients with cancer have become the primary focus of attention research. In recent years, immune checkpoint inhibitors (ICIs) have achieved good clinical efficacy as antitumor drugs; however, their severe adverse effects have made their use challenging. In order to clarify the predictors of adverse effects, scientists have conducted a series of studies. Blood counts can potentially monitor risk factors associated with the occurrence of immune-related adverse events (irAEs). Herein, a meta-analysis was performed to clarify further the guiding significance of blood counts in the clinical setting. Methods Studies that satisfied the inclusion criteria were obtained by searching the database. Included studies were those in which irAEs had been observed, and evidence of an association between blood counts and irAEs was reported. The included ones were evaluated for quality. In addition to sensitivity analysis and subgroup analysis, a meta-analysis was performed using the odds ratio (OR) and 95% confidence interval (CI) for each study. Results A total of 18 articles were included in our study. The analyses were performed separately according to different blood cell count indicators. The blood cell count metrics associated with irAEs were: absolute eosinophil count, neutrophil: lymphocyte ratio, and platelet: lymphocyte ratio. Conclusion Our review and meta-analysis of studies suggest that absolute eosinophil count, neutrophil: lymphocyte ratio, and platelet: lymphocyte ratio may serve as predictors of the emergence of irAEs. Given the small number of studies focusing on the relationship between patient blood cell counts and the risk of irAEs, future studies need to further explore the mechanisms of occurrence and potential associations.
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Affiliation(s)
- Juyue Zhou
- Graduate Institute, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zhonghai Du
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
- *Correspondence: Zhonghai Du,
| | - Jie Fu
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
| | - Xiuxiu Yi
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
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Tomizawa H, Yamada Y, Arima M, Miyabe Y, Fukuchi M, Hikichi H, Melo RCN, Yamada T, Ueki S. Galectin-10 as a Potential Biomarker for Eosinophilic Diseases. Biomolecules 2022; 12:biom12101385. [PMID: 36291593 PMCID: PMC9599181 DOI: 10.3390/biom12101385] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Galectin-10 is a member of the lectin family and one of the most abundant cytoplasmic proteins in human eosinophils. Except for some myeloid leukemia cells, basophils, and minor T cell populations, galectin-10 is exclusively present in eosinophils in the human body. Galectin-10 forms Charcot–Leyden crystals, which are observed in various eosinophilic diseases. Accumulating studies have indicated that galectin-10 acts as a new biomarker for disease activity, diagnosis, and treatment effectiveness in asthma, eosinophilic esophagitis, rhinitis, sinusitis, atopic dermatitis, and eosinophilic granulomatosis with polyangiitis. The extracellular release of galectin-10 is not mediated through conventional secretory processes (piecemeal degranulation or exocytosis), but rather by extracellular trap cell death (ETosis), which is an active cell death program. Eosinophils undergoing ETosis rapidly disintegrate their plasma membranes to release the majority of galectin-10. Therefore, elevated galectin-10 levels in serum and tissue suggest a high degree of eosinophil ETosis. To date, several studies have shown that galectin-10/Charcot–Leyden crystals are more than just markers for eosinophilic inflammation, but play functional roles in immunity. In this review, we focus on the close relationship between eosinophils and galectin-10, highlighting this protein as a potential new biomarker in eosinophilic diseases.
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Affiliation(s)
- Hiroki Tomizawa
- Clinical Laboratory Medicine, Department of General Internal Medicine, Akita University Graduate School of Medicine, Akita 010-8543, Japan
- Department of Otorhinolaryngology, Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Yoshiyuki Yamada
- Department of Pediatrics, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Misaki Arima
- Clinical Laboratory Medicine, Department of General Internal Medicine, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Yui Miyabe
- Clinical Laboratory Medicine, Department of General Internal Medicine, Akita University Graduate School of Medicine, Akita 010-8543, Japan
- Department of Otorhinolaryngology, Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Mineyo Fukuchi
- Clinical Laboratory Medicine, Department of General Internal Medicine, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Haruka Hikichi
- Clinical Laboratory Medicine, Department of General Internal Medicine, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Rossana C. N. Melo
- Laboratory of Cellular Biology, Department of Biology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora 36036-900, MG, Brazil
| | - Takechiyo Yamada
- Department of Otorhinolaryngology, Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Shigeharu Ueki
- Clinical Laboratory Medicine, Department of General Internal Medicine, Akita University Graduate School of Medicine, Akita 010-8543, Japan
- Correspondence: ; Tel./Fax: +81-18-884-6209
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Hino C, Nishino K, Pham B, Jeon WJ, Nguyen M, Cao H. Nivolumab plus ipilimumab induced endocrinopathy and acute interstitial nephritis in metastatic sarcomatoid renal-cell carcinoma: A case report and review of literature. Front Immunol 2022; 13:993622. [PMID: 36052087 PMCID: PMC9425087 DOI: 10.3389/fimmu.2022.993622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
The prognosis of sarcomatoid renal cell carcinoma has changed dramatically with the emergence of immune checkpoint inhibitors. Notably the use of nivolumab and ipilimumab combination therapy has demonstrated promising durable therapeutic response for patients with treatment-naïve sarcomatoid renal-cell carcinoma. We present a case of 45-year-old man with a history of metastatic sarcomatoid renal cell carcinoma treated with nivolumab plus ipilimumab who developed type 1 diabetes mellitus, adrenal insufficiency, thyroiditis/hypothyroidism, and acute interstitial nephritis as a result of immunotherapy.
