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Ansari J, Sheikh M, Riley E, Guo N, Traynor A, Carvalho B. A retrospective cohort study of the anesthetic management of postpartum tubal ligation. Int J Obstet Anesth 2024; 58:103974. [PMID: 38508961 DOI: 10.1016/j.ijoa.2023.103974] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/13/2023] [Accepted: 12/27/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Neuraxial anesthesia with reactivation of a labor epidural catheter is commonly utilized for postpartum tubal ligations (PPTL), although the optimal anesthetic approach is unknown. We assessed institutional anesthesia practices for PPTL, and evaluated the failure rates of reactivation of labor epidural catheters, de novo spinal anesthesia, and spinal anesthesia after failed blocks. METHODS We conducted a single-center retrospective cohort analysis of 300 consecutive patients who underwent a PPTL and 100 having spinal anesthesia for cesarean delivery. Anesthetic management data (existing labor epidural catheter reactivation, de novo spinal anesthesia or general anesthesia) were collected from electronic medical records. Anesthetic block failure rates were determined for each anesthetic technique. RESULTS The failure rate was 15% for de novo spinal anesthesia and 23% after failed reactivation of a labor epidural catheter or spinal anesthesia. The epidural catheter reactivation failure rate was 35%. The failure rate of spinal anesthesia for cesarean delivery was 4%. Drug dosage, epidural catheter use in labor, time since epidural catheter placement or delivery, labor neuraxial technique (combined spinal-epidural, epidural), supplemental top-up doses during labor, and anesthesiologist experience did not predict neuraxial anesthesia failures. CONCLUSIONS Our analysis revealed an unexpectedly high neuraxial anesthesia failure rate even when de novo spinal anesthesia was used for PPTL. The results are consistent with other institutions' recent findings, and are higher than spinal anesthesia failure rates associated with cesarean delivery. Further studies are required to determine optimal anesthesia dosing strategies, and to understand the mechanisms behind high neuraxial anesthesia failures for PPTL.
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Affiliation(s)
- J Ansari
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - M Sheikh
- Department of Obstetrical and Gynecological Anesthesiology, Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - E Riley
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - A Traynor
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Traynor A, Burns DT, Wu D, Karoonuthaisiri N, Petchkongkaew A, Elliott CT. An analysis of emerging food safety and fraud risks of novel insect proteins within complex supply chains. NPJ Sci Food 2024; 8:7. [PMID: 38245539 PMCID: PMC10799884 DOI: 10.1038/s41538-023-00241-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024] Open
Abstract
Food consumption play a crucial role in human life, yet conventional food production and consumption patterns can be detrimental to the environment. Thus, research and development has been directed towards alternative proteins, with edible insects being promising sources. Edible insects have been recognised for their sustainable benefits providing protein, with less emission of greenhouse gas, land and water usage compared to sources, such as beef, chicken, and dairy products. Among the over 2000 known edible insect species, only four, namely yellow mealworm (Tenebrio molitor), migratory locust/grasshopper (Locusta migratoria), grain mould beetle, also known as lesser mealworm which is a larval form of Alphitobius diaperinus (from the family of Tenebrionidae of darkling beetles) and house cricket (Acheta domesticus), are currently authorised in specific products through specific producers in the EU. The expansion of such foods into Western diets face challenges such as consumer barriers, gaps in microbiological and chemical safety hazard data during production and processing, and the potential for fraudulent supply chain activity. The main aim of this study was to map the supply chain, through interviews with personnel along the supply chain, coupled with searches for relevant publications and governmental documents. Thus, the main potential points of food safety and fraud along the edible insect supply chain were identified. Feed substrate was identified as the main area of concern regarding microbiological and chemical food safety and novel processing techniques were forecast to be of most concern for future fraudulent activity. Despite the on-going authorisation of insect species in many countries there are substantial food safety and authenticity information gaps in this industry that need to be addressed before edible insects can be viewed as a safe and sustainable protein sources by Western consumers.
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Affiliation(s)
- A Traynor
- Institute for Global Food Security, School of Biological Sciences, Queen's University of Belfast, Belfast, BT9 5DL, Northern Ireland, UK
| | - D Thorburn Burns
- Institute for Global Food Security, School of Biological Sciences, Queen's University of Belfast, Belfast, BT9 5DL, Northern Ireland, UK
| | - D Wu
- National Measurement Laboratory: Centre of Excellence in Agriculture and Food Integrity, Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast, Northern Ireland, BT9 5DL, UK
| | - N Karoonuthaisiri
- Institute for Global Food Security, School of Biological Sciences, Queen's University of Belfast, Belfast, BT9 5DL, Northern Ireland, UK
- National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, 111 Thailand Science Park, Phahonyothin Road, Pathumthani, 12120, Thailand
- International Joint Research Centre on Food Security (IJC-FOODSEC), 113 Thailand Science Park, Phahonyothin Road, Khong Luang, Pathum Thani, 12120, Thailand
| | - A Petchkongkaew
- International Joint Research Centre on Food Security (IJC-FOODSEC), 113 Thailand Science Park, Phahonyothin Road, Khong Luang, Pathum Thani, 12120, Thailand
- School of Food Science and Technology, Faculty of Science and Technology, Thammasat University, 99 Mhu 18, Phahonyothin road, Khong Luang, Pathum Thani, 12120, Thailand
| | - C T Elliott
- Institute for Global Food Security, School of Biological Sciences, Queen's University of Belfast, Belfast, BT9 5DL, Northern Ireland, UK.
- International Joint Research Centre on Food Security (IJC-FOODSEC), 113 Thailand Science Park, Phahonyothin Road, Khong Luang, Pathum Thani, 12120, Thailand.
- School of Food Science and Technology, Faculty of Science and Technology, Thammasat University, 99 Mhu 18, Phahonyothin road, Khong Luang, Pathum Thani, 12120, Thailand.
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Thomas C, Neumann KE, Smith C, Dominguez JE, Traynor A, Farber MK, Zakowski M, McCarthy RJ, Peralta FM. A survey of United States obstetric anesthesiologists' perceived value of obstetric anesthesiology fellowship. Int J Obstet Anesth 2023; 56:103930. [PMID: 37804553 DOI: 10.1016/j.ijoa.2023.103930] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Subspecialty training in obstetric anesthesiology is associated with improved patient outcomes and reduced anesthesia-related morbidity and mortality. Despite this, the demand for fellowship-trained obstetric anesthesiologists far exceeds the supply. This survey study aimed to evaluate the perceived value of obstetric anesthesiology subspecialty training on career trajectory, job satisfaction, quality of life, and job autonomy. METHODS After Institutional Review Board approval, we conducted a cross-sectional study of fellowship-trained obstetric anesthesiologists in the United States of America. In March and April 2022, program directors of obstetric anesthesiology fellowships distributed an electronic survey link containing 29 multiple-choice questions to their program alumni. Survey content included respondent demographic characteristics, practice models, career information, and perceived value of an obstetric anesthesiology fellowship. RESULTS We surveyed 217/502 (43%) fellowship-trained obstetric anesthesiologists with a response rate of 158/217 (73%). Most worked in urban, academic, and level IV perinatal health centers. The majority believed an obstetric anesthesiology fellowship was "extremely beneficial" (77%), enhanced quality of life (84%), improved the quality of patient care (99%), and was influential in helping obtain their first post-training job (86%). The perceived value of the fellowship included an enhanced career trajectory, a sense of purpose, improved job satisfaction, a sense of work community, lower burnout, involvement in maternal health initiatives, increased mentorship, and departmental leadership. CONCLUSION In this survey study, fellowship-trained obstetric anesthesiologists perceived a positive impact of fellowship training on career trajectory, job protection and autonomy, quality of life, and job satisfaction. This information may be meaningful to trainees considering pursuing a fellowship and a career in obstetric anesthesiology.
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Affiliation(s)
- C Thomas
- Department of Anesthesiology, University of Chicago Medical Center, Chicago, IL, USA.
| | - K E Neumann
- Department of Anesthesiology, Northwestern University, Chicago, IL, USA
| | - C Smith
- Department of Anesthesiology, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - J E Dominguez
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - A Traynor
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - M K Farber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Zakowski
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - R J McCarthy
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - F M Peralta
- Department of Anesthesiology, Northwestern University, Chicago, IL, USA
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Juloori A, Gan G, Zhang J, Abazeed M, Hara J, Baschnagel A, Traynor A, Bassetti M, Patel J, Chmura S, Bestvina C. EP14.03-001 DARES: A Phase II Trial of Durvalumab and Ablative Radiation in Extensive Stage Small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moore GD, Burns AL, Fish H, Gandhi N, Kebodeaux C, Meny LM, Policastri A, Sneed KB, Traynor A, Vosooney A, Bradley-Baker LR. The Report of the 2019-2020 Professional Affairs Standing Committee: Pharmacist Integration with Primary Care Practices. Am J Pharm Educ 2020; 84:ajpe8199. [PMID: 33149338 PMCID: PMC7596612 DOI: 10.5688/ajpe8199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The 2019-2020 Professional Affairs Committee was charged to (1) Describe the leadership role of schools of pharmacy in advancing interprofessional practice, with an emphasis on physician-pharmacist collaborative relationships; (2) Establish an inventory of resources that can support school efforts to grow collaborative partnerships between pharmacists and physicians; (3) Determine gaps that exist in the resources required to support schools in efforts to facilitate expansion of interprofessional partnerships; and (4) Define strategies and draft an action plan for AACP's role in facilitating member school efforts to accelerate the development of interprofessional practices within their geography of influence. This report provides information on the committee's process to address the committee charges as well as background and resources pertaining to the charges, describes the rationale for and the results from the focus groups conducted at the 2020 AACP Interim Meeting, communicates the results of an initial inventory of models that integrate pharmacists with primary care practices, and provides an overview on issues to continue the work to integrate pharmacists with primary care practices. The committee offered several revisions to current association policy statements and provided a proposed policy statement and several recommendations to AACP pertaining to the committee charges.
