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Carreras J, Ikoma H, Kikuti YY, Miyaoka M, Hiraiwa S, Tomita S, Kondo Y, Ito A, Nagase S, Miura H, Kawada H, Roncador G, Campo E, Hamoudi R, Nakamura N. Mutational, immune microenvironment, and clinicopathological profiles of diffuse large B-cell lymphoma and follicular lymphoma with BCL6 rearrangement. Virchows Arch 2024; 484:657-676. [PMID: 38462571 DOI: 10.1007/s00428-024-03774-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
BCL6-rearrangement (BCL6-R) is associated with a favorable prognosis of follicular lymphoma (FL), but the mechanism is unknown. We analyzed the clinicopathological, immune microenvironment (immune checkpoint, immuno-oncology markers), and mutational profiles of 10 BCL6-R-positive FL, and 19 BCL6-R-positive diffuse large B-cell lymphoma (DLBCL) cases (both BCL2-R and MYC-R negative). A custom-made panel included 168 genes related to aggressive B-cell lymphomas and FL. FL cases were nodal, histological grade 3A in 70%, low Ki67; and had a favorable overall and progression-free survival. DLBCL cases were extranodal in 60%, IPI high in 63%, non-GCB in 60%, EBER-negative; and had a progression-free survival comparable to that of DLBCL NOS. The microenvironment had variable infiltration of M2-like tumor-associated macrophages (TAMs) that were CD163, CSF1R, LAIR1, PD-L1, and CD85A (LILRB3) positive; but had low IL10 and PTX3 expression. In comparison to FL, DLBCL had higher TAMs, IL10, and PTX3 expression. Both lymphoma subtypes shared a common mutational profile with mutations in relevant pathogenic genes such as KMT2D, OSBPL10, CREBBP, and HLA-B (related to chromatin remodeling, metabolism, epigenetic modification, and antigen presentation). FL cases were characterized by a higher frequency of mutations of ARID1B, ATM, CD36, RHOA, PLOD2, and PRPRD (p < 0.05). DLBCL cases were characterized by mutations of BTG2, and PIM1; and mutations of HIST1H1E and MFHAS1 to disease progression (p < 0.05). Interestingly, mutations of genes usually associated with poor prognosis, such as NOTCH1/2 and CDKN2A, were infrequent in both lymphoma subtypes. Some high-confidence variant calls were likely oncogenic, loss-of-function. MYD88 L265P gain-of-function was found in 32% of DLBCL. In conclusion, both BCL6-R-positive FL and BCL6-R-positive DLBCL had a common mutational profile; but also, differences. DLBCL cases had a higher density of microenvironment markers.
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MESH Headings
- Humans
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/immunology
- Tumor Microenvironment/immunology
- Tumor Microenvironment/genetics
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/immunology
- Proto-Oncogene Proteins c-bcl-6/genetics
- Male
- Female
- Middle Aged
- Aged
- Mutation
- Adult
- Biomarkers, Tumor/genetics
- Aged, 80 and over
- Gene Rearrangement
- DNA Mutational Analysis
- Progression-Free Survival
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Grants
- 23K06454 the Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 15K19061 the Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 18K15100 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 24590430 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 2021-B04 Tokai University School of Medicine research incentive assistant plan
- VRI-20-10 ASPIRE, the technology program management pillar of Abu Dhabi's Advanced Technology Research Council (ATRC), via the ASPIRE Precision Medicine Research Institute Abu Dhabi (AS-PIREPMRIAD) award
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Affiliation(s)
- Joaquim Carreras
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan.
| | - Haruka Ikoma
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Yara Yukie Kikuti
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Masashi Miyaoka
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Shinichiro Hiraiwa
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Sakura Tomita
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Yusuke Kondo
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Atsushi Ito
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Shunsuke Nagase
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Hisanobu Miura
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Hiroshi Kawada
- Department of Hematology, School of Medicine, Tokai University, Tokyo, Japan
| | - Giovanna Roncador
- Monoclonal Antibodies Core Unit, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Elias Campo
- Department of Pathology, Esther Koplowitz Center (CEK), Centro de Investigacion Biomedica en Red de Cancer (CIBERONC), Hospital Clinic Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Rifat Hamoudi
- Research Institute for Medical and Health Science, Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Division of Surgery and Interventional Science, University College London, London, UK
- BIMAI-Lab, Biomedically Informed Artificial Intelligence Laboratory, University of Sharjah, Sharjah, United Arab Emirates
| | - Naoya Nakamura
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
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Bodla ZH, Hashmi M, Niaz F, Farooq U, Khalid F, Tariq MJ, Khalil MJ, Brown VS, Bray CL. Independent predictors of mortality and 5-year trends in mortality and resource utilization in hospitalized patients with diffuse large B cell lymphoma. Proc AMIA Symp 2023; 37:16-24. [PMID: 38174025 PMCID: PMC10761168 DOI: 10.1080/08998280.2023.2267921] [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: 08/19/2023] [Accepted: 09/24/2023] [Indexed: 01/05/2024] Open
Abstract
Background This retrospective study analyzed factors influencing all-cause inpatient mortality in 80,930 adult patients (2016-2020) with diffuse large B cell lymphoma using the National Inpatient Sample database. Methods Utilizing ICD-10 codes, patients were identified, and statistical analysis was conducted using STATA. Fisher's exact and Student's t tests compared proportions and variables, multivariate logistic regression examined mortality predictors, and a 5-year longitudinal analysis identified mortality and resource utilization trends. Results The inpatient mortality rate was found to be 6.56% with a mean age of 67.99 years. Several hospital- and patient-level factors including specific comorbidities such as congestive heart failure, atrial fibrillation, acute kidney injury, chronic obstructive pulmonary disease, liver failure, pancytopenia, tumor lysis syndrome, and severe protein-calorie malnutrition were independently associated with inpatient mortality. Hospitalization costs showed an increasing trend, impacting the overall population and survivors. Conclusion These insights may refine risk assessment, treatment selection, and interventions.
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Affiliation(s)
- Zubair Hassan Bodla
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, Florida, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, USA
| | - Mariam Hashmi
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, USA
| | - Fatima Niaz
- King Edward Medical University, Lahore, Punjab, Pakistan
- Mayo Hospital, Lahore, Punjab, Pakistan
| | - Umer Farooq
- Rochester Regional Health, Rochester, New York, USA
| | - Farhan Khalid
- Monmouth Medical Center, Long Branch, New Jersey, USA
| | | | | | - Victoria S. Brown
- Florida Cancer Specialists and Research Institute, Gainesville, Florida, USA
| | - Christopher L. Bray
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, Florida, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, USA
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Alves-Hanna FS, Crespo-Neto JA, Nogueira GM, Pereira DS, Lima AB, Ribeiro TLP, Santos VGR, Fonseca JRF, Magalhães-Gama F, Sadahiro A, Costa AG. Insights Regarding the Role of Inflammasomes in Leukemia: What Do We Know? J Immunol Res 2023; 2023:5584492. [PMID: 37577033 PMCID: PMC10421713 DOI: 10.1155/2023/5584492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Inflammation is a physiological mechanism of the immune response and has an important role in maintaining the hematopoietic cell niche in the bone marrow. During this process, the participation of molecules produced by innate immunity cells in response to a variety of pathogen-associated molecular patterns and damage-associated molecular patterns is observed. However, chronic inflammation is intrinsically associated with leukemogenesis, as it induces DNA damage in hematopoietic stem cells and contributes to the creation of the preleukemic clone. Several factors influence the malignant transformation within the hematopoietic microenvironment, with inflammasomes having a crucial role in this process, in addition to acting in the regulation of hematopoiesis and its homeostasis. Inflammasomes are intracellular multimeric complexes responsible for the maturation and secretion of the proinflammatory cytokines interleukin-1β and interleukin-18 and the cell death process via pyroptosis. Therefore, dysregulation of the activation of these complexes may be a factor in triggering several diseases, including leukemias, and this has been the subject of several studies in the area. In this review, we summarized the current knowledge on the relationship between inflammation and leukemogenesis, in particular, the role of inflammasomes in different types of leukemias, and we describe the potential therapeutic targets directed at inflammasomes in the leukemic context.
