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Szymczak JE, Getz KD, Madding R, Shuster S, Aftandilian C, Arnold SD, Collier AB, Gramatges MM, Henry M, Hijiya N, Mian A, Raetz E, Fisher BT, Aplenc R. Child and family perceptions of satisfaction with neutropenia management in pediatric acute myeloid leukemia. Pediatr Blood Cancer 2023:e30420. [PMID: 37194639 DOI: 10.1002/pbc.30420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Chemotherapy for pediatric acute myeloid leukemia (AML) is very intensive and many, but not all centers, require extended hospitalization until neutrophil recovery. Child and family preferences, beliefs, and experiences around hospitalization have not been systematically assessed. PATIENTS AND METHODS We recruited children with AML and their parents from nine pediatric cancer centers across the United States for a qualitative interview about their experiences of neutropenia management. Interviews were analyzed using a conventional content analysis approach. RESULTS Of 116 eligible individuals, 86 (74.1%) agreed to participate. Interviews were conducted with 32 children and 54 parents from 57 families. Of these 57 families, 39 were cared for as inpatients and 18 were managed as outpatients. A very high proportion of respondents in both groups reported satisfaction with the discharge management strategy recommended by the treating institution: 86% (57 individuals) of respondents who experienced inpatient management and 85% (17 individuals) of respondents who experienced outpatient management expressed satisfaction. Respondent perceptions associated with satisfaction related to safety (access to emergency interventions, infection risk, close monitoring) and psychosocial concerns (family separation, low morale, social support). Respondents believed it could not be assumed that all children would have the same experience due to varied life circumstances. CONCLUSION Children with AML and their parents express a very high degree of satisfaction with the discharge strategy recommended by their treating institution. Respondents saw a nuanced tradeoff between patient safety and psychosocial concerns that was mediated by a child's life circumstances.
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Affiliation(s)
- Julia E Szymczak
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kelly D Getz
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rachel Madding
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sydney Shuster
- Clinical Futures, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Catherine Aftandilian
- Division of Pediatric Hematology/Oncology, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Staci D Arnold
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Anderson B Collier
- Department of Pediatrics, Division of Hematology/Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Maria M Gramatges
- Texas Children's Cancer Center, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Meret Henry
- Division of Hematology/Oncology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA
| | - Nobuko Hijiya
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Amir Mian
- Department of Pediatric Hematology-Oncology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Elizabeth Raetz
- Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, New York, New York, USA
| | - Brian T Fisher
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richard Aplenc
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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2
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Elgarten CW, Otto WR, Shenton L, Stein MT, Horowitz J, Aftandilian C, Arnold SD, Bona KO, Caywood E, Collier AB, Gramatges MM, Henry M, Lotterman C, Maloney K, Modi AJ, Mian A, Mody R, Morgan E, Raetz EA, Verma A, Winick N, Wilkes JJ, Yu JC, Aplenc R, Fisher BT, Getz KD. Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia. Infect Control Hosp Epidemiol 2023; 44:222-229. [PMID: 35465865 DOI: 10.1017/ice.2022.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Bloodstream infections (BSIs) are a frequent cause of morbidity in patients with acute myeloid leukemia (AML), due in part to the presence of central venous access devices (CVADs) required to deliver therapy. OBJECTIVE To determine the differential risk of bacterial BSI during neutropenia by CVAD type in pediatric patients with AML. METHODS We performed a secondary analysis in a cohort of 560 pediatric patients (1,828 chemotherapy courses) receiving frontline AML chemotherapy at 17 US centers. The exposure was CVAD type at course start: tunneled externalized catheter (TEC), peripherally inserted central catheter (PICC), or totally implanted catheter (TIC). The primary outcome was course-specific incident bacterial BSI; secondary outcomes included mucosal barrier injury (MBI)-BSI and non-MBI BSI. Poisson regression was used to compute adjusted rate ratios comparing BSI occurrence during neutropenia by line type, controlling for demographic, clinical, and hospital-level characteristics. RESULTS The rate of BSI did not differ by CVAD type: 11 BSIs per 1,000 neutropenic days for TECs, 13.7 for PICCs, and 10.7 for TICs. After adjustment, there was no statistically significant association between CVAD type and BSI: PICC incident rate ratio [IRR] = 1.00 (95% confidence interval [CI], 0.75-1.32) and TIC IRR = 0.83 (95% CI, 0.49-1.41) compared to TEC. When MBI and non-MBI were examined separately, results were similar. CONCLUSIONS In this large, multicenter cohort of pediatric AML patients, we found no difference in the rate of BSI during neutropenia by CVAD type. This may be due to a risk-profile for BSI that is unique to AML patients.
