IL-6 levels dominate the serum cytokine signature of severe epidermolysis bullosa: A prospective cohort study

BACKGROUND

Systemic inflammation is considered a major player in the pathogenesis of epidermolysis bullosa (EB), but its pattern has only been described in small heterogeneous cohorts. There is controversy if and how systemic inflammation should be therapeutically targeted.

METHODS

We examined serum proinflammatory, anti-inflammatory, and itch related cytokines in a paediatric cohort of 29 patients with junctional and dystrophic EB. The cytokine that emerged as the most relevant was measured in a validation cohort of 42 patients during follow-up visits over 2 years.

RESULTS

IL-6 showed the most consistent and highest aberration dominating systemic inflammation. IL-6 correlated with wound body surface area (BSA) in both, finding and validation cohorts. Patients with less than 3% wound BSA had normal IL-6, while IL-6 levels significantly increased at more than 5% and 10% of wound BSA. TGF-β was only marginally elevated in patients with severe recessive dystrophic EB, while TNF-α, IFN-γ and IL-1β varied inconsistently. Patients reporting itch showed elevations in type 2 immunity (IgE, TSLP, IL4 and/or IL-31, respectively).

CONCLUSIONS

Our data suggest a dominant skin barrier and wound healing inflammatory pattern in junctional and dystrophic EB that depends on the wound area and not on the EB type. In EB, itch mediators may be similar to other pruritic disorders.

Mitochondrial DNA haplogroup, genetic ancestry, and susceptibility to Ewing sarcoma

Based on current studies, the incidence of Ewing sarcoma (ES) varies significantly by race and ethnicity, with the disease being most common in patients of European ancestry. However, race/ethnicity has generally been self-reported rather than formally evaluated at a population level using DNA evidence. Additionally, mitochondrial dysfunction is a hallmark of ES, yet there have been no reported studies of mitochondrial genetics in ES. Thus, we evaluated both the mitochondrial and nuclear ancestries of 420 pediatric ES patients in the United States using whole-genome sequencing. We found that the mitochondrial DNA (mtDNA) genomes of only six (1.4 %) patients belonged to African L haplogroups, while those of 90 % of the patients belonged to macrohaplogroup R, which includes haplogroup H, the most common maternal lineage in Europe. Compared to the general US population, European haplogroups were significantly enriched in ES patients (p < 2.2e-16) and the African haplogroups are significantly impoverished (p < 4.6e-16). Using the ancestry informative markers defined in a National Genographic study, the vast majority of patients exhibited significant nuclear ancestry originating from the Mediterranean, Northern Europe, and Southwest Asia, including all six patients with African L mtDNAs. Very few had primarily African nuclear ancestry. This is the first genomic epidemiology study to simultaneously interrogate the mitochondrial and nuclear ancestries of ES patients. While supporting previous findings of enriched European ancestry in ES patients, these results also suggest alternative hypotheses for the significant contribution of mitochondrial ancestry in ES patients, as well as the protective role of African ancestry.

Cancer Informatics for Cancer Centers: Scientific Drivers for Informatics, Data Science, and Care in Pediatric, Adolescent, and Young Adult Cancer

Cancer Informatics for Cancer Centers (CI4CC) is a grassroots, nonprofit 501c3 organization intended to provide a focused national forum for engagement of senior cancer informatics leaders, primarily aimed at academic cancer centers anywhere in the world but with a special emphasis on the 70 National Cancer Institute-funded cancer centers. This consortium has regularly held topic-focused biannual face-to-face symposiums. These meetings are a place to review cancer informatics and data science priorities and initiatives, providing a forum for discussion of the strategic and pragmatic issues that we faced at our respective institutions and cancer centers. Here, we provide meeting highlights from the latest CI4CC Symposium, which was delayed from its original April 2020 schedule because of the COVID-19 pandemic and held virtually over three days (September 24, October 1, and October 8) in the fall of 2020. In addition to the content presented, we found that holding this event virtually once a week for 6 hours was a great way to keep the kind of deep engagement that a face-to-face meeting engenders. This is the second such publication of CI4CC Symposium highlights, the first covering the meeting that took place in Napa, California, from October 14-16, 2019. We conclude with some thoughts about using data science to learn from every child with cancer, focusing on emerging activities of the National Cancer Institute's Childhood Cancer Data Initiative.

Poor-Prognosis Metastatic Cancers in Adolescents and Young Adults: Incidence Patterns, Trends, and Disparities

Background

For adolescents and young adults (AYAs, aged 15-39 years) with cancer, metastatic disease at diagnosis is the strongest predictor of mortality, but its associations with age and sociodemographic factors are largely unexplored.

Methods

Using Surveillance, Epidemiology, and End Results Program data from 2000 to 2016, we collected incident cases of poor-prognosis metastatic cancer (5-year survival < 50%) and compared the proportion, incidence, time trends, and incidence rate ratios for race and ethnicity, sex, and socioeconomic status among AYAs, middle-aged adults (aged 40-64 years) and older adults (aged 65-79 years).

Results

From 2000 to 2016, a total of 17 210 incident cases of poor-prognosis metastatic cancer were diagnosed in AYAs, 121 274 in middle-aged adults, and 364 228 in older adults. Compared with older patients, the proportion of AYAs having metastatic disease was equivalent or substantially lower in nearly every site except stomach and breast cancers, which were statistically significantly higher for AYAs compared with middle-aged and older adults (stomach: 57.3% vs 46.4% and 39.5%; breast: 6.6% vs 4.4% and 5.6%, respectively; 2-sided P < .001 for all comparisons). Incidence rates rose significantly faster among AYAs for breast, stomach, and kidney cancers and among AYAs and middle-aged adults for colorectal cancer. Markedly higher incidence rate ratios were noted for AYA racial and ethnic minorities with breast, stomach, and especially kidney cancer, where only non-Hispanic Black AYAs were at considerably higher risk. For most sites, incidence rate ratios were higher among male patients and individuals of low socioeconomic status across age groups.