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Affiliation(s)
- Fabíola Silva Alves-Hanna
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
| | - Juniel Assis Crespo-Neto
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
| | - Glenda Menezes Nogueira
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Daniele Sá Pereira
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Amanda Barros Lima
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
| | - Thaís Lohana Pereira Ribeiro
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | | | - Joey Ramone Ferreira Fonseca
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
| | - Fábio Magalhães-Gama
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil
| | - Aya Sadahiro
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
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Bangolo A, Sagireddy S, Desrochers P, Laabidi I, Nagesh VK, Jarri A, Sekhon I, Laabidi Y, Muralidhar D, Singh A, Sanjeeva PRP, Sandhu DS, Salma S, Khan SA, Ali MI, Kim SH, Bajwa W, Tai AC, Itani A, Ahmed K, Ozmen M, Hirpara B, Borse SM, Weissman S. Association between Multiple Myeloma and Ulcerative Colitis: A Cross-Sectional Analysis. Diseases 2023; 11:diseases11020059. [PMID: 37092441 PMCID: PMC10123639 DOI: 10.3390/diseases11020059] [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: 03/12/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND AND AIMS Multiple myeloma (MM) is a plasma cell dyscrasia that is common among patients with autoimmune diseases. However, the association between ulcerative colitis (UC) and multiple myeloma (MM) is yet to be established. We aimed to evaluate the prevalence of MM among patients with UC in the United States. METHODS This cross-sectional cohort analysis used the National Inpatient Sample from 2015-2018 to assess the overall MM prevalence among patients with and without UC, and within specific demographic subgroups. Prevalences were compared using a logistic regression model controlling for sex and age. RESULTS The crude prevalence of MM among patients with UC (n = 1750) compared with patients without UC (n = 366,265) was 0.44% vs. 0.37%, respectively. Patients with UC had increased overall odds of having MM (odds ratio (OR), 1.26). Males with UC had higher prevalence of MM (53.7% vs. 46.3%, respectively) than females. Patients with UC and MM were more likely to be African American than White (15.6% vs. 9.2%, respectively). Patients with UC age >64 had a higher prevalence of MM than those aged below 65 (70.9% vs. 29.1%, respectively). Patients with UC who were obese (BMI > 30) had a higher prevalence of MM than those who were non-obese (12.6% vs. 8.3%). CONCLUSIONS Overall, UC appears to be associated with MM. This association can be particularly observed in specific demographic groups, such as obese, African American males, or patients >64 years of age. Thus, a high degree of clinical suspicion for MM is warranted, even with minimal symptomatology, in patients with UC, in particular among elder, obese, and African American males.
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Affiliation(s)
- Ayrton Bangolo
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Sowmya Sagireddy
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Paul Desrochers
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Imane Laabidi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Vignesh K Nagesh
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Amer Jarri
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Imranjot Sekhon
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Youssef Laabidi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Deeksha Muralidhar
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Adarshpreet Singh
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Paranjyothy R P Sanjeeva
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Damanpartap S Sandhu
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Saba Salma
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Saad A Khan
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Mir I Ali
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Sung H Kim
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Wardah Bajwa
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Angela C Tai
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Assma Itani
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Kareem Ahmed
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Mevlut Ozmen
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Bhargav Hirpara
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Shruti M Borse
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
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Prognostic value of interim 18F-FDG PET/CT in adult follicular lymphoma treated with R-CHOP. Ann Hematol 2023; 102:795-800. [PMID: 36806973 DOI: 10.1007/s00277-023-05138-0] [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: 08/05/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The prognostic value of interim 18F-FDG PET/CT (I-PET) for follicular lymphoma (FL) is controversial, and may be related to the lack of strict standards in terms of age, chemotherapy regimen, and evaluation criteria in previous studies. This study aimed to investigate the prognostic value of I-PET in adult FL patients treated with R-CHOP. METHODS I-PET was performed in 30 adult FL patients after treatment with 3-5 cycles of R-CHOP. PET/CT images were assessed using the Deauville 5-point scale (D-5PS) criteria. Baseline PET/CT (B-PET) was performed in 24 of the patients with FL before treatment. The PET/CT image parameters, such as the SUVmax, TLG, and tMTV, were recorded. The prognostic values of sex, age, grade, Ann Arbor stage, LDH level, and I-PET were evaluated. RESULTS Kaplan-Meier analysis and Cox regression showed that sex, age, grade, Ann Arbor stage, LDH, and I-PET using the D-5PS criteria could not predict the PFS of adult patients with FL treated with R-CHOP (P>0.05). ROC curve analysis evaluated the predictive values of SUVmax, TLG, and tMTV in B-PET and I-PET and showed that none of them was predictive of PFS in adult FL patients (P>0.05). However, the variation in SUVmax (∆SUVmax) was predictive of PFS in adult FL patients (AUC=0.83, P=0.040), and the cutoff threshold was 4.85. CONCLUSIONS I-PET using the D-5PS criteria cannot predict the PFS of adult FL patients treated with R-CHOP. However, the ∆SUVmax between B-PET and I-PET is applicable for the prognosis of adult patients with FL.
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Delon C, Brown KF, Payne NWS, Kotrotsios Y, Vernon S, Shelton J. Differences in cancer incidence by broad ethnic group in England, 2013-2017. Br J Cancer 2022; 126:1765-1773. [PMID: 35233092 PMCID: PMC9174248 DOI: 10.1038/s41416-022-01718-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cancer incidence variation between population groups can inform public health and cancer services. Previous studies have shown cancer incidence rates vary by ethnic group in England. Since their publication, the completeness of ethnicity recording in cancer data has improved, and relevant inequalities (e.g. risk factor prevalence and healthcare access) may have changed. METHODS Age-standardised incidence rates were calculated for Asian, Black, Mixed/Multiple and White ethnic groups in England in 2013-2017, using almost 3 million diagnoses across 31 cancer sites. Rate ratios were calculated with the White ethnic group as reference. Sensitivity analyses used imputed ethnicity for cases with missing data and perturbed population estimates. RESULTS Incidence rates for most cancer sites and ethnic group and sex combinations were lower in non-White minority ethnic groups compared with the corresponding White group, with particularly low rate ratios (below 0.5) for melanoma skin cancer and some smoking-related cancers (lung, bladder and oesophageal cancers). Exceptions included prostate cancer (2.1 times higher in males of Black ethnicity), myeloma (2.7-3.0 times higher in people of Black ethnicity), several gastrointestinal cancers (1.1-1.9 times higher in people of Black ethnicity, 1.4-2.2 times higher in people of Asian ethnicity), Hodgkin lymphoma (1.1 times higher in males of Asian ethnicity, 1.3 times higher in males of Black ethnicity) and thyroid cancers (1.4 times higher in people of Asian ethnicity, 1.2 times higher in people of Black ethnicity). Sensitivity analyses did not materially alter these results (rate ratios changed by a maximum of 12 percentage points, the direction and significance of results were unchanged in all but two cancer site/sex/ethnic group combinations). CONCLUSIONS People of non-White minority ethnicity in England generally have lower cancer risk than the White population, though there are a number of notable exceptions. These results should galvanise efforts to better understand the reasons for this variation, and the possible impact on cancer services, patient experiences and outcomes.