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Affiliation(s)
- Gina D Moore
- University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, Colorado
| | - Anne L Burns
- American Pharmacists Association, Washington, District of Columbia
| | - Hannah Fish
- National Community Pharmacists Association, Alexandria, Virginia
| | - Nidhi Gandhi
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Clark Kebodeaux
- University of Kentucky, College of Pharmacy, Lexington, Kentucky
| | - Lisa M Meny
- Ferris State University, College of Pharmacy, Grand Rapids, Michigan
| | - Anne Policastri
- American Society of Health-System Pharmacists, Bethesda, Maryland
| | - Kevin B Sneed
- University of South Florida, College of Pharmacy, Tampa, Florida
| | - Andy Traynor
- Concordia University of Wisconsin, School of Pharmacy, Mequon, Wisconsin
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Leal T, Schehr J, Kaminski A, Campbell T, Traynor A, Lang J. PD.2.06 Identifying Resistance to Checkpoint Inhibitors by Screening for PD-L1 and MHC I Expression on CTCs in NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bassetti M, Lang J, Morris Z, Morris B, Eickhoff J, Traynor A, Campbell T, Matkowskyj K, Baschnagel A, Leal T. P3.04-009 Stereotactic Body Radiotherapy to All Sites of Oligometastatic Non-Small Cell Lung Cancer (NSCLC) Combined with Durvalumab and Tremelimumab. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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8
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Kuo JS, Weichert JP, Clark PA, Kandela IK, Vacaro A, Clark W, Longino M, Pinchuk A, Farhoud M, Swanson KI, Floberg J, Traynor A, Hall LT, Pazoles C. NOVEL ALKYLPHOSPHOCHOLINE ANALOGS FOR BROAD SPECTRUM CANCER IMAGING AND THERAPY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou206.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Wisinski KB, Burkard ME, Njiaju U, Donohue S, Hegeman R, Stella A, Mansky P, Shah V, Goggins T, Qamar R, Dietrich L, Kim K, Traynor A, Tevaarwerk A. Abstract P3-12-10: Feasibility of four cycles of docetaxel and cyclophosphamide every 14 days as an adjuvant regimen for breast cancer: A Wisconsin oncology network study. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-12-10] [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: 11/16/2022]
Abstract
Abstract
Background: Dose-dense therapies have had a major impact on reducing toxicity and improving outcomes in breast cancer. A combination of docetaxel plus cyclophosphamide (TC) every 3 weeks has emerged as a common chemotherapy regimen used for treatment of node-negative or lower-risk node-positive breast cancer. We tested whether it is feasible to deliver TC on a dose-dense schedule.
Patients and Methods: We enrolled women with early stage breast cancer on a single-arm phase II study of adjuvant dose-dense TC (ddTC) through a regional oncology network (WON). All women completed primary surgery; subsequent therapy with TC was deemed appropriate by the treating physician. Planned treatment was docetaxel 75 mg/m2 plus cyclophosphamide 600 mg/m2 every 2 weeks for 4 cycles with subcutaneous pegfilgrastim 6 mg administered 24-48 hours after the administration of each chemotherapy cycle. The primary endpoint was feasibility of administering therapy within 10 weeks. A Simon Optimal 2-Stage design was employed for the study design.
Results: Of 42 women enrolled, 41 were evaluable by prespecified criteria. Median age was 54 (28-73). Most subjects had node negative (73%) or hormone receptor positive (71%) tumors. Of the 41 subjects, 37 (90.2%) completed therapy within 10 weeks and 34 (83%) completed therapy at 8 weeks without dose modification. Rates of grade 2 neuropathy were similar to that reported previously (15%) and there were no cases of grade 3 or higher neuropathy. The rate of neutropenic fever was low (2.5%). Rash and plantar/palmar erythrodythesia were common and reached grade 3 in four subjects (9.8%).
Conclusion: Dose-dense TC is feasible with tolerability profiles similar to standard TC and a low likelihood of neutropenic fever. This study supports further clinical development of this 8-week adjuvant chemotherapy regimen.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-12-10.
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Affiliation(s)
- KB Wisinski
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - ME Burkard
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - U Njiaju
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - S Donohue
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - R Hegeman
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - A Stella
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - P Mansky
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - V Shah
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - T Goggins
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - R Qamar
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - L Dietrich
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - K Kim
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - A Traynor
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
| | - A Tevaarwerk
- University of Wisconsin Carbone Cancer Center, Madison, WI; Bellin Memorial Hospital, Green Bay, WI; Columbia St. Mary's, Milwaukee, WI; Fox Valley Hematology and Oncology, Appleton, WI; Aurora Cancer Care, Wauwatosa, WI; Gunderson Lutheran Health System, Lacrosse, WI
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Leal TB, Schelman W, Traynor A, Kolesar J, Marnosha R, Eickhoff J, Alberti D, Wilding G. A phase I study of R-(-)-gossypol (AT-101) in combination with cisplatin (P) and etoposide (E) in patients with advanced solid tumors and extensive-stage small cell lung cancer (ES-SCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e13502] [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
e13502 Background: AT-101 [R-(-)-gossypol acetic acid] (AT) is an orally-administered BH3 mimetic that lowers the threshold for apoptosis by direct binding to Bcl-2, Bcl-xL, Mc1–1, Bcl-W, and through upregulation of the proapoptotic proteins Noxa and Puma. Bcl- 2 is over-expressed in >80% of SCLC. In vitro study using SCLC cells showed that treatment with EP had synergistic cytotoxic effects in suppression of Bcl-2. This is a phase I dose-escalation study of AT in combination with EP with an expanded cohort of patients with ES-SCLC. This study is being conducted to determine the maximum tolerated dose (MTD), pharmacokinetics and activity of AT with EP ± pegfilgrastim (F) in patients with advanced, refractory solid tumors and/or ES-SCLC. Methods: This study used standard eligibility criteria except patients must not have received prior therapy that inhibits the Bcl-2 family. At dose level 1, patients received P 60 mg/m2 on day 1 and E 100 mg/m2 on days 1, 2, and 3 every 21 days. AT was administered 30 mg orally BID on days 1, 2 and 3 of each cycle. Results: 10 patients have been enrolled; 7 men, 3 women. Tumor types: 6 lung; 2 prostate; 1 head & neck; 1 unknown primary. 2 of 5 patients enrolled at dose level 1 experienced a DLT of neutropenic fever in cycle 1. Three subsequent patients were enrolled to dose level -1 (20 mg BID x 3 days, d1–3) which was well tolerated. Additional patients are being enrolled at dose level 1a (EP+AT with F). Grade 3/4 toxicities related to AT without F at dose level 1 and -1 were as follows: ANC (8), leucopenia (7), febrile neutropenia (2), low hemoglobin (1), thrombocytopenia (1), elevated AST (1), cardiac ischemia/MI (1), diarrhea (1). There were no reported grade 3/4 toxicities in two patients at level 1a. Four patients had stable disease; two progressive disease and four patients were unevaluable. Conclusions: The MTD without F was established at AT 20mg orally BID, P 60 mg/m2 on day 1, and E 100 mg/m2 on days 1, 2, and 3 every 21 days. The MTD with F has not yet been established. Accrual continues at dose level 1a. Subjective and objective evidence of clinical activity has been observed in patients with refractory solid tumors. This study was supported by NCI, UO1 CA062491, SAIC 25XS097 and 1ULRR025011. No significant financial relationships to disclose.