Conclusions

For most cancers, AYAs are not more likely to present with metastases than middle-aged and older adults. Further investigation is warranted for the disproportionate rise in incidence of metastatic breast, stomach, and kidney cancer among AYAs and their excess burden among AYA racial and ethnic minorities. The rising incidence of colorectal cancer among AYAs and middle-aged adults remains an additional concern.

Abstract PO-44: Past infection and risk of adolescent/young adult HL

Background: Adolescent/young adult (AYA) Hodgkin lymphoma (HL) risk is increasingly linked to a deficit of microbial exposure in early life, especially from fecal-oral transmission.

Methods: In this cross-sectional study, we examined past exposure to 15 infections in serum samples from 291 AYA HL cases and 194 of their unaffected family members. We measured antibodies to HSV1, HSV2, VZV, EBV, HHV7, HCMV, HHV6, KSHV, S. gallolyticus, F. nucleatum, T. gondii, H. pylori, Rubella virus, and Parvovirus B19 using a multiplex serology bead array (Luminex). A positive history was determined by a titer threshold specific for each infection. A logistic regression model was used to calculate the odds ratio (OR) of AYA HL risk for each infection separately adjusted for sex and age at sampling. We then applied the same logistic regression model, adding an adjustment for family.

Results: Evidence of past HHV6 infection was associated with an increased risk of AYA HL (OR= 1.80; 95% CI= 1.06-3.07). Having antibodies to H. pylori was associated with a decreased risk (OR= 0.49; 95% CI= 0.25-0.98). An increasing number of fecal-oral infections (H. pylori, T. gondii) was associated with a decreasing risk of AYA HL (ptrend&lt;0.001), while an increasing number of respiratory-transmitted infections (Rubella virus, Parvovirus) was not significantly associated (ptrend=0.062). After adjusting for family, infection with Parvovirus was the only significant risk factor for AYA HL (OR=3.8,1.06-13.6).

Conclusions: We show preliminary evidence for an inverse association between fecal-oral transmitted agents and risk of AYA HL, supporting the hypothesis that a deficit of early life fecal-oral transmitted microbes may be associated with increased risk. HHV6 and Parvovirus were associated with an increased risk, possibly due to a subclinical immune deficiency or an unknown mechanism. In the final presentation, we will add data from 40 additional unaffected family members currently missing age, and results by histology and EBV status.

Citation Format: Maryam Saleh, Amie Hwang, Julia Simon, Thomas M. Mack, Tim Waterboer, Wendy Cozen. Past infection and risk of adolescent/young adult HL [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-44.

Abstract IA15: Mobile virtual human health care guides for young adult childhood cancer survivors

Since the mid-1990s, a significant scientific literature has evolved regarding the mental/physical health outcomes from the use of what we now refer to as Clinical Virtual Reality (VR). While the preponderance of clinical work with VR has focused on building immersive virtual worlds for treating anxiety disorders with exposure therapy, providing distracting immersive experiences for acute pain management, and supporting physical rehabilitation with game-based interactive content, there are other emerging areas that have extended the impact of VR in healthcare. One such area involves the recent technological advances that have led to the evolution of intelligent virtual human (VH) agents. VH representations can now be designed to perceive and act in a 3D virtual world, engage in face-to-face spoken dialogues with real users, and in some cases, can exhibit human-like emotional reactions. We have reported positive outcomes from studies using VHs in the role of virtual patients for training novice clinicians, as job interview/social skill trainers for persons on the autism spectrum, and as online health care support agents with university students and military veterans. The computational capacity now exists to deliver similar VH interactions by way of mobile device technology. This capability can support the “anywhere/anytime” availability of VH characters as agents for engaging users with clinical care information and could provide opportunities for improving access to care and emotional support for childhood cancer survivors (CCS). With a survivorship rate of over 83%, CCS are living longer, with estimates indicating that there will be over 500,000 CCS in the United States by 2020. However, CCS are at high risk for late effects of treatment, including recurring or secondary cancers, unhealthy lifestyle, disengagement from care, and the lack of the social support that has been shown to be vital for health and well-being. The majority of CCS will have at least one chronic condition by age 40. Moreover, existing initiatives to serve the needs of CCS have had limited success as these populations can be hard to reach and difficult to engage. We conducted two preliminary studies to inform development and evaluate the usefulness of a mobile app that included VH interaction and guidance to help CCS navigate survivorship and maintain health. In Study 1, two rounds of focus group interviews were conducted with 15 CCS aged 13-30 years. In Study 2, a pilot VH-driven app was developed using the information collected in Study 1. The app was downloaded, tested, and evaluated for one week by 60 CCS between the ages of 13-29 years. The results indicated that dynamic, accessible, engaging and survivor-focused VH approaches could address the needs of young, “digitally native” CCS. We will present a brief introduction to the clinical use of VHs within the VR context (Rizzo), followed by a discussion of a new mobile-enabled VH project designed to promote access to health care information and emotional support in young adult CCS (Spruijt-Metz).

Citation Format: Skip Rizzo, Donna Spruijt-Metz, Arno Hartholt, Bill Swartout, Kayla de la Haye, Joel Milam, David Freyer, Kimberly Miller, Anamara Ritt-Olson, Stacy Schepens-Niemiec, Shinyi Wu, Maryalice Jordan-Marsh, Amie Hwang, Anya Samek, Dennis Wixon, George Tolomiczenko, Kenneth Hayashida, Marientina Gotsis, Stefan Schneider, Swaroop Samek, Yaniv Bar-Cohen. Mobile virtual human health care guides for young adult childhood cancer survivors [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr IA15.