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Affiliation(s)
- Caitlin W Elgarten
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - William R Otto
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Luke Shenton
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Madison T Stein
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Catherine Aftandilian
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Staci D Arnold
- Children's Healthcare of Atlanta/Emory University, Atlanta, Georgia
| | - Kira O Bona
- Pediatric Hematology-Oncology, Children's Hospital Boston, Boston, Massachusetts
| | - Emi Caywood
- A.I. Dupont Hospital for Children-Nemours, Wilmington, Delaware
| | | | | | - Meret Henry
- Children's Hospital of Michigan, Detroit, Michigan
| | - Craig Lotterman
- Ochsner Medical Center for Children, New Orleans, Lousisiana
| | - Kelly Maloney
- Children's Hospital Colorado and the Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Amir Mian
- Arkansas Children's Hospital, Little Rock, Arkansas
| | - Rajen Mody
- University of Michigan, Ann Arbor, Michigan
| | - Elaine Morgan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Elizabeth A Raetz
- Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, New York, New York
| | - Anupam Verma
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Naomi Winick
- Department of Pediatric Hematology Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennifer J Wilkes
- Department of Pediatrics, University of Washington, Division of Hematology-Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Jennifer C Yu
- Division of Pediatric Hematology-Oncology, Rady Children's Hospital San Diego, San Diego, California
| | - Richard Aplenc
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian T Fisher
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelly D Getz
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Laetsch TW, Janeway KA, Hawkins DS, Juszczak-Kosela K, Muscal JA, Collier AB. Phase 2 study to evaluate palbociclib in combination with irinotecan and temozolomide in pediatric patients with recurrent or refractory Ewing sarcoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps11583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS11583 Background: Palbociclib (PD-0332991) is a highly selective, reversible, small molecule inhibitor of cyclin-dependent kinases (CDK) 4 and 6, administered orally. Functional dependence of Ewing Sarcoma (EWS) cell lines and tumor xenografts on Cyclin D1/CDK4 via genetic knockdown has shown both Cyclin D1 and CDK4 as critical dependencies for EWS cell line proliferation. The phase 1 portion of the study established the recommended Phase 2 dose (RP2D) with two chemotherapy backbones in children with solid tumors. The Phase 2 portion of the study now enrolls patients with EWS. The primary objective of this portion of the study is to determine whether the addition of palbociclib to irinotecan (IRN) and temozolomide (TMZ) will prolong event-free survival (EFS) of pediatric and young adult patients with recurrent or refractory EWS. Methods: Patients with recurrent or refractory EWS are randomized 2:1 to receive either palbociclib in combination with IRN and TMZ or IRN and TMZ alone. Randomization is stratified by type and time of disease recurrence (primary refractory or 1st recurrence <2 years vs. 1st recurrence ≥2 years or 2nd or greater recurrence). The primary efficacy endpoint is EFS per investigator assessment. Secondary efficacy endpoints include objective response, progression-free survival and overall survival. An interim futility analysis will be conducted to allow for early stopping of the study due to futility/no signal of activity based on the primary endpoint of EFS. Safety and planned interim efficacy data will be assessed by an Independent Data Monitoring Committee (DMC). Key eligibility criteria include: recurrent or refractory EWS with evaluable disease, no known bone marrow metastases, histopathological