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Munsie C, Ebert J, Joske D, Collins J, Ackland T. The potential impact of exercise upon symptom burden in adolescents and young adults undergoing cancer treatment. Support Care Cancer 2024; 32:293. [PMID: 38632192 PMCID: PMC11023984 DOI: 10.1007/s00520-024-08497-0] [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: 07/21/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Adolescents and young adults (AYAs) experience vast symptom burden resulting from cancer treatment-related toxicities (TRTs). Evidence supports integrated exercise to mitigate several TRTs in other cohorts; however, evidence in AYAs is lacking. Conventional reporting of TRTs adopts a maximum grade approach failing to recognise the trajectory over time, of persistent, or lower grade toxicities. Alternatively, longitudinal analysis of toxicities over time (ToxT) may provide clinically meaningful summaries of this data. We evaluated the longitudinal impact of an exercise intervention on TRTs in AYAs undergoing cancer treatment. METHODS A prospective, randomised trial allocated participants to a 10-week exercise intervention (EG) or control group (CG) undergoing usual care. Detailed information on TRTs was collected throughout the intervention. All TRTs were graded per the Common Terminology Criteria for Adverse Events (CTCAE v5.0). RESULTS Forty-three (43) participants (63% male, mean age 21.1 years) were enrolled. When categorised to reflect the maximal worst grade experienced (Grade 0, Grade 1-2 and ≥ Grade 3), the CG reported an increased incidence of severe fatigue (≥ Grade 3) compared with the EG (p = 0.05). No other differences between groups were evident (p > 0.05). ToxT analysis of the four most common toxicities (fatigue, pain, nausea and mood disturbances) demonstrated no difference in the mean grade of each over time (p > 0.05). CONCLUSION A 10-week exercise intervention reduces the severity of fatigue in AYAs undergoing treatment. While the ToxT approach provided insight into the toxicity profile, adequately powered studies are needed to better understand these differences within a homogenous sample. TRIAL REGISTRATION (ACTRN12620000663954) 10th June 2020.
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Affiliation(s)
- Claire Munsie
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia.
- WA Youth Cancer Service, Locked Bag 2012, Nedlands, Perth, Western Australia, 6009, Australia.
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Jay Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Jo Collins
- WA Youth Cancer Service, Locked Bag 2012, Nedlands, Perth, Western Australia, 6009, Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Timothy Ackland
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
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Munsie C, Ebert J, Joske D, Ackland T. A randomised controlled trial investigating the ability for supervised exercise to reduce treatment-related decline in adolescent and young adult cancer patients. Support Care Cancer 2022; 30:8159-8171. [PMID: 35792926 PMCID: PMC9257117 DOI: 10.1007/s00520-022-07217-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/09/2022] [Indexed: 11/23/2022]
Abstract
Introduction Exercise is recognised as integral in mitigating a myriad negative consequences of cancer treatment. However, its benefit within adolescent and young adult (AYA) cancer cohorts remains relatively under researched, and caution should be taken in extrapolating outcomes from adult and paediatric populations given AYA distinctly different physiological and psychosocial contexts. This study sought to evaluate the impact of an exercise intervention on mitigating the expected decline in fitness, strength, physical functioning, and quality of life (QOL) in AYA undergoing cancer treatment. Methods This prospective, randomised controlled trial (FiGHTINGF!T) allocated 43 participants (63% male, mean age 21.1 years) to a 10-week, multimodal, bi-weekly exercise intervention (EG) or control group (CG) undergoing usual care. Pre- and post-intervention assessments included cardiopulmonary exercise tests, one-repetition maximum (1RM) strength, functional tests, and QOL patient-reported outcome measures. Data were analysed via linear mixed models and regression. Results While no significant group differences (p > 0.05) were observed, neither group significantly declined (p > 0.05) in any outcome measure over the 10-week period. No significant (p˃0.05) strength or functional improvements were observed in the CG, though the EG demonstrated significant improvements in their 1RM leg press (p = 0.004) and chest press (p = 0.032), maximal push ups (p = 0.032), and global QOL (p = 0.011). The EG reported a significant increase in fatigue (p = 0.014), while the CG reported significant positive changes in anxiety measures (p = 0.005). Conclusion The exercise intervention produced superior improvements in strength and global QOL, compared with the CG. Regardless of group allocation, enrolment in the exercise study appeared to mitigate the treatment-related decline expected in AYA undergoing cancer treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07217-w.