A Reappraisal of Sex-Specific Cancer Survival Trends Among Adolescents and Young Adults in the United States

BACKGROUND

Cancer survival among adolescents and young adults (AYAs) was previously reported as showing little or no improvement compared to younger or older counterparts. The role of the HIV/AIDS epidemic in the AYA survival deficit has not been evaluated.

METHODS

Using cancer registry data from the Surveillance, Epidemiology, and End Results program (SEER 9), we examined sex-specific 5-year relative survival trends for children (0-14 years old), AYAs (15-39 years old), and older adults (40 years and older) diagnosed with cancer during 1973-2009 and followed through the end of 2014. The analysis was conducted with and without Kaposi sarcoma (KS) and lymphomas, and by two time periods: 1973-1977 (before the human immunodeficiency virus/acquired immunodeficiency syndrome [HIV/AIDS] epidemic) and 2005-2009 (after the HIV/AIDS epidemic waned).

RESULTS

A total of 3 209 721 invasive cancer cases were included in the study (27 646 children, 213 930 AYAs, and 2 968 145 older adults; 24 803 children, 178 741 AYAs, and 2 844 062 older adults when KS and lymphoma cases were excluded). We found that 5-year relative survival for AYAs exceeded that of children and older adults before the onset of the HIV/AIDS epidemic (eg, during 1973-1979, 0.58-0.67 among male AYAs as compared with 0.47-0.61 for male children and 0.36-0.42 for male older adults; among female AYAs, the numbers were 0.73-0.77 as compared with 0.51-0.65 for female children and 0.52-0.55 for female older adults); substantially declined during 1983-1997 when HIV/AIDS lacked effective treatment among male AYAs; and returned to be higher than most age groups by the late 1990s after HIV/AIDS was controlled. Nonetheless, comparison of survival improvement between 1973-1977 and 2005-2009 demonstrated less progress in AYAs than other age groups, which was due to AYAs' better baseline survival and larger survival gains among children and older adults in recent years.

CONCLUSIONS

Apart from the temporary impact of HIV/AIDS, survival among AYA cancer patients has shown sustained improvement and superiority relative to other age groups. However, these encouraging findings do not negate the distinctive challenges in cancer diagnosis, treatment, and survivorship faced by AYAs.

Abstract IA17: Observations and implications from examining cancer incidence rates and trends of ethnic Asian Americans

Asian Americans are a fast-growing population group in the United States (US). The substantial heterogeneity within them (e.g., by origin, language, culture, immigration history, socioeconomic status, degree of acculturation, etc.) and its impact on health and cancer disparities are increasingly being recognized. Except for Japanese Americans, the majority of the ethnic Asian Americans are foreign-born. Monitoring cancer incidence rates and trends among immigrant populations, especially in comparison with those of their countries of origin and US, can provide valuable information for understanding cancer etiology and identifying modifiable environmental and behavioral risk factors. As population mobility increases globally with time, this area of research will become more important and needed. The Los Angeles Cancer Surveillance Program (LACSP) is the population-based cancer registry for Los Angeles County (LAC) in California with over 10 million residents. It is a member of the California Cancer Registry (CCR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. It is also the only U.S. cancer registry that has consistently reported cancer incidence for four ethnic Asian American populations (i.e., Chinese, Filipinos, Japanese, and Koreans) in its catchment area, which allows the comparisons of these largely immigrant populations against those of their countries of origin and US whites. The standardized and detailed data from LACSP and around the world published in the Cancer in Five Continents (CI5) volumes have enabled numerous international comparison studies. We used the CI5 online analysis tool, CI5plus, and extracted age-adjusted incidence rates by sex and cancer site in LAC for Chinese, Filipinos, Japanese, and Koreans, respectively, to compare with rates from China, Philippines, Japan, and South Korea, as well as those for whites from the SEER registries for the period of 1973-2012. We observed: 1) Cancer-specific incidence rates among all four Asian ethnic groups in LAC have deviated from the rates in their countries of origin to approaching US whites; 2) although their risks for some cancers decreased (e.g., cervical, gastric, and liver), their risks for other cancers increased (e.g., breast, uterine, non-Hodgkin lymphoma, and testicular); and 3) Filipino Americans display rather different cancer risk profiles from other ethnic Asian Americans. Our findings highlight the important changes in cancer-specific incidence rates and trends among the ethnic Asian American subgroups as compared to those of their countries of origin. These changes underline the significance of nongenetic factors, including environmental, behavioral, and lifestyle factors, in cancer development and deserve further attention. Along with existing literature on known differences in cancer risk among these subpopulations, our work will help establish priorities to decrease cancer burden among Asian immigrants.

Citation Format: Lihua Liu, Juanjuan Zhang, Andrea Sipin-Baliwas, Amie Hwang, Mariana C. Stern, Myles Cockburn, Dennis Deapen. Observations and implications from examining cancer incidence rates and trends of ethnic Asian Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA17.