confirmation of EWSR1-ETS or FUS-ETS rearrangement or availability of formalin fixed paraffin embedded (FFPE) tumor tissue sample for central testing, age ≥2 and <21 years at the time of study entry. Treatment intervention: Patients randomized to palbociclib with IRN and TMZ treatment arm will receive palbociclib at the RP2D of 75 mg/m2 orally (either as a capsule or oral solution) once daily on Days 1-14 of each 21-day treatment cycle. TMZ will be administered orally once daily at 100 mg/m2 on Days 1-5 (intravenously (IV) if patient cannot swallow the TMZ capsule). IRN will be administered IV at 50 mg/m2 on Days 1-5. Patients randomized to the chemotherapy only treatment arm will receive IRN and TMZ at the same doses on Days 1-5 of the 21-day treatment cycle. Treatment will continue until disease progression, patient and/or legal guardian refusal, unacceptable toxicity , or up to 24 months of treatment, whichever occurs first. The Phase 2 enrolment has been initiated and 1/75 patients has been enrolled as of Jan 2022. Clinical trial information: NCT03709680.
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Affiliation(s)
| | | | - Douglas S. Hawkins
- Seattle Children’s Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
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Collier AB, Krailo MD, Dang HM, DuBois SG, Hawkins DS, Bernstein ML, Bomgaars LR, Reed DR, Gorlick RG, Janeway KA. Outcome of patients with relapsed or progressive Ewing sarcoma enrolled on cooperative group phase 2 clinical trials: A report from the Children's Oncology Group. Pediatr Blood Cancer 2021; 68:e29333. [PMID: 34496122 PMCID: PMC8541905 DOI: 10.1002/pbc.29333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022]
Abstract
SevenChildren's Oncology Group phase 2 trials for patients with relapsed/progressive solid tumors were analyzed to estimate the event-free survival (EFS) for relapsed/progressive Ewing sarcoma. One hundred twenty-eight Ewing sarcoma patients were enrolled and 124 events occurred. The 6-month EFS was 12.7%, demonstrating the poor outcome of these patients. Only docetaxel achieved its protocol-specified radiographic response rate for activity; however, the EFS for docetaxel was similar to other agents, indicating that a higher radiographic response rate may not translate into superior disease control. This EFS benchmark could be utilized as an additional endpoint in trials for recurrent Ewing sarcoma.
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Affiliation(s)
- Anderson B. Collier
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS
| | - Mark D. Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Ha M. Dang
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Steven G. DuBois
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School; Boston, MA
| | | | | | - Lisa R. Bomgaars
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center; Houston, TX
| | - Damon R. Reed
- Johns Hopkins All Children’s Hospital; St Petersburg, FL
| | | | - Katherine A. Janeway
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School; Boston, MA
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Cox JA, Karlson CW, Dillard BC, Collier AB. Impact of COVID-19 Pandemic on Timing of Childhood Cancer Diagnoses. J Pediatr Hematol Oncol 2021; 43:e1244-e1246. [PMID: 34010931 DOI: 10.1097/mph.0000000000002199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic impacted the health care system in unprecedented ways. We reviewed the registry of new cancer patients who presented to the Children's of Mississippi Center for Cancer and Blood Disorders and showed the average number of new pediatric cancer diagnoses dropped during the initial COVID-19 months and rose significantly in June 2020. We must encourage families to seek health care when needed and keep scheduled appointments for routine vaccinations and health maintenance as we know the long-term sequela of delaying health maintenance far outweighs risks at present.