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Affiliation(s)
- Claire Munsie
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, Australia. .,WA Youth Cancer Service, Locked Bag 2012, Nedlands, WA, 6009, Australia. .,Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Jay Ebert
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Timothy Ackland
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, Australia
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Munsie C, Ebert J, Collins J, Plaster M, Joske D, Ackland T. A supervised exercise intervention during cancer treatment for adolescents and young adults-FiGHTING F!T: study protocol of a randomised controlled trial. Trials 2021; 22:676. [PMID: 34602065 PMCID: PMC8489079 DOI: 10.1186/s13063-021-05616-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND High-quality evidence supports the integration of exercise to mitigate treatment-related side effects in a wide range of paediatric and adult cancer cohorts. However, the implementation of exercise in adolescent and young adult (AYA) cancer patients is yet to be explored in depth. FiGHTINGF!T is a randomised controlled cross over trial designed to determine if a supervised, structured, and progressive exercise programme can reduce the decline in physical fitness (V02peak) associated with cancer treatment in AYAs from diagnosis. METHODS/DESIGN A total of 40 AYAs recently diagnosed and due to commence systemic treatment (± 2 weeks) for a primary haematological malignancy or solid tumour will be recruited and randomised to either an immediate exercise intervention or usual care (delayed exercise) for 10 weeks. This randomised controlled crossover trial will see both groups engage in a supervised exercise intervention from either diagnosis (baseline assessment) for 10 weeks (0-10 weeks) or following an interim assessment to 20 weeks (10-20 weeks). The bi-weekly tailored exercise programme will combine aerobic and resistance exercises and be supervised by an Accredited Exercise Physiologist. Participants will complete a range of assessments at 0, 10, and 20 weeks including cardiopulmonary exercise tests, 1 repetition maximum strength measures, physical functioning, and self-reported quality of life measurements. Patient-reported treatment-related toxicities will be recorded on a weekly basis. DISCUSSION The FiGHTINGF!T trial will provide insight into the potential benefits of a supervised exercise programme in AYAs undergoing cancer treatment. This trial will contribute to the evidence supporting the necessary integration of exercise during cancer treatment, specifically in the under-reported AYA cohort. TRIAL REGISTRATION This trial was registered retrospectively with the Australia New Zealand Clinical Trial registry ( ACTRN12620000663954 ). Registered on 10 June 2020.
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Affiliation(s)
- Claire Munsie
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - Jay Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
| | - Joanne Collins
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - Megan Plaster
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
- School of Medicine, University of Western Australia, Western Australia Perth, Australia
| | - Timothy Ackland
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
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Kent J, Joske D, Parry J. Diffuse large B cell lymphoma within an anal fistula: a case report with an intriguing possible aetiology. J Surg Case Rep 2021; 2021:rjab360. [PMID: 34408846 PMCID: PMC8367437 DOI: 10.1093/jscr/rjab360] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Described is a case of diffuse large B cell lymphoma that presented within a typical fistula tract, possibly secondary to oxidative stress within the fistula tract itself and consequent malignant change rather than a fistula as a consequence of necrosis in a lymphoma. If so it would be unique in the world literature. A 42-year-old fitness instructor presented with a typical appearing left lateral anal fistula. Biopsy of the fistulous tract revealed B cell lymphoma, graded 1E. Although chemotherapy cured the lymphoma, surgical treatment by ligation of the inter-sphincteric fistula tract was required to heal the fistula. At 3-year follow-up, there has been no recurrence of the lymphoma or the fistula. Neoplasia arising secondary to oxidative stress within an anal fistula is a well-established phenomenon. Early diagnosis of rare conditions associated with anal fistula can only be accomplished by routine biopsy of every fistula tract.
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Affiliation(s)
- James Kent
- Bentley Health Service, Department of Surgery, Perth, WA 6102, Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Department of Haematology, Nedlands, WA 6009, Australia
| | - Jeremy Parry
- Murdoch University, Department of Pathology, Murdoch, WA 6150, Australia
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5
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Koczwara B, Thornton-Benko E, Cohn RJ, Chan RJ, Rhee J, Joske D, Iddawela M, Vardy JL. Personalised cancer care in the era of precision medicine. Aust J Gen Pract 2021; 50:533-537. [PMID: 34333558 DOI: 10.31128/ajgp-04-21-5953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Advances in cancer treatment have not benefited all patients equally, underscoring the need for a personalised approach to care. OBJECTIVE The aim of this article is to outline the key elements of personalised cancer care, including delivery of goal-directed care, self-management and self-management support, care integration, focus on access and equity, reduction in cost and promotion of health literacy and e-health literacy. DISCUSSION Achievement of personalised cancer care requires a system-wide approach that targets the patient, healthcare provider and healthcare system with data informing practice. Primary care providers, including general practitioners (GPs) and practice nurses, play an important and growing part in the provision of personalised cancer care through support, advocacy, coordination, holistic care and health promotion. Cancer care systems can facilitate GPs' involvement in care through early input into multidisciplinary management, timely communication, rapid access to acute care and training opportunities.