Abstract B092: Epstein-Barr virus prevalence in classical Hodgkin lymphoma tumors by race/ethnicity in a multiethnic U.S. population

Background Classical Hodgkin lymphoma (cHL) is one of the most common cancers among adolescents and young adults (AYA). Incidence rates vary by demographic factors, with the highest incidence in whites of high SES. Malignant Hodgkin Reed-Sternberg (HRS) cells comprise a small percentage of the tumor (about 1%), with the remainder composed of various immune cells (tumor microenvironment, TME). The TME in cHL predicts survival and response to treatment in NHW, but has not been examined in diverse populations. We implemented a study to examine the TME and survival by race/ethnicity and SES in a multiethnic, multicenter set of 1,536 U.S. cHL cases. We conducted an initial analysis of factors associated with EBV status in tumors. Methods FFPE tumor blocks for 649 cases diagnosed from 1996-2016 were identified to date. Diagnosis and histological subtype was confirmed by pathology review for 554. Tissue microarrays were constructed with two 2 mm cores from each case with 29 cases on each array. EBER was assessed using in situ hybridization and scored as negative, positive in HRS cells or positive in the surrounding normal infiltrate. Demographic and clinical information, including the anatomic site of the biopsy, subtype, race/ethnicity (Hispanic, African American [AA], Asian, Native American, NHW), age at diagnosis and gender was collected. Multiple logistic regression was conducted to assess the relationship between age at diagnosis, race/ethnicity, gender, subtype and EBV tumor status. Results Race data was available at this time for 549 cases including 153 NHW, 235 Hispanics, 110 AAs, 36 Asians, 2 Native Americans and 13 with unknown race. 260 (47%) were female. EBV prevalence was available for 393 cases, with 316 nodular sclerosis (NS), 52 mixed cellularity (MC), 8 lymphocyte depleted (LD), 3 lymphocyte rich (LR), and 14 not otherwise specified (NOS). Age at diagnosis ranged from 5-87 years of age, with 189 (48.09%) in AYA (15-35 y). EBV+ by histology was 12.5%% for LD, 33% for LR, 47% for MC, 25% for NS, and 29% for NOS. Histologic subtype was a statically significant predictor of EBV tumor status (p=.0007), even after adjusting for age, sex, and race/ethnicity (p=.0085). Among NS cases, EBV+ was similar across racial/ethnic groups. However, there was a much higher prevalence of EBV+ in AA (73%) compared to NHW and Hispanic (36-42%) MC cases. HIV/AIDS status was available for 40% of the AA cases but none were positive. There was no correlation between year of diagnosis and the presence of EBV in tumors (r=0.05, p=0.42), thus block storage time did not affect the results. Conclusions This is the largest study of the Hodgkin lymphoma TME in a racially and ethnically diverse population. In an initial analysis, histologic subtype was the strongest predictor of positive EBV tumor status. Unlike previous reports, EBV-positive tumors were not more common among non-whites, except for AA MC cases. We expect to confirm these results in a larger sample as more cases are accrued.

Citation Format: Rachel Bolanos, Amie Hwang, Jose Aparicio, Chun Chao, Naba Qurashi, Christopher Flowers, Sheeja Pullarkat, David Conti, Sophia Wang, Karen Mann, Leon Bernal-Mizrachi, Joo Song, Christian Steidl, Imran Siddiqi, Wendy Cozen. Epstein-Barr virus prevalence in classical Hodgkin lymphoma tumors by race/ethnicity in a multiethnic U.S. population [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B092.

Abstract 5053: Epstein-Barr virus prevalence in classical Hodgkin lymphoma tumors is explained by histologic subtype, not race/ethnicity in a multiethnic US population

Epstein-Barr virus (EBV) is present in a varying proportion of classical Hodgkin lymphoma (cHL) tumors reportedly associated with age, sex, race/ethnicity and histologic subtype. As part of a study to examine the tumor microenvironment and survival in a multiethnic set of US cHL cases, we examined the distribution of EBV expression in tumor blocks from a subset of 269 of the available cases. We confirmed cHL diagnosis and histological subtype in H&E sections of FFPE tumor blocks of excisions and core biopsies from cases provided by Southern California Kaiser, Winship Cancer Center at Emory University, City of Hope National Medical Center, Grady Memorial Hosiptal, University of California Los Angeles and University of Southern California hospitals diagnosed from 1996-2016. Immunostain results were available for most cases. Tissue microarrays were constructed with two 2 mm cores from each case with 29 cases on each array. EBER was assessed using in situhybridization and scored as negative, positive in HRS cells or positive in the surrounding normal infiltrate. Demographic and clinical information, including the biopsy anatomic site, subtype, race/ethnicity (Hispanic, African American, Asian, non-Hispanic white), age at diagnosis and gender. Multiple logistic regression was conducted to assess the relationship between age, race/ethnicity, gender, subtype and EBV tumor status. Race/ethnicity data was available at this time for 237 cases. Of these, 186 were nodular sclerosis (NS), 53 were mixed cellularity (MC), 8 were lymphocyte depleted (LD), 3 were lymphocyte rich (LR), and 10 were not otherwise specified (NOS). Fifty-seven cases were African American, 48 were non-Hispanic white, 115 were Hispanic, 16 were Asian and one was other race. 106 were female (42%). Age at diagnosis ranged from 5-84 years, with 118 (50%) in the adolescent/young adult (AYA) range (15-35). EBV prevalence in HRS cells by subtype was 0% for LD, 47% for MC, 33% for LR, 23% for NS and 50% for NOS. When restricted to the two most common subtypes, NS and MC, histologic subtype alone was a statistically significant predictor of EBV tumor status (p=.0008) and when adjusting for age, sex, site and race/ethnicity (p=.0011). In NS cases, EBV HRS cell positivity was highest in non-Hispanic whites (31%), followed by Hispanics (23%) and African Americans (18%). Among MC cases, it was very high among African Americans (80%) compared to Hispanics and non-Hispanic whites (33-39%). The patterns were similar when restricted to the AYA age group. 6.5%, 4% and 20% of EBV-negative NS, MC and NOS cases, respectively, had EBV present in non-malignant lymphocytes but not in HRS cells. Histologic subtype was the strongest predictor of EBV HRS cell positivity in this set of multiethnic cHL patients. Unlike previous reports, EBV-positive tumors were not more common among non-whites, except for African American MC cases.