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Affiliation(s)
- Christine Delon
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK.
| | - Katrina F Brown
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Nick W S Payne
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Yannis Kotrotsios
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Sally Vernon
- National Disease Registration Service, NHS Digital, 7 and 8 Wellington Place, Leeds, LS1 4AP, UK
| | - Jon Shelton
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
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Abraham S, Foreman N, Sidat Z, Sandhu P, Marrone D, Headley C, Akroyd C, Nicholson S, Brown K, Thomas A, Howells LM, Walter HS. Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S14-S24. [PMID: 35648663 DOI: 10.12968/bjon.2022.31.10.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
More people in the UK are living with cancer than ever before. With an increasingly ethnically diverse population, greater emphasis must be placed on understanding factors influencing cancer outcomes. This review seeks to explore UK-specific variations in engagement with cancer services in minority ethnic groups and describe successful interventions. The authors wish to highlight that, despite improvement to engagement and education strategies, inequalities still persist and work to improve cancer outcomes across our communities still needs to be prioritised. There are many reasons why cancer healthcare inequities exist for minority communities, reported on a spectrum ranging from cultural beliefs and awareness, through to racism. Strategies that successfully enhanced engagement included language support; culturally-sensitive reminders; community-based health workers and targeted outreach. Focusing on the diverse city of Leicester the authors describe how healthcare providers, researchers and community champions have worked collectively, delivering targeted community-based strategies to improve awareness and access to cancer services.
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Affiliation(s)
- Shalin Abraham
- F2 Academic Foundation Doctor, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Nalini Foreman
- Quality Assistant, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Zahirah Sidat
- Senior Research Practitioner, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Pavandeep Sandhu
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Domenic Marrone
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Catherine Headley
- Senior Cancer Services Manager, Leicester City Clinical Commissioning Group, Leicester
| | - Carol Akroyd
- Collaboration for Leadership in Applied Health Research and Care Equality and Diversity Theme Manager, Centre for Ethnic Health Research, University of Leicester, Leicester
| | - Sarah Nicholson
- Hope Clinical Trials Facility Manager/Cancer, Haematology, Urology, Gastroenterology, General Surgery Research Lead, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Karen Brown
- Professor in Translational Cancer Research, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Anne Thomas
- Professor of Cancer Therapeutics, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Lynne M Howells
- Experimental Cancer Medicine Centre Translational Research Manager, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Harriet S Walter
- Associate Professor of Medical Oncology, Leicester Cancer Research Centre, University of Leicester, Leicester
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8
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Chory RM, Cone R, Hollingsworth J. An Abnormal Presentation of Multiple Myeloma in Pregnancy: A Case Report. Cureus 2022; 14:e23363. [PMID: 35475093 PMCID: PMC9020588 DOI: 10.7759/cureus.23363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/05/2022] Open
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9
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Karam D, Gertz M, Lacy M, Dispenzieri A, Hayman S, Dingli D, Buadi F, Kapoor P, Kourelis T, Warsame R, Hogan W, Kumar S. Impact of maintenance therapy post autologous stem cell transplantation for multiple myeloma in early and delayed transplant. Bone Marrow Transplant 2022; 57:803-809. [PMID: 35297404 DOI: 10.1038/s41409-022-01631-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/09/2022]
Abstract
Based on phase 3 trials, maintenance therapy after autologous stem cell transplantation (ASCT) has become the standard of care in multiple myeloma (MM). We examined the trends in maintenance therapy in a large group of patients (2530) transplanted at a single institution over two decades. Majority (n = 1958; 77%) had an ASCT within 12 months of diagnosis (early ASCT). Maintenance was employed in 39% of the patients; 42% among early ASCT and 30.5% among delayed ASCT. Most common maintenance approach was an IMiD (61%), followed by a PI (31%), or a PI + IMiD (4%). Patients with high-risk FISH received PI-based maintenance more frequently. The PFS was superior with maintenance (36 vs. 22 months, p < 0.001); 37 vs. 25 months for early ASCT (p < 0.001) and 29 vs. 17 months for delayed ASCT (p = 0.0008). OS from ASCT was higher with maintenance for the whole cohort at 93 vs. 73 months (p < 0.001). OS from diagnosis was also better for the whole cohort with maintenance therapy, 112 vs. 93 months (p < 0.001). The improvement in PFS and OS was seen in high-risk and standard risk disease. The experience with maintenance therapy post ASCT for myeloma in a non-clinical trial setting confirms the findings from the phase 3 trials.
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Affiliation(s)
- Dhauna Karam
- Department of Community Internal Medicine, Mayo Clinic Health System, Albert Lea, MN, USA
| | - Morie Gertz
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Lacy
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Suzanne Hayman
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Francis Buadi
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Rahma Warsame
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William Hogan
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA.
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Lupak O, Xiaoxia H, Xie P, Thanikachalam K, Jabbour-Aida H, Farhan S, Emole J. Disparities in Utilization of Autologous Stem Cell Transplantation as Consolidative Therapy for Multiple Myeloma: A Single Institution Retrospective Review. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e680-e685. [PMID: 34148850 DOI: 10.1016/j.clml.2021.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most guidelines recommend induction therapy followed by autologous hematopoietic cell transplantation. A Surveillance, Epidemiology, and End Results-Medicare database analysis from 2000 to 2011 noted a lower use of HCT and bortezomib among Black patients, despite adjusting for care barriers, and this practice was associated with a poorer outcome. The goal of this study was to evaluate patterns of acceptance of HCT as consolidative therapy for MM. METHODS Cox proportional hazards model was used to investigate the association between the survival time of the patients (overall survival) and age of the diagnosis, race, socioeconomic status, disease cytogenetic, and initial induction regimens. A total of 194 patients with a confirmed diagnosis of MM who were referred for HCT between January 1, 2009, and June 30, 2019, were included in this study. Patients who received autologous stem cell transplant for relapsed MM were excluded. RESULTS We found that income category was not significantly associated with overall survival, time to transplant or transplant-/relapse-related mortality. High-risk cytogenetic was significantly associated with shorter overall survival, higher transplant-related mortality and relapse-related mortality (P < .002). The use of aggressive induction choices was associated with poorer transplant outcomes (P = .02). Time to transplant tended to be shorter in African American compared with other ethnic groups (P = .07). CONCLUSION There was no significant difference in the use rate of the HCT between Caucasians and AA patients with MM. Further comparative studies of MM induction therapy and access to clinical trials in African Americans and other racial minorities are warranted.
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Affiliation(s)
- Oleksandra Lupak
- Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Han Xiaoxia
- Henry Ford Hospital, Detroit, Michigan, USA.
| | - Peter Xie
- Henry Ford Hospital, Detroit, Michigan, USA.