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Affiliation(s)
- Christopher Hino
- Department of Internal Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Kevin Nishino
- Department of Internal Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Bryan Pham
- Department of Internal Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Won Jin Jeon
- Department of Internal Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Michael Nguyen
- Department of Oncology/Hematology, Department of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Huynh Cao
- Department of Oncology/Hematology, Department of Medicine, Loma Linda University, Loma Linda, CA, United States
- *Correspondence: Huynh Cao,
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Chen YW, Tucker MD, Brown LC, Yasin HA, Ancell KK, Armstrong AJ, Beckermann KE, Davis NB, Harrison MR, Kaiser EG, McAlister RK, Schaffer KR, Wallace DE, George DJ, Rathmell WK, Rini BI, Zhang T. The Association between a Decrease in On-Treatment Neutrophil-to-Eosinophil Ratio (NER) at Week 6 after Ipilimumab Plus Nivolumab Initiation and Improved Clinical Outcomes in Metastatic Renal Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14153830. [PMID: 35954493 PMCID: PMC9367298 DOI: 10.3390/cancers14153830] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
A lower baseline neutrophil-to-eosinophil ratio (NER) has been associated with improved responses to immune checkpoint inhibitors (ICI)-treated metastatic renal cell carcinoma (mRCC). This study investigated the decrease in NER at week 6 after ipilimumab/nivolumab (ipi/nivo) initiation and treatment responses in mRCC. A retrospective study of ipi/nivo-treated mRCC at two US academic cancer centers was conducted. A landmark analysis at week 6 was performed to assess the association between the change in NER and clinical responses (progression-free survival (PFS)/overall survival (OS)). Week 6 NER was modeled as a continuous variable, after log transformation (Ln NER), and a categorical variable by percent change. There were 150 mRCC patients included: 78% had clear cell histology, and 78% were IMDC intermediate/poor risk. In multivariable regression analysis, every decrease of 1 unit of Ln NER at week 6 was associated with improved PFS (adjusted hazard ratio (AHR): 0.78, p-value:0.005) and OS (AHR: 0.67, p-value: 0.002). When NER was modeled by percent change, decreased NER > 50% was associated with improved PFS (AHR: 0.55, p-value: 0.03) and OS (AHR: 0.37, p-value: 0.02). The decrease in week 6 NER was associated with improved PFS/OS in ipi/nivo-treated mRCC. Prospective studies are warranted to validate NER change as a biomarker to predict ICI responses.
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Affiliation(s)
- Yu-Wei Chen
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Matthew D. Tucker
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
- Grandview Cancer Center, Alabama Oncology, 3670 Grandview Pkwy, Birmingham, AL 35243, USA
| | - Landon C. Brown
- Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC 28204, USA
| | - Hesham A. Yasin
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Kristin K. Ancell
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Andrew J. Armstrong
- Duke Cancer Institute, 2 Seeley Mudd, 10 Bryan Searle Drive, Durham, NC 27710, USA
| | - Kathryn E. Beckermann
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Nancy B. Davis
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Michael R. Harrison
- Duke Cancer Institute, 2 Seeley Mudd, 10 Bryan Searle Drive, Durham, NC 27710, USA
| | - Elizabeth G. Kaiser
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Renee K. McAlister
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Kerry R. Schaffer
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Deborah E. Wallace
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Daniel J. George
- Duke Cancer Institute, 2 Seeley Mudd, 10 Bryan Searle Drive, Durham, NC 27710, USA
| | - W. Kimryn Rathmell
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Brian I. Rini
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Tian Zhang
- Duke Cancer Institute, 2 Seeley Mudd, 10 Bryan Searle Drive, Durham, NC 27710, USA
- Division of Hematology Oncology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
- Correspondence: ; Tel.: +1-214-648-4180
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