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Chan B, Taylor AO, Doucette K, Ma X, Ahn J, Lai C. Influence of Income, Education, and Medicaid Expansion on Palliative Care in Acute Myeloid Leukemia Using the National Cancer Database. J Pain Symptom Manage 2024; 67:e341-e346. [PMID: 38218411 DOI: 10.1016/j.jpainsymman.2024.01.005] [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: 10/25/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
Palliative care is integral to symptom management, and we examined its relationship with income, education, and Medicaid expansion in acute myeloid leukemia. This was a retrospective cross-sectional study using the National Cancer Database that included patients with acute myeloid and monocytic leukemias > 18 years of age treated at Commission on Cancer facilities from 2004 to 2016. Univariate and multivariate models were adjusted for demographic variables and facility characteristics. There were 124,988 patients, but only 106,495 had palliative care data, and of this 4111 (3%) received palliative care. The most educated had the highest odds of receiving palliative care (odds ratio, OR 1.23, 95% CI 1.08-1.41; P = 0.002), but the highest income bracket (≥ $63,333) had the lowest odds (OR 0.82, 95% CI 0.72-0.93; P = 0.003). Residence in states with Medicaid expansion (January 2014 onward) had greater palliative care utilization. Palliative care use was associated with higher education but underutilized with higher incomes. Increased access with Medicaid expansion suggests the importance of public insurance.
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Affiliation(s)
- Bryan Chan
- Department of Medicine (B.C.), Huntington Memorial Hospital, Pasadena, California, USA
| | - Allison O Taylor
- Division of Hematologic Malignancies and Cellular Therapy (A.O.T.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Kimberley Doucette
- Division of Hematology and Oncology (K.D.), Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Xiaoyang Ma
- Department of Biostatistics, Bioinformatics and Biomathematics (X.M., J.A.), Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics (X.M., J.A.), Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Catherine Lai
- Division of Hematology and Oncology (C.L.), Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Williams LS, Williams KM, Gillis N, Bolton K, Damm F, Deuitch NT, Farhadfar N, Gergis U, Keel SB, Michelis FV, Panch SR, Porter CC, Sucheston-Campbell L, Tamari R, Stefanski HE, Godley LA, Lai C. Donor-Derived Malignancy and Transplantation Morbidity: Risks of Patient and Donor Genetics in Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2024; 30:255-267. [PMID: 37913908 PMCID: PMC10947964 DOI: 10.1016/j.jtct.2023.10.018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a key treatment option for hematologic malignancies (HMs), although it carries significant risks. Up to 30% of patients relapse after allo-HSCT, of which up to 2% to 5% are donor-derived malignancies (DDMs). DDMs can arise from a germline genetic predisposition allele or clonal hematopoiesis (CH) in the donor. Increasingly, genetic testing reveals that patient and donor genetic factors contribute to the development of DDM and other allo-HSCT complications. Deleterious germline variants in CEBPA, DDX41, GATA2, and RUNX1 predispose to inferior allo-HSCT outcomes. DDM has been linked to donor-acquired somatic CH variants in DNMT3A, ASXL1, JAK2, and IDH2, often with additional new variants. We do not yet have evidence to standardize donor genetic sequencing prior to allo-HSCT. The presence of hereditary HM disorders should be considered in patients with myeloid malignancies and their related donors, and screening of unrelated donors should include family and personal history of cytopenia and HMs. Excellent multidisciplinary care is critical to ensure efficient timelines for screening and necessary discussions among medical oncologists, genetic counselors, recipients, and potential donors. After allo-HSCT, HM relapse monitoring with genetic testing effectively results in genetic sequencing of the donor, as the transplanted hematopoietic system is donor-derived, which presents ethical challenges for disclosure to patients and donors. We encourage consideration of the recent National Marrow Donor Program policy that allows donors to opt-in for notification about detection of their genetic variants after allo-HSCT, with appropriate genetic counseling when feasible. We look forward to prospective investigation of the impact of germline and acquired somatic genetic variants on hematopoietic stem cell mobilization/engraftment, graft-versus-host disease, and DDM to facilitate improved outcomes through knowledge of genetic risk.
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Affiliation(s)
- Lacey S Williams
- Lombardi Clinical Cancer Center, Georgetown University, Washington, District of Columbia.
| | - Kirsten M Williams
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Nancy Gillis
- Department of Cancer Epidemiology and Department of Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kelly Bolton
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Frederik Damm
- Hematology, Oncology, and Cancer Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Natalie T Deuitch
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Usama Gergis
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Siobán B Keel
- Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | | | - Sandhya R Panch
- Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Christopher C Porter
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | | | - Roni Tamari
- Memorial Sloan Kettering, New York, New York
| | - Heather E Stefanski
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Lucy A Godley
- Division of Hematology/Oncology and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Catherine Lai
- Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Vakilpour A, Lefebvre B, Lai C, Scherrer-Crosbie M. Heartbreaker: Detection and prevention of cardiotoxicity in hematological malignancies. Blood Rev 2024; 64:101166. [PMID: 38182490 DOI: 10.1016/j.blre.2023.101166] [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] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024]
Abstract
Cancer survivors are at significant risk of cardiovascular (CV) morbidity and mortality; patients with hematologic malignancies have a higher rate of death due to heart failure compared to all other cancer subtypes. The majority of conventional hematologic cancer treatments is associated with increased risk of acute and long-term CV toxicity. The incidence of cancer therapy induced CV toxicity depends on the combination of patient characteristics and on the type, dose, and duration of the therapy. Early diagnosis of CV toxicity, appropriate referral, more specific cardiac monitoring follow-up and timely interventions in target patients can decrease the risk of CV adverse events, the interruption of oncological therapy, and improve the patient's prognosis. Herein, we summarize the CV effects of conventional treatments used in hematologic malignancies with a focus on definitions and incidence of the most common CV toxicities, guideline recommended early detection approaches, and preventive strategies before and during cancer treatments.
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Affiliation(s)
- Azin Vakilpour
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Bénédicte Lefebvre
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; The Thalheimer Center for Cardio-oncology, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Catherine Lai
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; The Thalheimer Center for Cardio-oncology, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Solomon SR, Powell BL, Koprivnikar J, Lai C, Male H, Michaelis LC, Newell LF, Sanford D, Jenkins J, Zelaya A, Coppola S, Faderl S, Walter RB. CPX-351 Pharmacokinetics and Safety in Adults with Hematologic Malignancies and Renal Function Impairment: Phase 1 Trial. Cancers (Basel) 2024; 16:915. [PMID: 38473278 DOI: 10.3390/cancers16050915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
This open-label phase 1 study (clinicaltrials.gov, NCT03555955) assessed CPX-351 pharmacokinetics (PK) and safety in patients with hematologic malignancies with normal or impaired renal function. Patients were enrolled into three cohorts based on their creatinine clearance (CrCl): ≥90 mL/min (Cohort 1, normal renal function, n = 7), 30 to <59 mL/min (Cohort 2, moderate renal impairment, n = 8), or <30 mL/min (Cohort 3, severe renal impairment, n = 6). Patients received intravenous CPX-351 for initial induction; blood and urine samples were collected for PK analysis. The primary objective was to assess the PK parameters for cytarabine, daunorubicin, and their respective metabolites, arabinosyluracil (Ara-U) and daunorubicinol. Renal impairment did not significantly impact the cytarabine, daunorubicin, or daunorubicinol exposure, but it caused a slight increase in the Ara-U exposure. The CPX-351 side effect profile was similar in patients with impaired renal function compared to those with normal renal function. All the patients reported ≥1 treatment-emergent adverse event (TEAE), most commonly febrile neutropenia and nausea (57% each) and hyperglycemia (43%); no patients discontinued treatment due to TEAEs. These data suggest that CPX-351 dose adjustment is not required for patients with hematologic malignancies with moderate or severe renal impairment.
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Affiliation(s)
- Scott R Solomon
- Bone & Marrow Transplant (BMT), Leukemia and Cellular Immunotherapy Programs, Northside Hospital Cancer Institute, Atlanta, GA 30342, USA
| | - Bayard L Powell
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Jamie Koprivnikar
- John Theurer Cancer Center at Hackensack Meridian Health, Hackensack, NJ 07601, USA
| | - Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Heather Male
- University of Kansas Cancer Center, Kansas City, KS 66160, USA
| | - Laura C Michaelis
- Division of Hematology/Oncology, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Laura F Newell
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR 97239, USA
| | - David Sanford
- Leukemia and Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Jack Jenkins
- Jazz Pharmaceuticals, Philadelphia, PA 19103, USA
| | - Amy Zelaya
- Jazz Pharmaceuticals, Philadelphia, PA 19103, USA
| | | | | | - Roland B Walter
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
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5
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Lai C, Sun R, Zhang W, Peng Y. Gastrointestinal: A case of IgG4-related disease involving intestinal tract and orbital cavity. J Gastroenterol Hepatol 2023; 38:1865. [PMID: 37340618 DOI: 10.1111/jgh.16254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/22/2023]
Affiliation(s)
- C Lai
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment and Standardization, Xiangya Hospital of Central South University, Changsha, China
| | - R Sun
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment and Standardization, Xiangya Hospital of Central South University, Changsha, China
| | - W Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment and Standardization, Xiangya Hospital of Central South University, Changsha, China
| | - Y Peng
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Organ Fibrosis, Changsha, China
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6
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Franco S, Geng X, Korostyshevskiy V, Karp JE, Lai C. Systematic review and meta-analysis: Prognostic impact of time from diagnosis to treatment in patients with acute myeloid leukemia. Cancer 2023; 129:2975-2985. [PMID: 37254580 DOI: 10.1002/cncr.34894] [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] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/11/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) has been considered an oncologic emergency that requires initiation of chemotherapy immediately after diagnosis. With the introduction of novel targeted therapies, there is a potential benefit associated with delaying definitive treatment for identification of actionable therapeutic targets. Unfortunately, cytogenetic/molecular testing can take >7 days to return, and there is not a consensus regarding the prognostic impact of time from diagnosis to treatment (TDT) in AML. METHODS A literature review and meta-analysis of studies done to date that evaluate TDT was conducted. Studies that reported baseline characteristics, TDT, and outcomes for patients with AML were selected. Outcomes included overall survival (OS), complete remission (CR), and mortality. Studies that measured CR rates within each TDT range and data to calculate odds ratios were included in the meta-analysis. The remaining outcomes were synthesized descriptively for literature review. RESULTS Thirteen studies were identified, which comprised a total of 14,946 patients. Median TDT values were between 1 and 8 days. Several studies found a significant association between prolonged TDT and older age and lower proliferation burden. Four of 11 studies did not detect a significant relationship between TDT and OS. No studies found a significant association between TDT and early death. Six of eight studies did not find a significant association between TDT and CR rate. The meta-analysis found a significant association between prolonged TDT and decreased achievement of CR (p < .05). CONCLUSIONS Results were highly variable but suggest it may be feasible to pursue cytogenetic/molecular testing in patients who are clinically stable, particularly in those aged 60 years and older.
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Affiliation(s)
- Stephanie Franco
- Department of Internal Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Xue Geng
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Valeriy Korostyshevskiy
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Judith E Karp
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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7
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Ujjani C, Gooley TA, Spurgeon SE, Stephens DM, Lai C, Broome CM, O’Brien S, Zhu H, Laing KJ, Winter AM, Pongas G, Greninger AL, Koelle DM, Siddiqi T, Davids MS, Rogers KA, Danilov AV, Sperling A, Tu B, Sorensen T, Launchbury K, Burrow CJ, Quezada G, Hill JA, Shadman M, Thompson PA. Diminished humoral and cellular responses to SARS-CoV-2 vaccines in patients with chronic lymphocytic leukemia. Blood Adv 2023; 7:4728-4737. [PMID: 36516082 PMCID: PMC9906469 DOI: 10.1182/bloodadvances.2022009164] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Previous studies have demonstrated low rates of seroconversion to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients with chronic lymphocytic leukemia (CLL). In this national collaboration of 11 cancer centers in the United States, we aimed to further characterize and understand vaccine-induced immune responses, including T-cell responses, and the impact of CLL therapeutics (#NCT04852822). Eligible patients were enrolled in 2 cohorts (1) at the time of initial vaccination and (2) at the time of booster vaccination. The serologic response rates (anti-S) from 210 patients in the initial vaccination cohort and 117 in the booster vaccination cohort were 56% (95% confidence interval [CI], 50-63) and 68% (95% CI, 60-77), respectively. Compared with patients not on therapy, those receiving B-cell-directed therapy were less likely to seroconvert (odds ratio [OR], 0.27; 95% CI, 0.15-0.49). Persistence of response was observed at 6 months; anti-S titers increased with the administration of booster vaccinations. In the initial vaccination cohort, positive correlations were observed between the quantitative serologic response and CD4 T-cell response for the Wuhan variant and, to a lesser degree, for the Omicron variant (Spearman P = 0.45 Wuhan; P = 0.25 Omicron). In the booster vaccination cohort, positive correlations were observed between serologic responses and CD4 T-cell responses for both variants (P = 0.58 Wuhan; P = 0.57 Omicron) and to a lesser degree for CD8 T-cell responses (P = 0.33 Wuhan; P = 0.22 Omicron). Although no deaths from coronavirus disease 2019 (COVID-19) have been reported after booster vaccinations, patients should use caution as newer variants emerge and escape vaccine-induced immunity. This trial was registered at www.clinicaltrials.gov as #NCT04852822.