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11
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A phase 3 randomized study (HOMER) of ofatumumab vs rituximab in iNHL relapsed after rituximab-containing therapy. Blood Adv 2021; 4:3886-3893. [PMID: 32810220 DOI: 10.1182/bloodadvances.2020001942] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/15/2020] [Indexed: 02/03/2023] Open
Abstract
Because of high relapse rates with rituximab combinations, there is an unmet need for new therapeutic agents for treatment of indolent B-cell non-Hodgkin lymphoma (iNHL) or follicular lymphoma (FL). In previous trials, ofatumumab in combination with chemotherapy showed good results in relapsed/refractory FL pretreated with rituximab. This phase 3 trial evaluated the efficacy and safety of single-agent ofatumumab vs single-agent rituximab in rituximab-sensitive relapsed FL that relapsed at least 6 months after completing the last prior treatment with single-agent rituximab or a rituximab-containing regimen. Patients were randomized 1:1 to receive either ofatumumab (1000 mg) or rituximab (375 mg/m2) every week for 4 weeks for the induction phase, followed by once every 2 months for 4 additional doses. The primary endpoint, progression-free survival (PFS) and secondary endpoints, overall response rate (ORR) and overall survival (OS), were evaluated. Overall, 438 patients were assigned to receive ofatumumab (n = 219) and rituximab (n = 219). Baseline characteristics were similar in both arms. The independent review committee assessed whether median PFS was shorter in the ofatumumab arm than in the rituximab arm (16.33 vs 21.29 months), with no significant difference (hazard ratio, 1.15; 95% confidence interval, 0.89-1.49; P = .29) and also showed a lower ORR (50%) compared with the rituximab arm (66%). At the time of analysis, data were not matured for OS results. The number of grade >3 adverse events was higher in the ofatumumab arm (37%) than the rituximab arm (28%). Ofatumumab showed no superiority over rituximab in patients with FL who had relapsed after a rituximab-containing therapy. This study was registered at www.clinicaltrials.gov as #NCT01200589.
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12
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Okello CD, Mulumba Y, Omoding A, Ddungu H, Welch K, Thompson CL, Cowan AJ, Cooney MM, Orem J. Characteristics and outcomes of patients with multiple myeloma at the Uganda Cancer Institute. Afr Health Sci 2021; 21:67-74. [PMID: 34394283 PMCID: PMC8356586 DOI: 10.4314/ahs.v21i1.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Data on multiple myeloma (MM) in sub-Sahara Africa is scarce. In Uganda, there is a progressively increasing incidence of MM over the years. METHODS We performed a retrospective study on 217 patients with MM at the UCI using purposive sampling method. The objectives of the study were to determine the clinical characteristics, treatment outcomes, 5 year overall survival and predictors of survival of patients with MM at the UCI from 01 January 2008 to 31 December 2012. RESULTS There were 119 (54.8%) males; the mean(SD) age of the study population at presentation was 59(12.8) years; 183(84.3%) patients presented with bone pain, and 135 (61.9%) had skeletal pathology; 186(85.3%) were HIV negative, and 152(70%) had Durie-Salmon stage III. The median overall survival was 2.5 years, (95% CI, 0.393-0.595); factors significantly associated with worse survival were Durie-Salmon stage III disease, HR=5.9, 95% CI (1.61 - 21.74; P=0.007) and LDH >225 U/L HR=3.3, 95% CI (0.57 - 5.92; P=0.029). CONCLUSION Most patients with multiple myeloma at the UCI were diagnosed at a relatively young age, presented with late stage disease and bone pain, and had a shorter survival time. Factors associated with worse survival were Durie-Salmon stage III and LDH >225 U/L.
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13
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Karam D, Kumar S. Post-Transplant Maintenance Treatment Options in Multiple Myeloma. Oncol Ther 2021; 9:69-88. [PMID: 33615426 PMCID: PMC8140028 DOI: 10.1007/s40487-021-00143-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/03/2021] [Indexed: 12/04/2022] Open
Abstract
Maintenance therapy post autologous stem cell transplant (ASCT) is commonly employed in myeloma patients to prolong remission, as relapse invariably occurs after ASCT. After initial diagnosis and risk stratification, patients receive initial therapy with a combination of drugs, typically a proteasome inhibitor and an immunomodulatory imide drug (IMiD), and in those considered eligible, high-dose chemotherapy followed by autologous stem cell transplant. The aim of our study was to review the literature and consolidate evidence regarding different maintenance therapies post stem cell transplant in myeloma patients. We reviewed major databases including PubMed, Cochrane Library and Evidence-Based Medicine Reviews (EBMR), along with American Society of Hematology/American Society of Clinical Oncology (ASH/ASCO) conference abstracts to include relevant literature. Ongoing clinical trials were also reviewed. Consolidation therapy is often employed to enhance the response to induction therapy and SCT and also to delay progression. Melphalan and thalidomide with or without steroids were initially used as maintenance therapy. More recently, lenalidomide-, bortezomib-, ixazomib-, or carfilzomib-based regimens have been employed as maintenance. Lenalidomide and bortezomib are the most commonly used drugs, with the latter being preferred in high-risk populations. Newer trials are utilizing tumor-specific antigen based vaccines along with adoptive T-cell therapies, and monoclonal antibodies as maintenance therapy. We conclude that maintenance therapy post SCT, with lenalidomide or bortezomib is the standard of care in myeloma patients. Patient tolerability, disease risk stratification and prior therapy received are major determinants of the choice of maintenance. Significant toxicity associated with maintenance therapies is a hindrance to long-term maintenance post stem cell transplant.
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Affiliation(s)
- Dhauna Karam
- Division of Community Internal Medicine, Mayo Clinic Health System, Austin, USA.,Mayo Clinic Health System, Albert Lea, MN, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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14
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Yang S, Varghese AM, Sood N, Chiattone C, Akinola NO, Huang X, Gale RP. Ethnic and geographic diversity of chronic lymphocytic leukaemia. Leukemia 2020; 35:433-439. [PMID: 33077870 DOI: 10.1038/s41375-020-01057-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 12/16/2022]
Abstract
East Asians, Asian Indians and Amerindians have a five to ten-fold lower age-adjusted incidence rate (AAIR) of chronic lymphocytic leukaemia (CLL) compared with persons of predominately European descent. The data we review suggest a genetic rather than environmental basis for this discordance. All these populations arose from a common African Black ancestor but different clades have different admixture with archaic hominins including Neanderthals, Denisovans and Homo erectus, which may explain different CLL incidences. There are also some differences in clinical laboratory and molecular co-variates of CLL between these populations. Because the true age-adjusted incidence rate in African Blacks is unknown it is not possible to determine whether modern Europeans acquired susceptibility to CLL or the other populations lost susceptibility and/or developed resistance to developing CLL. We also found other B-cell lymphomas and T- and NK-cell cancers had different incidences in the populations we studied. These data provide clues to determining the cause(s) of CLL.
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Affiliation(s)
- Shenmiao Yang
- Peking University Peoples Hospital; Peking University Institute of Hematology, Beijing, China
| | - Abraham M Varghese
- Little Flower Hospital and Research Centre, Kerala, India.,St James University Hospital, Leeds, UK
| | - Nitin Sood
- Clinical Haematology and Stem Cell Transplant, Medanta-Medicity, Gurgaon, India
| | - Carlos Chiattone
- Department of Hematology and Oncology, Santa Casa Medical School, Sao Paulo, Brazil
| | - Norah O Akinola
- Department of Haematology and Immunology, Obafemi Awolowo University and Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Xiaojun Huang
- Peking University Peoples Hospital; Peking University Institute of Hematology, Beijing, China
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK.