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Affiliation(s)
- Bogda Koczwara
- BMBS, MBioethics, FRACP, Professor of Cancer Medicine, Flinders University, SA; Senior Staff Specialist, Department of Medical Oncology, Flinders Medical Centre, SA
| | - Elysia Thornton-Benko
- BSc, MBBS (Hons), PhD, FRACGP, Specialist General Practitioner, Sydney, NSW; Research Fellow, Behavioural Sciences Unit, Faculty of Medicine, University of New South Wales, Sydney, NSW; Kids Cancer Centre, Sydney Children@s Hospital, Randwick, NSW
| | - Richard J Cohn
- MBBCh, DCH, FRACP, Paediatric Haematologist Oncologist, Director of Survivorship Program, Kids Cancer Centre, Sydney Children@s Hospital, Randwick, NSW; Professor, School of Women@s and Children@s Health, University of New South Wales, Sydney, NSW
| | - Raymond J Chan
- RN, BNurs, MAppSci, PhD, FACN, Director and Professor in Cancer Nursing, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA
| | - Joel Rhee
- BSc (Med), MBBS (Hons), GCULT, PhD, FRACGP, Associate Professor of General Practice, General Practice Academic Unit, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW; Illawarra Health and Medical Research Institute, Wollongong, NSW; General Practitioner, HammondCare Centre for Positive Ageing and Care, Hammondville, NSW
| | - David Joske
- MBBS, FRACP, FRCPA, FCHSM, Clinical Haematologist, Sir Charles Gairdner Hospital, Nedlands, WA; Clinical Professor of Medicine, University of Western Australia, Crawley, WA
| | - Mahesh Iddawela
- MBBS, PhD, Medical Oncologist, Department of Medical Oncology, Alfred Health, Melbourne, Vic; Monash University, Melbourne, Vic
| | - Janette L Vardy
- BMed (Hons), FRACP, PhD, Professor of Cancer Medicine, Faculty of Medicine and Health, University of Sydney, NSW; Concord Cancer Centre, Concord Repatriation General Hospital, NSW
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6
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Bhabha FK, McCormack C, Wells J, Campbell BA, Newland K, Lade S, Buelens O, Joske D, Shortt J, Mapp S, Radeski D, Hertzberg M, Khot A, Van Der Weyden C, Khoo C, Hawkes E, Prince HM. Mycosis fungoides and Sézary syndrome: Australian clinical practice statement. Australas J Dermatol 2020; 62:e8-e18. [PMID: 33368169 DOI: 10.1111/ajd.13467] [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: 06/16/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
Primary cutaneous lymphomas represent a heterogeneous group of T- and B-cell lymphomas with distinct clinical presentations, histopathologic features, treatment approaches and outcomes. The cutaneous T-cell lymphomas, which include mycosis fungoides and Sézary syndrome, account for the majority of the cutaneous lymphomas. This Clinical Practice Statement is reflective of the current clinical practice in Australia. An expanded form of the Clinical Practice Statement (and updates), along with helpful patient resources and access to support groups, can be found at the following (http://www.australasianlymphomaalliance.org.au).
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Affiliation(s)
- Friyana K Bhabha
- Department of Dermatology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Christopher McCormack
- Department of Dermatology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jillian Wells
- Department of Dermatology, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Kate Newland
- Department of Dermatology, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Lade
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Odette Buelens
- Nurse Practitioner, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Joske
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jake Shortt
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Haematology, Monash Health, Clayton, Victoria, Australia
| | - Sally Mapp
- Haematology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Dejan Radeski
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Randwick, Australia
| | - Amit Khot
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carrie Van Der Weyden
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Christine Khoo
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Eliza Hawkes
- Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Victoria, Australia.,Eastern Health, Box Hill, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - H Miles Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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7
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Sutton E, De Santis D, Hay L, McKinnon E, D'Orsogna L, Joske D. Correlating HLA associations with follicular lymphoma in an Australian data set: A pilot study. HLA 2020; 96:192-193. [PMID: 32342606 DOI: 10.1111/tan.13918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/11/2020] [Accepted: 04/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Edwina Sutton
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Dianne De Santis
- Department of Clinical Immunology, PathWest, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Louise Hay
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Elizabeth McKinnon
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia
| | - Lloyd D'Orsogna
- Department of Clinical Immunology, PathWest, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - D Joske
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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8
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Sunderland AJ, Steiner RE, Al Zahrani M, Pinnix CC, Dabaja BS, Gunther JR, Nastoupil LJ, Jerkeman M, Joske D, Cull G, El‐Galaly T, Villa D, Cheah CY. An international multicenter retrospective analysis of patients with extranodal marginal zone lymphoma and histologically confirmed central nervous system and dural involvement. Cancer Med 2020; 9:663-670. [PMID: 31808316 PMCID: PMC6970027 DOI: 10.1002/cam4.2732] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022] Open
Abstract
Marginal zone lymphoma of the central nervous system (CNS MZL) is rare. The clinical features, treatment, and prognosis are not well characterized. We performed a multicenter retrospective study of CNS MZL. Twenty-six patients were identified: half with primary and half with secondary CNS involvement. The median age was 59 years (range 26-78), 62% female and 79% with ECOG performance status ≤ 1. The most common disease site was the dura (50%). Treatment was determined by the treating physician and varied substantially. After a median follow up of 1.9 years, the estimated 2-year progression-free (PFS) and overall survival (OS) rates were 59% and 80%, respectively. Secondary CNS MZL was associated with 2-year OS of 58%. CNS MZL is rare, but relative to other forms of CNS lymphoma, outcomes appear favorable, particularly among the subset of patients with dural presentation and primary CNS presentation.