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Affiliation(s)
- Jennifer A Cox
- Department of Pediatrics, Division Pediatric Hematology-Oncology
| | | | - Benjamin C Dillard
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Mississippi Medical Center, Jackson, MS
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Getz KD, Szymczak JE, Li Y, Madding R, Huang YSV, Aftandilian C, Arnold SD, Bona KO, Caywood E, Collier AB, Gramatges MM, Henry M, Lotterman C, Maloney K, Mian A, Mody R, Morgan E, Raetz EA, Rubnitz J, Verma A, Winick N, Wilkes JJ, Yu JC, Fisher BT, Aplenc R. Medical Outcomes, Quality of Life, and Family Perceptions for Outpatient vs Inpatient Neutropenia Management After Chemotherapy for Pediatric Acute Myeloid Leukemia. JAMA Netw Open 2021; 4:e2128385. [PMID: 34709389 PMCID: PMC8554641 DOI: 10.1001/jamanetworkopen.2021.28385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Pediatric acute myeloid leukemia (AML) requires multiple courses of intensive chemotherapy that result in neutropenia, with significant risk for infectious complications. Supportive care guidelines recommend hospitalization until neutrophil recovery. However, there are little data to support inpatient over outpatient management. OBJECTIVE To evaluate outpatient vs inpatient neutropenia management for pediatric AML. DESIGN, SETTING, AND PARTICIPANTS This cohort study used qualitative and quantitative methods to compare medical outcomes, patient health-related quality of life (HRQOL), and patient and family perceptions between outpatient and inpatient neutropenia management. The study included patients from 17 US pediatric hospitals with frontline chemotherapy start dates ranging from January 2011 to July 2019, although the specific date ranges differed for the individual analyses by design and relative timing. Data were analyzed from August 2019 to February 2020. EXPOSURES Discharge to outpatient vs inpatient neutropenia management. MAIN OUTCOMES AND MEASURES The primary outcomes of interest were course-specific bacteremia incidence, times to next course, and patient HRQOL. Course-specific mortality was a secondary medical outcome. RESULTS Primary quantitative analyses included 554 patients (272 [49.1%] girls and 282 [50.9%] boys; mean [SD] age, 8.2 [6.1] years). Bacteremia incidence was not significantly different during outpatient vs inpatient management (67 courses [23.8%] vs 265 courses [29.0%]; adjusted rate ratio, 0.73; 95% CI, 0.56 to 1.06; P = .08). Outpatient management was not associated with delays to the next course compared with inpatient management (mean [SD] 30.7 [12.2] days vs 32.8 [9.7] days; adjusted mean difference, -2.2; 95% CI, -4.1 to -0.2, P = .03). Mortality during intensification II was higher for patients who received outpatient management compared with those who received inpatient management (3 patients [5.4%] vs 1 patient [0.5%]; P = .03), but comparable with inpatient management at other courses (eg, 0 patients vs 5 patients [1.3%] during induction I; P = .59). Among 97 patients evaluated for HRQOL, outcomes did not differ between outpatient and inpatient management (mean [SD] Pediatric Quality of Life Inventory total score, 70.1 [18.9] vs 68.7 [19.4]; adjusted mean difference, -2.8; 95% CI, -11.2 to 5.6). A total of 86 respondents (20 [23.3%] in outpatient management, 66 [76.7%] in inpatient management) completed qualitative interviews. Independent of management strategy received, 74 respondents (86.0%) expressed satisfaction with their experience. Concerns for hospital-associated infections among caregivers (6 of 7 caregiver respondents [85.7%] who were dissatisfied with inpatient management) and family separation (2 of 2 patient respondents [100%] who were dissatisfied with inpatient management) drove dissatisfaction with inpatient management. Stress of caring for a neutropenic child at home (3 of 3 respondents [100%] who were dissatisfied with outpatient management) drove dissatisfaction with outpatient management. CONCLUSIONS AND RELEVANCE This cohort study found that outpatient neutropenia management was not associated with higher bacteremia incidence, treatment delays, or worse HRQOL compared with inpatient neutropenia management among pediatric patients with AML. While outpatient management may be safe for many patients, course-specific mortality differences suggest that outpatient management in intensification II should be approached with caution. Patient and family experiences varied, suggesting that outpatient management may be preferred by some but may not be feasible for all families. Further studies to refine and standardize safe outpatient management practices are warranted.