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15
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Fowler NH, Chen G, Lim S, Manson S, Ma Q, Li F(Y. Treatment Patterns and Health Care Costs in Commercially Insured Patients with Follicular Lymphoma. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2020; 7:148-157. [PMID: 33043061 PMCID: PMC7539759 DOI: 10.36469/jheor.2020.16784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Few studies have estimated the real-world economic burden such as all-cause and follicular lymphoma (FL)-related costs and health care resource utilization (HCRU) in patients with FL. OBJECTIVES This study evaluated outcomes in patients who were newly initiated with FL indicated regimens by line of therapy with real-world data. METHODS A retrospective study was conducted among patients with FL from MarketScan® databases between January 1, 2010 and December 31, 2013. Patients were selected if they were ≥18 years old when initiated on a FL indicated therapy, had at least 1 FL-related diagnosis, ≥1 FL commonly prescribed systemic anti-cancer therapy after diagnosis, and did not use any FL indicated regimen in the 24 months prior to the first agent. These patients were followed up at least 48 months and the outcomes, including the distribution of regimens by line of therapy, the treatment duration by line of therapy, all-cause and FL-related costs, and HCRU by line of therapy were evaluated. RESULTS This study identified 598 patients who initiated FL indicated treatment. The average follow-up time was approximately 5.7 years. Of these patients, 50.2% (n=300) were female, with a mean age of 60.7 years (SD=13.1 years) when initiating their treatment with FL indicated regimens. Overall, 598 (100%) patients received first-line therapy, 180 (43.6%) received second-line therapy, 51 received third-line therapy, 21 received fourth-line therapy, and 10 received fifth-line therapy. Duration of treatment by each line of therapy was 370 days, 392 days, 162 days, 148 days, and 88 days, respectively. The most common first-line regimens received by patients were rituximab (n=201, 33.6%), R-CHOP (combination of rituximab, cyclophosphamide, doxorubicin hydrochloride [hydroxydaunomycin]; n=143, 24.0%), BR (combination of bendamustine and rituximab; n=143, 24.0%), and R-CVP (combination of rituximab, cyclophosphamide, vincristine, and prednisone; n=71, 11.9%). The most common second-line treatment regimens were (N=180): rituximab (n=78, 43.3%) and BR (n=41, 22.8%). Annualized all-cause health care costs per patient ranged from US$97 141 (SD: US$144 730) for first-line to US$424 758 (SD: US$715 028) for fifth-line therapy. CONCLUSIONS The primary regimens used across treatment lines conform to those recommended by the National Comprehensive Cancer Network clinical practice guidelines. The economic burden for patients with FL is high and grows with subsequent lines of therapy.
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Affiliation(s)
- Nathan H. Fowler
- The University of Texas MD Anderson Cancer Center, Houston, TX,
USA
| | | | - Stephen Lim
- Novartis Pharmaceuticals Corporation, East Hanover, NJ,
USA
| | | | - Qiufei Ma
- Novartis Pharmaceuticals Corporation, East Hanover, NJ,
USA
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16
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Kamath GR, Renteria AS, Jagannath S, Gallagher EJ, Parekh S, Bickell NA. Where you live can impact your cancer risk: a look at multiple myeloma in New York City. Ann Epidemiol 2020; 48:43-50.e4. [PMID: 32620423 DOI: 10.1016/j.annepidem.2020.05.005] [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: 01/09/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To visualize variation in multiple myeloma (MM) incidence and mortality rates by race-ethnicity and geographic location and evaluate their correlation with neighborhood-level population covariates within New York City (NYC). METHODS Trends and racial differences in MM incidence and mortality for the United States [Surveillance, Epidemiology, and End Results Cancer Registry (SEER), National Center for Health Statistics], and NYC [New York State Cancer Registry] were compared using Joinpoint regression. Pearson's correlation coefficients measured neighborhood-level MM-covariate relationships (n = 34). RESULTS MM incidence rates are double in African-Americans compared with Whites, in SEER-13 areas (rate ratio (RR) = 2.27; 95% confidence interval [CI] = 2.22-2.32) and NYC (RR = 2.11; 95% CI = 2.03-2.20). Incidence rates increased faster in NYC (average annual percentage change difference, -1.1; 95% CI, -2.3 to -0.1). NYC African-American men experienced the steepest increase in mortality rates after 2001. In NYC, strong neighborhood-level correlations exist between incidence and mortality rates and high prevalence of residents of African ancestry, Latin American birth, daily sugary beverage and low fruit and vegetable consumption, and neighborhood walkability. Higher MM mortality also correlates with Hispanic ethnicity, obesity, diabetes, poverty, HIV/AIDS, air benzene concentration, and indoor pesticide use. CONCLUSIONS NYC neighborhoods with large minority populations have higher prevalence of poverty-related factors associated with MM incidence and mortality, warranting public health policies to address exposures and access to care.
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Affiliation(s)
- Geetanjali R Kamath
- Department of Population Health Science and Policy, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anne S Renteria
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sundar Jagannath
- Department of Population Health Science and Policy, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emily Jane Gallagher
- Department of Population Health Science and Policy, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samir Parekh
- Department of Population Health Science and Policy, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nina A Bickell
- Department of Population Health Science and Policy, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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17
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Abstract
Follicular lymphoma (FL) is a common indolent lymphoma subtype in Western countries. FL incidence increases with age, and shows considerable variation by race/ethnicity and geography. In the United States and France, FL incidence has been stable since 2000, whereas in other Western and Asian countries it has been increasing. Five-year relative survival rates have been increasing in Western and Asian countries. Progress on identifying FL-specific risk factors has accelerated with the implementation of the InterLymph nested classification and the availability of larger epidemiologic studies and pooled analyses. Identification of risk factors for FL requires further research.
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Affiliation(s)
- James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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18
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Ormond Filho AG, Carneiro BC, Pastore D, Silva IP, Yamashita SR, Consolo FD, Hungria VTM, Sandes AF, Rizzatti EG, Nico MAC. Whole-Body Imaging of Multiple Myeloma: Diagnostic Criteria. Radiographics 2019; 39:1077-1097. [DOI: 10.1148/rg.2019180096] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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19
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Adıyaman SC, Alacacıoğlu İ, Ersen Danyeli A, Türkyılmaz D, Sevindik ÖG, Demirkan F, Pişkin Ö, Özcan MA, Ündar B, Özkal S, Özsan GH. Prognostic Factors in Elderly Patients with Diffuse Large B-Cell Lymphoma and Their Treatment Results. Turk J Haematol 2019; 36:81-87. [PMID: 30724061 PMCID: PMC6516089 DOI: 10.4274/tjh.galenos.2019.2018.0219] [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] [Indexed: 12/04/2022] Open
Abstract
Objective: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL). The treatment of older NHL patients has always been a struggle; however, treatment statistics have begun showing favorable results similar to those of younger DLBCL patients thanks to newer treatment protocols. Here, we analyze the progress of our own elderly DLBCL patients who were followed between 2000 and 2016 in our center. Materials and Methods: Eighty-seven DLBCL patients, who were diagnosed and treated in the Dokuz Eylül University Department of Hematology between 2000 and 2016, were included in this study. Median age was 72 (65-89) years and 13 (14.9%) patients were older than 80 years. Results: Median follow-up time was 19 months and 45 patients (51.7%) died during the follow-up period. Median overall survival (OS) was 55 months and median progression-free survival was calculated as 27 months. Sixty-three patients (72.4%) received standard R-CHOP therapy. Complete response was seen in 46 (52.9%) patients. The median survival time for patients who had complete response was 136 months (p<0.001); however, OS was not statistically different between older (>80 years) and younger patients (p=0.236). Conclusion: According to our findings, we think that being able to complete standard R-CHOP therapy is vital for the survival rate of elderly DLBCL patients.