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Affiliation(s)
- T. B. Leal
- University of Wisconsin - Paul P. Carbone CCC, Madison, WI; University of Wisconsin Madison, Madison, WI
| | - W. Schelman
- University of Wisconsin - Paul P. Carbone CCC, Madison, WI; University of Wisconsin Madison, Madison, WI
| | - A. Traynor
- University of Wisconsin - Paul P. Carbone CCC, Madison, WI; University of Wisconsin Madison, Madison, WI
| | - J. Kolesar
- University of Wisconsin - Paul P. Carbone CCC, Madison, WI; University of Wisconsin Madison, Madison, WI
| | - R. Marnosha
- University of Wisconsin - Paul P. Carbone CCC, Madison, WI; University of Wisconsin Madison, Madison, WI
| | - J. Eickhoff
- University of Wisconsin - Paul P. Carbone CCC, Madison, WI; University of Wisconsin Madison, Madison, WI
| | - D. Alberti
- University of Wisconsin - Paul P. Carbone CCC, Madison, WI; University of Wisconsin Madison, Madison, WI
| | - G. Wilding
- University of Wisconsin - Paul P. Carbone CCC, Madison, WI; University of Wisconsin Madison, Madison, WI
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11
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Liu G, LoRusso PM, Goncalves P, Holen K, Traynor A, Zhang J, Hee B, Tortorici M, Shalinsky DR, Ricart AD. Phase I pharmacokinetic (PK) and pharmacodynamic (PD) study of PF-00337210, a highly selective VEGFR inhibitor. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3519] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3519 Background: PF-00337210 potently inhibits VEGFR2 phosphorylation and is >10-fold more selective, based on IC50, for VEGFR2 than other kinases (eg, KIT and PDGFRs). In vitro, PF-00337210 inhibits VEGF-mediated HUVEC survival (IC50 = 0.53 nM). In vivo, it inhibits tumor angiogenesis and human xenograft growth. Methods: The primary objectives were to determine the safety profile and MTD of PF-00337210. PK and PD (DCE-MRI at baseline and cycle [C] 1, day [D] 2) were also evaluated. The volume rate transfer constant (Ktrans) assessed VEGFR inhibitory effects on vascular permeability and perfusion. Results: To date, 29 patients (pts) with advanced solid tumors were treated with PF-00337210 at doses of 0.67–9 mg QD, 13 of whom (45%) had received prior VEGF/VEGFR inhibitors. No dose-limiting toxicities (DLTs) occurred at 0.67–8 mg QD. Two DLTs occurred at 9 mg QD: one pt had chest pain, G3 troponin I, and G3 myocardial ischemia; a second pt had significant hypertension (HTN) at the anticipated Tmax after the first dose (systolic ≥180 mmHg over 3 hrs). HTN and fatigue were the most common treatment-related adverse events (AEs). HTN occurred in 8 pts (28%); incidence and intensity corresponded with dose, but was well controlled with antihypertensive agents. Fatigue was reported in 9 pts (31%) and occurred most frequently in pts receiving ≥6 mg QD. Other AEs included nausea, anorexia, proteinuria, and diarrhea. PK data indicated that mean (%CV) t1/2 at 8 mg QD was 8.60 (81) h (n=4) and AUC0–24 was 309 (45) ng.h/mL at steady-state (SS) on C1D15. Exposures (AUC0–24) were generally linear and variability ranged from 21 to 44% across doses. The observed accumulation ratio (Rac) at SS was 1.22 (15) (n=21), which was predicted by t1/2. PF-00337210 decreased mean Ktrans (1/min) values by 22.5±11.8 (n=2), 15.2 (n=1), 5.4±4.8 (n=3), and 25.3±8.5% (n=4) at 4, 6, 8, and 9 mg QD, respectively. No objective responses were observed but 7/29 pts (24%) had stable disease. Conclusions: PF-00337210 was well tolerated with the DLTs being HTN and myocardial ischemia. The QD MTD was determined to be 8 mg. Preliminary evidence of VEGFR inhibition was shown by DCE-MRI at ≥4 mg QD. The trial is now evaluating BID dosing which may allow increased drug exposures and fewer hypertensive effects that may be related to Cmax. [Table: see text]
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Affiliation(s)
- G. Liu
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
| | - P. M. LoRusso
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
| | - P. Goncalves
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
| | - K. Holen
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
| | - A. Traynor
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
| | - J. Zhang
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
| | - B. Hee
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
| | - M. Tortorici
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
| | - D. R. Shalinsky
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
| | - A. D. Ricart
- University of Wisconsin, Waunakee, WI; Wayne State University/Karmanos Cancer Institute, Detroit, MI; Pfizer Oncology, San Diego, CA
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12
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Kolesar J, Brundage R, Pomplun M, Jiang Z, Schelman W, Alberti D, Holen K, Traynor A, Ivy P, Wilding G. Population pharmacokinetics of 3-aminopyridine-2-carboxaldehyde thiosemicarbazone in cancer patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2508] [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
2508 Background: 3-Aminopyridine-2-carboxaldehyde thiosemicarbazone (3AP) is an inhibitor of ribonucletoide reductatse with activity in hematological malignancies as well as melanoma and prostate cancer. This study describes the population PK of 3AP and the relationship between 3AP disposition and patient covariates. Methods: 40 pts with advanced cancer from two phase 1 studies were included in the PK model building. Pts received 3AP 25–105 mg/m2 IV on day 1. 3AP plasma and erythrocyte levels were sampled at 10 timepoints over a 24-hour period and measured by a validated HPLC method. Data were analyzed by a nonlinear mixed- effects modeling approach with NONMEM system Version V. Xpose10 and S-PLUS were used for goodness-of-fit assessment and model evaluation to obtain clearance (CL), volume of distribution (V) for compartment (C) 1, plasma (V1); V for C2, erythrocytes (V2); and V for C3 (V3). 15 covariates were evaluated, including: weight, BSA, gender, PS, age, ABCB1[C1236T, G2667T, C3436T] genotypes, toxicity, concurrent chemotherapy [irinotecan, doxorubicin], response and number of cycles administered. Normal renal and hepatic function were required for study entry and were not included as covariates. Response was assessed after 2 cycles of therapy. Results: 3AP PK were described as a 3-compartment model with first-order elimination. Estimated paramaters were: V1 =5.68 L/m2 (95%CI 4.3–7.1); V2=18.9 L/m2 (95%CI 14.6–23.2); V3= 40.0 L/m2 (95%CI 23.8–55.4); CL 25.4 L/hr/m2 (95%CI 22.4–28.4). Gender was associated with V; women had a lower V2 (p<0.05). This may be related to a lower hemoglobin in women. The number of cycles administered was associated with decreased CL; those with decreased CL received less than 2 cycles before going off study. Conclusions: Women had a lower V2 than men and pts with decreased CL received less than 2 cycles of therapy, suggesting PK may be helpful in individualizing dosing. ABCB1 genotypes and concurrent irinotecan or doxorubicin do not influence 3AP disposition. Supported by: U01CA062491 “Early Clinical Trials of Anti-Cancer Agents with Phase I Emphasis” NCI; CTEP TRI Funding 24XS090, and 1ULRR025011 Clinical and Translational Science Award of the National Center for Research Resources, NIH. No significant financial relationships to disclose.
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Affiliation(s)
- J. Kolesar
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
| | - R. Brundage
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
| | - M. Pomplun
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
| | - Z. Jiang
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
| | - W. Schelman
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
| | - D. Alberti
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
| | - K. Holen
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
| | - A. Traynor
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
| | - P. Ivy
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
| | - G. Wilding
- University of Wisconsin, Madison, WI; University of Minnesota, Minneapolis, MN; National Cancer Institute, Bethesda, MD
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13
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Traynor A, Sandler A, Schiller J, Ilagan J, Harper K, VerMeulen W, Liu G, Tye L, Chao R, Robert F. 711 POSTER Sunitinib (SU) plus docetaxel (D) in patients (pts) with advanced solid tumors: a phase I dose-escalation and pharmacokinetic (PK) study. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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Robert F, Sandler A, Schiller JH, Ilagan J, VerMeulen W, Harper K, Liu G, Tye L, Chao R, Traynor A. A phase I dose-escalation and pharmacokinetic (PK) study of sunitinib (SU) plus docetaxel (D) in patients (pts) with advanced solid tumors (STs). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
3543 Background: SU is an oral, multitargeted tyrosine kinase inhibitor of VEGFRs, PDGFRs, KIT, RET and FLT3, approved multinationally for the treatment of advanced RCC and imatinib-resistant or -intolerant GIST. In mouse xenograft models of breast cancer, SU enhanced the antitumor activity of D. This study was designed to assess the safety/maximum tolerated doses (MTDs), PK profile and preliminary efficacy of SU+D in pts with advanced STs. Methods: This is a phase I, dose-finding study in pts with advanced STs. The primary objective is to determine the MTD and safety of SU and D administered in combination. Successive cohorts of pts with advanced STs were to receive oral SU at 25, 37.5 or 50 mg daily for 4 wks of a 6-wk cycle (4/2 schedule) or for 2 wks of a 3-wk cycle (2/1 schedule) in combination with IV D at 60 or 75 mg/m2 every 21 days (q21d). The MTD was defined as the highest dose at which 0 of 3 or 1 of 6 pts encountered dose-limiting toxicities (DLTs) during cycle 1. Antitumor activity was assessed by CT or MRI scan. Results: 37 pts (most common primary tumor types: mRCC [n=10], NSCLC [n=13]) have been enrolled as of Nov. 2006: 10 pts on the 4/2 schedule and 27 pts on the 2/1 schedule (see table ). The most commonly observed DLT was neutropenia (with or without fever; maximum grade 4), which occurred in 5 pts and was manageable/reversible. There was 1 grade 5 event on the 2/1 schedule (C1D3), of pulseless electrical activity and pulmonary hemorrhage. The MTDs on the 4/2 schedule were SU 25 mg and D 60 mg/m2. The MTDs on the 2/1 schedule were SU 37.5 mg and D 75 mg/m2; PK analysis at this dose level is ongoing. Stable disease has been observed in 5 of 9 evaluable pts (56%) on the 4/2 schedule and 20 of 25 evaluable pts (80%) on the 2/1 schedule at the MTD. Conclusions: The combination of oral SU 37.5 mg/day on the 2/1 schedule with D 75 mg/m2 IV q21d has a manageable safety profile in pts with advanced STs. PK and preliminary efficacy analyses are ongoing to support these dosing combinations for further study. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- F. Robert