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Affiliation(s)
- Kelly D. Getz
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Julia E. Szymczak
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yimei Li
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel Madding
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yuan-Shung V. Huang
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Catherine Aftandilian
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Stanford University, Palo Alto, California
| | - Staci D. Arnold
- Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Kira O. Bona
- Pediatric Hematology/Oncology, Children’s Hospital Boston, Boston, Massachusetts
| | - Emi Caywood
- A.I. Dupont Hospital for Children, Nemours, Wilmington, Delaware
| | | | | | | | | | - Kelly Maloney
- Children’s Hospital Colorado and the Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Amir Mian
- Arkansas Children’s Hospital, Little Rock
| | | | - Elaine Morgan
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Elizabeth A. Raetz
- Stephen D. Hassenfeld Children’s Center for Cancer and Blood Disorders, New York, New York
| | - Jeffrey Rubnitz
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Anupam Verma
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Salt Lake City
| | - Naomi Winick
- Department of Pediatric Hematology Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Jennifer J. Wilkes
- Department of Pediatrics, University of Washington, Division of Hematology/Oncology, Seattle Children’s Hospital, Seattle
| | - Jennifer C. Yu
- Division of Pediatric Hematology Oncology, Rady Children’s Hospital San Diego, San Diego, California
| | - Brian T. Fisher
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Richard Aplenc
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Yabroff KR, Reeder-Hayes K, Zhao J, Halpern MT, Lopez AM, Bernal-Mizrachi L, Collier AB, Neuner J, Phillips J, Blackstock W, Patel M. Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research. J Natl Cancer Inst 2020; 112:671-687. [PMID: 32337585 PMCID: PMC7357319 DOI: 10.1093/jnci/djaa048] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/12/2020] [Accepted: 03/27/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. METHODS We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. RESULTS Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. CONCLUSIONS Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Michael T Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Ana Maria Lopez
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Anderson B Collier
- Children’s Cancer Center, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Joan Neuner
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Manali Patel
- Stanford University School of Medicine, Stanford, CA, USA
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8
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Farkas A, Lirette ST, Al Hmada Y, Collier AB, Barr J, Vijayakumar S, Vijayakumar V. Single-Institution Experience of Synovial Sarcoma. South Med J 2020; 113:16-19. [PMID: 31897493 DOI: 10.14423/smj.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the patient population and outcomes of synovial sarcoma at a single institution. METHODS A retrospective review of the medical records of 28 patients with synovial sarcoma diagnosed from 1992 to 2017 was performed. Demographics, staging, disease location, treatment, and response to treatment were reviewed. RESULTS Individuals with larger tumors at the time of presentation had an increased risk of death. An additional factor associated with poor prognosis in synovial sarcoma was increasing patient age. The patient population had a higher rate of nonextremity disease and lower overall survival when compared with national averages. CONCLUSIONS Nonextremity disease and large size of tumor at presentation may have contributed to the disparity in institutional outcomes from the national averages. The advanced presentation of synovial sarcoma remains a significant challenge in improving patient survival.