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Affiliation(s)
- Süleyman Cem Adıyaman
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, İzmir, Turkey
| | - İnci Alacacıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Ayça Ersen Danyeli
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Doğuş Türkyılmaz
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Ömür Gökmen Sevindik
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Fatih Demirkan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Özden Pişkin
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Mehmet Ali Özcan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Bülent Ündar
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Sermin Özkal
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Güner Hayri Özsan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
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20
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Akl YMK, Zawam HME, ElKorashy RIM, Ismail MS, Hanna AKM. Role of fiberoptic bronchoscopy in the diagnosis of pulmonary infiltrates in patients with hematological malignancies. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2018. [DOI: 10.4103/ejb.ejb_107_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Sayeed S, Barnes I, Ali R. Childhood cancer incidence by ethnic group in England, 2001-2007: a descriptive epidemiological study. BMC Cancer 2017; 17:570. [PMID: 28841853 PMCID: PMC5574126 DOI: 10.1186/s12885-017-3551-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/14/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND After the first year of life, cancers are the commonest cause of death in children. Incidence rates vary between ethnic groups, and recent advances in data linkage allow for a more accurate estimation of these variations. Identifying such differences may help identify potential risk or protective factors for certain childhood cancers. This study thus aims to ascertain whether such differences do indeed exist using nationwide data across seven years, as have previously been described in adult cancers. METHODS We obtained data for all cancer registrations for children (aged 0-14) in England from January 2001 to December 2007. Ethnicity (self-assigned) was established through record linkage to the Hospital Episodes Statistics database or cancer registry data. Cancers were classified morphologically according to the International Classification of Childhood Cancer into four groups - leukaemias; lymphomas; central nervous system; and other solid tumours. Age standardised incidence rates were estimated for each ethnic group, as well as incidence rate ratios comparing each individual ethnic group (Indian, Pakistani, Bangladeshi, Black African, Black Carribean, Chinese) to Whites, adjusting for sex, age and deprivation. RESULTS The majority of children in the study are UK born. Black children (RR = 1.18, 99% CI: 1.01-1.39), and amongst South Asians, Pakistani children (RR = 1.19, 99% CI: 1.02-1.39) appear to have an increased risk of all cancers. There is an increased risk of leukaemia in South Asians (RR = 1.31, 99% CI: 1.08-1.58), and of lymphoma in Black (RR = 1.72, 99% CI: 1.13-2.63) and South Asian children (RR = 1.51, 99% CI: 1.10-2.06). South Asians appear to have a decreased risk of CNS cancers (RR = 0.71, 99% CI: 0.54-0.95). CONCLUSIONS In the tradition of past migrant studies, such descriptive studies within ethnic minority groups permit a better understanding of disease incidence within the population, but also allow for the generation of hypotheses to begin to understand why such differences might exist. Though a major cause of mortality in this age group, childhood cancer remains a relatively rare disease; however, the methods used here have permitted the first nationwide estimation of childhood cancer by individual ethnic group.
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Affiliation(s)
- Shameq Sayeed
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF, UK
| | - Isobel Barnes
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF, UK
| | - Raghib Ali
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF, UK. .,Public Health Research Center, New York University Abu Dhabi , Abu Dhabi, United Arab Emirates.
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22
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McIlroy G, Mytton J, Evison F, Yadav P, Drayson MT, Cook M, Pratt G, Cockwell P, Pinney JH. Increased fracture risk in plasma cell dyscrasias is associated with poorer overall survival. Br J Haematol 2017; 179:61-65. [DOI: 10.1111/bjh.14815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/05/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Graham McIlroy
- Department of Renal Medicine; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Jemma Mytton
- Department of Health Informatics; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Felicity Evison
- Department of Health Informatics; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Punit Yadav
- Department of Renal Medicine; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Mark T. Drayson
- Institute of Immunology and Immunotherapy; College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | - Mark Cook
- Centre for Clinical Haematology; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Guy Pratt
- Centre for Clinical Haematology; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Paul Cockwell
- Department of Renal Medicine; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Jennifer H. Pinney
- Department of Renal Medicine; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
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23
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Yazdy MS, Ujjani C. Current challenges in the management of follicular lymphoma. Int J Hematol Oncol 2017; 6:13-24. [PMID: 30302218 PMCID: PMC6171972 DOI: 10.2217/ijh-2017-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/24/2017] [Indexed: 12/29/2022] Open
Abstract
Although typically indolent in nature, follicular lymphoma remains an ongoing challenge for practicing oncologists. While response rates >90% can be achieved with rituximab-based chemoimmunotherapy in advanced stage patients, the complete remission rates are substantially lower and patients inevitably relapse. The inability to achieve a complete remission and an early progression of disease have recently been determined to be indicative of poorer long-term outcomes. A greater understanding of the pathogenesis of follicular lymphoma has enabled the development of targeted therapies, which may improve standard treatment approaches. Examples include lenalidomide and obinutuzumab, which are currently in front-line Phase III investigation. Other therapies of interest include small molecule inhibitors, immune checkpoint inhibitors and chimeric antigen receptor T cells.
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Affiliation(s)
- Maryam Sarraf Yazdy
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC 20007, USA
| | - Chaitra Ujjani
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC 20007, USA
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24
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Castellino A, Santambrogio E, Nicolosi M, Botto B, Boccomini C, Vitolo U. Follicular Lymphoma: The Management of Elderly Patient. Mediterr J Hematol Infect Dis 2017; 9:e2017009. [PMID: 28105297 PMCID: PMC5224805 DOI: 10.4084/mjhid.2017.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/01/2016] [Indexed: 11/17/2022] Open
Abstract
Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma, which typically affects mature adults and elderly, whose median age at diagnosis is 65 years. The natural history of FL appears to have been favorably impacted by the introduction of Rituximab. Randomized clinical trials demonstrated that the addition of rituximab to standard chemotherapy induction has improved the overall survival and new strategies of chemo-immunotherapy, such as Bendamustine combined with Rituximab, showed optimal results on response and reduced hematological toxicity, becoming one of the standard treatments, particularly in elderly patients. Moreover, maintenance therapy with Rituximab demonstrated improvement of progression-free survival. Despite these exciting results, FL is still an incurable disease. It remains a critical unmet clinical need finding new prognostic factors to identify poor outcome patients better, to reduce the risk of transformation and to explore new treatment strategies, especially for patients not candidate to intensive chemotherapy regimens, such as elderly patients. Some progress were already reached with novel agents, but larger and more validated studies are needed. Elderly patients are the largest portion of patients with FL and represent a subgroup with higher treatment difficulties, because of comorbidities and smaller spectrum for treatment choice. Further studies, focused on elderly follicular lymphoma patients, with their peculiar characteristics, are needed to define the best-tailored treatment at diagnosis and at the time of relapse in this setting.