Citation Format: Rachel Bolanos, Amie Hwang, Chun Chao, Christopher Flowers, Sheeja Pullarkat, Jose Aparicio, Sophia Wang, Karen Mann, Leon Bernal-Mizrachi, Joo Song, Christian Steidl, Christine Lee, Wendy Cozen, Iran Siddiqi. Epstein-Barr virus prevalence in classical Hodgkin lymphoma tumors is explained by histologic subtype, not race/ethnicity in a multiethnic US population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5053.

Emerging Cancer Survival Trends, Disparities, and Priorities in Adolescents and Young Adults: A California Cancer Registry-Based Study

BACKGROUND

Although landmark studies in the 1990s demonstrated that adolescents and young adults (AYAs, ages 15-39 years) with cancer had lower survival improvement compared to other ages, therapeutic advances warrant reappraisal of those observations. We utilized more recent data to study site-specific AYA survival trends and disparities and gain a more contemporary understanding of this problem.

METHODS

Using California Cancer Registry data from 1988 to 2014, we calculated 1) 5-year overall survival improvement for AYAs compared to other age groups; 2) hazard ratios (HRs) of death for AYAs comparing 2001-2014 with 1988-2000 stratified by site, stage, sex, age group, race and ethnicity, and socioeconomic status (SES); and 3) site-specific adjusted HRs (aHRs) for AYA risk groups and interaction analyses by time period.

RESULTS

For all cancers combined, AYAs demonstrated survival improvement that exceeded all other age groups, largely due to reduced mortality in human immunodeficiency virus and acquired immunodeficiency syndrome-related cancers. The strongest predictor of death was cancer stage (aHR = 6.32 for distant vs localized, 95% confidence interval [CI] = 6.20 to 6.45). The aHR of death was statistically significantly higher for blacks (1.46, 95% CI = 1.42 to 1.50), Asian and Pacific Islanders (1.12, 95% CI = 1.09 to 1.15), and Latino whites (1.06, 95% CI = 1.04 to 1.08) compared to non-Latino whites, and was statistically significantly higher for low SES compared to high (1.31, 95% CI = 1.29 to 1.34). Survival disparities by stage, race and ethnicity, and SES worsened over time.

CONCLUSIONS

For AYAs in aggregate, the historical cancer survival improvement gap has been closed. However, the growing survival disparities in AYA subsets reported here, including advanced stage disease, racial and ethnic minorities, and low SES, highlight new priorities in need of increased attention, including inequities in cancer care and delivery within this vulnerable population.

Abstract 223: A meta-analysis of genome-wide association studies of multiple myeloma among African Americans

Multiple myeloma (MM) is twice as common in African Americans (AA) compared to European Americans (EA). The reported familial clustering and the elevated MM risk among first-degree relatives of cases implicate genetic susceptibility. Previous genome-wide association studies (GWAS) in EA have identified 16 novel risk loci. In this study, we tested the generalizability of the established risk alleles to AA and conducted a meta-GWAS analysis using two sets of AA to identify additional novel common MM risk variants. In the first study, we genotyped 1,305 incident AA MM cases from the African American Multiple Myeloma Study (AAMMS) using the Illumina HumanCore GWAS array and compared them to 7,078 AA controls from the African Ancestry Prostate Cancer Consortium (AAPC) and African Ancestry Breast Cancer Consortium (AABC) using the Illumina 1M-Duo. In the second study, 95 additional AAMMS cases and 435 AA MM cases from the University of Arkansas for Medical Sciences (UAMS) were genotyped using the Illumina MegaBead Chip and compared to 2,390 AA controls from the Multiethnic Cohort. The Haplotype Reference Consortium (HRC) was used to impute the overlapping typed SNPS from each GWAS case and control set together. Per-allele risk associations were tested for 8,715,278 overlapping genotyped and imputed variants with &gt;1% frequency and &gt;0.8 imputation score using unconditional logistic regression in both sets, and the combined effects were estimated using a fixed-effect meta-analysis. Of the 16 reported risk loci discovered in EA, directional consistency was present for 15 variants; eight of these replicated at nominal significance p&lt;0.05, with the most statistically significant variant being rs4487645 at 7p15.3 (OR=1.38, p=3.56×10-6). AA individuals with polygenic risk scores from these 16 variants (PRS) in the top 10% stratum had a 1.44-fold increased MM risk compared to those with a PRS in the 25th -75th percentiles. Additionally, we identified three suggestive novel loci located at 12q12, 9p24.3 and 9p13.1 at p&lt;1×10-6, with ORs ranging from 1.25-1.55, but none reached genome-wide significance. The variant at 9p24.3 is located in an intron in the KANK1 gene and a correlated SNP in EAs (r2=0.5) is strongly associated with gene expression in neoplastic plasma cells (unpublished, Weinhold and Morgan). Our study replicated most of the reported risk loci discovered among EA, demonstrated that a PRS constructed using the 16 reported risk alleles was associated with MM risk, and provides suggestive evidence for additional loci associated with MM risk in AAs.

Citation Format: Zhaohui Du, Chi Song, Kristin Rand, Niels Weinhold, David Van Den Berg, Amie Hwang, Xin Sheng, Victor Hom, Sikander Ailawadhi, Ajay K. Nooka, Seema Singhal, Karen Pawlish, Edward S. Peters, Cathryn Bock, Ann Mohrbacher, Alexander Stram, Sonja I. Berndt, William Blot, John David Carpten, Antoinette Stroup, Andrew Olshan, Wei Zhang, African Ancestry Breast & Prostate Consortium, Stephen Chanock, Jayesh Mehta, Graham A. Colditz, Jeffrey Wolf, Thomas G. Martin, Michael Tomasson, Mark A. Fiala, Howard Terebelo, Nalini Janakiraman, Laurence Kolonel, Loic LeMarchand, Elad Ziv, Daniel Stram, Ravi Vij, Leon Bernal-Mizrachi, Gareth J. Morgan, Jeffrey A. Zonder, Carol Ann Huff, Sagar Lonial, Robert Z. Orlowski, David V. Conti, Christopher A. Haiman, Wendy Cozen. A meta-analysis of genome-wide association studies of multiple myeloma among African Americans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 223.