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Affiliation(s)
- Chaitra Ujjani
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | - Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Catherine M. Broome
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC
| | - Susan O’Brien
- Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA
| | - Haiying Zhu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Kerry J. Laing
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Georgios Pongas
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - David M. Koelle
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
- Benaroya Research Institute, Seattle, WA
| | | | | | - Kerry A. Rogers
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | | | | | - Brian Tu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | | | | | | | | | - Joshua A. Hill
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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Foran JM, Sun Z, Lai C, Fernandez HF, Cripe LD, Ketterling RP, Racevskis J, Luger SM, Paietta E, Lazarus HM, Zhang Y, Bennett JM, Levine RL, Rowe JM, Litzow MR, Tallman MS. Obesity in adult acute myeloid leukemia is not associated with inferior response or survival even when dose capping anthracyclines: An ECOG-ACRIN analysis. Cancer 2023; 129:2479-2490. [PMID: 37185873 PMCID: PMC10932613 DOI: 10.1002/cncr.34807] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/04/2023] [Accepted: 03/02/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Obesity (body mass index [BMI] ≥30 kg/m2 ) is an important epidemiological risk factor for developing acute myeloid leukemia (AML). Therefore, the authors studied the association of obesity with clinical and genetic phenotype and its impact on outcome in adults with AML. METHODS The authors analyzed BMI in 1088 adults who were receiving intensive remission induction and consolidation therapy in two prospective, randomized therapeutic clinical trials of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network: E1900 (ClinicalTrials.gov identifier NCT00049517; patients younger than 60 years) and E3999 (ClinicalTrials.gov identifier NCT00046930; patients aged 60 years or older). RESULTS Obesity was prevalent at diagnosis (33%) and, compared with nonobesity, was associated with intermediate-risk cytogenetics group (p = .008), poorer performance status (p = .01), and a trend toward older age (p = .06). Obesity was not associated with somatic mutations among a selected 18-gene panel that was tested in a subset of younger patients. Obesity was not associated with clinical outcome (including complete remission, early death, or overall survival), and the authors did not identify any patient subgroup that had inferior outcomes based on BMI. Obese patients were significantly more likely to receive <90% of the intended daunorubicin dose despite protocol specification, particularly in the E1900 high-dose (90 mg/m2 ) daunorubicin arm (p = .002); however, this did not correlate with inferior overall survival on multivariate analysis (hazard ratio, 1.39; 95% confidence interval, 0.90-2.13; p = .14). CONCLUSIONS Obesity is associated with unique clinical and disease-related phenotypic features in AML and may influence physician treatment decisions regarding daunorubicin dosing. However, the current study demonstrates that obesity is not a factor in survival, and strict adherence to body surface area-based dosing is not necessary because dose adjustments do not affect outcomes.
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Affiliation(s)
- James M. Foran
- Division of Hematology and Medical Oncology and Mayo Clinic Cancer Center, Mayo Clinic, Jacksonville, Florida
| | - Zhuoxin Sun
- ECOG-ACRIN Biostatistics Center, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hugo F. Fernandez
- Blood & Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Larry D. Cripe
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Rhett P. Ketterling
- Department of Laboratory Medicine and Pathology and Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Selina M. Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Yanming Zhang
- Cytogenetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John M. Bennett
- Hematopathology Division, Department of Pathology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Ross L. Levine
- Cytogenetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Mark R. Litzow
- Department of Laboratory Medicine and Pathology and Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Martin S. Tallman
- Northwestern University Feinberg School of Medicine, Robert H.Lurie Comprehensive Cancer Center, Chicago, Illinois
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9
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Matthews AH, Perl AE, Luger SM, Gill SI, Lai C, Porter DL, Skuli S, Bruno XJ, Carroll MP, Freyer CW, Carulli A, Babushok DV, Frey NV, Hexner EO, Martin ME, McCurdy SR, Stadtmauer EA, Loren AW, Paralkar VR, Maillard IP, Pratz KW. Real-world effectiveness of intensive chemotherapy with 7&3 versus venetoclax and hypomethylating agent in acute myeloid leukemia. Am J Hematol 2023; 98:1254-1264. [PMID: 37334852 PMCID: PMC11057024 DOI: 10.1002/ajh.26991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/21/2023]
Abstract
Intensive chemotherapy with cytarabine and anthracycline (7&3) remains the standard therapy for patients medically fit for induction, but the assessment of fitness remains controversial. Venetoclax and hypomethylating agent (ven/HMA) combination therapy has improved outcomes in unfit patients but no prospective study has assessed ven/HMA versus 7&3 as initial therapy in older, fit patients. Given no studies and expectation of ven/HMA use in patients outside of trial criteria, we evaluated retrospective outcomes among newly diagnosed patients. A nationwide electronic health record (EHR)-derived database and the University of Pennsylvania EHR identified 312 patients receiving 7&3 and 488 receiving ven/HMA who were 60-75 years old without history of organ failure. Ven/HMA patients were older and more likely to have secondary AML, adverse cytogenetics, and adverse mutations. Median overall survival (OS) for patients receiving intensive chemotherapy was 22 versus 10 months for ven/HMA (HR 0.53, 95% CI 0.40-0.60). Controlling for measured baseline characteristic imbalances reduced survival advantage by half (HR 0.71, 95% CI 0.53-0.94). A sub-group of patients with equipoise, likelihood at least 30%-70% of receiving either treatment, had similar OS outcomes (HR 1.10, 95% CI 0.75-1.6). Regarding safety outcomes, 60-day mortality was higher for ven/HMA (15% vs. 6% at 60 days) despite higher documented infections and febrile neutropenia for 7&3. In this multicenter real-word dataset, patients selected for intensive chemotherapy had superior OS but a large group had similar outcomes with ven/HMA. Prospective randomized studies, controlling for both measured and unmeasured confounders, must confirm this outcome.
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Affiliation(s)
- Andrew H. Matthews
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander E. Perl
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Selina M. Luger
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saar I. Gill
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine Lai
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David L. Porter
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah Skuli
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ximena Jordan Bruno
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin P. Carroll
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Craig W. Freyer
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alison Carulli
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daria V. Babushok
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Noelle V. Frey
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth O. Hexner
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Ellen Martin
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shannon R. McCurdy
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward A. Stadtmauer
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alison W. Loren
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vikram R. Paralkar
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ivan P. Maillard
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Keith W. Pratz
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Marks JA, Wang X, Fenu EM, Bagg A, Lai C. TP53 in AML and MDS: The new (old) kid on the block. Blood Rev 2023; 60:101055. [PMID: 36841672 DOI: 10.1016/j.blre.2023.101055] [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] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
MDS and AML are clonal hematopoietic stem cell disorders of increasing incidence, having a variable prognosis based, among others, on co-occurring molecular abnormalities. TP53 mutations are frequently detected in these myeloid neoplasms and portend a poor prognosis with known therapeutic resistance. This article provides a timely review of the complexity of TP53 alterations, providing updates in diagnosis and prognosis based on new 2022 International Consensus Classification (ICC) and World Health Organization (WHO) guidelines. The article addresses optimal testing strategies and reviews current and arising therapeutic approaches. While the treatment landscape for this molecular subgroup is under active development, further exploration is needed to optimize the care of this group of patients with unmet needs.
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Affiliation(s)
- Jennifer A Marks
- Department of Medicine, Division of Hematology and Oncology, Georgetown University, 3800 Reservoir Road NW, Washington, D.C. 20007, USA.
| | - Xin Wang
- Department of Medicine, Division of Hematology and Oncology, Georgetown University, 3800 Reservoir Road NW, Washington, D.C. 20007, USA; Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, 12 South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Elena M Fenu
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Catherine Lai
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, 12 South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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11
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Lai C, Bhansali RS, Kuo EJ, Mannis G, Lin RJ. Older Adults With Newly Diagnosed AML: Hot Topics for the Practicing Clinician. Am Soc Clin Oncol Educ Book 2023; 43:e390018. [PMID: 37155946 DOI: 10.1200/edbk_390018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, our understanding of AML pathogenesis and pathophysiology has improved significantly with mutational profiling. This has led to translational advances in therapeutic options, as there have been 10 new US Food and Drug Administration (FDA) approvals for AML therapies since 2017, half of which target specific driver mutations in FLT3, IDH1, or IDH2. These new agents have expanded the therapeutic armamentarium for AML, particularly for patients who are considered ineligible for intensive chemotherapy with anthracycline- and cytarabine-containing regimens. These new treatment options are relevant because the median age at diagnosis is 68 years, and outcomes for patients older than 60 years have historically been dismal. However, the optimal approach to incorporating novel agents into frontline regimens remains a clinical challenge, particularly with regard to sequencing of therapies, considering the role of allogeneic hematopoietic stem cell transplantation and managing toxicities.
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Affiliation(s)
- Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Rahul S Bhansali
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Eric J Kuo
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Gabriel Mannis
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Richard J Lin
- Memorial Sloan Kettering Cancer Center, New York, NY
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12
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Doucette K, Taylor AO, Chan B, Ma X, Ahn J, Vesole DH, Lai C. Hospital facility characteristics and socioeconomic factors on outcomes and treatment in patients with multiple myeloma: National Cancer Database analysis. Ann Hematol 2023; 102:1443-1458. [PMID: 37093241 DOI: 10.1007/s00277-023-05194-6] [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: 08/26/2022] [Accepted: 12/19/2022] [Indexed: 04/25/2023]
Abstract
Previous studies have shown that socioeconomic factors play an important role in multiple myeloma (MM) health outcomes. We postulated that the type of treatment facilities and their volume of cases also affect overall survival, utilization of various therapies including palliative care services in newly diagnosed MM. Using the National Cancer Database (NCDB), we analyzed 174,551 newly diagnosed MM participants from across the country. We found that at high volume facility centers (over 90th percentile of new patient volume from 2004 to 2016), the median overall survival (OS) was 62.3 months versus 35.3 months at lower volume facilities (p <0.001). Similarly, high volume academic cancer centers had an improved median OS of 66.4 months (65.3-67.4 CI) versus 39.2 months (37.9-40.4 months CI) in lower volume academic centers (p <0.001). The odds of utilizing chemotherapy, immunotherapy, and autologous transplants were higher in academic cancer centers compared to community cancer centers, after adjusting for demographic and socioeconomic factors (OR 1.10, 1.23, and 2.06 respectively, all with p<0.001). There was significantly decreased odds of receiving palliative care (OR 0.89, 95% CI 0.85-0.93) in high volume facilities compared to low volume. Palliative care services were more frequently utilized at integrated network cancers and comprehensive community cancer centers compared to community cancer centers, with similar odds of receiving palliative care between community and academic facility types. Our results likely reflect increased provider experience and resources in higher volume and academic facilities. This highlights the need to integrate resources and improve access to community programs.
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Affiliation(s)
- Kimberley Doucette
- Divison of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA.
| | - Allison O Taylor
- Department of Medicine, Duke University Hospital, Durham, NC, USA
| | - Bryan Chan
- Divison of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
| | - Xiaoyang Ma
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - David H Vesole
- Divison of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
- Division of Hematology and Oncology, Hackensack Meridian John Theurer Cancer Center, Hackensack, NJ, USA
| | - Catherine Lai
- Division of Hematology and Oncology, Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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13
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Lai C, Sun QR, Lai MD, Teng XD. [Clinical application and critical thinking of the 5th WHO classification of renal cell carcinoma]. Zhonghua Bing Li Xue Za Zhi 2023; 52:328-332. [PMID: 36973191 DOI: 10.3760/cma.j.cn112151-20221215-01044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- C Lai
- Department of Urology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Q R Sun
- Department of Pathology and Pathophysiology, School of Basic Medical Science, Zhejiang University, Hangzhou 310058, China
| | - M D Lai
- Department of Pathology and Pathophysiology, School of Basic Medical Science, Zhejiang University, Hangzhou 310058, China
| | - X D Teng
- Department of Pathology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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14
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Abstract
Acute myeloid leukemia (AML) is the most common acute leukemia in adults. While survival for younger patients over the last several decades has improved nearly sixfold with the optimization of intensive induction chemotherapy and allogeneic stem cell transplantation (alloHSCT), this effect has been largely mitigated in older and less fit patients as well as those with adverse-risk disease characteristics. However, the last 10 years has been marked by major advances in the molecular profiling of AML characterized by a deeper understanding of disease pathobiology and therapeutic vulnerabilities. In this regard, the classification of AML subtypes has recently evolved from a morphologic to a molecular and genetic basis, reflected by recent updates from the World Health Organization and the new International Consensus Classification system. After years of stagnation in new drug approvals for AML, there has been a rapid expansion of the armamentarium against this disease since 2017. Low-intensity induction therapy with hypomethylating agents and venetoclax has substantially improved outcomes, including in those previously considered to have a poor prognosis. Furthermore, targeted oral therapies against driver mutations in AML have been added to the repertoire. But with an accelerated increase in treatment options, several questions arise such as how to best sequence therapy, how to combine therapies, and if there is a role for maintenance therapy in those who achieve remission and cannot undergo alloHSCT. Moreover, certain subtypes of AML, such as those with TP53 mutations, still have dismal outcomes despite these recent advances, underscoring an ongoing unmet need and opportunity for translational advances. In this review, we will discuss recent updates in the classification and risk stratification of AML, explore the literature regarding low-intensity and novel oral combination therapies, and briefly highlight investigative agents currently in early clinical development for high-risk disease subtypes.