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
| | - A. Sandler
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
| | - J. H. Schiller
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
| | - J. Ilagan
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
| | - W. VerMeulen
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
| | - K. Harper
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
| | - G. Liu
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
| | - L. Tye
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
| | - R. Chao
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
| | - A. Traynor
- University of Alabama at Birmingham, Birmingham, AL; Vanderbilt University Medical Center, Nashville, TN; UT Southwestern, Dallas, TX; Pfizer Global Research and Development, La Jolla, CA; Vanderbilt Ingram Cancer Center, Nashville, TN; University of Wisconsin, Madison, WI
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15
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Loh Y, Oyama Y, Statkute L, Traynor A, Satkus J, Quigley K, Yaung K, Barr W, Bucha J, Gheorghiade M, Burt RK. Autologous hematopoietic stem cell transplantation in systemic lupus erythematosus patients with cardiac dysfunction: feasibility and reversibility of ventricular and valvular dysfunction with transplant-induced remission. Bone Marrow Transplant 2007; 40:47-53. [PMID: 17483845 DOI: 10.1038/sj.bmt.1705698] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/08/2022]
Abstract
Patients with cardiac dysfunction may be at increased risk of cardiac toxicity when undergoing hematopoietic stem cell transplantation (HSCT), which may preclude them from receiving this therapy. Cardiac dysfunction is, however, common in systemic lupus erythematosus (SLE) patients. While autologous HSCT (auto-HSCT) has been performed increasingly for SLE, its impact on cardiac function has not previously been evaluated. We, therefore, performed a retrospective analysis of SLE patients who had undergone auto-HSCT in our center to determine the prevalence of significant cardiac involvement, and the impact of transplantation on this. The records of 55 patients were reviewed, of which 13 were found to have abnormal cardiac findings on pre-transplant two-dimensional echocardiography or multi-gated acquisition scan: impaired left ventricular ejection fraction (LVEF) (n = 6), pulmonary hypertension (n = 5), mitral valve dysfunction (n = 3) and large pericardial effusion (n = 1). At a median follow-up of 24 months (8-105 months), there were no transplant-related or cardiac deaths. With transplant-induced disease remission, all patients with impaired LVEF remained stable or improved; while three with symptomatic mitral valve disease similarly improved. Elevated pulmonary pressures paralleled activity of underlying lupus. These data suggest that auto-HSCT is feasible in selected patients with lupus-related cardiac dysfunction, and with control of disease activity, may improve.
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Affiliation(s)
- Y Loh
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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16
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Statkute L, Verda L, Oyama Y, Traynor A, Villa M, Shook T, Clifton R, Jovanovic B, Satkus J, Loh Y, Quigley K, Yaung K, Gonda E, Krosnjar N, Spahovic D, Burt RK. Mobilization, harvesting and selection of peripheral blood stem cells in patients with autoimmune diseases undergoing autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2007; 39:317-29. [PMID: 17277794 DOI: 10.1038/sj.bmt.1705579] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [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: 12/29/2022]
Abstract
Peripheral blood stem cells (PBSC) were mobilized in 130 patients with autoimmune diseases undergoing autologous hematopoietic stem cell transplantation using cyclophosphamide 2 g/m(2) and either granulocyte colony-stimulating factor (G-CSF) 5 mcg/kg/day (for systemic lupus erythematosus (SLE) and secondary progressive multiple sclerosis, SPMS) or G-CSF 10 mcg/kg/day (for relapsing remitting multiple sclerosis (RRMS), Crohn's disease (CD), systemic sclerosis (SSc), and other immune-mediated disorders). Mobilization-related mortality was 0.8% (one of 130) secondary to infection. Circulating peripheral blood (PB) CD34(+) cells/microl differed significantly by disease. Collected CD34(+) cells/kg/apheresis and overall collection efficiency was significantly better using Spectra apheresis device compared to the Fenwall CS3000 instrument. Patients with SLE and RRMS achieved the lowest and the highest CD34(+) cell yields, respectively. Ex vivo CD34(+) cell selection employing Isolex 300iv2.5 apparatus was significantly more efficient compared to CEPRATE CS device. Circulating PB CD34(+) cells/microl correlated positively with initial CD34(+) cells/kg/apheresis and enriched product CD34(+) cells/kg. Mean WBC and platelet engraftment (ANC>0.5 x 10(9)/l and platelet count >20 x 10(9)/l) occurred on days 9 and 11, respectively. Infused CD34(+) cell/kg dose showed significant direct correlation with faster white blood cell (WBC) and platelet engraftment. When adjusted for CD34(+) cell/kg dose, patients treated with a myeloablative regimen had significantly slower WBC and platelet recovery compared to non-myeloablative regimens.
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Affiliation(s)
- L Statkute
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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17
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Chang JE, Morgan Meadows S, Traynor A, Kolesar J, Marnocha R, Lee F, Eickoff J, Beth E, Binger K, Wilding G. A phase I study of triapine in combination with doxorubicin in refractory tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13168] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13168 Background: Triapine (T) is a novel ribonucleotide reductase inhibitor, affecting the M2 subunit. It has in vitro and in vivo antitumor activity. Hematologic toxicity was dose limiting in single agent phase I trials. Triapine potentiates the activity of DNA damaging agents such as doxorubicin (D), with synergy demonstrated in vivo. Methods: D was administered on day 1 and T was administered on days 1–4 of a 21-day cycle. Patients enrolled in cohorts of three, beginning at D60 mg/m2 and T25 mg/m2. Dose limiting toxicity was defined as grade 3 or 4 leukopenia or thrombocytopenia lasting 7 days, febrile neutropenia or grade 3 or 4 non-hematologic toxicity. Results: Fourteen patients have enrolled in four dose cohorts, receiving 23 courses. At dose level 2 (D60 mg/m2, T45 mg/m2), two patients experienced DLT (febrile neutropenia, grade 4 thrombocytopenia). An additional 3 patients enrolled at dose level one without initial toxicity. Enrollment then resumed at dose level 2a with a decreased dose of doxorubicin (D45 mg/m2, T45 mg/m2). Two patients enrolled on this level had DLT. Enrollment was planned to resume at dose level 1 (D60 mg/m2, T25 mg/m2); however, the sixth patient enrolled to this cohort developed grade 5 heart failure (ejection fraction 20%, pretreatment EF 62%) after the second course. Enrollment has begun at doses of D45 mg/m2 and T25 mg/m2. Hematologic toxicity has predominated, with 52% of courses having grade 3 or 4 neutropenia. Non-hematologic toxicity included grade 2 fatigue in 17% of courses and 1 episode of grade 5 heart failure. Although no objective antitumor responses have been seen, 1 patient with metastatic melanoma had stable disease through 6 cycles of treatment. Another patient with previously rapidly progressive metastatic melanoma had stable disease for over 2 months of treatment. Conclusions: The combination of triapine and doxorubicin appears to have increased toxicity. Enrollment continues. [Table: see text]
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Affiliation(s)
- J. E. Chang
- University of Wisconsin Hospital and Clinics, Madison, WI
| | | | - A. Traynor
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - J. Kolesar
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - R. Marnocha
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - F. Lee
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - J. Eickoff
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - E. Beth
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - K. Binger
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - G. Wilding
- University of Wisconsin Hospital and Clinics, Madison, WI
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18
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Dubey S, Siegfried J, Stabile L, Kolesar J, Belani C, Hoang T, Eickhoff J, Marcotte S, Schiller J, Traynor A. PD-071 Combination therapy with gefitinib and fulvestrant (G/F) forwomen with non-small cell lung cancer (NSCLC). Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Burt RK, Patel D, Thomas J, Yeager A, Traynor A, Heipe F, Arnold R, Marmont A, Collier D, Glatstein E, Snowden J. The rationale behind autologous autoimmune hematopoietic stem cell transplant conditioning regimens: concerns over the use of total-body irradiation in systemic sclerosis. Bone Marrow Transplant 2005; 34:745-51. [PMID: 15361910 DOI: 10.1038/sj.bmt.1704671] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is becoming an increasingly recognized indication for treatment of autoimmune diseases and severe immune-mediated disorders. However, multicenter registry data have demonstrated higher than anticipated early toxicity, approximately 10% for autoimmune diseases in general, and 20-27% for diffuse systemic sclerosis (scleroderma). If uncorrected, this high treatment-related mortality will hinder development of stem cell therapy for immune-mediated diseases. In order to develop safer regimens, we address some pitfalls and concepts involved in design and selection of conditioning regimens for autoimmune diseases in general, and because it is associated with the highest regimen-related toxicity, scleroderma in specific.