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Affiliation(s)
- Amy Farkas
- From the Departments of Radiology, Data Science, Pathology, Pediatric Oncology, Orthopedic Surgery, and Radiation Oncology, University of Mississippi Medical Center, Jackson
| | - Seth T Lirette
- From the Departments of Radiology, Data Science, Pathology, Pediatric Oncology, Orthopedic Surgery, and Radiation Oncology, University of Mississippi Medical Center, Jackson
| | - Youssef Al Hmada
- From the Departments of Radiology, Data Science, Pathology, Pediatric Oncology, Orthopedic Surgery, and Radiation Oncology, University of Mississippi Medical Center, Jackson
| | - Anderson B Collier
- From the Departments of Radiology, Data Science, Pathology, Pediatric Oncology, Orthopedic Surgery, and Radiation Oncology, University of Mississippi Medical Center, Jackson
| | - Jennifer Barr
- From the Departments of Radiology, Data Science, Pathology, Pediatric Oncology, Orthopedic Surgery, and Radiation Oncology, University of Mississippi Medical Center, Jackson
| | - Srinivasan Vijayakumar
- From the Departments of Radiology, Data Science, Pathology, Pediatric Oncology, Orthopedic Surgery, and Radiation Oncology, University of Mississippi Medical Center, Jackson
| | - Vani Vijayakumar
- From the Departments of Radiology, Data Science, Pathology, Pediatric Oncology, Orthopedic Surgery, and Radiation Oncology, University of Mississippi Medical Center, Jackson
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9
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Szymczak JE, Getz KD, Madding R, Fisher B, Raetz E, Hijiya N, Gramatges MM, Henry M, Mian A, Arnold SD, Aftandilian C, Collier AB, Aplenc R. Identifying patient- and family-centered outcomes relevant to inpatient versus at-home management of neutropenia in children with acute myeloid leukemia. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26927. [PMID: 29286570 PMCID: PMC6857179 DOI: 10.1002/pbc.26927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 11/12/2022]
Abstract
Efficacy of therapeutic strategies relative to patient- and family-centered outcomes in pediatric oncology must be assessed. We sought to identify outcomes important to children with acute myeloid leukemia and their families related to inpatient versus at-home management of neutropenia. We conducted qualitative interviews with 32 children ≥8 years old and 54 parents. Analysis revealed the impact of neutropenia management strategy on siblings, parent anxiety, and child sleep quality as being outcomes of concern across respondents. These themes were used to inform the design of a questionnaire that is currently being used in a prospective, multiinstitutional comparative effectiveness trial.
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Affiliation(s)
- Julia E. Szymczak
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kelly D. Getz
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel Madding
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian Fisher
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Raetz
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Nobuko Hijiya
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Division of Pediatric Hematology Oncology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Maria M. Gramatges
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
| | - Meret Henry
- Division of Hematology/Oncology, Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Amir Mian
- Department of Pediatric Hematology-Oncology, College of Medicine, Arkansas Children’s Hospital, University of Arkansas Medical Sciences, Little Rock, Arkansas
| | - Staci D. Arnold
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Catherine Aftandilian
- Division of Pediatric Hematology/Oncology, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Anderson B. Collier
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Richard Aplenc
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania,Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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10
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Ramsey LH, Karlson CW, Collier AB. Mirror Therapy for Phantom Limb Pain in a 7-Year-Old Male with Osteosarcoma. J Pain Symptom Manage 2017; 53:e5-e7. [PMID: 28274843 DOI: 10.1016/j.jpainsymman.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Logan H Ramsey
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
| | - Cynthia W Karlson
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anderson B Collier
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
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11
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Abstract
Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Although curable, approximately 20% of patients relapse. In an effort to detect relapse earlier, our institution performed surveillance bone marrow (BM) and cerebrospinal fluid (CSF) evaluations every 3 months from the end of therapy to 1 year off. This study retrospectively reviewed all patients with B-cell ALL (B-ALL) from September 2005 to September 2010 to determine the benefit and cost of these procedures. Forty-one patients completed therapy and had 190 BMs and 190 lumbar punctures (LPs) performed. Four of 41 patients (9.8%) experienced a relapse. Relapse was detected in only 1 patient by routine BM evaluation (0.5%). Zero LPs were positive. The professional fees for the procedures were $8,738/patient. Therefore, off-therapy BM and CSF evaluations are not effective at detecting relapse and are expensive. Our institution has abandoned off-therapy surveillance for ALL.