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Affiliation(s)
- Alessia Castellino
- Città della Salute e della Scienza University and Hospital, Hematology Unit, Turin, Italy
| | - Elisa Santambrogio
- Città della Salute e della Scienza University and Hospital, Hematology Unit, Turin, Italy
| | - Maura Nicolosi
- Città della Salute e della Scienza University and Hospital, Hematology Unit, Turin, Italy
| | - Barbara Botto
- Città della Salute e della Scienza University and Hospital, Hematology Unit, Turin, Italy
| | - Carola Boccomini
- Città della Salute e della Scienza University and Hospital, Hematology Unit, Turin, Italy
| | - Umberto Vitolo
- Città della Salute e della Scienza University and Hospital, Hematology Unit, Turin, Italy
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25
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Jiang D, Li Y, Hong Q, Shen Y, Xu C, Xu Y, Zhu H, Dai D, Ouyang G, Duan S. DNA methylation and leukemia susceptibility in China: Evidence from an updated meta-analysis. Mol Clin Oncol 2016; 5:193-207. [PMID: 27588182 PMCID: PMC4997969 DOI: 10.3892/mco.2016.959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 05/20/2016] [Indexed: 12/16/2022] Open
Abstract
Mounting evidence supports a role for DNA methylation in the pathogenesis of leukemia; however, there no overview of these results in the Chinese population. The present study performed a comprehensive meta-analysis to establish candidate genes with an altered methylation status in Chinese leukemia patients. Eligible studies were identified through searching the National Center of Biotechnology Information PubMed and Wanfang databases. Studies were pooled and overall odds ratios with corresponding confidence intervals were calculated. A total of 4,325 leukemia patients and 2,010 controls from 94 studies on 53 genes were included in this meta-analysis, and 47 genes were found to be aberrantly methylated in leukemia patients. A further subgroup meta-analysis by leukemia subtype demonstrated that hypermethylation of 5 genes, namely cyclin-dependent kinase (CDKN)2A, DNA-binding protein inhibitor-4, CDKN2B, glioma pathogenesis-related protein 1 and p73, contributed to the risk of various subtypes of leukemia. In addition, a strong association between CDKN2A and leukemia was identified in Chinese (P<0.00001) but not in European patients. The aberrantly methylated genes identified in the present meta-analysis may help elucidate the mechanisms underlying the development of leukemia in Chinese patients.
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Affiliation(s)
- Danjie Jiang
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Yirun Li
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Qingxiao Hong
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Yusheng Shen
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Chunjing Xu
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Yan Xu
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Huangkai Zhu
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Dongjun Dai
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Guifang Ouyang
- Department of Hematology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Shiwei Duan
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
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26
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Mercer LK, Galloway JB, Lunt M, Davies R, Low ALS, Dixon WG, Watson KD, Symmons DPM, Hyrich KL. Risk of lymphoma in patients exposed to antitumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum Dis 2016; 76:497-503. [PMID: 27502891 PMCID: PMC5446004 DOI: 10.1136/annrheumdis-2016-209389] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/22/2016] [Accepted: 06/19/2016] [Indexed: 11/24/2022]
Abstract
Objectives Patients with rheumatoid arthritis (RA) are at increased risk of lymphoma compared with the general population. There are concerns that tumour necrosis factor inhibitors (TNFi) may exacerbate this risk. However, since the excess risk of lymphoma in RA is related to the cumulative burden of inflammation, TNFi may conversely reduce the risk of lymphoma by decreasing the burden of inflammation. The aim of this study was to compare the risk of lymphoma in subjects with RA treated with TNFi with those treated with non-biological therapy. Methods Subjects diagnosed by a rheumatologist with RA enrolled in the British Society for Rheumatology Rheumatoid Arthritis Register (BSRBR-RA), a prospective cohort study, were followed until first lymphoma, death or until 30 November 2013. Rates of lymphoma in the TNFi and non-biological-treated cohorts were compared using Cox regression. Results 11 931 TNFi-treated patients were compared with 3367 biological-naive patients. 84 lymphomas (88 (95% CI 70 to 109) per 100 000 person-years) were reported in the TNFi cohort and 30 lymphomas (154 (95% CI 104 to 220)) in the biological-naive cohort. After adjusting for differences in baseline characteristics, there was no difference in the risk of lymphoma for the TNFi versus the biological-naive group: HR 1.00 (95% CI 0.56 to 1.80). No risk differences were observed for individual TNFi. Conclusions In medium-term follow-up, there is no evidence that tumour necrosis factor inhibition influences the risk of lymphoma over the background risk in subjects with RA.
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Affiliation(s)
- Louise K Mercer
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Audrey L S Low
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Kath D Watson
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Deborah P M Symmons
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
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27
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Reagan PM, Friedberg JW. Follicular lymphoma: first-line treatment without chemotherapy for follicular lymphoma. Curr Treat Options Oncol 2016; 16:32. [PMID: 26031546 DOI: 10.1007/s11864-015-0351-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Opinion statement: The optimal initial treatment of follicular lymphoma (FL) is not known, and initial management of patients varies considerably between providers and institutions. The assertion that patients with low tumor burden can be observed for a period of time is being challenged owing to the safety and tolerability of novel therapeutics and the movement of the field away from traditional chemotherapy agents. Single agent rituximab has become increasingly popular as initial management of patients with low tumor burden disease, and there is evidence that prolonged treatment with rituximab can improve progression-free survival (PFS) when compared to induction with rituximab or observation. Radioimmunotherapy (RIT) has similarly shown efficacy in low tumor burden disease. Novel agents such as lenalidomide, idelalisib, and ibrutinib are being studied in the first-line setting. Importantly, none of these strategies have demonstrated an improved overall survival in a randomized study versus observation. It is the opinion of the authors that endpoints such as PFS alone, while important, should not drive changes in management with limited resources. Composite endpoints including quality of life are more informative on the true impact of treatments on patients with follicular lymphoma. Providers should encourage all patients to be treated in the context of an appropriate clinical trial when possible. If a patient is not a clinical trial candidate, we typically treat patients with advanced stage and high tumor burden with chemoimmunotherapy. The decision to give maintenance rituximab is individualized to the patient, as there is no overall survival benefit. In patients with early stage disease, we favor consideration of radiation therapy if the patient is a candidate. Our initial recommendation to patients with advanced stage, low tumor burden disease, is close observation or "watch and wait." We have observed that most patients become comfortable over time with an observation approach. If a patient is not comfortable with this recommendation, we will use single agent rituximab. If the patient responds to therapy, we do not recommend maintenance rituximab in low tumor burden disease but rather prefer a retreatment strategy or an extended schedule of four additional doses of rituximab.
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Affiliation(s)
- Patrick M Reagan
- University of Rochester Medical Center, 601 Elmwood Ave, Box 704, Rochester, NY, 14642, USA,
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28
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Kralovicova J, Knut M, Cross NCP, Vorechovsky I. Exon-centric regulation of ATM expression is population-dependent and amenable to antisense modification by pseudoexon targeting. Sci Rep 2016; 6:18741. [PMID: 26732650 PMCID: PMC4702124 DOI: 10.1038/srep18741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 11/25/2015] [Indexed: 01/10/2023] Open
Abstract
ATM is an important cancer susceptibility gene that encodes a critical apical kinase of the DNA damage response (DDR) pathway. We show that a key nonsense-mediated RNA decay switch exon (NSE) in ATM is repressed by U2AF, PUF60 and hnRNPA1. The NSE activation was haplotype-specific and was most promoted by cytosine at rs609621 in the NSE 3' splice-site (3'ss), which is predominant in high cancer risk populations. NSE levels were deregulated in leukemias and were influenced by the identity of U2AF35 residue 34. We also identify splice-switching oligonucleotides (SSOs) that exploit competition of adjacent pseudoexons to modulate NSE levels. The U2AF-regulated exon usage in the ATM signalling pathway was centred on the MRN/ATM-CHEK2-CDC25-cdc2/cyclin-B axis and preferentially involved transcripts implicated in cancer-associated gene fusions and chromosomal translocations. These results reveal important links between 3'ss control and ATM-dependent responses to double-strand DNA breaks, demonstrate functional plasticity of intronic variants and illustrate versatility of intronic SSOs that target pseudo-3'ss to modify gene expression.