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Affiliation(s)
| | | | - Musa Al Zahrani
- University of British Columbia and BC Cancer Centre for Lymphoid CancerVancouverBritish ColumbiaCanada
- Department of MedicineKing Saud University HospitalRiyadhSaudi Arabia
| | - Chelsea C. Pinnix
- Department of Radiation OncologyMD Anderson Cancer CenterHoustonTXUSA
| | | | | | | | | | - David Joske
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory Medicine WANedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
| | - Gavin Cull
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory Medicine WANedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
| | - Tarec El‐Galaly
- Department of HematologyAalborg University HospitalAalborgDenmark
| | - Diego Villa
- University of British Columbia and BC Cancer Centre for Lymphoid CancerVancouverBritish ColumbiaCanada
| | - Chan Yoon Cheah
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory Medicine WANedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
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9
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Vardy JL, Chan RJ, Koczwara B, Lisy K, Cohn RJ, Joske D, Dhillon HM, Jefford M. Clinical Oncology Society of Australia position statement on cancer survivorship care. Aust J Gen Pract 2019; 48:833-836. [DOI: 10.31128/ajgp-07-19-4999] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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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10
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Van Der Nest BM, Leslie C, Joske D, Radeski D, White R, Cheah CY. Peripheral T-Cell Lymphoma Arising in Patients With Chronic Lymphocytic Leukemia. Am J Clin Pathol 2019; 152:818-827. [PMID: 31433844 DOI: 10.1093/ajcp/aqz109] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To describe three further cases of anaplastic large cell lymphoma (ALCL) occurring in patients with preexisting chronic lymphocytic leukemia (CLL). We also reviewed the literature of previously published cases. METHODS We discuss the clinical features, histopathology, and outcomes for three patients with ALCL and CLL from Perth, Australia. The cases were also included in a literature review of existing cases and comparisons were made with our cohort. RESULTS The three patients included two men (aged 77 and 74 years) and one woman (aged 66 years). All had a history of untreated CLL with diagnosis established 4 to 16 years before. They had lymphadenopathy and/or cutaneous/soft tissue lesions that proved to be ALCL, ALK+ (one case) or ALCL, ALK- (two cases). CONCLUSIONS Further research is required in this area to establish prognostic and management recommendations. Increasing numbers of cases are being described. Positron emission tomography with computed tomography was not useful in our cohort for diagnosing progression.
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Affiliation(s)
| | - Connull Leslie
- Department of Anatomical Pathology, Pathwest Laboratory Medicine, Perth, Australia
| | - David Joske
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- Pathwest Laboratory Medicine WA, Nedlands, Australia
- Medical School, University of Western Australia, Crawley
| | - Dejan Radeski
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- Pathwest Laboratory Medicine WA, Nedlands, Australia
- Medical School, University of Western Australia, Crawley
| | - Rohen White
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- Pathwest Laboratory Medicine WA, Nedlands, Australia
- Medical School, University of Western Australia, Crawley
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11
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Taylor K, Chivers P, Bulsara C, Joske D, Bulsara M, Monterosso L. Care After Lymphoma (CALy) trial: A phase II pilot pragmatic randomised controlled trial of a nurse-led model of survivorship care. Eur J Oncol Nurs 2019; 40:53-62. [DOI: 10.1016/j.ejon.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 01/02/2023]
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12
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Munsie C, Ebert J, Joske D, Ackland T. The Benefit of Physical Activity in Adolescent and Young Adult Cancer Patients During and After Treatment: A Systematic Review. J Adolesc Young Adult Oncol 2019; 8:512-524. [PMID: 31090475 DOI: 10.1089/jayao.2019.0013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cancer and its associated therapies can severely impact the physical and psychosocial functioning of adolescent and young adults (AYAs), both during treatment and well into survivorship. Physical activity during and after cancer treatment could be beneficial to the AYA population, although this cohort has received little scientific attention. A systematic search of the literature was conducted to investigate current exercise interventions in AYA-specific populations. Studies were eligible for inclusion if >50% of the study population was aged between 15 and 25 years and the study included a physical activity intervention during or after cancer treatment. Studies were critically appraised using the Cochrane Risk of Bias tool. Six articles were identified as meeting the criteria, of which 2 were nonrandomized controlled studies and 4 were pilot studies, comprising a total of 135 AYA participants. The quality of studies was variable across all assessed domains. Direct comparison on intervention outcomes was not possible due to the heterogeneity of the studies; however, trends emerged on the feasibility, acceptability, and potential positive impact of physical activity in this cohort. This review highlights the lack of high-quality studies aimed to improve physical and psychosocial functioning in AYA patients across the cancer continuum. Physical activity interventions in this cohort appear to be feasible; however, larger randomized controlled trials are warranted to investigate the direct impact of interventions on health outcomes in this cohort.
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Affiliation(s)
- Claire Munsie
- School of Human Sciences, University of Western Australia, Perth, Australia.,WA Youth Cancer Service, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
| | - Jay Ebert
- School of Human Sciences, University of Western Australia, Perth, Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Timothy Ackland
- School of Human Sciences, University of Western Australia, Perth, Australia
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13
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Lasica M, Willcox A, Burbury K, Ross DM, Branford S, Butler J, Filshie R, Januszewicz H, Joske D, Mills A, Simpson D, Tam C, Taylor K, Watson AM, Wolf M, Grigg A. The effect of tyrosine kinase inhibitor interruption and interferon use on pregnancy outcomes and long-term disease control in chronic myeloid leukemia. Leuk Lymphoma 2019; 60:1796-1802. [PMID: 30632843 DOI: 10.1080/10428194.2018.1551533] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The management of CML in pregnancy is challenging with the need to balance disease control against potential teratogenic effects of TKI therapy. In this multi-center case-cohort study of 16 women in chronic phase, CML ceased TKI treatment pre- or post-conception during their first pregnancy. Thirteen patients were on imatinib; 9 ceased their TKI prior to conception and 7 ceased at pregnancy confirmation. Twelve patients had achieved either MMR or better at time of TKI cessation. Eleven women lost MMR during pregnancy and two patients lost CHR. Fourteen women reestablished MMR on TKI recommenced. The depth molecular response prior to conception appeared to correlate well with restoration of disease control on TKI recommencement though duration of MMR did not appear to be as important. While interruption of TKI treatment for pregnancy usually leads to loss of molecular response, loss of hematological response is uncommon and disease control is reestablished with resumption of therapy in the majority of women.