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Affiliation(s)
- Rahul S Bhansali
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Keith W Pratz
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Catherine Lai
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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15
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McCurdy SR, Gier SH, Gill S, Martin ME, Lai C, Frey NV, Hexner EO, Luger SM, Porter DL, Loren AW, Gimotty P. Frailty Phenotype Declines in Older Patients after Allogeneic Transplantation and Predicts Subsequent Overall Survival. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00129-x] [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: 02/07/2023]
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16
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Lai C, Chundangayil R, Shapanis A, Sommerlad M, Al-Shamkhani A, Healy E. 449 Identification of tertiary lymphoid structures in primary cutaneous squamous cell carcinoma. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.463] [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: 11/19/2022]
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17
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Tolaney S, de Azambuja E, Emens L, Loi S, Pan W, Huang J, Sun S, Lai C, Schmid P. 276TiP ASCENT-04/KEYNOTE-D19: Phase III study of sacituzumab govitecan (SG) plus pembrolizumab (pembro) vs treatment of physician’s choice (TPC) plus pembro in first-line (1L) programmed death-ligand 1-positive (PD-L1+) metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1860] [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: 11/01/2022] Open
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18
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Bardia A, Punie K, Barrios C, Schneeweiss A, Zhai X, D.H. Huynh, Vaksman N, Lai C, Tolaney S. 275TiP ASCENT-03: Phase III study of sacituzumab govitecan (SG) vs treatment of physician’s choice (TPC) in first-line (1L) metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1859] [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: 11/28/2022] Open
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19
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Liao Q, He WH, Li TM, Lai C, Yu L, Xia LY, Luo Y, Zhu P, Liu H, Zeng Y, Zhu NH, Lyu N. [Evaluation of severity and prognosis of acute pancreatitis by CT severity index and modified CT severity index]. Zhonghua Yi Xue Za Zhi 2022; 102:2011-2017. [PMID: 35817726 DOI: 10.3760/cma.j.cn112137-20220424-00914] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objectives: To explore the role of computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI) in assessing the severity of acute pancreatitis (AP) under the revised Atlanta classification (RAC) and predicting the clinical prognosis. Methods: Based on the prospectively entered AP database, the clinical data of consecutive adult AP inpatients admitted to the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University from January 2012 to December 2020 were retrospectively screened. The imaging data were independently evaluated by two radiologists and entered to the database to calculate the CTSI and MCTSI scores. Their relationship with the difference of RAC severity grade and clinical prognosis was analyzed. Compared with Acute Physiology and Chronic Health Assessment Ⅱ (APACHE Ⅱ) score, the receiver operating characteristic curve was used to evaluate the predictive value of CTSI and MCTSI scores for persistent organ failure and infectious pancreatic necrosis (IPN). Results: A total of 2 612 patients with AP, aged (50±15) years, were included in the study, including 1 547 males (59.2%) and 1 065 females (40.8%). According to RAC standard, AP was divided into 699 cases (26.8%) of mild pancreatitis (MAP), 1 098 cases (42.0%) of moderately severe pancreatitis (MSAP), and 815 cases (31.2%) of severe pancreatitis (SAP). MCTSI judged AP severity similarly to RAC, with 668 cases of MAP (25.6%), 1 207 cases of MSAP (46.2%) and 737 cases of SAP (28.2%), while CTSI judged SAP patients less(400 cases, 15.3%). The severity of AP determined by CTSI and MCTSI scores was significantly correlated with clinical prognosis (r=0.06-0.43, all P<0.05). Compared with APACHE Ⅱ score, CTSI had the highest area under the curve (AUC) for predicting IPN (AUC=0.85, 95%CI: 0.83-0.87), followed by MCTSI (AUC=0.82, 95%CI: 0.80-0.85). APACHE Ⅱ was more accurate in predicting persistent organ failure than CTSI and MCTSI scores,with AUC of 0.73 (95%CI: 0.71-0.75), 0.72 (95%CI: 0.70-0.74) and 0.72 (95%CI: 0.70-0.74), respectively. Conclusions: AP severity judged by MCTSI is consistent with RAC, and SAP patients judged by CTSI are less than RAC. CTSI and MCTSI are significantly correlated with clinical prognosis. CTSI and MCTSI have higher accuracy in predicting IPN, but lower accuracy in predicting persistent organ failure than APACHE Ⅱ.
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Affiliation(s)
- Q Liao
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - W H He
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - T M Li
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - C Lai
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - L Yu
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - L Y Xia
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Y Luo
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - P Zhu
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - H Liu
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Y Zeng
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - N H Zhu
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Nonghua Lyu
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
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20
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Cook MR, Dykes K, White K, Desale S, Agrawal R, Fernandez S, Huang X, Cobb NK, Lai C. Thrombotic and Clinical Outcomes in Patients with Hematologic Malignancy and COVID-19. Clin Lymphoma Myeloma Leuk 2022; 22:e452-e458. [PMID: 35058217 PMCID: PMC8710237 DOI: 10.1016/j.clml.2021.12.011] [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] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/19/2021] [Indexed: 04/22/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common complication in acute COVID-19 and those with hematologic malignancy (HM) may be at an even higher risk. We performed a retrospective analysis of patients with history of HM and acute COVID-19 to evaluate thrombotic and clinical outcomes. METHODS Patients with COVID-19 were identified by positive SARS-CoV-2 PCR test. Our primary endpoints were rate of VTE and CVA in patients with HM compared to the general population (GP). Secondary outcomes included composite thrombotic events (CVA + VTE), COVID-19 fatality, respiratory support, ICU admission rates, and length of ICU stay RESULTS: A total of 833 patients were evaluated, 709 in the GP cohort, 124 patients in the HM cohort. CVA was more prevalent in the HM cohort (5.4% vs. 1.6%, P = .011). Rates of VTE were numerically higher for the HM cohort (8.0% vs. 3.6%, P = .069). The composite thrombotic rate was increased in the HM cohort (13.4% vs. 5.2%, P = .005). Patients with HM had a higher inpatient fatality rate (35.5% vs. 11.3%, P < .001), required more respiratory support (74.6% vs. 46.5%, P < .001) and had a higher rate of ICU admission (31.9% vs. 12.1%, P = .001). CONCLUSION Our data demonstrated an increased rate of composite thrombotic (CVA + VTE) outcomes, indicating HM patients with acute COVID-19 are at increased risk of thrombosis. Irrespective of disease status, HM patients also have significantly increased need for intensive care, respiratory support, and have higher fatality rates.
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Affiliation(s)
- Michael R Cook
- Lombardi Comprehensive Cancer Center and MedStar Georgetown University Hospital, Washington, DC.
| | - Kaitlyn Dykes
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Katherine White
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Sameer Desale
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Hyattsville, MD
| | - Rajeev Agrawal
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Hyattsville, MD
| | - Stephen Fernandez
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Hyattsville, MD
| | - Xu Huang
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Hyattsville, MD
| | - Nathan K Cobb
- Division of Pulmonary, Critical Care, and Sleep Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Catherine Lai
- Lombardi Comprehensive Cancer Center and MedStar Georgetown University Hospital, Washington, DC
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21
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Vobugari N, Heuston C, Lai C. Clonal cytopenias of undetermined significance: potential predictor of myeloid malignancies? Clin Adv Hematol Oncol 2022; 20:375-383. [PMID: 35731608] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The recent identification of the potential for clonal replication in patients with unexplained cytopenias, resulting in myelodysplastic syndrome (MDS) or myeloid malignancies, has opened the way to identifying a new precursor entity: clonal cytopenia of undetermined significance (CCUS). CCUS has come into the spotlight in recent years with the detection of molecular abnormalities in cytogenetic studies, fluorescence in situ hybridization, and next-generation sequencing. Several clinical trials and retrospective studies are underway to examine further the associated mutation profiles, study the progression of CCUS to MDS or myeloid neoplasm, and investigate potential treatment options. In this review, we discuss CCUS-related mutations in genes such as DNMT3A, TET2, IDH1/2, ASXL1, KDM6A, PHF6, SF3B1, SRSF2, U2AF1, ZRSR2, RUNX1, BCOR, NRAS, KRAS, KIT, PTEN, CBL, TP53, and ATM. We highlight the most common mutations in CCUS, including those in DNMT3A, TET2, ASXL1, SRSF2, and SF3B1, and high-risk mutations, including those in U2AF1, ZRSR2, SRSF2, JAK2, RUNX1, and TP53. Cognizance of these mutations can guide surveillance and heighten awareness of the need to screen patients with unexplained cytopenia as a means of primary prevention in the realm of MDS and AML. Knowledge of mutation profiles, prognostic risk factors, treatment, and follow-up strategies is evolving, and prospective studies are warranted.
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Affiliation(s)
- Nikitha Vobugari
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, DC
| | | | - Catherine Lai
- University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania
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22
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Lai C, Conway O, Lee M, Le-Rademacher J, Mandelblatt JS, Klepin HD. Deficit Accumulation Frailty Index (DAFI) scores and acute myeloid leukemia outcomes. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12040] [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
12040 Background: Novel strategies are needed to assess frailty in the context of therapy decisions for older adults with acute myeloid leukemia (AML). Our objectives were to describe pre-treatment DAFI scores for older AML patients treated on clinical trials and explore their relationship with treatment outcomes. Methods: We conducted a exploratory analysis utilizing data from two clinical trials of adults aged ≥60 years with newly diagnosed AML (Alliance/CALGB 11001 [intensive therapy] and Alliance/CALGB 11002 [non-intensive therapy]). We included the subset of patients in each trial enrolled on geriatric assessment companion studies (Alliance/CALGB 361006, 361101). A DAFI score was calculated for each patient using 51 variables including demographic, geriatric assessment, and laboratory data derived from the geriatric assessment. Individuals with ≥90% items were included (consistent with other studies); DAFI scores ranged from 0 to 1 and were evaluated using established categories (0- <.2 [robust]; 0.2-<.35 [pre-frail]; 0.35+ [frail]) and as a continuous score. Associations between DAFI scores and toxicity and overall survival (OS) were evaluated with Fisher’s exact-testing and Kaplan Meier/cox proportional hazards, respectively. Results: The median age was 68 years (range 61, 82) and 72 years (range 61, 92) for those getting intensive (N=31) and less intensive therapy (N= 75), respectively. Individuals in the intensive study had a median pre-treatment DAFI score of 0.15 (range 0.05, 0.31) and were all categorized as robust (75%) or pre-frail (25%). There was no significant difference in median OS (14.6 vs. 14.7 months) or non-hematological grade 3+ adverse events (AEs; 85% vs. 89%) between robust vs. pre-frail individuals in this trial, respectively. However, pre-frail adults experienced a trend towards greater grade 4 non-hematological toxicity than robust individuals (67% vs 26%, p=0.05). In the non-intensive trial, the median DAFI score was 0.24 (range 0.04, 0.48) and most individuals were pre-frail (49.3%) or frail (17.3%). Non-hematologic grade 3+ AEs did not vary by DAFI group, 88% robust, 95% pre-frail, and 77% frail (p=0.15). Median OS was 7.4, 10.8, and 6.3 months for robust, pre-frail, and frail respectively (p=0.17). Adjusting for age, each 0.1 increase in DAFI score was associated with increased mortality hazard (HR 1.8, 95% CI 1.0-3.2). Conclusions: DAFI score calculation provides a potential novel strategy for categorization of frailty in AML. In our assessment, higher DAFI scores were associated with toxicity during intensive induction and mortality in the less intensive setting. This method should be studied in larger samples randomized by treatment intensity. Support: UG1CA189823; Bayer Healthcare/Berlex (CALGB 11001); NCT01253070 (CALGB 11001). Clinical trial information: NCT01253070, NCT01420926.