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Affiliation(s)
- Jana Kralovicova
- University of Southampton Faculty of Medicine Southampton SO16 6YD United Kingdom
| | - Marcin Knut
- University of Southampton Faculty of Medicine Southampton SO16 6YD United Kingdom
| | - Nicholas C. P. Cross
- University of Southampton Faculty of Medicine Southampton SO16 6YD United Kingdom
- Wessex Regional Genetics Laboratory Salisbury Hospital Salisbury SP2 8BJ United Kingdom
| | - Igor Vorechovsky
- University of Southampton Faculty of Medicine Southampton SO16 6YD United Kingdom
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29
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Maruthappu M, Barnes I, Sayeed S, Ali R. Incidence of prostate and urological cancers in England by ethnic group, 2001-2007: a descriptive study. BMC Cancer 2015; 15:753. [PMID: 26486598 PMCID: PMC4618465 DOI: 10.1186/s12885-015-1771-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/10/2015] [Indexed: 01/08/2023] Open
Abstract
Background The aetiology of urological cancers is poorly understood and variations in incidence by ethnic group may provide insights into the relative importance of genetic and environmental risk factors. Our objective was to compare the incidence of four urological cancers (kidney, bladder, prostate and testicular) among six ‘non-White’ ethnic groups in England (Indian, Pakistani, Bangladeshi, Black African, Black Caribbean and Chinese) to each other and to Whites. Methods We obtained Information on ethnicity for all urological cancer registrations from 2001 to 2007 (n = 329,524) by linkage to the Hospital Episodes Statistics database. We calculated incidence rate ratios adjusted for age, sex and income, comparing the six ethnic groups (and combined ‘South Asian’ and ‘Black’ groups) to Whites and to each other. Results There were significant differences in the incidence of all four cancers between the ethnic groups (all p < 0.001). In general, ‘non-White’ groups had a lower incidence of urological cancers compared to Whites, except prostate cancer, which displayed a higher incidence in Blacks. (IRR 2.55) There was strong evidence of differences in risk between Indians, Pakistanis and Bangladeshis for kidney, bladder and prostate cancer (p < 0.001), and between Black Africans and Black Caribbeans for all four cancers (p < 0.001). Conclusions The risk of urological cancers in England varies greatly by ethnicity, including within groups that have traditionally been analysed together (South Asians and Blacks). In general, these differences are not readily explained by known risk factors, although the very high incidence of prostate cancer in both black Africans and Caribbeans suggests increased genetic susceptibility. g. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1771-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Isobel Barnes
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK.
| | - Shameq Sayeed
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK.
| | - Raghib Ali
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK. .,New York University Abu Dhabi, Abu Dhabi, PO Box 129188, United Arab Emirates.
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30
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De Braekeleer M, De Braekeleer E, Douet-Guilbert N. Geographic/ethnic variability of chromosomal and molecular abnormalities in leukemia. Expert Rev Anticancer Ther 2015. [DOI: 10.1586/14737140.2015.1068123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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31
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Samy EF, Ross J, Bolton E, Morris EJ, Oliver SE. Variation in incidence and survival by ethnicity for patients with myeloma in England (2002-2008). Leuk Lymphoma 2015; 56:2660-7. [PMID: 25651425 DOI: 10.3109/10428194.2014.1003060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Incidence and relative survival of myeloma by ethnic group was estimated using data from cancer registries in England (2002-2008). Multiple imputation was used to address missing ethnicity data. In total 24 361 cases of myeloma were identified. Age-standardized incidence rate (ASIR) (per 100 000) was higher in the Black ethnic category at 15.00 (95% confidence interval [CI] 13.50-16.40), than amongst South Asians (ASIR = 5.45, 95% CI 4.76-6.14) or the White group (ASIR = 6.11, 95% CI 6.00-6.22). There was a lower risk of death in the Black group for both 1- and 3-year survival (hazard ratio [HR]1 year = 0.66, 95% CI 0.55-0.79; HR3 year = 0.69, 95% CI 0.58-0.83) and South Asians at 1, 3 and 5 years (HR1 year = 0.65, 95% CI 0.51-0.82; HR3 year = 0.72, 95% CI I 0.57-0.90; HR5 year = 0.68, 95% CI 0.50-0.92) when compared to the White population. Further study of differences in myeloma and precursor biology between population groups is important.
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Affiliation(s)
- E Faye Samy
- a Public Health England Knowledge and Information Team (Northern and Yorkshire), Innovation Centre, University of York , York , UK
| | - James Ross
- b Haematological Malignancy Clinical Reference Group, National Cancer Intelligence Network , London , UK
| | - Edward Bolton
- c Cancer Informatics Team, Leeds Teaching Hospitals , Leeds , UK
| | - Eva J Morris
- d Cancer Epidemiology Group, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital , Leeds , UK
| | - Steven E Oliver
- e Department of Health Sciences and the Hull York Medical School , University of York , York , UK
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32
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Shirley MH, Barnes I, Sayeed S, Finlayson A, Ali R. Incidence of breast and gynaecological cancers by ethnic group in England, 2001-2007: a descriptive study. BMC Cancer 2014; 14:979. [PMID: 25522857 PMCID: PMC4301395 DOI: 10.1186/1471-2407-14-979] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although international comparisons reveal large geographical differences in the incidence of breast and gynaecological cancers, incidence data for ethnic groups in England remains scarce. METHODS We compared the incidence of breast, ovarian, cervical and endometrial cancer in British Indians, Pakistanis, Bangladeshis, Black Africans, Black Caribbeans, Chinese and Whites between 2001 and 2007. We identified 357,476 cancer registrations from which incidence rates were calculated using mid-year population estimates from 2001 to 2007. Ethnicity was obtained through linkage to the Hospital Episodes Statistics database. Incidence rate ratios were calculated, comparing the 6 non-White ethnic groups to Whites, and were adjusted for age and income. RESULTS We found evidence of differences in the incidence of all 4 cancers by ethnic group (p<0.001). Relative to Whites, South Asians had much lower rates of breast, ovarian and cervical cancer (IRRs of 0.68, 0.66 and 0.33 respectively), Blacks had lower rates of breast, ovarian and cervical cancer but higher rates of endometrial cancer (IRRs of 0.85, 0.62, 0.72 and 1.16 respectively), and Chinese had lower rates of breast and cervical cancer (IRRs of 0.72 and 0.68 respectively). There were also substantial intra-ethnic differences, particularly among South Asians, with Bangladeshis experiencing the lowest rates of all 4 cancers. CONCLUSIONS Our study provides evidence that the risk of breast and gynaecological cancers varies by ethnic group and that those groups typically grouped together are not homogenous with regards to their cancer risk. Furthermore, several of our findings cannot be readily explained by known risk factors and therefore warrant further investigation.
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Affiliation(s)
- Megan H Shirley
- />Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF UK
| | - Isobel Barnes
- />Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF UK
| | - Shameq Sayeed
- />Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF UK
| | - Alexander Finlayson
- />Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF UK
| | - Raghib Ali
- />Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF UK
- />17666 Al Ain, United Arab Emirates
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