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Affiliation(s)
- Jitsuda Sitthi-Amorn
- a Staff Physician, Hospitalist Medicine , St. Jude Children's Research Hospital , Memphis , Tennessee , USA
| | - Anderson B Collier
- b Department of Pediatric Hematology-Oncology , University of Mississippi Medical Center , Jackson , Mississippi , USA
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12
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Collier AB, Coon LM, Monteleone P, Umaru S, Swanson KC, Hoyer JD, Oliveira JL. A Novelβ-Globin Chain Hemoglobin Variant, Hb Allentown [β137(H15)Val→Trp (GTG>TGG)HBB: c.412_413delinsTG, p.Val138Trp], Associated with Low Oxygen Saturation, Intermittent Aplastic Crises and Splenomegaly. Hemoglobin 2015; 40:130-3. [DOI: 10.3109/03630269.2015.1115766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Sampson VB, Vetter NS, Kamara DF, Collier AB, Gresh RC, Kolb EA. Vorinostat Enhances Cytotoxicity of SN-38 and Temozolomide in Ewing Sarcoma Cells and Activates STAT3/AKT/MAPK Pathways. PLoS One 2015; 10:e0142704. [PMID: 26571493 PMCID: PMC4646493 DOI: 10.1371/journal.pone.0142704] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/26/2015] [Indexed: 11/03/2022] Open
Abstract
Histone deacetylase inhibitors (HDACi) have been evaluated in patients with Ewing sarcoma (EWS) but demonstrated limited activity. To better understand the potential for HDACi in EWS, we evaluated the combination of the HDACi vorinostat, with DNA damaging agents SN-38 (the active metabolite of irinotecan and topoisomerase 1 inhibitor) plus the alkylating agent temozolomide (ST). Drugs were evaluated in sequential and simultaneous combinations in two EWS cell lines. Results demonstrate that cell viability, DNA damage and reactive oxygen species (ROS) production are dependent on the sequence of drug administration. Enhanced cytotoxicity is exhibited in vitro in EWS cell lines treated with ST administered before vorinostat, which was modestly higher than concomitant treatment and superior to vorinostat administered before ST. Drug combinations downregulate cyclin D1 to induce G0/G1 arrest and promote apoptosis by cleavage of caspase-3 and PARP. When ST is administered before or concomitantly with vorinostat there is activation of STAT3, MAPK and the p53 pathway. In contrast, when vorinostat is administered before ST, there is DNA repair, increased AKT phosphorylation and reduced H2B acetylation. Inhibition of AKT using the small molecule inhibitor MK-2206 did not restore H2B acetylation. Combining ST with the dual ALK and IGF-1R inhibitor, AZD3463 simultaneously inhibited STAT3 and AKT to enhance the cytotoxic effects of ST and further reduce cell growth suggesting that STAT3 and AKT activation were in part mediated by ALK and IGF-1R signaling. In summary, potent antiproliferative and proapoptotic activity were demonstrated for ST induced DNA damage before or simultaneous with HDAC inhibition and cell death was mediated through the p53 pathway. These observations may aid in designing new protocols for treating pediatric patients with high-risk EWS.