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Affiliation(s)
- Masa Lasica
- a Department of Clinical Hematology , Austin Hospital , Heidelberg , Australia
| | - Abbey Willcox
- a Department of Clinical Hematology , Austin Hospital , Heidelberg , Australia.,b Australian Centre for Blood Disease , Monash University , Melbourne , Australia
| | - Kate Burbury
- c Peter MacCallum Cancer Centre , East Melbourne , Australia
| | - David M Ross
- d Bedford Park , Flinders University and Medical Centre , Adelaide Australia
| | - Susan Branford
- e Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia , Adelaide , Australia
| | - Jason Butler
- f Royal Brisbane and Women's Hospital , Brisbane , Australia
| | | | | | - David Joske
- h Sir Charles Gairdner Hospital , Nedlands , Australia
| | - Anthony Mills
- i Ramsay Specialist Centre, Greenslopes Private Hospital , Greenslopes , Australia
| | - David Simpson
- j North Shore Hospital, Waitemata District Health Board , Auckland , New Zealand
| | - Constantine Tam
- c Peter MacCallum Cancer Centre , East Melbourne , Australia
| | - Kerry Taylor
- k Icon Cancer Care, Mater Medical Centre , South Brisbane , Australia
| | | | - Max Wolf
- c Peter MacCallum Cancer Centre , East Melbourne , Australia
| | - Andrew Grigg
- a Department of Clinical Hematology , Austin Hospital , Heidelberg , Australia
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14
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de Wet R, Lane H, Tandon A, Augustson B, Joske D. 'It is a journey of discovery': living with myeloma. Support Care Cancer 2018; 27:2435-2442. [PMID: 30368672 DOI: 10.1007/s00520-018-4502-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/14/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Although multiple myeloma (MM) is incurable, many people live with the disease for a number of years. Thus, understanding the effect of the disease and its therapies on the lives of those with MM is important. This qualitative study explores the impact of MM and its treatments on patients. METHODS People with newly diagnosed or relapsed MM were recruited from a tertiary institution. Participants were interviewed using a semi-structured approach. The questions were designed to obtain insight into how participants viewed their diagnosis, treatment, and symptoms and how these had impacted on their lives. Data were analysed using a phenomenological approach. RESULTS Fifteen people with MM with a mean age of 62 were recruited. Participants' mean time since diagnosis was 2.7 years and they had received a mean of 1.7 lines of therapy. The first major theme to emerge was lifestyle changes. Interviewees described MM as causing changes to all aspects of their lives, including substantial functional changes, as well as changes to employment, relationships, and their sense of self. The second major theme was 'adjust, adjust, adjust'. Alongside challenging life changes, participants described a range of practical, psychological, and relational approaches to adjusting to living with MM. CONCLUSION This study highlights the importance of and the need for improved supportive care in patients with MM, ideally with a multidisciplinary approach. It also identifies the potential for further investigation of patient approaches to adjusting to MM and development of support strategies.
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Affiliation(s)
- Rosslyn de Wet
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Heather Lane
- Rockingham General Hospital, Elanora Dr, Cooloongup, WA, 6168, Australia
| | - Anil Tandon
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Bradley Augustson
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia
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15
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Chin CK, Tsang E, Mediwake H, Khair W, Biccler J, Hapgood G, Mollee P, Nizich Z, Joske D, Radeski D, Cull G, Villa D, El-Galaly TC, Cheah CY. Frequency of bowel perforation and impact of bowel rest in aggressive non-Hodgkin lymphoma with gastrointestinal involvement. Br J Haematol 2018; 184:826-828. [PMID: 29676487 DOI: 10.1111/bjh.15173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- C K Chin
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - E Tsang
- British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - H Mediwake
- Cancer Care Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - W Khair
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - J Biccler
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - G Hapgood
- Cancer Care Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - P Mollee
- Cancer Care Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Z Nizich
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - D Joske
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Department of Haematology, Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia.,Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - D Radeski
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Department of Haematology, Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia.,Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - G Cull
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Department of Haematology, Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia.,Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - D Villa
- British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - T C El-Galaly
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - C Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Department of Haematology, Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia.,Medical School, University of Western Australia, Crawley, Western Australia, Australia
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16
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Sharma S, Joske D, Watson D, Caccetta T, Baltic S, Kumarasinghe SP. Schnitzler syndrome: A rare cause of chronic recalcitrant urticaria successfully treated with Anakinra. Australas J Dermatol 2017; 59:e222-e224. [DOI: 10.1111/ajd.12731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Surabhi Sharma
- Department of Dermatology; Fiona Stanley Hospital; Perth Western Australia Australia
| | - David Joske
- Sir Charles Gairdner Hospital; Perth Western Australia Australia
- School of Medicine and Pharmacology; University of Western Australia; Perth Western Australia Australia
| | - David Watson
- St John of God Subiaco Hospital; Perth Western Australia Australia
| | - Tony Caccetta
- Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - Svetlana Baltic
- School of Medicine and Pharmacology; University of Western Australia; Perth Western Australia Australia
- Harry Perkins Institute of Medical Research; QEII Medical Centre; Perth Western Australia Australia
| | - Sujith Prasad Kumarasinghe
- Department of Dermatology; Fiona Stanley Hospital; Perth Western Australia Australia
- School of Medicine and Pharmacology; University of Western Australia; Perth Western Australia Australia
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17
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Monterosso L, Taylor K, Platt V, Lobb E, Musiello T, Bulsara C, Stratton K, Joske D, Krishnasamy M. Living With Multiple Myeloma: A Focus Group Study of Unmet Needs and Preferences for Survivorship Care. J Patient Exp 2017; 5:6-15. [PMID: 29582005 PMCID: PMC5862374 DOI: 10.1177/2374373517715011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Indexed: 11/25/2022] Open
Abstract
Purpose: To describe the unmet informational, psychological, emotional, social, practical, and physical needs and preferences for posttreatment survivorship care of individuals living with multiple myeloma to inform the development of relevant, person-centered, survivorship services. Methods: An exploratory, descriptive study using 2 focus groups with 14 participants, 6 to 49 months postdiagnosis. Results: Thematic analysis revealed 7 key themes: information needs, experience with health-care professionals, coping with side effects, communicating with family and friends, dealing with emotions, support needs, and living with the chronicity of myeloma. Participants described key characteristics of survivorship care relevant to their needs and indicated they would like a more whole of person approach to follow-up when the main treatment phases had completed. Conclusion: Participants in this study described unmet needs across a breadth of domains that varied over time. The development of flexible, person-centered approaches to comprehensive survivorship care is needed to address the considerable quality-of-life issues experienced by people living with multiple myeloma. Nurse-led care may offer 1 viable model to deliver enhanced patient experience—providing the vital “link” that people described as missing from their survivorship care.