Stomach Cancer Disparity among Korean Americans by Tumor Characteristics: Comparison with Non-Hispanic Whites, Japanese Americans, South Koreans, and Japanese

Background: Stomach cancer incidence shows substantial racial-ethnic disparity in the United States, with Korean Americans experiencing by far the highest incidence. We examined stomach cancer incidence trends in Korean Americans by tumor subsite, histology, and stage and compared them with incidence rates in racial-ethnic groups with the second highest rate (Japanese Americans) and the lowest rate (non-Hispanic whites; NHWs) as well as populations in South Korea and Japan.Methods: We calculated age-adjusted incidence rates by racial-ethnic groups, sex, and tumor characteristics, using the 1988-2012 California Cancer Registry data. Data on South Korea and Japan were obtained from the literature and other resources.Results: Between 1988 and 2012 in California, Korean Americans had about five times greater incidence than NHWs and twice that of Japanese Americans. Tumor characteristics differed by ethnic group and gender. The incidence in Korean Americans has declined during recent years, for both cardia and noncardia sites and for both intestinal- and diffuse-type histology. Although Korean Americans were diagnosed at an earlier stage than other Californians, the proportion with localized disease (43%) was much smaller than in South Korea (57%), where population-based screening is available.Conclusions: Stomach cancer incidence declined in the highest risk ethnic groups. However, the persistent disparity between Korean Americans and other racial-ethnic groups warrants additional strategies for prevention and earlier diagnosis.Impact: Analysis of California Cancer Registry data identified a racial-ethnic subgroup with stomach cancer disparity that may benefit from targeted prevention and screening efforts. Cancer Epidemiol Biomarkers Prev; 26(4); 587-96. ©2016 AACR.

SU-D-211-04: Sector Intensity Modulated (SIM) Gamma Knife Stereotactic Radiosurgery

PURPOSE

The latest Gamma Knife (GK) system, Perfexion, consists of 192 Co-60 sources divided into eight sectors. Treatment delivery includes multiple shots placed at different positions. For every shot, each sector can be either blocked or open with four different aperture sizes. However, the beam-on time is designed to be fixed. We proposed an innovative concept, Sector Intensity Modulated (SIM) Gamma Knife by dynamically varying the beam-on time for each individual sector to improve stereotactic radiosurgery planning quality.

METHODS

The anatomic structures and dose matrices from each sector for every shot were obtained from the GK workstation. The beam-on time for each sector was decomposed with various discrete levels and brute-force algorithm was used to get the optimal solution. The resulting SIM plan was then re-entered into the GK workstation. Six indices were used to benchmark the plan quality: Coverage, Conformality, Gradient, Maximum Dose(s) to critical structure(s), Volume receiving over 8 and 12 Gy. All the SIM plans in comparison with the original plans were further reviewed by an experienced oncologist.

RESULTS

The simulations were tested on various pituitary adenoma cases. Results consistently showed that SIM yielded better plans with all quantitative indices improved compared to original plan. It provides better conformality, quicker drop off of the isodose line outside the tumor, lower doses to the critical structures as optical- nerve/chiasm while maintaining at least 99% coverage of the tumor. Results were more favorable according to oncologist's view. In particular, up to 20% or 0.6 cc volume decrease in healthy tissue receiving 8 Gy was observed. This may translate into clinically observable reduction in acute/late toxicities.

CONCLUSIONS

Our preliminary results show that Sector Intensity Modulated Gamma Knife offers superior treatment plans compared to the originally delivered plans. Further works as adding dynamic shot location and dynamic shot shaping will be discussed.

A Two-Step Optimization Method for Improving Multiple Brain Lesion Treatments with Robotic Radiosurgery

Planning robotic radiosurgery treatments for multiple (n > 3) metastatic brain lesions is challenging due to the need of satisfying a large number of dose-volume constraints and the requirement of prescribing different dose levels to individual targets. In this study, we developed a sequential two-step optimization technique to improve the planning quality of such treatments. In contrast to the conventional approach of where all targets are simultaneously planned, we have developed a two-step optimization method. In this method, the first step was to create treatment plans for individual targets. In the second step, the 3D dose matrices associated with each plan were exported to Dicom-RT digital files and subsequently optimized. For the optimization, a singular-value-decomposition (SVD) algorithm was implemented to minimize the dose interferences among different targets. Finally, we compared the optimized treatment plans with the treatment plans created using the conventional method to determine the effectiveness of the new method. Large improvements in target dose distributions as well as normal brain sparing were found for the two-step optimization treatment plans as compared with the conventional treatment plans. The two-step optimization significantly lowered the volume of normal brain receiving relatively low doses. For example, the normal brain volume receiving 12-Gy was reduced by averaged 42% (range 34%–47%) with the two-step optimization. Such improvements generally enlarged with increasing number of targets being treated regardless of target sizes. Of note, normal brain dose was found to increase non-linearly with increasing number of targets. In summary, a two-step optimization technique is demonstrated to significantly improve the treatment plan quality as well as reduce the planning effort for multi-target robotic radiosurgery.

Abstract 155: A comparison of DNA methylation in identical twins discordant for Hodgkin lymphoma

DNA methylation is an epigenetic change that may affect gene expression. Environmental determinants are largely unknown but strongly suspected. Because twins are matched on genome and to some extent, early life exposures, a comparison of DNA methylation between twins is of more interest than one between unrelated individuals.