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Affiliation(s)
| | | | | | | | | | - Heidi D. Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC
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23
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Cook MR, Karp JE, Lai C. The spectrum of genetic mutations in myelodysplastic syndrome: Should we update prognostication? EJHaem 2022; 3:301-313. [PMID: 35846202 PMCID: PMC9176033 DOI: 10.1002/jha2.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 06/12/2023]
Abstract
The natural history of patients with myelodysplastic syndrome (MDS) is dependent upon the presence and magnitude of diverse genetic and molecular aberrations. The International Prognostic Scoring System (IPSS) and revised IPSS (IPSS-R) are the most widely used classification and prognostic systems; however, somatic mutations are not currently incorporated into these systems, despite evidence of their independent impact on prognosis. Our manuscript reviews prognostic information for TP53, EZH2, DNMT3A, ASXL1, RUNX1, SRSF2, CBL, IDH 1/2, TET2, BCOR, ETV6, GATA2, U2AF1, ZRSR2, RAS, STAG2, and SF3B1. Mutations in TP53, EZH2, ASXL1, DNMT3A, RUNX1, SRSF2, and CBL have extensive evidence for their negative impact on survival, whereas SF3B1 is the lone mutation carrying a favorable prognosis. We use the existing literature to propose the incorporation of somatic mutations into the IPSS-R. More data are needed to define the broad spectrum of other genetic lesions, as well as the impact of variant allele frequencies, class of mutation, and impact of multiple interactive genomic lesions. We postulate that the incorporation of these data into MDS prognostication systems will not only enhance our therapeutic decision making but lead to targeted treatment in an attempt to improve outcomes in this formidable disease.
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Affiliation(s)
- Michael R. Cook
- Division of Hematology and OncologyLombardi Comprehensive Cancer CenterGeorgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Judith E. Karp
- Divison of Hematology and OncologyThe Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University HospitalBaltimoreMarylandUSA
| | - Catherine Lai
- Division of Hematology and OncologyLombardi Comprehensive Cancer CenterGeorgetown University HospitalWashingtonDistrict of ColumbiaUSA
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24
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Srinath A, Romanos S, Li Y, Xie B, Chen C, Moore T, Lightle R, DeBiasse D, Sone JYY, Shen L, McCurdy SG, Lai C, Stadnik A, Piedad K, Dorrestein P, Weldon K, Snellings D, Shenkar R, Gilbert J, D'Souza M, Sulakhe D, Ji Y, Lopez-ramirez MA, Kahn ML, Marchuk DA, Ginsberg MH, Girard R, Awad IA. Abstract TMP1: Multi-omic Biomarker Development In A Mendelian Neurovascular Disease, Cavernous Angioma. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tmp1] [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
Introduction:
Cavernous Angioma (CA) is a hemorrhagic neurovascular disease characterized by either a familial form with autosomal dominant germline mutations in one of three CCM genes or a sporadic form with somatic mutations of the same genes. Circulating proteins have been previously investigated as possible diagnostic and prognostic biomarkers of disease activity, with up to 86% and 88% sensitivity and specificity, respectively. We hypothesize that differentially expressed (DE) plasma microRNAs and metabolites in CA patients can be integrated with plasma proteins to increase the sensitivity and specificity of circulating CA biomarkers.
Methods:
Mechanistically relevant homologous DE miRNAs were identified between familial CA patients and preclinical murine models and validated in an independent cohort of patients using real time qPCR. In conjunction, DE metabolites were determined in CA patients using liquid-chromatography mass spectrometry. The interactions of these metabolites with the previously established CA transcriptome, proteome, and microbiome were queried to assess for mechanistic relevance. Optimal diagnostic models of proteins, DE miRNAs, and DE metabolites alone were next established. Plasma metabolites and miRNAs were then separately integrated with protein, using a machine learning-implemented, Bayesian approach to develop diagnostic CA biomarkers.
Results:
The optimal diagnostic biomarker model with only DE miRNAs performed at up to 68%, while proteins and metabolites achieved up to 68%, and 82% accuracy respectively. The optimal combination for proteins with miRNAs improved the diagnostic association of familial-CA disease to up to 94.7% sensitivity and 100% specificity. Integrating metabolites and proteins improved the diagnosis of CA disease and its clinical manifestations to 100% sensitivity and 100% specificity.
Conclusion:
Combining plasma proteins with miRNAs or metabolites can improve diagnostic accuracy of CA disease and its disease characteristics above any single molecular modality alone. Future studies should incorporate proteins, miRNAs, and metabolites to further increase diagnostic accuracy, and validate these in a larger cohort with control for demographic and disease features.
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Affiliation(s)
| | | | - Ying Li
- Univ of Chicago, Chicago, IL
| | | | | | | | | | | | | | - Le Shen
- Univ of Chicago, Chicago, IL
| | | | | | | | | | | | | | | | | | | | | | | | - Yuan Ji
- Univ of Chicago, Chicago, IL
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25
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Goswami M, Gui G, Dillon LW, Lindblad KE, Thompson J, Valdez J, Kim DY, Ghannam JY, Oetjen KA, Destefano CB, Smith DM, Tekleab H, Li Y, Dagur P, Hughes T, Marté JL, Del Rivero J, Klubo-Gwiezdzinksa J, Gulley JL, Calvo KR, Lai C, Hourigan CS. Pembrolizumab and decitabine for refractory or relapsed acute myeloid leukemia. J Immunother Cancer 2022; 10:jitc-2021-003392. [PMID: 35017151 PMCID: PMC8753450 DOI: 10.1136/jitc-2021-003392] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background The powerful ‘graft versus leukemia’ effect thought partly responsible for the therapeutic effect of allogeneic hematopoietic cell transplantation in acute myeloid leukemia (AML) provides rationale for investigation of immune-based therapies in this high-risk blood cancer. There is considerable preclinical evidence for potential synergy between PD-1 immune checkpoint blockade and the hypomethylating agents already commonly used for this disease. Methods We report here the results of 17 H-0026 (PD-AML, NCT02996474), an investigator sponsored, single-institution, single-arm open-label 10-subject pilot study to test the feasibility of the first-in-human combination of pembrolizumab and decitabine in adult patients with refractory or relapsed AML (R-AML). Results In this cohort of previously treated patients, this novel combination of anti-PD-1 and hypomethylating therapy was feasible and associated with a best response of stable disease or better in 6 of 10 patients. Considerable immunological changes were identified using T cell receptor β sequencing as well as single-cell immunophenotypic and RNA expression analyses on sorted CD3+ T cells in patients who developed immune-related adverse events (irAEs) during treatment. Clonal T cell expansions occurred at irAE onset; single-cell sequencing demonstrated that these expanded clones were predominately CD8+ effector memory T cells with high cell surface PD-1 expression and transcriptional profiles indicative of activation and cytotoxicity. In contrast, no such distinctive immune changes were detectable in those experiencing a measurable antileukemic response during treatment. Conclusion Addition of pembrolizumab to 10-day decitabine therapy was clinically feasible in patients with R-AML, with immunological changes from PD-1 blockade observed in patients experiencing irAEs.
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Affiliation(s)
- Meghali Goswami
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA.,National Cancer Institute, Bethesda, Maryland, USA
| | - Gege Gui
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Laura W Dillon
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | | | - Julie Thompson
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Janet Valdez
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Dong-Yun Kim
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Jack Y Ghannam
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Karolyn A Oetjen
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | | | - Dana M Smith
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Hanna Tekleab
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Yeusheng Li
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Pradeep Dagur
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Thomas Hughes
- National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | | | | | | | | | - Katherine R Calvo
- National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Catherine Lai
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Christopher S Hourigan
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA .,Trans-NIH Center for Human Immunology, National Institutes of Health, Bethesda, Maryland, USA
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26
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Sun X, Wu B, Chiang HC, Deng H, Zhang X, Xiong W, Liu J, Rozeboom AM, Harris BT, Blommaert E, Gomez A, Garcia RE, Zhou Y, Mitra P, Prevost M, Zhang D, Banik D, Isaacs C, Berry D, Lai C, Chaldekas K, Latham PS, Brantner CA, Popratiloff A, Jin VX, Zhang N, Hu Y, Pujana MA, Curiel TJ, An Z, Li R. Tumour DDR1 promotes collagen fibre alignment to instigate immune exclusion. Nature 2021; 599:673-678. [PMID: 34732895 DOI: 10.1038/s41586-021-04057-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 09/22/2021] [Indexed: 12/27/2022]
Abstract
Immune exclusion predicts poor patient outcomes in multiple malignancies, including triple-negative breast cancer (TNBC)1. The extracellular matrix (ECM) contributes to immune exclusion2. However, strategies to reduce ECM abundance are largely ineffective or generate undesired outcomes3,4. Here we show that discoidin domain receptor 1 (DDR1), a collagen receptor with tyrosine kinase activity5, instigates immune exclusion by promoting collagen fibre alignment. Ablation of Ddr1 in tumours promotes the intratumoral penetration of T cells and obliterates tumour growth in mouse models of TNBC. Supporting this finding, in human TNBC the expression of DDR1 negatively correlates with the intratumoral abundance of anti-tumour T cells. The DDR1 extracellular domain (DDR1-ECD), but not its intracellular kinase domain, is required for immune exclusion. Membrane-untethered DDR1-ECD is sufficient to rescue the growth of Ddr1-knockout tumours in immunocompetent hosts. Mechanistically, the binding of DDR1-ECD to collagen enforces aligned collagen fibres and obstructs immune infiltration. ECD-neutralizing antibodies disrupt collagen fibre alignment, mitigate immune exclusion and inhibit tumour growth in immunocompetent hosts. Together, our findings identify a mechanism for immune exclusion and suggest an immunotherapeutic target for increasing immune accessibility through reconfiguration of the tumour ECM.
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Affiliation(s)
- Xiujie Sun
- Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Bogang Wu
- Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Huai-Chin Chiang
- Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Hui Deng
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiaowen Zhang
- Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Wei Xiong
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Junquan Liu
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aaron M Rozeboom
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Brent T Harris
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Eline Blommaert
- ProCURE, Catalan Institute of Oncology, Oncobell, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - Antonio Gomez
- Rheumatology Department and Rheumatology Research Group, Vall d'Hebron Hospital Research Institute, Barcelona, Spain
| | - Roderic Espin Garcia
- ProCURE, Catalan Institute of Oncology, Oncobell, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - Yufan Zhou
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Payal Mitra
- Department of Anatomy and Cell Biology, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Madeleine Prevost
- Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Deyi Zhang
- Department of Medicine, The Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Debarati Banik
- Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Deborah Berry
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Catherine Lai
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Krysta Chaldekas
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Patricia S Latham
- Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Christine A Brantner
- GW Nanofabrication and Imaging Center, The George Washington University, Washington, DC, USA
| | - Anastas Popratiloff
- GW Nanofabrication and Imaging Center, The George Washington University, Washington, DC, USA
| | - Victor X Jin
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ningyan Zhang
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yanfen Hu
- Department of Anatomy and Cell Biology, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Miguel Angel Pujana
- ProCURE, Catalan Institute of Oncology, Oncobell, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain.
| | - Tyler J Curiel
- Department of Medicine, The Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Zhiqiang An
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Rong Li
- Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
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27
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Doucette K, Percival ME, Williams L, Kandahari A, Taylor A, Wang S, Ahn J, Karp JE, Lai C. Hypoalbuminemia as a prognostic biomarker for higher mortality and treatment complications in acute myeloid leukemia. Hematol Oncol 2021; 39:697-706. [PMID: 34499366 DOI: 10.1002/hon.2925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/02/2021] [Revised: 07/05/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022]
Abstract
Older age and poor performance status lead to worse outcomes in acute myeloid leukemia (AML) patients. Hypoalbuminemia is a negative predictor of morbidity and mortality in several malignancies. We evaluated the relationship between baseline serum albumin levels on treatment-related complications, as well as short-term mortality and overall survival (OS) in 756 newly diagnosed AML patients. We conducted a retrospective multicenter study to examine treatment-related complications and OS according to pretreatment serum albumin levels: normal albumin ≥3.5 g/dl, marked hypoalbuminemia <2.5 g/dl, and hypoalbuminemia 2.5-3.4 g/dl. In an adjusted multivariate analysis, a lower baseline albumin was independently associated with a higher number of grade ≥3 complications when adjusting for age, secondary AML, sex and intensive treatment. When comparing normal to markedly low albumin levels, the estimated mean number of complications increases by a factor of 1.35. Patients who had a normal baseline albumin had a 30 day-mortality rate of 4.8%, which was significantly lower compared with patients with hypoalbuminemia (16.5%) and marked hypoalbuminemia (33.9%; p < 0.01). Similarly, 60-day mortality rate was significantly higher in the hypoalbuminemia group (24.0%) and marked hypoalbuminemia group (45%) compared with normal albumin group (8.3%; p < 0.01). Patients with lower baseline albumin levels have increased treatment-related morbidity and mortality, suggesting that pre-treatment serum albumin is an important independent prognostic marker.