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Affiliation(s)
- Leanne Monterosso
- Centre for Nursing and Midwifery Research, School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,St John of God Murdoch Hospital, Western Australia, Australia.,School of Nursing, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karen Taylor
- Centre for Nursing and Midwifery Research, School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Western Australia Cancer and Palliative Care Network, Perth, Australia
| | - Violet Platt
- Centre for Nursing and Midwifery Research, School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Western Australia Cancer and Palliative Care Network, Perth, Australia
| | - Elizabeth Lobb
- Calvary Health Care Kogarah, New South Wales and Cunningham Centre for Palliative Care, Darlinghurst, New South Wales, Australia.,School of Medicine, The University of Notre Dame, Darlinghurst, New South Wales, Australia
| | - Toni Musiello
- School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Caroline Bulsara
- Centre for Nursing and Midwifery Research, School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Kendall Stratton
- Centre for Nursing and Midwifery Research, School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,WA Youth Cancer Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Meinir Krishnasamy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia
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18
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Chin C, Tsang E, Mediwake H, Khair W, Biccler J, El-Galaly T, Hapgood G, Mollee P, Villa D, Nizich Z, Joske D, Radeski D, Cull G, Cheah C. FREQUENCY OF PERFORATION & IMPACT OF BOWEL REST IN AGGRESSIVE NON-HODGKIN LYMPHOMA WITH GASTROINTESTINAL INVOLVEMENT: AN INTERNATIONAL, MULTI-CENTER RETROSPECTIVE STUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- C.K. Chin
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Australia
| | - E. Tsang
- Division of Medical Oncology, British Columbia Cancer Agency; Vancouver Canada
| | - H. Mediwake
- Cancer Care Services, Princess Alexandra Hospital; Woolloongabba Australia
| | - W. Khair
- Department of Haematology; Aalborg University Hospital; Aalborg Denmark
| | - J.L. Biccler
- Department of Haematology; Aalborg University Hospital; Aalborg Denmark
| | - T.C. El-Galaly
- Department of Haematology; Aalborg University Hospital; Aalborg Denmark
| | - G. Hapgood
- Cancer Care Services, Princess Alexandra Hospital; Woolloongabba Australia
| | - P. Mollee
- Cancer Care Services, Princess Alexandra Hospital; Woolloongabba Australia
| | - D. Villa
- Division of Medical Oncology, British Columbia Cancer Agency; Vancouver Canada
| | - Z. Nizich
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Australia
| | - D. Joske
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Australia
| | - D. Radeski
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Australia
| | - G. Cull
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Australia
| | - C.Y. Cheah
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Australia
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19
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Monterosso L, Taylor K, Platt V, Lobb E, Krishnasamy M, Musiello T, Bulsara C, Stratton K, Joske D. A qualitative study of the post-treatment experiences and support needs of survivors of lymphoma. Eur J Oncol Nurs 2017; 28:62-68. [PMID: 28478857 DOI: 10.1016/j.ejon.2017.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 09/19/2016] [Revised: 02/10/2017] [Accepted: 03/05/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore the post-treatment experiences and preferences for follow-up support of lymphoma survivors. METHODS Two focus groups were conducted with 17 participants to explore informational, psychological, emotional, social, practical and physical needs, 6-30 months post-treatment for lymphoma. Perceptions regarding a potential model of survivorship care were also elicited. RESULTS Thematic content analysis revealed five key themes: Information; Loss and uncertainty; Family, support and post-treatment experience; Transition, connectivity and normalcy, and Person-centred post-treatment care. Participants described a sense of loss as they transitioned away from regular interaction with the hospital at the end of treatment, but also talked about the need to find a "new normal". Establishing post-treatment support structures that can provide individualised information, support, reassurance and referrals to community and peer support were identified as a helpful way to navigate the transition from patient to post-treatment survivor. CONCLUSIONS Participants in our study articulated a need for a flexible approach to survivorship care, providing opportunities for individuals to access different types of support at different times post-treatment. Specialist post-treatment nurse care coordinators working across acute and community settings may offer one effective model of post-treatment support for survivors of haematological malignancies.