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20
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Burt RK, Oyama Y, Traynor A, Quigley K, Brush M, Rodriguez J, Barr WG. Hematopoietic stem cell transplantation for systemic sclerosis with rapid improvement in skin scores: is neoangiogenesis occurring? Bone Marrow Transplant 2003; 32 Suppl 1:S65-7. [PMID: 12931246 DOI: 10.1038/sj.bmt.1704055] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 11/09/2022]
Abstract
Systemic sclerosis (SSc) is presumed to be an immune-mediated vasculopathy of unknown etiology. SSc is unresponsive to most immune-modulating therapies except for intravenous cyclophosphamide, which is reported to demonstrate some benefit. We, therefore, dose-escalated cyclophosphamide to 200 mg/kg and added rabbit ATG 7.5 mg/kg along with infusion of unselected hematopoietic stem cells to minimize the cytopenic interval. Engraftment occurred rapidly (day 8) with minimal unexpected toxicity, no infections, and unexpectedly rapid improvement in the modified Rodnan Skin Score.
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Affiliation(s)
- R K Burt
- Department of Medicine, Division of Immunotherapy, Northwestern University Medical Center, 320 East Superior, Searle 3-489, Chicago, IL 60611, USA
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21
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Burt RK, Marmont A, Arnold R, Heipe F, Firestein GS, Carrier E, Hahn B, Barr W, Oyama Y, Snowden J, Kalunian K, Traynor A. Development of a phase III trial of hematopoietic stem cell transplantation for systemic lupus erythematosus. Bone Marrow Transplant 2003; 32 Suppl 1:S49-51. [PMID: 12931242 DOI: 10.1038/sj.bmt.1703943] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 12/29/2022]
Abstract
At Northwestern University, a phase I/II trial of hematopoietic stem cell transplant (HSCT) for systemic lupus erythematosus (SLE) has shown promising results. A phase III HSCT trial is being developed to confirm efficacy of HSCT vs continuing the currently accepted standard of care, intravenous pulse cyclophosphamide.
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Affiliation(s)
- R K Burt
- Northwestern University Medical Center, Chicago, IL 60611, USA
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22
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Abstract
It is clear that some patients with severe Crohn's disease (CD) fail to respond favorably to the standard treatment, including antibody to Tumor Necrosis Factor alpha (TNFalpha), We have embarked on a unique therapy for this group of patients, intense immune suppression followed by autologous hematopoietic stem cell transplantation (HSCT). The response to this approach in our first four patients has been excellent, with there being no significant untoward event from the transplantation and with each patient entering clinical remission in terms of the Crohn's Disease Activity Index off all therapy for CD and no diarrhea or abdominal pain. However, some evidence of minor laboratory abnormalities and slight inflammation of the colon on colonoscopic evaluation persist up to 1 year post-transplant. It is suggested that HSCT should be considered a reasonable option for patients who have failed standard CD therapy, although long-term follow-up will be necessary to confirm the duration of the induced clinical remission.
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Affiliation(s)
- R M Craig
- Division of Immunotherapy, Northwestern University Medical Center, Chicago, IL 60611, USA
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23
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Bakhshandeh A, Bruns I, Traynor A, Robins HI, Eberhardt K, Demedts A, Kaukel E, Koschel G, Gatzemeier U, Kohlmann T, Dalhoff K, Ehlers EM, Gruber Y, Zumschlinge R, Hegewisch-Becker S, Peters SO, Wiedemann GJ. Ifosfamide, carboplatin and etoposide combined with 41.8 degrees C whole body hyperthermia for malignant pleural mesothelioma. Lung Cancer 2003; 39:339-45. [PMID: 12609573 DOI: 10.1016/s0169-5002(02)00536-6] [Citation(s) in RCA: 21] [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: 11/26/2022]
Abstract
We performed a phase II study combining 41.8 degrees C whole body hyperthermia with ICE chemotherapy, i.e. ifosfamide (5 g/m(2)), carboplatin (300 mg/m(2)) and etoposide (150 mg/m(2) on days 2 and 3), administered every 4 weeks, for patients with malignant pleural mesothelioma. Of 27 chemonäive, non-metastatic patients enrolled, 25 patients were evaluable for response. Overall response rate was 20% (five partial remissions; 95% CI 8.9-39.1%). Median survival time from the start of treatment for all patients was 76.6 weeks (95% CI 65.4-87.8 weeks). Progression free survival for all patients measured 29.6 weeks (95% CI 24.4-34.7 weeks). One year overall survival was 68% and 2 year overall survival was 20%. Major treatment toxicities included grade 3/4 neutropenia and thrombocytopenia in 74 and 33% of treatment cycles, respectively. One patient died due to sepsis. These promising results are consistent with continued clinical investigation; a phase III clinical trial with whole body hyperthermia as the independent variable has been initiated.
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Affiliation(s)
- A Bakhshandeh
- Medical University of Lübeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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24
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Frey P, Stinson T, Siston A, Knight SJ, Ferdman E, Traynor A, O'Gara K, Rademaker A, Bennett C, Winter JN. Lack of caregivers limits use of outpatient hematopoietic stem cell transplant program. Bone Marrow Transplant 2002; 30:741-8. [PMID: 12439696 DOI: 10.1038/sj.bmt.1703676] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [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: 08/29/2001] [Accepted: 05/08/2002] [Indexed: 11/08/2022]
Abstract
Our goal was to compare direct and indirect medical costs and quality of life associated with inpatient vs outpatient autologous hematopoietic stem cell transplantation (AuHSCT). Twenty-one sequential outpatients and 26 inpatients were enrolled on this prospective trial. All candidates for AuHSCT were screened for eligibility for outpatient transplantation. Patients with either breast cancer or hematologic malignancy, insurance coverage for the outpatient procedure, one to three caregivers available to provide 24 h coverage, and no significant comorbidities were eligible to participate. Patients without caregivers or insurance coverage for outpatient transplant were accrued to the study in a consecutive manner as inpatient controls, based on willingness to participate in the quality of life portion of the study and to permit review of their hospital and billing records. Approximately half of all 139 prospective outpatient candidates were ineligible because they lacked a caregiver. Most commonly, the patient without a caregiver was single or widowed or their family and friends were needed to provide childcare. Most caregivers were college educated from families with incomes greater than US dollars 80000. Indirect costs to the caregivers totaled a median of US dollars 2520 (range US dollars 684-US dollars 4508), with the majority attributed to lost 'opportunity costs'. Overall, there were significant differences in the total costs of treatment for inpatient vs outpatient AuHSCT (US dollars 40985 vs US dollars 29210, P < 0.01)). In general, no significant differences were detected between inpatient and outpatient scores on quality of life measures. Although significant cost savings were associated with outpatient transplantation, this approach was applicable to only half of our otherwise eligible candidates because of a lack of caregivers. The financial burden associated with the caretaking role may underlie this finding.
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Affiliation(s)
- P Frey
- Department of Medicine, Northwestern University Medical School, Chicago, IL 60611, USA
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25
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Oyama Y, Cohen B, Traynor A, Brush M, Rodriguez J, Burt RK. Engraftment syndrome: a common cause for rash and fever following autologous hematopoietic stem cell transplantation for multiple sclerosis. Bone Marrow Transplant 2002; 29:81-5. [PMID: 11840150 DOI: 10.1038/sj.bmt.1703324] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2001] [Accepted: 09/24/2001] [Indexed: 01/20/2023]
Abstract
Autologous hematopoietic stem cell transplantation (HSCT) is currently being evaluated as a therapy for patients with progressive multiple sclerosis (MS) at risk of debilitating neurological impairment. While preliminary results from a few studies have been reported, little is known about toxicities or outcome of HSCT for MS. We report a relatively frequent triad of non-infectious fever, rash and fatigue or lassitude that may also be associated with pruritus, pulmonary symptoms, and eosinophilia and frequently occurs around engraftment. This syndrome occurred in 26% of our series of patients (5/19) undergoing HSCT for multiple sclerosis. The engraftment syndrome is usually self-limited but may require intervention with systemic corticosteroids.
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Affiliation(s)
- Y Oyama
- Division of Immune Therapy and Autoimmune Disease, Northwestern University School of Medicine, Chicago, IL 60611, USA
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26
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Burt RK, Barr W, Oyama Y, Traynor A, Slavin S. Future strategies in hematopoietic stem cell transplantation for rheumatoid arthritis. J Rheumatol Suppl 2001; 64:42-8. [PMID: 11642504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Patients with coincidental rheumatoid arthritis (RA) treated by allogeneic hematopoietic stem cell transplantation (HSCT) for drug induced aplastic anemia have been fortuitously cured of RA. Other than these examples with allogeneic HSCT, there is no known curative therapy for RA. Despite its potential to cure, allogeneic transplantation is not being offered to patients with RA due to transplant related mortality. Advances in HSCT conditioning regimens and better prevention of graft-versus-host disease should allow consideration of allogeneic HSCT as therapy for severe RA. We propose a new, well tolerated, nonmyeloablative allogeneic stem cell transplant regimen as treatment for RA.
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Affiliation(s)
- R K Burt
- Division of Immunotherapy and Autoimmune Disease, Northwestern University, Chicago, Illinois, USA.