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Affiliation(s)
- Kimberley Doucette
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Mary-Elizabeth Percival
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lacey Williams
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Adrese Kandahari
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allison Taylor
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Shuqi Wang
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Jaeil Ahn
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Judith E Karp
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Catherine Lai
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
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28
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Yao MX, Hao X, Xia XX, Lai C, Diao XQ. Retrospective analysis of molecular biology mechanism of ABO blood group typing discrepancy among blood donors in Jinan blood station. Transfus Clin Biol 2021; 29:75-78. [PMID: 34217816 DOI: 10.1016/j.tracli.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To accurately identify ABO blood typing in pre-transfusion testing is very important to ensure blood transfusion safely, which is a major responsibility of blood station. METHODS Eighty-one blood donors samples with ABO blood group typing discrepancy was collected among 61952 donor samples in our blood station from January 2019 to July 2020. Blood group serological method was used to detect ABO blood group. DNA Sequencing was used to determine the genotype. The antibody screening test detects antibodies other than ABO. RESULTS In total, 61,952 donor samples were analysed for ABO typing discrepancies. The incidence among blood donors was 0.13% (81/61952). The most common reason of ABO typing discrepancies was due to specific antibody or non-specific agglutination (54.32%, 44/81), mainly anti-M antibody, cold autoantibody, anti-D antibody, anti-N antibody and anti-Lea antibody. The major cause of forward typing discrepancies among blood donors was ABO subgroups (25.93%, 21/81), including 10 cases of A subtype (1 case of A2, 2 cases of A3, 2 cases of Ax, 3 cases of AxB, 1 case of Ael, 1 case of Ahm), 6 cases of B subtype (2 cases of B3, 1 case of Bel, 3 cases of AB3), 2 cases of B subtype (A), 1 case of cisAB, and 2 cases of acquired B. The serum antibody was weakened in 16 cases (19.75%). CONCLUSIONS The blood types should be correctly identified by combining serology with gene sequencing to ensure the safety of clinical blood transfusion, when the forward and reverse typing discrepancies among the blood donors.
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Affiliation(s)
- M X Yao
- Jinan, 250000 Shandong, China
| | - X Hao
- Jinan, 250000 Shandong, China.
| | - X X Xia
- Jinan, 250000 Shandong, China
| | - C Lai
- Jinan, 250000 Shandong, China
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29
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Williams L, Doucette K, Karp JE, Lai C. Genetics of donor cell leukemia in acute myelogenous leukemia and myelodysplastic syndrome. Bone Marrow Transplant 2021; 56:1535-1549. [PMID: 33686252 DOI: 10.1038/s41409-021-01214-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 01/31/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is an important therapeutic modality for patients with acute myelogenous leukemia (AML) with poor risk features. Nonetheless, roughly 30% of such patients have leukemia recurrence and up to 2% of these are donor-derived leukemias, in which malignancy develops in the donor's transplanted cells, despite extremely low rates of leukemia in the donors themselves. Notably, over 20% of these malignancies carry chromosome 7 abnormalities nearly all of which are monosomies. Recent advances in whole exome and genome sequencing have allowed for detection of candidate genes that likely contribute to the development of AML in donor cells (donor leukemia, DCL). These genes include CEBPA, GATA2, JAK2, RUNX1, DDX41, EZH2, IDH1/2, DNMT3A, ASXL1, XPD, XRCC3, and CHEK1. The potential roles of variants in these genes are evaluated based on familial clustering of MDS/AML and corresponding animal studies demonstrating their leukemogenic nature. This review describes the spectrum of genetic aberrations detected in DCL cases in the literature with regard to the character of the individual cases, existing family cohorts that carry individual genes, and functional studies that support etiologic roles in AML development. DCL presents a unique opportunity to examine genetic variants in the donors and recipients with regards to progression to malignancy.
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Affiliation(s)
- Lacey Williams
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Kimberley Doucette
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Judith E Karp
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine Lai
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
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30
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Dillon LW, Ghannam J, Nosiri C, Gui G, Goswami M, Calvo KR, Lindblad KE, Oetjen KA, Wilkerson M, Soltis AR, Sukumar G, Dalgard CL, Thompson J, Valdez J, DeStefano CB, Lai C, Sciambi A, Durruthy-Durruthy R, Llanso A, Gulati S, Wang S, Ooi A, Dagur PK, McCoy JP, Burr P, Li Y, Hourigan CS. Personalized Single-Cell Proteogenomics to Distinguish Acute Myeloid Leukemia from Non-Malignant Clonal Hematopoiesis. Blood Cancer Discov 2021; 2:319-325. [PMID: 34258102 DOI: 10.1158/2643-3230.bcd-21-0046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Genetic mutations associated with acute myeloid leukemia (AML) also occur in age-related clonal hematopoiesis, often in the same individual. This makes confident assignment of detected variants to malignancy challenging. The issue is particularly crucial for AML post-treatment measurable residual disease monitoring, where results can be discordant between genetic sequencing and flow cytometry. We show here, that it is possible to distinguish AML from clonal hematopoiesis and to resolve the immunophenotypic identity of clonal architecture. To achieve this, we first design patient-specific DNA probes based on patient's whole-genome sequencing, and then use them for patient-personalized single-cell DNA sequencing with simultaneous single-cell antibody-oligonucleotide sequencing. Examples illustrate AML arising from DNMT3A and TET2 mutated clones as well as independently. The ability to personalize single-cell proteogenomic assessment for individual patients based on leukemia-specific genomic features has implications for ongoing AML precision medicine efforts.
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Affiliation(s)
- Laura W Dillon
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Jack Ghannam
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Chidera Nosiri
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Gege Gui
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Meghali Goswami
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Katherine R Calvo
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892 United States
| | - Katherine E Lindblad
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Karolyn A Oetjen
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Matthew Wilkerson
- Precision Medicine Initiative for Military Medical Research and Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD 20817.,Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Anthony R Soltis
- Precision Medicine Initiative for Military Medical Research and Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD 20817
| | - Gauthaman Sukumar
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD 20817.,The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Clifton L Dalgard
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814.,The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Julie Thompson
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Janet Valdez
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Christin B DeStefano
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Catherine Lai
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Adam Sciambi
- Mission Bio, Inc., South San Francisco, CA, 94080, USA
| | | | - Aaron Llanso
- Mission Bio, Inc., South San Francisco, CA, 94080, USA
| | | | - Shu Wang
- Mission Bio, Inc., South San Francisco, CA, 94080, USA
| | - Aik Ooi
- Mission Bio, Inc., South San Francisco, CA, 94080, USA
| | - Pradeep K Dagur
- Flow Cytometry Core, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - J Philip McCoy
- Flow Cytometry Core, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Patrick Burr
- DNA Sequencing and Genomics Core, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Yuesheng Li
- DNA Sequencing and Genomics Core, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 United States
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Chan BL, Taylor AO, Doucette K, Ahn J, Ma X, Lai C. Receipt of palliative care (PC) in acute myeloid leukemia (AML) using data from the National Cancer Database (NCDB). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12087 Background: AML is an aggressive disease with high mortality and significant impact on quality of life. Palliative care (PC) services have become integral in managing patient’s symptoms during treatment as well as at the end of life. We hypothesize that socioeconomic factors such as achieving higher levels of education, and higher incomes, increases the odds of receiving PC. Methods: This is a retrospective analysis using NCDB data of 124,988 newly diagnosed non-M3 AML patients over 18 yrs from 2004-2016. Unadjusted and multivariate adjusted logistic regression analysis (MVA) evaluated the impact of socioeconomic variables on the receipt of PC. In the MVA, we adjusted for demographic variables and facility characteristics including facility type, facility volume, age, sex, race, Hispanic origin, income, education, urban/rural residence, Charlson-Deyo score, great circle distance, Medicaid expansion status state group, and insurance status. Patients with Medicaid expansion < 39yrs were excluded due to low patient numbers. Results: For the 124,988 patients, median age was 63 years (range 18-90) with 54% males and 86% White. 25% of patients lived in regions with the highest education level defined as < 6.3% of adults over 25 without a high school diploma. 35% of patients had a household income bracket of ≥ $63,333. A total of 3% of patients received PC. MVA showed that patients within the highest income bracket of ≥ $63,333 were less likely to have used PC services (OR 0.82, p < 0.01). More educated patients residing in regions with < 6.3% of adults without a high school diploma had higher odds of receiving PC treatment compared with patients with less education (OR 1.23, p < 0.01). Residence in states with Medicaid expansion in January 2014 or later was associated with greater utilization of PC services (Jan 2014 expansion states: OR 1.33 and late expansion states/after Jan 2014: OR 1.43, p < 0.01) compared to residence in non-expansion states. No difference was seen across races; except Hispanics with decreased use of PC services(OR 0.8, p = 0.022). Conclusions: In this large cohort, a small percentage of patients received PC. Higher education was associated with higher likelihood of using PC, while, surprisingly, higher income was associated with a lower likelihood of PC. Additionally, the higher use of PC services with Medicaid expansion suggests a broad impact of public health insurance in providing increased access to PC services.
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Affiliation(s)
- Bryan Lee Chan
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Allison O. Taylor
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Kimberley Doucette
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Jaeil Ahn
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Xioyang Ma
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Catherine Lai
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
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Saji S, McArthur HL, Ignatiadis M, Bailey A, El-Abed S, Brandao M, Metzger O, Lai C, Guillaume S, Fumagalli D, Agbor-tarh D, Seiller A, Altarcheh Xifro R, Honvault V, Viale G, DuFrane C, Barata T, Winer EP, Gelber RD, Piccart-Gebhart MJ. ALEXANDRA/IMpassion030: A phase 3 study of standard adjuvant chemotherapy with or without atezolizumab in patients with early-stage triple-negative breast cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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
TPS597 Background: Early stage triple negative breast cancer (TNBC) is associated with a high risk of distant relapse. Because TNBC does not currently have specific targeted agents approved for use in the early setting, it is treated primarily with chemotherapy. TNBC may be more immunogenic than other subtypes of breast cancer. Atezolizumab (an anti–PD-L1 antibody), in combination with nab-paclitaxel has been approved in >70 countries for the treatment of PD-L1-positive unresectable locally advanced or metastatic TNBC based on the results of the randomized phase 3 IMpassion130 trial. The phase 3 IMpassion031 study, evaluating atezolizumab in combination with chemotherapy (nab-paclitaxel followed by doxorubicin and cyclophosphamide) in comparison to placebo plus chemotherapy as neoadjuvant treatment demonstrated a statistically significant and clinically meaningful improvement in pCR in both PD-L1 positive and PD-L1 negative tumors. ALEXANDRA/IMpassion030 is a global, prospective, randomized, open-label, phase 3 trial currently investigating the efficacy, safety and pharmacokinetic profile of adjuvant atezolizumab plus standard anthracycline/taxane adjuvant chemotherapy versus chemotherapy alone in early stage TNBC. Methods: ALEXANDRA/IMpassion030 will randomize 2300 patients with operable stage II-III TNBC, confirmed by central pathology review. Patients are stratified by type of surgery, nodal status, and centrally assessed PD-L1 status. Adjuvant chemotherapy consist of weekly paclitaxel 80 mg/m2 for 12 weeks followed by dose dense anthracycline (epirubicin 90 mg/m2 or doxorubicin 60 mg/m2) and cyclophosphamide 600 mg/m2 for 4 doses every 2 weeks or the same chemotherapy regimen (T-EC/AC) given concomitantly with atezolizumab 840 mg every 2 weeks followed by maintenance atezolizumab 1200 mg every 3 weeks until completion of 1 year of atezolizumab. The primary endpoint is invasive disease-free survival (iDFS) and secondary endpoints include, iDFS in the PD-L1 selected tumour status (IC1/2/3) and node-positive subpopulations, overall survival, safety, patient functioning and health related quality of life (HRQoL). Tumor tissue and blood samples will be collected for biomarker research. The first site was activated on May 4 2018, and approximately 373 sites in 30 countries are currently participating in this trial. This trial is sponsored by F. Hoffmann-La Roche Ltd and conducted in partnership with the Breast International Group, Frontier Science and Technology Research Foundation, Institute Jules Bordet and Alliance Foundation Trials. Clinical trial information: NCT03498716.