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Affiliation(s)
- Valerie B. Sampson
- Nemours Center for Cancer and Blood Disorders, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Nancy S. Vetter
- Nemours Center for Cancer and Blood Disorders, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Davida F. Kamara
- Nemours Center for Cancer and Blood Disorders, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Anderson B. Collier
- Department of Pediatrics, Division of Hematology and Oncology, Children's Healthcare of Mississippi, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Renee C. Gresh
- Nemours Center for Cancer and Blood Disorders, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware, United States of America
- * E-mail:
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14
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Nisi RS, Østgaard N, Gjesteland T, Collier AB. An altitude and distance correction to the source fluence distribution of TGFs. J Geophys Res Space Phys 2014; 119:8698-8704. [PMID: 26167434 PMCID: PMC4497453 DOI: 10.1002/2014ja019817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 09/08/2014] [Indexed: 06/04/2023]
Abstract
The source fluence distribution of terrestrial gamma ray flashes (TGFs) has been extensively discussed in recent years, but few have considered how the TGF fluence distribution at the source, as estimated from satellite measurements, depends on the distance from satellite foot point and assumed production altitude. As the absorption of the TGF photons increases significantly with lower source altitude and larger distance between the source and the observing satellite, these might be important factors. We have addressed the issue by using the tropopause pressure distribution as an approximation of the TGF production altitude distribution and World Wide Lightning Location Network spheric measurements to determine the distance. The study is made possible by the increased number of Ramaty High Energy Solar Spectroscopic Imager (RHESSI) TGFs found in the second catalog of the RHESSI data. One find is that the TGF/lightning ratio for the tropics probably has an annual variability due to an annual variability in the Dobson-Brewer circulation. The main result is an indication that the altitude distribution and distance should be considered when investigating the source fluence distribution of TGFs, as this leads to a softening of the inferred distribution of source brightness.
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Affiliation(s)
- R S Nisi
- Department of Physics and Technology, University of BergenBergen, Norway
- Birkeland Center for Space ScienceBergen, Norway
| | - N Østgaard
- Department of Physics and Technology, University of BergenBergen, Norway
- Birkeland Center for Space ScienceBergen, Norway
| | - T Gjesteland
- Department of Physics and Technology, University of BergenBergen, Norway
- Birkeland Center for Space ScienceBergen, Norway
| | - A B Collier
- School of Chemistry and Physics, University of KwaZulu-NatalDurban, South Africa
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15
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Beuten J, Gelfond JA, Piwkham D, Pollock BH, Winick NJ, Collier AB, Tomlinson GE. Candidate gene association analysis of acute lymphoblastic leukemia identifies new susceptibility locus at 11p15 ( LMO1 ). Carcinogenesis 2011; 32:1349-53. [DOI: 10.1093/carcin/bgr091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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16
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Swinney RM, Beuten J, Collier AB, Chen TTL, Winick NJ, Pollock BH, Tomlinson GE. Polymorphisms in CYP1A1 and Ethnic-Specific Susceptibility to Acute Lymphoblastic Leukemia in Children. Cancer Epidemiol Biomarkers Prev 2011; 20:1537-42. [DOI: 10.1158/1055-9965.epi-10-1265] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Piwkham D, Gelfond JA, Rerkamnuaychoke B, Pakakasama S, Rebel VI, Pollock BH, Winick NJ, Collier AB, Tomlinson GE, Beuten J. Multilocus Association of Genetic Variants in MLL, CREBBP, EP300, and TOP2A with Childhood Acute Lymphoblastic Leukemia in Hispanics from Texas. Cancer Epidemiol Biomarkers Prev 2011; 20:1204-12. [DOI: 10.1158/1055-9965.epi-11-0059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Bhat P, Sisler I, Collier AB. Exchange transfusion as treatment for rasburicase induced methemoglobinemia in a glucose-6-phosphate dehydrogenase deficient patient. Pediatr Blood Cancer 2008; 51:568. [PMID: 18561168 DOI: 10.1002/pbc.21582] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Ewing sarcoma (EWS) is a bone tumor occurring primarily in adolescence and young adulthood. Multi-institutional clinical trials have improved the outcome for patients with nonmetastatic EWS, but not with metastatic EWS. Furthermore, although 30% of EWS recur, multi-institutional studies have not been completed for this high-risk group. Planning such studies has been hampered by both the lack of novel therapies and the inability to incorporate the biology of EWS. While the importance and detail of the EWS-FLI-1 translocation between chromosomes 11 and 22 are described, these have not yet led to new drug development for this orphan tumor. However, recent evidence supporting novel cytotoxic therapy, antiangiogenic therapy, and receptor-targeted therapy provides reason for optimism for patients with high-risk disease.
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Affiliation(s)
- Patrick J Leavey
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA.
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