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27
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Mehta J, Oyama Y, Winter J, Williams S, Tallman M, Singhal S, Villa M, Shook T, Burt R, Traynor A, Soff G, Masarik S, Ramsey G, Gordon L. CD34(+) cell collection efficiency does not correlate with the pre-leukapheresis hematocrit. Bone Marrow Transplant 2001; 28:597-601. [PMID: 11607773 DOI: 10.1038/sj.bmt.1703197] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2001] [Accepted: 07/11/2001] [Indexed: 11/09/2022]
Abstract
One hundred and seventy-seven large-volume leukapheresis procedures performed on 91 patients over a 15 month period were reviewed to see if the pre-apheresis hematocrit (Hct) affected the CD34(+) cell collection efficiency (CE) of the Fenwal CS 3000 Plus cell separator. The Hct was 0.174-0.461 (median 0.317), and the peripheral blood CD34(+) cell count 2-2487 per microl (median 21). The total CD34(+) cell quantity collected was 3.0-2677.2 x 10(6) (median 113.0). Based on the number of CD34(+)cells contained in the blood volume processed (23.3-37303.2 x 10(6); median 318.0), the CE was 1.7-87.5% (median 30.3). No correlation was found between the Hct and CE (r(2) = 0.0034; P = 0.44) or the total CD34(+) cell quantity collected (r2 = 0.0040; P = 0.40). CEs for Hct <0.25 (median CE 36%), Hct 0.25-0.299 (median CE 30%) and Hct 0.30 (median CE 30%) were comparable. As expected, highly significant correlations were seen between the CD34(+) cell quantities collected and quantities processed (r2 = 0.59; P < 10(-6)) as well as the peripheral blood CD34(+) cell counts (r2= 0.60; P < 10(-6)). We conclude that the minimum acceptable Hct or hemoglobin level for leukapheresis should be dictated by clinical circumstances because it does not affect stem cell collection.
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Affiliation(s)
- J Mehta
- The Hematopoietic Stem Cell Transplant Program, Division of Hematology/Oncology, Department of Internal Medicine, Northwestern University Medical School and The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
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28
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Tulpule A, Rarick MU, Kolitz J, Bernstein J, Myers A, Buchanan LA, Espina BM, Traynor A, Letzer J, Justice GR, McDonald D, Roberts L, Boswell W, Nathwani B, Levine AM. Liposomal daunorubicin in the treatment of relapsed or refractory non-Hodgkin's lymphoma. Ann Oncol 2001; 12:457-62. [PMID: 11398876 DOI: 10.1023/a:1011181016401] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 11/12/2022] Open
Abstract
PURPOSE To assess the efficacy and toxicity of liposomal daunorubicin administered as a two-hour intravenous infusion to patients with relapsed or refractory non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS Eligible patients had relapsed or refractory NHL with measurable or evaluable disease, and low grade, select intermediate grade, or mantle cell pathologic types. Prior exposure to an anthracycline or anthracenedione was allowed. Liposomal daunorubicin at a dose of 100 mg/m2 was given intravenously over a minimum of 120 minutes every 3 weeks. as a single agent. RESULTS Thirty-three patients were accrued: twenty-three (70%) had low-grade histologies; six (18%) had intermediate-grade histologies (follicular large-cell and diffuse small cleaved); and four (12%) patients had mantle-cell lymphoma. Eighteen (55%) had received two or more prior regimens; fourteen (42%) received a prior anthracycline. A median of six cycles of liposomal daunorubicin were administered (range 1-15). Of 31 patients evaluable for response, 2 complete and 10 partial remissions were documented for a major response rate of 39% (95% confidence interval (CI): 22%-58%). The median duration of response was 19.5 months (range 4.3-41.1+). Six responders (50%) had received a prior anthracycline; one responder had mantle-cell histology. The major toxicities were grade 3 or 4 neutropenia in 26 patients (79%), mild to moderate nausea in 22 (67%), and fatigue in 16 (48%). CONCLUSIONS Liposomal daunorubicin at 100 mg/m2 every three weeks has activity in patients with relapsed or refractory NHL, including patients with prior exposure to an anthracycline. Further studies of liposomal daunorubicin in combination with other agents are warranted.
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Affiliation(s)
- A Tulpule
- University of Southern California Schools of Medicine and Pathology, Los Angeles, USA.
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29
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Abstract
Adoptive cellular therapy is developing as a supplement or alternative to chemotherapy and/or radiation for malignant disease. Our focus is two ongoing clinical studies with transgeneic (genetically altered) cellular therapy; one uses allogeneic (from another person) lymphocytes to treat leukemia, and the second uses xenogeneic (from another species) fibroblast cells genetically altered to contain a toxin-producing suicide gene to treat ovarian cancer. Allogeneic donor lymphocyte infusions (DLI) are known to induce remission of hematologic malignancies. However, the toxicity associated with DLI is related to graft-versus-host-disease, which is due to donor lymphocytes attacking normal tissue in the recipient. Therefore, we have taken the approach of infusing DLI that have been modified to contain a latent suicide gene to treat leukemia. To treat ovarian cancer, we used xenogeneic nonimmune fibroblast-derived cells to deliver a tumor-directed cytotoxic gene to carcinoma cells. These cells release HStk transgene retroviruses that in turn transduce replicating tumor cells but not quiescent epithelium, rendering the tumor selectively susceptible to ganciclovir-mediated killing. These initial trials summarize the early stage of allogeneic/xenogeneic adoptive cellular therapy for cancer, and although the data are limited, it is encouraging to see some patients with evidence of antitumor responses. Advances in our understanding of the basic science of these treatments, together with improvements in the technology of vector design, will be required to streamline these methodologies into broader application.
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Affiliation(s)
- C J Link
- Northwestern University School of Medicine and The Robert H. Lurie Cancer Center, Chicago, Illinois, USA
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30
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Link CJ, Traynor A, Seregina T, Burt RK. Adoptive immunotherapy for leukemia: donor lymphocytes transduced with the herpes simplex thymidine kinase gene. Cancer Treat Res 2000; 101:369-75. [PMID: 10800657 DOI: 10.1007/978-1-4615-4987-1_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/16/2023]
Abstract
The overall goal of adoptive immunotherapy with genetically modified lymphocytes is to decrease the morbidity and mortality associated with allogeneic bone marrow transplantation. The initial data reviewed here suggest that the behavior of the allogeneic HStk transgenic cells can be modified after administration to patients. Further study is needed to identify the response rates and risks associated with this procedure. In particular, larger studies will be needed with appropriate randomization to determine if the response rate to genetically modified cells is equivalent to the response rates with unmodified cells. Wider application of these techniques in the initial setting of allogeneic transplantation will undoubtedly occur and such trials have been initiated at several institutions. Careful attention to vector, suicide gene, selectable marker, efficiency of transduction, and cell dose will be necessary when comparing different trials since these variables will probably affect transgenic cell survival and response rates. [figure: see text]
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Affiliation(s)
- C J Link
- Human Gene Therapy Research Institute, Des Moines, IA 50309, USA
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31
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Burt RK, Traynor A, Burns W. Hematopoietic stem cell transplantation of multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus. Cancer Treat Res 2000; 101:157-84. [PMID: 10800649 DOI: 10.1007/978-1-4615-4987-1_8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R K Burt
- Northwestern University Medical Center, Chicago, IL 60611, USA
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32
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Abstract
Adoptive cellular therapy is developing as a supplement or alternative to chemotherapy and/or radiation for malignant disease. Our focus is two ongoing clinical studies with transgeneic (genetically altered) cellular therapy; one uses allogeneic (from another person) lymphocytes to treat leukemia, and the second uses xenogeneic (from another species) fibroblast cells genetically altered to contain a toxin-producing suicide gene to treat ovarian cancer. Allogeneic donor lymphocyte infusions (DLI) are known to induce remission of hematologic malignancies. However, the toxicity associated with DLI is related to graft-versus-host-disease, which is due to donor lymphocytes attacking normal tissue in the recipient. Therefore, we have taken the approach of infusing DLI that have been modified to contain a latent suicide gene to treat leukemia. To treat ovarian cancer, we used xenogeneic nonimmune fibroblast-derived cells to deliver a tumor-directed cytotoxic gene to carcinoma cells. These cells release HStk transgene retroviruses that in turn transduce replicating tumor cells but not quiescent epithelium, rendering the tumor selectively susceptible to ganciclovir-mediated killing. These initial trials summarize the early stage of allogeneic/xenogeneic adoptive cellular therapy for cancer, and although the data are limited, it is encouraging to see some patients with evidence of antitumor responses. Advances in our understanding of the basic science of these treatments, together with improvements in the technology of vector design, will be required to stream-line these methodologies into broader application.
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Affiliation(s)
- C J Link
- Northwestern University School of Medicine, Chicago, IL 60611, USA
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33
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Burt RK, Guitart J, Traynor A, Link C, Rosen S, Pandolfino T, Kuzel TM. Allogeneic hematopoietic stem cell transplantation for advanced mycosis fungoides: evidence of a graft-versus-tumor effect. Bone Marrow Transplant 2000; 25:111-3. [PMID: 10654025 DOI: 10.1038/sj.bmt.1702099] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [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: 11/09/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation should be considered as a therapeutic option for patients with generalized erythoderma or tumor stage MF. Indeed, the only curative option for MF may be an allogeneic transplant. Bone Marrow Transplantation (2000) 25, 111-113.