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Affiliation(s)
- Shigehira Saji
- Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | | | - Andrew Bailey
- Frontier Science, Kincraig Inverness-Shire, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Giuseppe Viale
- European Institute of Oncology, University of Milan, Milan, Italy
| | | | | | - Eric P. Winer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, and Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA
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Doucette K, Karp J, Lai C. Advances in therapeutic options for newly diagnosed, high-risk AML patients. Ther Adv Hematol 2021; 12:20406207211001138. [PMID: 33995985 PMCID: PMC8111550 DOI: 10.1177/20406207211001138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
Acute myeloid leukemia (AML) is an aggressive malignancy characterized by clonal proliferation of neoplastic immature precursor cells. AML impacts older adults and has a poor prognosis. Despite recent advances in treatment, AML is complex, with both genetic and epigenetic aberrations in the malignant clone and elaborate interactions with its microenvironment. We are now able to stratify patients on the basis of specific clinical and molecular features in order to optimize individual treatment strategies. However, our understanding of the complex nature of these molecular abnormalities continues to expand the defining characteristics of high-risk mutations. In this review, we focus on genetic and microenvironmental factors in adverse risk AML that play critical roles in leukemogenesis, including those not described in an European LeukemiaNet adverse risk group, and describe therapies that are currently in the clinical arena, either approved or under development.
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Affiliation(s)
- Kimberley Doucette
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Judith Karp
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Catherine Lai
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3800 Reservoir Road, NW, Washington, DC 20007, USA
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van der Laan S, Billah T, Chi C, Lai C, Litton E. Anaemia among intensive care unit survivors and association with days alive and at home: an observational study. Anaesthesia 2021; 76:1352-1357. [PMID: 33872384 DOI: 10.1111/anae.15483] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 01/22/2023]
Abstract
Anaemia is highly prevalent at the time of intensive care unit discharge and is persistent for a high proportion of intensive care unit survivors. Whether anaemia is a driver of impaired recovery after critical illness is uncertain. The aim of this study was to test the hypothesis that, in adult intensive care survivors, anaemia at the time of intensive care unit discharge independently predicts decreased days at home-90. This retrospective cohort study was conducted in a tertiary intensive care unit in Perth, Western Australia. All patients aged ≥ 16 years, discharged alive from their index intensive care unit admission and without documented treatment limitations were included. Median (IQR [range]) age of the 6358 participants was 61 (46-72 [16-95]) years and included 3385 (53.2%) unplanned admissions. Intensive care unit discharge with a haemoglobin concentration < 100 g.l-1 occurred in 2886 (45.4%) patients, a threshold that identified a cohort with significantly lower days at home-90 (median (IQR [range]) 80 (64-85 [0-90]) days vs. 85 (77-88 [0-90]) days (median difference 5 days, 95%CI 4.4-5.5, p < 0.0001). The association followed a severity-response relationship with more severe anaemia predicting lower days at home-90. When accounting for prespecified covariates including admission haemoglobin concentration and red blood cell transfusion, anaemia at intensive care unit discharge remained a significant predictor of decreased days at home-90, relative risk 0.96 (0.93-0.98), p < 0.002. These findings support the need for interventional trials investigating whether this risk is modifiable.
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Affiliation(s)
- S van der Laan
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - T Billah
- Curtin University, Bentley, Western Australia, Australia
| | - C Chi
- Curtin University, Bentley, Western Australia, Australia
| | - C Lai
- Curtin University, Bentley, Western Australia, Australia
| | - E Litton
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Intensive Care Unit, St John of God Hospital, Subiaco, Western Australia, Australia.,School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
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Phelan DE, Mota C, Lai C, Kierans SJ, Cummins EP. Carbon dioxide-dependent signal transduction in mammalian systems. Interface Focus 2021; 11:20200033. [PMID: 33633832 PMCID: PMC7898142 DOI: 10.1098/rsfs.2020.0033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/15/2022] Open
Abstract
Carbon dioxide (CO2) is a fundamental physiological gas known to profoundly influence the behaviour and health of millions of species within the plant and animal kingdoms in particular. A recent Royal Society meeting on the topic of 'Carbon dioxide detection in biological systems' was extremely revealing in terms of the multitude of roles that different levels of CO2 play in influencing plants and animals alike. While outstanding research has been performed by leading researchers in the area of plant biology, neuronal sensing, cell signalling, gas transport, inflammation, lung function and clinical medicine, there is still much to be learned about CO2-dependent sensing and signalling. Notably, while several key signal transduction pathways and nodes of activity have been identified in plants and animals respectively, the precise wiring and sensitivity of these pathways to CO2 remains to be fully elucidated. In this article, we will give an overview of the literature relating to CO2-dependent signal transduction in mammalian systems. We will highlight the main signal transduction hubs through which CO2-dependent signalling is elicited with a view to better understanding the complex physiological response to CO2 in mammalian systems. The main topics of discussion in this article relate to how changes in CO2 influence cellular function through modulation of signal transduction networks influenced by pH, mitochondrial function, adenylate cyclase, calcium, transcriptional regulators, the adenosine monophosphate-activated protein kinase pathway and direct CO2-dependent protein modifications. While each of these topics will be discussed independently, there is evidence of significant cross-talk between these signal transduction pathways as they respond to changes in CO2. In considering these core hubs of CO2-dependent signal transduction, we hope to delineate common elements and identify areas in which future research could be best directed.
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Affiliation(s)
- D. E. Phelan
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - C. Mota
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - C. Lai
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - S. J. Kierans
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - E. P. Cummins
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
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Krackeler ML, Broome C, Lai C. Complete remission of aggressive T-cell LGL leukemia with pentostatin therapy: first case report. Stem Cell Investig 2021; 7:24. [PMID: 33437844 DOI: 10.21037/sci-2020-035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/10/2020] [Indexed: 11/06/2022]
Abstract
This is the first report of a complete remission in aggressive T-cell large granular lymphocytic (T-LGL) leukemia after treatment with pentostatin. The aggressive variant of the disease is rare, and traditional therapies include immunosuppressive agents, however, there is no standard consensus for treatment. Cytotoxic chemotherapy has led to remission in a few reported cases. We present this unique case as an alternative treatment for individuals refractory to chemotherapy. A 55-year-old African American male with hypertension, type II diabetes mellitus, hyperlipidemia, and gout presented with symptoms of multiple ecchymosis, fatigue, and weight loss. He was found to have splenomegaly (SM) and significant leukocytosis to 101 k/µL with 30% blasts on peripheral smear. Following bone marrow aspiration and biopsy with flow cytometry, he was diagnosed with aggressive T-LGL leukemia. The chemotherapy regimen hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) was initially chosen based on his clinical presentation but was refractory to treatment. His therapy was changed to alemtuzumab; however, patient tolerated poorly and did not respond. Pentostatin was added to alemtuzumab with improvement in clinical symptoms and laboratory parameters. The patient was transitioned to pentostatin monotherapy and achieved complete remission after 1 month. This report provides support for pentostatin as an effective treatment for patients with aggressive T-cell malignancies refractory to cytotoxic chemotherapy. Pentostatin has previously been studied to treat T-cell prolymphocytic leukemia (T-PLL), hairy cell leukemia, and marginal zone lymphoma. This case suggests an alternative, well-tolerated option that could be considered for initial therapy of aggressive T-LGL leukemia.
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Affiliation(s)
| | - Catherine Broome
- Medstar Georgetown University Hospital, Lombardi Cancer Center, Washington, DC, USA
| | - Catherine Lai
- Medstar Georgetown University Hospital, Lombardi Cancer Center, Washington, DC, USA
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37
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Shapanis A, Lai C, Smith S, Coltart G, Sommerlad M, Schofield J, Parkinson E, Skipp P, Healy E. Identification of proteins associated with development of metastasis from cutaneous squamous cell carcinomas (cSCCs) via proteomic analysis of primary cSCCs. Br J Dermatol 2020; 184:709-721. [PMID: 32794257 DOI: 10.1111/bjd.19485] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers capable of metastasizing. Proteomic analysis of cSCCs can provide insight into the biological processes responsible for metastasis, as well as future therapeutic targets and prognostic biomarkers. OBJECTIVES To identify proteins associated with development of metastasis in cSCC. METHODS A proteomic-based approach was employed on 105 completely excised, primary cSCCs, comprising 52 that had metastasized (P-M) and 53 that had not metastasized at 5 years post-surgery (P-NM). Formalin-fixed, paraffin-embedded cSCCs were microdissected and subjected to proteomic profiling after one-dimensional (1D), and separately two-dimensional (2D), liquid chromatography fractionation. RESULTS A discovery set of 24 P-Ms and 24 P-NMs showed 144 significantly differentially expressed proteins, including 33 proteins identified via both 1D and 2D separation, between P-Ms and P-NMs. Several differentially expressed proteins were also associated with survival in SCCs of other organs. The findings were verified by multiple reaction monitoring on six peptides from two proteins, annexin A5 (ANXA5) and dolichyl-diphosphooligosaccharide-protein glycosyltransferase noncatalytic subunit (DDOST), in the discovery group and validated on a separate cohort (n = 57). Increased expression of ANXA5 and DDOST was associated with reduced time to metastasis in cSCC and decreased survival in cervical and oropharyngeal cancer. A prediction model using ANXA5 and DDOST had an area under the curve of 0·93 (confidence interval 0·83-1·00), an accuracy of 91·2% and higher sensitivity and specificity than cSCC staging systems currently in clinical use. CONCLUSIONS This study highlights that increased expression of two proteins, ANXA5 and DDOST, is significantly associated with poorer clinical outcomes in cSCC.
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Affiliation(s)
- A Shapanis
- Dermatopharmacology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C Lai
- Dermatopharmacology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Smith
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - G Coltart
- Dermatopharmacology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Sommerlad
- Histopathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Schofield
- Centre for Proteomic Research, Institute for Life Sciences, University of Southampton, Southampton, UK
| | - E Parkinson
- Centre for Proteomic Research, Institute for Life Sciences, University of Southampton, Southampton, UK
| | - P Skipp
- Centre for Proteomic Research, Institute for Life Sciences, University of Southampton, Southampton, UK
| | - E Healy
- Dermatopharmacology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Rosser E, Buckner E, Avedissian T, Cheung DSK, Eviza K, Hafsteinsdóttir TB, Hsu MY, Kirshbaum MN, Lai C, Ng YC, Ramsbotham J, Waweru S. The Global Leadership Mentoring Community: building capacity across seven global regions. Int Nurs Rev 2020; 67:484-494. [PMID: 32869285 DOI: 10.1111/inr.12617] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this paper is to report on the evaluation of the online Global Leadership Mentoring Community, a programme designed to build relationships across seven global regions and promote leadership development for emerging nurse leaders. BACKGROUND There is a pressing need and opportunity for sustainable global leadership mentoring programmes. This programme of Sigma Theta Tau International (Sigma) brought mentors and mentees together from across the world to build leadership capacity, understand global leadership issues and build networks. Community coordinators purposively selected mentors from each of Sigma's seven Global Regions, and mentees were chosen through a process of snowball sampling. Mentors and mentees met monthly with quarterly group calls. METHODS The study followed a programme evaluation, outcomes-focused approach. All eleven pairs of mentors-mentees were invited to complete online surveys at the outset and end of programme capturing both quantitative and qualitative data. Quantitative data were analysed using descriptive statistics and for qualitative data, a thematic analysis. FINDINGS Quantitative data confirmed that all 22 participants gained from the experience. From qualitative analysis, themes emerged illustrating the scope of achievements: 1. facilitation of successful outcomes for both mentors and mentees, 2. challenges of global mentoring and 3. strategies for successful global mentoring. DISCUSSION/CONCLUSION Participants reported that creating global leadership is a longitudinal process that needs sustained attention to effect change. This evaluation identified many strengths of the programme and recommended its continuation to help further development of global leaders, particularly through focusing more purposefully on policy issues. IMPLICATIONS FOR NURSING POLICY Empowerment of nurses globally through a Global Leadership Mentoring Community can improve leadership at all levels, thus emboldening their voices to influence nursing and health policy and ultimately improve patient care.