To evaluate the possibility of an association between DNA methylation and young adult Hodgkin lymphoma (HL), DNA samples from blood or saliva were collected from both members of 25 identical twin pairs in whom one twin had developed HL prior to age 50 (discordant pairs). The median time since diagnosis was 16 years. DNA methylation status at 27,578 loci in 14,475 genes was measured in each sample using the Illumina Infinium methylation assay. We measured any difference (&lt; or &gt; 0) in the level of DNA methylation at each locus between the case and the unaffected co-twin and applied a paired t-test.

The overall pattern indicated that cases had higher levels of DNA methylation at loci with lower average DNA methylation levels, but the reverse was true at loci with higher overall levels of DNA methylation (e.g., here the cases had lower levels). With respect to specific loci, the HL case consistently had a higher level of DNA methylation compared to his/her unaffected co-twin at locus cg24693053 in the MFSD7 (major facilitator superfamily domain containing 7) gene in 22/25 pairs; this was also the locus with the most significant p-value (p= 0.0000332). Twenty-two out of 25 cases had a lower level of DNA methylation than their unaffected co-twin at loci cg17385448 in the AGMAT (Agmatine ureohydrolase [agmatinase]) gene (p= 0.0001587) and cg09809672 in the EDARADD (EDAR-associated death domain) gene (p= 0.003775846).

Seventeen out of 19 cases with the nodular sclerosis subtype had consistently higher DNA methylation levels at 9 loci and lower levels at 7 loci compared to their unaffected co-twin (binomial test p=0.0007). There was no overall effect on the pattern of methylation by time since diagnosis.

We observed suggestive differences in DNA methylation levels in normal peripheral blood mononuclear cells collected from young adult HL patients in remission relative to their unaffected identical co-twins. The differences may have resulted from HL disease or treatment, or could have pre-dated the diagnosis. The results are compatible with a role of the cumulative environment on DNA methylation.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 155.

The effect of selenium supplementation on DTH skin responses in healthy North American men

The trace element selenium (Se) is essential for immune system development and function in animals. However, the exact functions of Se in the human immune system and the achievable health benefits from Se supplementation remain unclear. To test whether an increased intake of dietary Se affects immune function, we conducted a randomized, controlled trial of Se supplementation in healthy free-living men. Forty-two men were administered 300microg of Se a day as high-Se Baker's yeast, or low-Se yeast for 48 weeks. Serum immunoglobulins, differential complete blood counts and lymphocyte sub-populations were measured every 6 weeks. Tests of delayed-type hypersensitivity (DTH) skin responses to mumps, candida, trychophyton, tuberculin-purified protein, and tetanus were performed at baseline and at the end of 48 weeks of treatment. Supplementation increased blood Se concentration by 50%. Surprisingly, consumption of the low-Se yeast induced anergy in DTH skin responses and increased counts of natural killer (NK) cells and T lymphocytes expressing both subunits of the high affinity interleukin-2 receptor (IL2R). DTH skin responses and IL2R+ cells did not change in the high-Se group, suggesting Se supplementation blocked induction of DTH anergy. There were no differences between groups in quality of life indicators, number of days sick, other leukocyte phenotypes, serum immunoglobulins, or complement factors. These results suggest that Se plays a role in immunotolerization, a cell-mediated process involved in many aspects of immune function.

Phase I pharmacokinetic (PK) and pharmacodynamic (PD) study of LBH589, a novel deacetylase (DAC) inhibitor given intravenously on a new once weekly schedule

14019

Background: LBH589 is a novel deacetylase inhibitor that inhibits proliferation of tumor cells at nanomolar levels. This phase I study tested the safety and tolerability of IV LBH589 once each week for 3 of 4 wks in pts with advanced solid tumors or lymphoma. Methods: LBH589 was administered IV over 30 min. on days 1, 8 and 15 of a 28-day cycle. Western blots on peripheral blood lymphocytes were used to study histone acetylation (HA). Plasma PK profiles were analyzed on Days 1 and 8. Results: Thirty five pts (median age: 70 yrs; 23M, 12F) have been treated on 3 dose levels [10 mg/m2 (8pts), 15 mg/m2 (8 pts), 20 mg/m2 (19 pts)] with the following tumor types: Cutaneous and peripheral T cell lymphoma (7 pts), prostate (6 pts), mesothelioma (4 pts), colon (3 pts) and other (15 pts). There was one dose-limiting toxicity (transient grade 4 thrombocytopenia) at 20 mg/m2, none at the lower doses. Other G3/G4 toxicities (all cycles) include: transient thrombocytopenia (G4–5 pts, G3–5 pts), neutropenia (G3–2 pts), anemia (G3–5 pts), G3 hypophosphatemia (1 pt), G3 hypokalemia (1 pt), G3 nausea (1 pt) and G3 pruritus (1 pt). Thrombocytopenia was transient. Of 2,042 ECGs, 1 pt had an increase in QTcF from baseline of > 60 msec another with a QTcF >500 msec, both at 20 mg/m2. There was a dose-dependent increase in HA 7 days after one dose with 43% (10 mg/m2), 50% (15 mg/m2) and 60% (20 mg/m2) of pts with increased acetylation. The LBH589 plasma conc. peaked at the end of the 0.5 hr infusion with a mean terminal half-life of 16 hr. Median Cmax achieved with 20 mg/m2 was 1,000 ng/mL (2.86 μM). The AUC0-inf increased linearly with IV doses of 10–20 mg/m2. One pt with CTCL achieved a complete response (CR) on cycle 3, Day 1; this pt had previously received oral LBH589 at 20 mg MWF, achieving a CR on cycle 6, Day 28 that lasted for 7 months. One peripheral T-Cell lymphoma pt achieved a partial response that has persisted for >7 months. One pt with prostate cancer has had a 26% reduction in nodal disease and > 50% drop in PSA in the first 2 cycles. Conclusions: The maximum tolerated dose of LBH589 given IV wkly on a 3 of 4 wk schedule is 20 mg/m2. This dose produced sustained PD effects and higher systemic exposure compared to oral LBH589. Preliminary evidence of antitumor activity has been observed.