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Affiliation(s)
- R K Burt
- The Robert H Lurie Comprehensive Cancer Center, Department of Medicine, Division of Hematology Oncology, Iowa Methodist Medical Center, Des Moines, IA, USA
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34
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Burt RK, Brenner M, Burns W, Courier E, Firestein G, Hahn B, Heslop H, Link C, McFarland H, Roland M, Territo M, Tsokos G, Traynor A. Gene-marked autologous hematopoietic stem cell transplantation of autoimmune disease. J Clin Immunol 2000; 20:1-9. [PMID: 10798601 DOI: 10.1023/a:1006673408343] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 12/29/2022]
Abstract
In phase I (safety) trials, we have demonstrated the feasibility of autologous hematopoietic stem cell transplantation (HSCT) for patients with autoimmune diseases. Although this review comments on results of our phase I trials, the focus is on phase II (efficacy) trials using gene-marked autologous stem cells.
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Affiliation(s)
- R K Burt
- Northwestern University Medical Center, and the Rupert H. Lurie Cancer Center, Chicago, Illinois, USA
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35
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Burt RK, Georganas C, Schroeder J, Traynor A, Stefka J, Schuening F, Graziano F, Mineishi S, Brush M, Fishman M, Welles C, Rosen S, Pope R. Autologous hematopoietic stem cell transplantation in refractory rheumatoid arthritis: sustained response in two of four patients. Arthritis Rheum 1999. [PMID: 10555021 DOI: 10.1002/1529-0131(199911)42:11<2281::aid-anr4>3.0.co;2-e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of immune ablation with subsequent autologous hematopoietic stem cell transplantation (HSCT) in severe rheumatoid arthritis (RA). METHODS Four patients with refractory RA and poor prognostic indicators were treated. Stem cells were collected and lymphocytes were depleted by 2.3-4.0 logs. The conditioning regimen included cyclophosphamide (200 mg/kg), antithymocyte globulin (90 mg/kg), and, for 1 patient, total body irradiation (TBI) with 400 cGy. Improvement was evaluated according to the American College of Rheumatology (ACR) preliminary definition of improvement in RA (ACR 20), and also according to the ACR 50 and ACR 70 criteria. RESULTS HSCT was well tolerated. Three patients fulfilled the ACR 70 criteria at 1 month and 3 months post-HSCT. One patient did not fulfill the ACR 20 criteria because of persistent joint tenderness, despite improvement of the joint swelling. At 6 months post-HSCT, 1 patient fulfilled the ACR 70 criteria and 1 fulfilled the ACR 50 criteria, and these 2 patients fulfilled the ACR 70 criteria at 9 months post-HSCT. The other 2 patients (including the patient who received TBI) did not meet the ACR 20 criteria at 6 months and 9 months post-HSCT. The only patient with followup of >9 months fulfilled the ACR 70 criteria at 20 months post-HSCT. CONCLUSION In this series, autologous HSCT was safe and effective in inducing major clinical response and maintained significant benefit for 2 patients at 9 months and 20 months posttreatment, respectively. Sustained response did not occur for 2 of 4 patients. A regimen dose-response effect may exist, but the addition of TBI did not prevent disease relapse for 1 of the patients. More aggressive T cell depletion of the autograft, use of a myeloablative regimen, or use of an allograft may be necessary to decrease relapse rates.
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Affiliation(s)
- R K Burt
- Northwestern University Medical School, Chicago, Illinois, USA
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36
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Burt RK, Georganas C, Schroeder J, Traynor A, Stefka J, Schuening F, Graziano F, Mineishi S, Brush M, Fishman M, Welles C, Rosen S, Pope R. Autologous hematopoietic stem cell transplantation in refractory rheumatoid arthritis: sustained response in two of four patients. Arthritis Rheum 1999; 42:2281-5. [PMID: 10555021 DOI: 10.1002/1529-0131(199911)42:11<2281::aid-anr4>3.0.co;2-e] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of immune ablation with subsequent autologous hematopoietic stem cell transplantation (HSCT) in severe rheumatoid arthritis (RA). METHODS Four patients with refractory RA and poor prognostic indicators were treated. Stem cells were collected and lymphocytes were depleted by 2.3-4.0 logs. The conditioning regimen included cyclophosphamide (200 mg/kg), antithymocyte globulin (90 mg/kg), and, for 1 patient, total body irradiation (TBI) with 400 cGy. Improvement was evaluated according to the American College of Rheumatology (ACR) preliminary definition of improvement in RA (ACR 20), and also according to the ACR 50 and ACR 70 criteria. RESULTS HSCT was well tolerated. Three patients fulfilled the ACR 70 criteria at 1 month and 3 months post-HSCT. One patient did not fulfill the ACR 20 criteria because of persistent joint tenderness, despite improvement of the joint swelling. At 6 months post-HSCT, 1 patient fulfilled the ACR 70 criteria and 1 fulfilled the ACR 50 criteria, and these 2 patients fulfilled the ACR 70 criteria at 9 months post-HSCT. The other 2 patients (including the patient who received TBI) did not meet the ACR 20 criteria at 6 months and 9 months post-HSCT. The only patient with followup of >9 months fulfilled the ACR 70 criteria at 20 months post-HSCT. CONCLUSION In this series, autologous HSCT was safe and effective in inducing major clinical response and maintained significant benefit for 2 patients at 9 months and 20 months posttreatment, respectively. Sustained response did not occur for 2 of 4 patients. A regimen dose-response effect may exist, but the addition of TBI did not prevent disease relapse for 1 of the patients. More aggressive T cell depletion of the autograft, use of a myeloablative regimen, or use of an allograft may be necessary to decrease relapse rates.
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Affiliation(s)
- R K Burt
- Northwestern University Medical School, Chicago, Illinois, USA
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37
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Abstract
OBJECTIVE For patients with systemic lupus erythematosus (SLE) who are at risk of disease-related mortality, we have initiated a protocol of intensive immunosuppression and haematopoietic stem cell support. The first patient enrolled in this study was in the midst of a lupus flare manifest by nephritis and rapidly declining renal function, uncontrolled hypertension, immune-mediated cytopenias, and serositis characterized by a large pericardial effusion and abdominal pain. Antinuclear antibody (ANA), anti-double-stranded (ds) DNA and complement were abnormal. This patient is now more than 1 yr post-stem cell transplant and is taking no immunosuppressive medication. Her serologies are normal, effusions have resolved, blood pressure is normal and renal function is markedly improved. The clinical and serological course of this patient is summarized here. METHODS Autologous haematopoietic stem cells (HSC) were mobilized with cyclophosphamide (2.0 g/m2) and granulocyte colony-stimulating factor (G-CSF) (10 microg/kg/day). Stem cells were enriched ex vivo using CD34-positive immunoselection and reinfused after immunosuppression with cyclophosphamide (200 mg/kg) and antithymocyte globulin (ATG) (90 mg/kg). RESULTS White blood cell engraftment with an absolute neutrophil count (ANC) of >500/microl (0.5 x 10(9)/l) and platelet engraftment with a non-transfused platelet count of >20000/microl (20 x 10(9)/l) occurred on day 10 and 14, respectively. Therapy was complicated by a cell lysis-like effect with hyperphosphataemia, hyperuricaemia, normal anion gap metabolic acidosis and transient exacerbation of renal insufficiency. CONCLUSION This is the first autologous T-cell-depleted haematopoietic stem cell transplantation performed to treat lupus in an active flare. This patient has, for the first time since discase onset (13 yr ago), entered a complete clinical and serological remission which persists at >1 yr of follow-up. The durability of this remission is unknown.
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Affiliation(s)
- A Traynor
- Northwestern University School of Medicine, Division of Hematology Oncology and the Robert H. Lurie Cancer Center, Chicago, IL 60611, USA
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38
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Anderson KC, Hamblin TJ, Traynor A. Management of multiple myeloma today. Semin Hematol 1999; 36:3-8. [PMID: 9989482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Multiple myeloma is almost invariably fatal despite a wide variety of chemotherapeutic and supportive treatment options. There are several unresolved problems with existing approaches, including the specific indications for treatment; the optimal combination of agents and doses; and the type, frequency, and timing of high-dose therapy and stem-cell transplantation. High-dose chemotherapy followed by stem-cell transplantation produces higher remission rates, but patients rarely, if ever, are cured by a single regimen. Allogeneic hematopoietic stem-cell transplantations offer a potential graft-versus-myeloma (GVM) effect. Researchers are focusing efforts on improving the safety of transplant procedures, increasing response rates to ablative therapy, and testing novel posttransplant options to improve outcomes. The newly devised National Comprehensive Cancer Network (NCCN) guidelines for treating multiple myeloma are also discussed.