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Affiliation(s)
- E Rosser
- Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
| | - E Buckner
- Ida Moffett School of Nursing, Samford University, Birmingham, AL, USA
| | - T Avedissian
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - D S K Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - K Eviza
- Sentara Martha Jefferson Hospital, Charlottesville, VA, USA
| | - T B Hafsteinsdóttir
- Department of Nursing Science, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Y Hsu
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | | | - C Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Y C Ng
- University of Alabama in Hunstville, Huntsville, AL, USA
| | - J Ramsbotham
- School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - S Waweru
- USA College of Nursing, South Alabama, Mobile, AL, USA
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Vadakekolathu J, Lai C, Reeder S, Church SE, Hood T, Muth J, Altmann H, Ciciarello M, Curti A, Valk PJ, Löwenberg B, Bornhäuser M, DiPersio JF, Davidson-Moncada JK, Rutella S. Abstract CT035: TP53 abnormalities correlate with immune infiltration and are associated with response to flotetuzumab, an investigational immunotherapy, in acute myeloid leukemia. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct035] [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: Acute myeloid leukemia (AML) is a molecularly and clinically heterogeneous disease. TP53 mutations and 17p (TP53) deletions occur in 37-46% of AML cases with adverse risk cytogenetics and are associated with primary induction failure (PIF), high risk of relapse and dismal prognosis. Herein, we aimed to determine whether TP53 abnormalities identify a patient subgroup that may benefit from immunotherapy approaches. Patients and Methods: We used the following transcriptomic data sets and patient cohorts (C) for in silico and wet-lab analyses: 1) The Cancer Genome Atlas (TCGA; 162 adult AML patients, 13 with TP53 mutations); 2) Beat AML Master Trial (281 adult AML patients, 17 with TP53 mutations); 3) HOVON (618 adult AML patients, 14 with TP53 mutations); 4) 24 diagnostic bone marrow (BM) samples from patients with TP53-wild-type AML (Bologna series); 5) 36 diagnostic BM samples from patients with TP53-mutated AML (Studien Allianz Leukämie [SAL] series); 6) 30 BM samples from patients with relapsed/refractory (R/R) AML (10 cases with TP53 mutations and/or 17p deletion) that received immunotherapy with flotetuzumab, a CD123×CD3 bispecific DART molecule (NCT02152956). Microenvironmental immune gene expression profiles (wet-lab cohorts, C4 and C5) were analyzed using the Pan-Cancer IO 360 Panel (NanoString Technologies, Seattle, WA). Immune cell type-specific and biological activity signature scores were computed as recently published (JITC 2017; 5: 18). Results: Compared with TCGA-AML cases (C1) with favorable-risk and intermediate-risk molecular features, all patients with TP53 mutations showed high levels of immune infiltration, including genes associated with adaptive immune responses and an interferon (IFN)-γ-dominant tumor microenvironment (TME), and a higher tumor mutational burden (14 versus 10 mutations on average in patients with TP53-mutated and TP53-wild-type AML, respectively; p=0.02). Similarly, 16 out of 17 (94%) TP53-mutated Beat AML cases (C2) expressed high levels of IFN signaling molecules, CD8 and markers of cytotoxicity (GZMB). Compared with patients with TP53-wild-type AML (C4), primary BM samples from patients with TP53-mutated AML (C5) showed higher levels of CD8A, markers of cellular senescence (EOMES, KLRD1, HRAS), IFN-γ-inducible genes (IRF1) and negative immune checkpoints including LAG3, IDO1, PDL1 and VSIR (VISTA). Interestingly, 10 patients with R/R AML (C6) had TP53 abnormalities and 5 of 6 patients evaluated for immune gene profiles had an immune-infiltrated TME. In patients with TP53 abnormalities, the overall response rate (ORR) was 40% to flotetuzumab (2 patients with CR, 1 patient with CRh, and 1 patient with morphologic leukemia-free state). The overall decrease of BM blasts averaged 42%. Stable disease was observed in 3 patients. Median overall survival (OS) was 3.5 months (range 1.25-21.25), which favorably compares with survival estimates for TP53-mutated cases with PIF in large AML series, such as HOVON (C3; median OS=1.16 months). Conclusions: This study provides evidence for a correlation between IFN-γ-dominant immune subtypes of AML and TP53 abnormalities. The ORR seen in this patient subgroup encourages further study of this immunotherapeutic approach.
Citation Format: Jayakumar Vadakekolathu, Catherine Lai, Stephen Reeder, Sarah E. Church, Tressa Hood, John Muth, Heidi Altmann, Marilena Ciciarello, Antonio Curti, Peter J. Valk, Bob Löwenberg, Martin Bornhäuser, John F. DiPersio, Jan K. Davidson-Moncada, Sergio Rutella. TP53 abnormalities correlate with immune infiltration and are associated with response to flotetuzumab, an investigational immunotherapy, in acute myeloid leukemia [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT035.
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Affiliation(s)
- Jayakumar Vadakekolathu
- 1John van Geest Cancer Research Centre, Nottingham Trent University, Nottingham, United Kingdom
| | - Catherine Lai
- 2MedStar Georgetown University Hospital's Lombardi Comprehensive Cancer Center, Washington, DC
| | - Stephen Reeder
- 1John van Geest Cancer Research Centre, Nottingham Trent University, Nottingham, United Kingdom
| | | | | | | | - Heidi Altmann
- 5University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marilena Ciciarello
- 6Institute of Hematology "L. and A. Serágnoli", Department of Hematology and Oncology, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Antonio Curti
- 6Institute of Hematology "L. and A. Serágnoli", Department of Hematology and Oncology, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Peter J. Valk
- 7Department of Hematology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Bob Löwenberg
- 7Department of Hematology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Martin Bornhäuser
- 5University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - John F. DiPersio
- 8Division of Oncology, Department of Internal Medicine, Washington University in St. Louis, St Louis, MO
| | | | - Sergio Rutella
- 1John van Geest Cancer Research Centre, Nottingham Trent University, Nottingham, United Kingdom
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Lai C, Filippetti G, Schifano I, Aceto P, Tomai M, Lai S, Pierro L, Renzi A, Carnovale A, Maranghi M. Psychological, emotional and social impairments are associated with adherence and healthcare spending in type 2 diabetic patients: an observational study. Eur Rev Med Pharmacol Sci 2020; 23:749-754. [PMID: 30720183 DOI: 10.26355/eurrev_201901_16889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of the present study was to assess the association among anxiety, depression, stress, social support and emotional abilities with adherence and healthcare spending in type 2 diabetic patients. PATIENTS AND METHODS Sixty-four patients were enrolled and completed: Interpersonal Processes of Care (IPC), 20-item Toronto Alexithymia Scale (TAS-20), Rapid Stress Assessment Scale (RSAS), Morisky Medication Adherence Scale (MMAS-4), International Physical Activity Questionnaire (IPAQ)-Short Form and a socio-anamnestic questionnaire regarding also the healthcare spending. RESULTS Mathematical linear regressions models were performed showing the predictive effects of: anxiety and social support scores (RSAS) on adherence levels (respectively p =. 019; p =. 016); adherence levels on anxiolytic use (p =.04); aggressiveness scores (RSAS) on the number of general check-ups (p =.031); TAS-20 and physician-patient communication (IPC) on the number of hospitalization days (respectively p=.001; p=.008); physician patient decision making (IPC) scores on physical activity (IPAQ) levels (p=.025); physical activity (IPAQ) on the number of medical examinations (p=.039). CONCLUSIONS An association among psychosocial impairment, adherence and healthcare spending was found. Future studies should investigate the effect of a brief psychological intervention in increasing adherence levels and reducing the healthcare spending in this clinical population.
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Affiliation(s)
- C Lai
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy.
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Doucette K, Lai C, Pohlmann PR. Rebound lymphocytosis in a patient with chronic lymphocytic leukemia after cessation of a CDK 4/6 inhibitor for concomitant breast cancer. Breast J 2020; 26:2031-2033. [PMID: 32639043 DOI: 10.1111/tbj.13955] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 01/31/2023]
Abstract
Herein, we present the case of a female with co-occurring chronic lymphocytic leukemia (CLL) and metastatic ER/PR-positive breast cancer, who when taken off palbociclib for severe neutropenia and infectious complications, experienced rebound lymphocytosis. Though this was ultimately a benign clinical outcome, it exemplifies how CDK4/6 inhibitors induce a cell cycle arrest by decreasing the proliferation of hematopoietic stem cells (HSC), in this case CLL cells, with recovery of counts once drug is stopped.
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Affiliation(s)
- Kimberley Doucette
- Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Catherine Lai
- Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Paula R Pohlmann
- Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Lai C, Zhao L, Zhou J, Xu D, Tian X, Zeng X, Zhang F. AB0498 CHARACTERISTICS AND OUTCOME OF CORONARY ARTERY LESIONS DUE TO POLYARTERITIS NODOSA: ANALYSIS OF A SINGLE CENTER COHORT IN CHINA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that mainly affects medium-sized muscular arteries. The coronary artery could be affected. Some severe cases can lead to spontaneous coronary artery dissection (SCAD) and about 0.02% will die abruptly. Early diagnosis will improve prognosis, but relative studies are all case reports so far.Objectives:To investigate the clinical characteristics, risk factors and outcome of patients with polyarteritis nodosa (PAN) complicated with coronary artery lesions in China.Methods:Data of 158 patients with PAN who were admitted to Peking Union Medical College Hospital from September 1986 to September 2019 were retrospective collected. Data were analyzed and compared according to with and without coronary artery lesions due to PAN.Results:17 (10.8%) patients with PAN had the coronary artery lesions due to PAN. The age at coronary artery lesion was 36.9±10.3 years. 12 (70.6%) patients were male. There are not statistical differences between two groups in common risk factors of coronary arterial atherosclerosis including smoking, hypertension, diabetes mellitus and hyperlipidemia. Most of them are multi-vessel lesions (8 cases are triple-vessel lesions and 3 cases are bi-vessel lesions). Type of coronary artery affected is shown mainly in stenosis (13 cases). Myocardial infarction are shown in 8 cases (47.1%). Compared to patients without coronary artery lesions, patients with coronary artery lesions had less nervous system involvement (17.6% vs.46.8%) and elevated number of leukocyte (17.6% vs.56%). Besides, patients with coronary artery affected exhibit more cranial and carotid artery involvement(29.4% vs. 5.0%), renal artery involvement (41.2% vs.17.0%), coeliac artery involvement (58.8% vs.27.0%), new onset hypertension (47.1% vs.14.5%), renal infarction (27.3% vs.5.4%, ) and higher proportion of 2009 Five-factor score (FFS)≥2 (62.5% vs.15.6%). All patients with coronary artery lesions received at least moderate dose of prednisone and CTX except one refused medication. 3 cases underwent interventional therapy. Stent placement was performed on 2 of them, and in-stent restenosis was appeared in a patient one year later. 2 cases died,one for vascular rupture after coronary aneurysmsutrue plus coronary artery bypass grafting, another for myocardial infarction after stopping immunosuppressant therapy himself.Survival analysis showed patients with digital g angrene had poor prognosis though no significant difference(p=0.055).Conclusion:PAN with coronary artery lessions are not uncommon. These patients exhibit young age, more proportion of multi-vessel of coronary artery involvement, more combined involvments of other organ arteries and more severe disease.References:[1]Munguti CM, Ndunda PM, Muutu TM. Sudden Death From Spontaneous Coronary Artery Dissection Due to Polyarteritis Nodosa. Cureus, 2017;9 (10), e1737[2]Kritta nawong C, Kumar A, Johnson KW, et al.Conditions and Factors Associated With Spontaneous Coronary Artery Dissection (From a National Population-Based Cohort Study).Am J Cardiol, 2019; 123 (2): 249-253[3]Hwang J, Yang JH, Kim DK, Cha HS.Polyarteritis Nodosa Involving Renal and Coronary Arteries. J Am Coll Cardiol. 2012;59(7):e13Disclosure of Interests: :Chinchih Lai: None declared, Lin Zhao: None declared, Jiaxin Zhou: None declared, Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared
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Pattinson CL, Edwards K, Guedes VA, Mithani S, Yun S, Taylor P, Dunbar K, Lai C, Roy MJ, Gill JM. 0024 PTSD with Concurrent Excessive Daytime Sleepiness Alters Gene Expression in Military Personnel and Veterans; An RNA-Sequencing Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.023] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Up to 91% of military personnel and veterans with posttraumatic stress disorder (PTSD) report co-occurring sleep disturbances, including. insomnia and excessive daytime sleepiness (EDS). Sleep disturbances have been shown not only to increase the risk of developing PTSD, but to exacerbate and maintain PTSD symptomology. The aim of this study was to examine gene expression in active duty military personnel and veterans with PTSD, with and without EDS. Participants were categorized into three groups; 1) PTSD with EDS (PTSDwEDS; n=21), 2) PTSD without EDS (PTSDnoEDS; n=25), or 3) Controls (no PTSD and no EDS; n=57).
Methods
Participants were 79% male, mean age of 37.6years (SD=11.2years). PTSD symptoms were measured using the PTSD checklist for civilians (PCL-C); participants were classified as PTSD-present using DSM-IV-TR criteria of “moderate-to-severe”. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS), high sleepiness was indicated by an ESS score >13. We performed RNA-seq with Illumina’s HiSeq 2500 in paired-end. We conducted quality control using FastQC and aligned to GRCh38 reference genome using STAR (v2.5.3a). Differentially expressed genes identified using DESeq2 (v1.20.0) with False Discovery Rate of 0.10. Finally, Ingenuity Pathway Analysis (IPA) was conducted to identify dysregulated gene networks.
Results
Between the Controls and PTSDnoEDS groups, two genes were significantly dysregulated. In controls and PTSDwEDS groups, 251 genes were dysregulated. The IPA networks showed that genes associated with inflammation were significantly dysregulated. Finally, between PTSDwEDS and PTSDnoEDS there were 1,873 significantly dysregulated genes. The IPA networks identified dysregulation of genes related to sleep, fatigue, circadian, and mitochondrial function.