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Affiliation(s)
- Leanne Monterosso
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia; St John of God Murdoch Hospital, Western Australia, Australia; School of Nursing, Edith Cowan University Joondalup, Western Australia, Australia.
| | - Karen Taylor
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia; Western Australia Cancer and Palliative Care Network, Perth, Australia
| | - Violet Platt
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia; Western Australia Cancer and Palliative Care Network, Perth, Australia
| | - Elizabeth Lobb
- Calvary Health Care, Kogarah, New South Wales, Australia; Cunningham Centre for Palliative Care, Darlinghurst, New South Wales, Australia; The University of Notre Dame, Darlinghurst, New South Wales, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Victoria, Australia; Research and Education Lead-Nursing, The Victorian Comprehensive Cancer Centre, Victoria, Australia
| | - Toni Musiello
- University of Western Australia, Crawley, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Kendall Stratton
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - David Joske
- University of Western Australia, Crawley, Western Australia, Australia; Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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20
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Williams AM, Lester L, Bulsara C, Petterson A, Bennett K, Allen E, Joske D. Patient Evaluation of Emotional Comfort Experienced (PEECE): developing and testing a measurement instrument. BMJ Open 2017; 7:e012999. [PMID: 28122833 PMCID: PMC5278251 DOI: 10.1136/bmjopen-2016-012999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/19/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The Patient Evaluation of Emotional Comfort Experienced (PEECE) is a 12-item questionnaire which measures the mental well-being state of emotional comfort in patients. The instrument was developed using previous qualitative work and published literature. DESIGN Instrument development. SETTING Acute Care Public Hospital, Western Australia. PARTICIPANTS Sample of 374 patients. INTERVENTIONS A multidisciplinary expert panel assessed the face and content validity of the instrument and following a pilot study, the psychometric properties of the instrument were explored. MAIN OUTCOME MEASURES Exploratory and confirmatory factor analysis assessed the underlying dimensions of the PEECE instrument; Cronbach's α was used to determine the reliability; κ was used for test-retest reliability of the ordinal items. RESULTS 2 factors were identified in the instrument and named 'positive emotions' and 'perceived meaning'. A greater proportion of male patients were found to report positive emotions compared with female patients. The instrument was found to be feasible, reliable and valid for use with inpatients and outpatients. CONCLUSIONS PEECE was found to be a feasible instrument for use with inpatient and outpatients, being easily understood and completed. Further psychometric testing is recommended.
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Affiliation(s)
- A M Williams
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - L Lester
- Health Promotion Evaluation Unit, School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - C Bulsara
- School of Nursing and Midwifery, Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - A Petterson
- SolarisCare Foundation, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - K Bennett
- School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - E Allen
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - D Joske
- Department of Haematology, Sir Charles Gairdner Hospital, The University of Western Australia, Crawley, Western Australia, Australia
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21
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Cornwall S, Cull G, Joske D, Ghassemifar R. Green tea polyphenol "epigallocatechin-3-gallate", differentially induces apoptosis in CLL B-and T-Cells but not in healthy B-and T-Cells in a dose dependant manner. Leuk Res 2016; 51:56-61. [PMID: 27855324 DOI: 10.1016/j.leukres.2016.10.011] [Citation(s) in RCA: 10] [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: 09/13/2016] [Revised: 10/24/2016] [Accepted: 10/31/2016] [Indexed: 01/18/2023]
Abstract
B-cell chronic lymphocytic leukaemia (CLL) is characterized by an accumulation of CD5-positive monoclonal B-cells due in large part to a failure of apoptosis. The ability to study CLL B-cells in vitro has always been a challenge and hampered by the low viability of the CLL B-cells in cell culture systems. In this study, we present a multicellular cell culture system to maintain CLL B-cells viable in culture for 60h in the presence of a stromal cell feeder layer in combination with a whole white blood cell preparation. Using this optimized system, we tested and showed that the addition of epigallocatechin-3-gallate (EGCG) at concentrations ranging from 25 to 100μg/ml induced apoptosis in CLL B-cells whilst not affecting healthy control B-cells. Moreover, the results showed that in contrast to healthy controls, T-cells from CLL patients underwent apoptosis in the presence of EGCG. This study demonstrated that the combination of a cell feeder layer with a whole white blood cell preparation maintained B-cell viability in vitro over an extended period of time. In addition, the study showed that EGCG differentially induces apoptosis in CLL B-and T-Cells but not in healthy B-and T-Cells in a dose dependent manner.
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Affiliation(s)
- Scott Cornwall
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia
| | - Gavin Cull
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia; Haematology Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - David Joske
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia; Haematology Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia
| | - Reza Ghassemifar
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia.