No significant financial relationships to disclose.

Cell cycle-dependent usage of transcriptional start sites. A novel mechanism for regulation of cyclin B1

Cyclin B1 mRNA is expressed temporally throughout the cell cycle with peak expression in G2 and M phase. Both transcriptional and posttranscriptional controls are important for this cell cycle-dependent regulation of cyclin B1 mRNA. In this study, we observed that cyclin B1 has two major transcripts: (a) a constitutively expressed transcript, and (b) a cell cycle-regulated transcript expressed predominantly during G2-M phase. These different transcripts are due to alternative start sites. The constitutively expressed transcript starts 65 bases upstream from the cell cycle-regulated message. Changes in mRNA stability did not appear to control the expression of the cell cycle-specific transcript, but we were able to identify a 24-base pair region of the cyclin B1 promoter spanning the start site of the cell cycle-regulated transcript that was critical for its cell cycle-regulated promoter activity. This suggests that transcriptional regulation is responsible for controlling the presence of each message. The 24-base pair sequence required for cell cycle regulation was notable for containing the nucleotides GGCT repeated three times. The possibility that these two transcripts might be physiologically distinct was raised when the cell cycle-specific transcript was found to be translated more efficiently in vitro than the constitutively expressed transcript. These results characterize a novel mechanism for the regulation of cyclin B1 throughout the cell cycle that is dependent upon the use of different transcriptional start sites.

Radiation and the G2 phase of the cell cycle

Exposure of mammalian cells to X rays results in prolongation of the cell cycle, including delays or arrests in G1, S and G2 phase. While G1-phase arrest occurs only in cells with wild-type p53 function, a G2-phase delay occurs in all cells regardless of p53 status. In this review, we summarize what is known about cell cycle progression through G2 and M phase and discuss the experimental findings that implicate different mechanisms in the G2-phase delay. Finally, we consider the possibility that G2-phase arrest plays a role in cell survival after irradiation.

Delayed cyclin B1 expression during the G2 arrest following DNA damage

Exposure of cells to DNA damaging agents results in a G2 arrest. Exposure of HeLa cells to camptothecin, etoposide or nitrogen mustard for 1 h in S phase resulted in delayed expression of cyclin B1 mRNA during the G2 arrest. Initially the levels of cyclin B1 protein were low as well; however, with extended time the cells blocked in G2 regained higher levels of cyclin B1 protein. In the case of cells treated with nitrogen mustard the higher levels coincided with cells exiting the G2 block into G1. However, with camptothecin or etoposide treatment, while the accumulation of cyclin B1 protein was delayed, its levels eventually surpassed peak levels seen in control cells, in spite of the fact that cells were still blocked in G2. These cells did not continue to progress through the cell cycle indicating further complexity to the mechanisms underlying the G2 block. Decreased transcription and stability of cyclin B1 mRNA were shown to occur after treatment with these DNA damaging agents. These results indicate that suppression of cyclin B1 mRNA expression is one consequence of DNA damage in HeLa cells.

Cell cycle-dependent regulation of the cyclin B1 promoter

Cyclin B1 mRNA expression varies through the cell cycle with its peak in G2/M. In cycling mammalian cells, its lowest level is in G1 with a steady increase in S until a level 50-fold greater than that in G1 is reached. In order to characterize the transcriptional component to this variation in expression, we cloned the upstream region 872 base pairs upstream from the start site of the cyclin B1 gene and have demonstrated that it confers cell cycle-dependent regulation onto two reporter genes, both chloramphenicol acetyltransferase and luciferase. Its activity was 25-fold greater in G2/M than in G1 in HeLa cells with intermediate activity in S. This cyclical activity could be seen with sequences encompassing only 90 base pairs upstream from the start site. Protein binding to this region was demonstrated using electrophoretic mobility shift assays, and the binding profiles appeared to vary depending upon the phase of the cycle in which the extracts are made. Thus, transcriptional control plays an important role in determining cyclin B1 mRNA levels, and cell cycle-dependent activity is regulated through interactions with the region 90 bases upstream from the start site.

Endomyocardial gene expression during development of pacing tachycardia-induced heart failure in the dog

Selective and specific changes in gene expression characterize the end-stage failing heart. However, the pattern and relation of these changes to evolving systolic and diastolic dysfunction during development of heart failure remains undefined. In the present study, we assessed steady-state levels of mRNAs encoding a group of cardiac proteins during the early development of left ventricular dysfunction in dogs with pacing-induced cardiomyopathy. Corresponding hemodynamic assessments were made in the conscious state in the same animals and at the same time points at baseline, after 1 week of ventricular pacing, and at the onset of clinical heart failure. Systolic dysfunction dominated after 1 week of pacing, whereas diastolic dysfunction was far more pronounced with the onset of heart failure. Atrial natriuretic factor mRNA was undetectable in 7 of 12 hearts at baseline but was expressed in all hearts at 1 week (P < .01 by chi 2 test), and it increased markedly with progression to failure (P = .05). Creatine kinase-B mRNA also rose markedly with heart failure (P < .01). Levels of mRNA encoding beta-myosin heavy chain, mitochondrial creatine kinase, phospholamban, and sarcoplasmic reticulum Ca(2+)-ATPase did not significantly change from baseline, despite development of heart failure. Additional analysis to determine if these mRNA changes were related to the severity of diastolic or systolic dysfunction revealed that phospholamban mRNA decreased in hearts with larger net increases in end-diastolic pressure (+19.2 +/- 1.9 mm Hg) compared with those hearts in which it did not change (+4.0 +/- 4.9, P < .02).(ABSTRACT TRUNCATED AT 250 WORDS)