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Affiliation(s)
- K C Anderson
- Dana Farber Cancer Institute, Boston, MA 02115, USA
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39
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Stevenson FK, Link CJ, Traynor A, Yu H, Corr M. DNA vaccination against multiple myeloma. Semin Hematol 1999; 36:38-42. [PMID: 9989489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
A variety of approaches to antitumor therapy are currently being explored that use both antigen-encoding DNA and noncoding nucleotides as a component of gene vaccination. Among the specific strategies reviewed are a construct that fuses a single-chain variable fragment (scFv) that incorporates both the variable-region genes necessary to encode the idiotypic determinants with fragment C (FrC) of tetanus toxin; a novel vector system using herpes simplex virus 1 (HSV-1) for in vivo gene delivery; the possibility of eliciting hyperacute xenograft response to treat human cancer; and the use of gene gun-mediated granulocyte-macrophage colony-stimulating factor (GM-CSF) cDNA-based tumor cell vaccines. The protection provided by DNA vaccination against viral diseases such as influenza suggested a role for such vaccines against cancer. However, unlike vaccines against infectious diseases, cancer vaccines are therapeutic, rather than prophylactic. With multiple myeloma, for example, it is possible that the optimal timing of administration of such a vaccine is during a remission that has been induced by traditional therapies, to eliminate residual disease. DNA cancer vaccines are designed to activate immune responses to tumor antigens to which the immune system has already been exposed. To do so, the vaccines must first overcome immune tolerance that may have already developed to the tumor. There is increasing evidence that tumor antigens, unlike viral or bacterial antigens, do not consistently activate an immune response. One major factor in determining whether a reaction occurs appears to be whether antigen presentation is accompanied by danger signals. With viral or bacterial infection, the accompanying tissue destruction and inflammation produce costimulatory signals that promote T-cell activation. However, inflammatory and tissue-destructive processes are absent during initial tumor transformation. The typical outcome may be immunologic tolerance.
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Affiliation(s)
- F K Stevenson
- Tenovus Laboratory, Southampton University Hospitals Trust, UK
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40
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Keller GN, Berzofsky RN, Burt R, Stefka J, Traynor A, Link C, LeFever A. The determination of endotoxin in the finished cellular product. Cytotherapy 1999; 1:423-428. [PMID: 20443235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND With the advancement of genetics and hematopoiesis resulting in therapeutic applications, a growing focus has developed on the quality assessment of biological products generated for various cellular therapies. Endotoxin is a critical measure for the presence of Gram-negative bacteria, known to cause endotoxemia. Cellular products are currently regulated as medical devices. Each location engaged in clinical protocols is responsible for establishing a quality assurance program. METHODS In this study, endotoxin levels were assayed using both the gel-clot and kinetic chromogenic Limulus amebocyte lysate (LAL) assays on 33 patients' cellular products, produced in clinical laboratory settings as part of a clinical trial or approved protocol. These patient samples include tumor infiltrating lymphocytes (HSVtk). We sought to identify the more reliable and informative method for the determination of endotoxin levels in a variety of cellular products, to meet the growing demand for standardization of product quality assessment. Comparison of the most sensitive gel-clot LAL test (0.03 EU/mL), with the kinetic chromogenic LAL test, with a lysate sensitivity of 0.005 EU/mL, found many advantages of the more sensitive method. RESULTS The kinetic chromogenic LAL test, which has the greatest sensitivity, increased the percentage of samples with valid spike recoveries compared with the gel-clot LAL test from 65% to 70% at a 1:10 sample dilution; and from 81% to 88% at a 1:100 sample dilution. Ata sample dilution of 1:50 the kinetic chromogenic LAL test provided valid spike recoveries on 81% of all samples tested. DISCUSSION In the interest of providing the highest quality and safety in the finished cellular product, the determination of endotoxin by the kinetic chromogenic LAL test is a rapid, effective, easy-to-use method to detect the presence of Gram-negative bacterial contamination.
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Affiliation(s)
- G N Keller
- BioWhittaker Inc., Walkersville, Maryland, USA
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41
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Abstract
Adoptive immunotherapy may be performed with either autologous or allogeneic lymphocytes. Autologous cellular immunotherapy is hindered by the inability to break anergy or self-tolerance. Advances in this area have focused on the use of tumor-specific lymphocytes activated by antigen-pulsed or transgene modified dendritic cells. Allogeneic cellular immunotherapy is effective even with the use of non-specific and unactivated donor lymphocytes. Allogeneic cellular therapy is, however, complicated by graft-versus-host disease (GVHD). Advances in allogeneic immunotherapy will require better control of GVHD.
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Affiliation(s)
- R K Burt
- Northwestern University Medical School, Department of Medicine, Chicago, IL 60611, USA
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42
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Abstract
Hematopoietic stem cell transplantation is a new therapy for severe autoimmune diseases. Patients who have failed standard therapies and are at high risk of subsequent morbidity and mortality are being considered as candidates. Early results are encouraging. However, the number of patients treated is limited, only short-term follow-up is available, the mechanism of improvement or stabilization is unknown, and the procedure has the potential for life-threatening toxicity.
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Affiliation(s)
- R K Burt
- Northwestern University Medical School and the Robert H. Lurie Cancer Center, Department of Medicine, Chicago, IL 60611, USA
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43
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44
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Finn WG, Thangavelu M, Yelavarthi KK, Goolsby CL, Tallman MS, Traynor A, Peterson LC. Karyotype correlates with peripheral blood morphology and immunophenotype in chronic lymphocytic leukemia. Am J Clin Pathol 1996; 105:458-67. [PMID: 8604688 DOI: 10.1093/ajcp/105.4.458] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [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: 01/31/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is recognized as a distinct entity. However, morphologic and immunophenotypic heterogeneity exist. Twenty-six patients with CLL were studied to investigate whether an association exists among peripheral blood karyotype, morphology and immunophenotype. Clonal cytogenetic abnormalities were detected in 14 patients (53%), using conventional karyotyping techniques in addition to fluorescence in situ hybridization (FISH) for chromosome 12. By FAB guidelines, 7 of the 8 patients (88%) with trisomy 12 had mixed cell morphology compared to only 3 of 18 (17%) without trisomy 12 (P = .004). One patient (12%) with trisomy 12 had lymphocyte morphology typical for CLL. Six of the eight (75%) with trisomy 12 had atypical immunophenotype including one or more of the following: strong CD20 expression, strong surface light chain expression, or absence of CD23 expression. Only 2 of the 18 patients (11%) without trisomy 12 had atypical immunophenotype (P = .005). None of the three patients with clonal structural abnormalities of chromosome 13q14 had mixed cell morphology or atypical immunophenotype. One of the 12 patients (8%) without clonal cytogenetic abnormalities had mixed cell morphology and one had atypical immunophenotype. This study suggests that a correlation exists among karyotype, morphology, and immunophenotype in CLL, and that CLL subgroups can be identified based on laboratory parameters. Although normal karyotypes or clonal structural abnormalities of 13q14 are associated with morphology and immunophenotype considered typical for CLL, trisomy 12 is associated with mixed cell morphology and atypical immunophenotype. These findings may have implications for evaluating variation in both disease course and response to emerging therapies.
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MESH Headings
- Aged
- Antigens, CD/analysis
- Chromosome Aberrations
- Female
- Humans
- Immunophenotyping
- Karyotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/classification
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphocytes/immunology
- Lymphocytes/pathology
- Male
- Middle Aged
- Retrospective Studies
- Trisomy
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Affiliation(s)
- W G Finn
- Northwestern University Medical School, Chicago, Illinois 60611, USA
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45
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Abstract
Hormonal manipulation of cancer is no longer confined to the use of effective antiestrogen therapy for breast cancer or surgical or hormonal castration for prostate cancer. A broader acknowledgment of the potential of different hormonal ligands to evoke cell cycle arrest to prevent the progress of neoplastic transformation, and even to elicit active cell death, has expanded the concept of hormonal therapy. The use of retinoids and deltanoids in conjunction with antiestrogens and antiandrogens is progressing into clinical trials. The use of glucocorticoids in conjunction with cyclic AMP may enhance apotosis induction. The use of antiandrogens in conjunction with cytotoxic therapy may diminish the risk of bcl-2-mediated resistance in prostate cancer. Innovative use of sequential and synergistic hormonal manipulations based on an expanding understanding of transcriptional regulation promises to advance this science.
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Affiliation(s)
- A Traynor
- Northwestern University Medical School, Lurie Cancer Center, Division of Hematology-Oncology, Chicago, IL 60611-3008, USA
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46
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Traynor A, Kuzel T, Samuelson E, Kanwar Y. Minimal-change glomerulopathy and glomerular visceral epithelial hyperplasia associated with alpha-interferon therapy for cutaneous T-cell lymphoma. Nephron Clin Pract 1994; 67:94-100. [PMID: 7914355 DOI: 10.1159/000187894] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [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: 01/27/2023] Open
Abstract
A 44-year-old man was diagnosed with cutaneous T-cell lymphoma characterized by a proliferation of CD4-positive cells. In response to alpha-interferon therapy, he experienced rapid regression of his cutaneous disease. This improvement was associated with development of renal failure, characterized by nephrotic-range proteinuria with interstitial nephritis and minimal-change nephropathy. The remarkable finding of renal biopsy was marked proliferation of visceral epithelial cells (podocytes). Renal disease improved significantly in response to discontinuation of interferon and initiation of prednisone therapy. Nephrotic range proteinuria regressed, but never completely resolved. This case is illustrative of the probable role for lymphokine-mediated nephrotoxicity in the setting of lymphoproliferative disease.
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Affiliation(s)
- A Traynor
- Department of Medicine, Northwestern University Medical School, Chicago, IL 60611
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