Conclusion
Taken together this data indicates that EDS that is co-morbidly experienced with PTSD is associated with significant gene dysregulation, above and beyond that observed in participants with PTSD without significant EDS and controls. Treating EDS in military personnel and veterans with PTSD is important.
Support
This work was supported by the Center for Neuroscience and Regenerative Medicine (CNRM)
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Affiliation(s)
- C L Pattinson
- The University of Queensland, Institute for Social Science Research, Brisbane, AUSTRALIA
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - K Edwards
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - V A Guedes
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - S Mithani
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - S Yun
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - P Taylor
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Bethesda, MD
| | - K Dunbar
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Bethesda, MD
| | - C Lai
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - M J Roy
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD., Bethesda, MD
| | - J M Gill
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
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Leete JJ, Pattinson CL, Guedes VA, Lai C, Devoto C, van der Merwe A, Lippa S, Shahim P, Moore BE, Chan L, Gill J. 1118 Examining the Role of Serum and Exosomal Biomarkers in Symptoms of Fatigue and Daytime Sleepiness Following Traumatic Brain Injury. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1113] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Fatigue and daytime sleepiness are two of the most common chronic symptoms reported after traumatic brain injury (TBI). However, there is limited understanding of the pathophysiological mechanisms following TBI that result in these symptoms. Previous research has observed elevations in peripheral blood levels of proteins in TBI patients versus controls, including neurofilament light chain (NFL)—predominantly expressed in long myelinated subcortical axons—and glial fibrillary acidic protein (GFAP)—predominantly expressed in reactive astrocytes responding to central nervous system injuries. This study examines the relationship between serum and exosomal NFL and GFAP, and symptoms of fatigue and daytime sleepiness in TBI patients 1-year after injury.
Methods
Sixty-seven patients with TBIs ranging from mild to severe were included in this study. Blood samples were collected from all participants 1-year post TBI, with concentrations of GFAP and NFL measured in serum and exosomes using Single Molecule Array technology (Simoa), an ultrasensitive assay. Participants reported fatigue using the Fatigue Severity Scale (FSS), and daytime sleepiness using the Epworth Sleepiness Scale (ESS).
Results
A linear regression model of fatigue symptoms and exosomal NFL controlling for age revealed that fatigue was negatively associated with exosomal NFL concentrations (β = -.317, p = .041, ηp2 = -.343) and accounted for 20.2% of the change in NFL. Serum NFL concentrations were not associated with fatigue, nor were GFAP serum or exosomes. No significant associations were found between NFL, GFAP, and daytime sleepiness.
Conclusion
Our findings suggest that exosomal NFL may be related to mechanisms underlying TBI-related fatigue and the potential of NFL as a biomarker of fatigue. To our knowledge, this study is the first to examine the relationship between post-TBI NFL levels and fatigue symptoms. Further investigation into serum and exosome biomarkers of TBI-related fatigue and daytime sleepiness is warranted.
Support
National Institutes of Health and Center for Neuroscience and Regenerative Medicine
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Affiliation(s)
- J J Leete
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - C L Pattinson
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - V A Guedes
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - C Lai
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - C Devoto
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - A van der Merwe
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
- Henry M. Jackson Foundation, Bethesda, MD
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD
| | - S Lippa
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - P Shahim
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD
| | - B E Moore
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
- Henry M. Jackson Foundation, Bethesda, MD
- Uniformed Services University for the Health Sciences, Bethesda, MD
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD
| | - L Chan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD
| | - J Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD
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Popescu B, Sheela S, Thompson J, Grasmeder S, Intrater T, DeStefano CB, Hourigan CS, Lai C. Timed sequential salvage chemotherapy for relapsed or refractory acute myeloid leukemia. Clin Hematol Int 2020; 2:27-31. [PMID: 32190831 PMCID: PMC7079712 DOI: 10.2991/chi.d.191128.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/27/2019] [Indexed: 01/12/2023] Open
Abstract
Therapy for those with relapsed or refractory acute myeloid leukemia is suboptimal. Studies have suggested that timed sequential salvage combination cytotoxic chemotherapy may have particular utility for that indication. We report here a series of ten such adult patients treated sequentially at a single center with EMA (cytarabine 500 mg/m2/day as continuous infusion on days 1-3 and days 8-10, mitoxantrone 12 mg/m2/day on days 1-3, and etoposide 200 mg/m2/day as continuous infusion on days 8-10). The overall complete remission rate was 40% (including 3 of 4 of those with relapsed disease) but use of this regimen was associated with prolonged cytopenia and a high rate of infectious adverse events. Even with the availability of modern infectious prophylaxis and therapies, the EMA regimen is likely best reserved for those with relapsed disease treated with curative intent prior to an allogeneic hematopoietic cell transplant.
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Affiliation(s)
- Bogdan Popescu
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Room 10CRC 5-5130, 10 Center Drive, Bethesda, Maryland 20a814-1476, USA
| | - Sheenu Sheela
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Room 10CRC 5-5130, 10 Center Drive, Bethesda, Maryland 20a814-1476, USA
| | - Julie Thompson
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Room 10CRC 5-5130, 10 Center Drive, Bethesda, Maryland 20a814-1476, USA
| | - Sophia Grasmeder
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Room 10CRC 5-5130, 10 Center Drive, Bethesda, Maryland 20a814-1476, USA
| | - Therese Intrater
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Room 10CRC 5-5130, 10 Center Drive, Bethesda, Maryland 20a814-1476, USA
| | - Christin B. DeStefano
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Room 10CRC 5-5130, 10 Center Drive, Bethesda, Maryland 20a814-1476, USA
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Ng S, Liu T, Chan C, Chan C, Chu C, Poon C, Poon L, Lai C, Tse M. Reliability and validity of the long-distance corridor walk among stroke survivors. J Rehabil Med 2020; 52:jrm00062. [DOI: 10.2340/16501977-2691] [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: 11/16/2022] Open
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Lai C, Kandahari AM, Ujjani C. The Evolving Role of Brentuximab Vedotin in Classical Hodgkin Lymphoma. Blood Lymphat Cancer 2019; 9:63-71. [PMID: 31849558 PMCID: PMC6910100 DOI: 10.2147/blctt.s231821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022]
Abstract
The arrival of the CD30 directed antibody-drug conjugate, brentuximab vedotin (BV), has altered the approach to patients with classical Hodgkin lymphoma. Since initial approval in 2011, BV has been extensively studied in previously untreated and relapsed/refractory patients. Treatment indications for the antibody-drug conjugate have been expanded from the previously treated population to include maintenance therapy after autologous stem cell transplantation and recently, combination with chemotherapy in newly diagnosed advanced stage patients. This article will review the evolution of BV in classical Hodgkin lymphoma, detailing the studies that led to the approved indications and discussion of recent trials in combination with chemotherapy and immunotherapy.
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Affiliation(s)
- Catherine Lai
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Adrese Michael Kandahari
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Chaitra Ujjani
- Seattle Cancer Care Alliance, Fred Hutchinson CRC, University of Washington, Seattle, WA, USA
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Lai C, Sceats LA, Qiu W, Park KT, Morris AM, Kin C. Patient decision-making in severe inflammatory bowel disease: the need for improved communication of treatment options and preferences. Colorectal Dis 2019; 21:1406-1414. [PMID: 31295766 DOI: 10.1111/codi.14759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023]
Abstract
AIM Patients with inflammatory bowel disease and their physicians must navigate ever-increasing options for treatment. The aim of this study was to elucidate the key drivers of treatment decision-making in inflammatory bowel disease. METHODS We conducted qualitative semi-structured in-person interviews of 20 adult patients undergoing treatment for inflammatory bowel disease at an academic medical centre who either recently initiated biologic therapy or underwent an operation or surgical evaluation. Interviews were audio-recorded, transcribed verbatim, iteratively coded, and discussed to consensus by five researchers. We used thematic analysis to explore factors influencing decision-making. RESULTS Four major themes emerged as key drivers of treatment decision-making: perceived clinical state and disease severity, the patient-physician relationship, knowledge, attitudes and beliefs about treatment options, and social isolation and stigma. Patients described experiencing a clinical turning point as the impetus for proceeding with a previously undesired treatment such as infusion medication or surgery. Patients reported delays in care or diagnosis, inadequate communication with their physicians, and lack of control over their disease management. Patients often stated that they considered surgery to be the treatment of last resort, which further compounded the complexity of making treatment decisions. CONCLUSION Patients described multiple barriers to making informed and collaborative decisions about treatment, especially when considering surgical options. Our study reveals a need for more comprehensive communication between the patient and their physician about the range of medical and surgical treatment options. We recommend a patient-centred approach toward the decision-making process that accounts for patient decision-making preferences, causes of social stress, and clinical status.
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Affiliation(s)
- C Lai
- Stanford University School of Medicine, Stanford, California, USA
| | - L A Sceats
- Department of Surgery, S-SPIRE Center, Stanford University School of Medicine, Stanford, California, USA
| | - W Qiu
- Stanford University School of Medicine, Stanford, California, USA
| | - K T Park
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - A M Morris
- Department of Surgery, S-SPIRE Center, Stanford University School of Medicine, Stanford, California, USA
| | - C Kin
- Department of Surgery, S-SPIRE Center, Stanford University School of Medicine, Stanford, California, USA
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Tonioni F, Mazza M, Autullo G, Pellicano GR, Aceto P, Catalano V, Marano G, Corvino S, Martinelli D, Fiumana V, Janiri L, Lai C. Socio-emotional ability, temperament and coping strategies associated with different use of Internet in Internet addiction. Eur Rev Med Pharmacol Sci 2019; 22:3461-3466. [PMID: 29917199 DOI: 10.26355/eurrev_201806_15171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the present study was to compare socio-emotional patterns, temperamental traits, and coping strategies, between a group of Internet addiction (IA) patients and a control group. PATIENTS AND METHODS Twenty-five IA patients and twenty-six healthy matched subjects were tested on IA, temperament, coping strategies, alexithymia and attachment dimensions. Participants reported their prevalent Internet use (online pornography, social networks, online games). RESULTS The IA patients using Internet for gaming online showed a greater attitude to novelty seeking and a lower tendency to use socio-emotional support and self-distraction compared to patients using Internet for social networking. Moreover, they showed a lower level of acceptance than patients using Internet for pornography. In the control group, the participants using Internet for online gaming showed higher levels of IA, emotional impairments and social alienation compared to social-networks and pornography users. CONCLUSIONS Findings showed a higher psychological impairment in gaming online users compared to social networking and online pornography users.
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Affiliation(s)
- F Tonioni
- Psychiatry and Psychology Institute, A. Gemelli Foundation Hospital, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
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Perilli V, Aceto P, Ancona P, De Cicco R, Papanice D, Magalini S, Pepe G, Cozza V, Gui D, Lai C, Sollazzi L. Role of surgical setting and patients-related factors in predicting the occurrence of postoperative pulmonary complications after abdominal surgery. Eur Rev Med Pharmacol Sci 2019; 22:547-550. [PMID: 29424916 DOI: 10.26355/eurrev_201801_14208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to evaluate the role of surgical setting (urgent vs. elective) and approach (open vs. laparoscopic) in affecting postoperative pulmonary complications (PPCs) prevalence in patients undergoing abdominal surgery. PATIENTS AND METHODS After local Ethical Committee approval, 409 patients who had undergone abdominal surgery between January and December 2014 were included in the final analysis. PPCs were defined as the development of one of the following new findings: respiratory failure, pulmonary infection, aspiration pneumonia, pleural effusion, pneumothorax, atelectasis on chest X-ray, bronchospasm or un-planned urgent re-intubation. RESULTS PPCs prevalence was greater in urgent (33%) vs. elective setting (7%) (χ2 with Yates correction: 44; p=0.0001) and in open (6%) vs. laparoscopic approach (1.9%) (χ2 with Yates correction: 12; p=0.0006). PPCs occurrence was positively correlated with in-hospital mortality (Biserial Correlation r=0.37; p=0.0001). Logistic regression showed that urgent setting (p=0.000), Ariscat (Assess Respiratory Risk in Surgical Patients in Catalonia) score (p=0.004), and age (p=0.01) were predictors of PPCs. A cut-off of 23 for Ariscat score was also identified as determining factor for PPCs occurrence with 94% sensitivity and 29% specificity. CONCLUSIONS Patients undergoing abdominal surgery in an urgent setting were exposed to a higher risk of PPCs compared to patients scheduled for elective procedures. Ariscat score fitted with PPCs prevalence and older patients were exposed to a higher risk of PPCs. Prospective studies are needed to confirm these results.
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Affiliation(s)
- V Perilli
- Department of Anaesthesiology and Intensive Care, A. Gemelli University Hospital Foundation, Rome, Italy.
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