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22
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Musiello T, Dixon G, O'Connor M, Cook D, Miller L, Petterson A, Saunders C, Joske D, Johnson C. A pilot study of routine screening for distress by a nurse and psychologist in an outpatient haematological oncology clinic. Appl Nurs Res 2016; 33:15-18. [PMID: 28096010 DOI: 10.1016/j.apnr.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 04/27/2016] [Revised: 07/28/2016] [Accepted: 09/22/2016] [Indexed: 10/21/2022]
Abstract
AIM To explore the: 1) prevalence of distress, type of problems experienced by haematological patients, and referrals for supportive care; 2) effect of demographic and clinical variables on distress, and 3) effect on the time of health professionals conducting the screening in the ambulatory chemotherapy setting. METHODS Participants completed the National Comprehensive Cancer Network Distress Thermometer and Problem List and had a follow-up screening discussion with a health professional. RESULTS Of 68 participants, 40% reported significant distress (≥4) on the Distress Thermometer (mean 3.2, SD 2.4). All patients reported physical problems and 72% reported emotional problems-the major contributors to distress and to time spent with the health professional. Distress was unrelated to age, gender or cancer type. Patients were less likely to have significant distress at the end of treatment than at the beginning (OR=0.15, 95% CI: 0.03; 0.72,). Forty patients (59%) were referred to supportive services. The psychologist spent less time with patients compared to the nurse (18 vs 48min, p<0.001). The more emotional problems reported, the greater the time spent with the patient (rs=0.34, p=0.009). CONCLUSIONS Nurses can appropriately screen for distress and address significant distress reported by haematology patients undergoing chemotherapy without over burdening the nurse or patient.
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Affiliation(s)
- Toni Musiello
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Glenys Dixon
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, Kent St, Bentley, Western Australia 6102, Australia
| | - Deb Cook
- Department of Haematology, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Lisa Miller
- Department of Psychiatry, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Anna Petterson
- SolarisCare, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Christobel Saunders
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - David Joske
- Department of Haematology, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia; SolarisCare, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Claire Johnson
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
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23
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Cheah CY, Joske D, Cull G, Gilbertson M, Opat SS, Tam CS, Wirth A, Seymour JF. High-dose therapy and autologous stem cell transplantation may only be applicable to selected patients with secondary CNS diffuse large B-cell lymphoma. Br J Haematol 2016; 178:991-994. [PMID: 27470657 DOI: 10.1111/bjh.14187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia
| | - David Joske
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia
| | - Gavin Cull
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia
| | - Michael Gilbertson
- Department of Haematology, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
| | - Stephen S Opat
- Department of Haematology, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
| | - Constantine S Tam
- Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Andrew Wirth
- University of Melbourne, Parkville, Victoria, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia
| | - John F Seymour
- Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
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24
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Taylor K, Joske D, Bulsara M, Bulsara C, Monterosso L. Protocol for Care After Lymphoma (CALy) trial: a phase II pilot randomised controlled trial of a lymphoma nurse-led model of survivorship care. BMJ Open 2016; 6:e010817. [PMID: 27194317 PMCID: PMC4874152 DOI: 10.1136/bmjopen-2015-010817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Lymphoma is the sixth most common cancer diagnosed in Australia and internationally. Owing to the aggressive nature of the disease and intensity of treatment, survivors face long-term effects that impact on quality of life. Current models of follow-up post-treatment fail to address these complex issues. Given that 74% of patients with lymphoma cancer now survive 5 years beyond diagnosis and treatment, it is important to address this gap in care. AIM To determine self-reported informational and practical needs, anxiety, depression, stress, coping and empowerment at baseline, 3 and 6 months. METHODS AND ANALYSIS A pilot randomised controlled trial will test the effect of a nurse-led lymphoma survivorship clinic compared with usual post-treatment care at a large tertiary cancer centre in Western Australia. The intervention will comprise three face-to-face appointments with delivery of tailored resources, a survivorship care plan and treatment summary (SCP TS). The SCP TS will be given to the participant and general practitioner (GP). Intervention participants will be interviewed at completion to explore the perceived value of the intervention components and preferred dose. An evaluation developed for GPs will assess receipt and use of SCP TS. The primary intent of analysis will be to address the feasibility of a larger trial and requisite effect and sample size. ETHICS AND DISSEMINATION Ethics approval has been granted by the University of Notre Dame Australia and Sir Charles Gairdner Hospital in Western Australia. Peer-reviewed publications and conference presentations will report the results of this phase II trial. TRIAL REGISTRATION NUMBER ANZCTRN12615000530527; Pre-results.
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Affiliation(s)
- Karen Taylor
- Western Australia Cancer and Palliative Care Network, Perth, Western Australia, Australia
- School of Nursing and Midwifery and Centre for Nursing and Midwifery Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery and Centre for Nursing and Midwifery Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Leanne Monterosso
- School of Nursing and Midwifery and Centre for Nursing and Midwifery Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- St John of God Hospital, Murdoch, Western Australia, Australia
- School of Nursing, Edith Cowan University, Joondalup, Western Australia, Australia
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Lucas M, Jeelall Y, Kavanagh S, Bundell C, Hew M, Wood BA, Joske D, McLean-Tooke A. B-cell small lymphocytic lymphoma associated with extremely high total IgE and cutaneous vasculitis. J Allergy Clin Immunol Pract 2016; 4:552-4. [PMID: 26883544 DOI: 10.1016/j.jaip.2015.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/24/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Michaela Lucas
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia.
| | - Yogesh Jeelall
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Simon Kavanagh
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Christine Bundell
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Meilyn Hew
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Benjamin A Wood
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - David Joske
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
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Bates SE, Eisch R, Ling A, Rosing D, Turner M, Pittaluga S, Prince HM, Kirschbaum MH, Allen SL, Zain J, Geskin LJ, Joske D, Popplewell L, Cowen EW, Jaffe ES, Nichols J, Kennedy S, Steinberg SM, Liewehr DJ, Showe LC, Steakley C, Wright J, Fojo T, Litman T, Piekarz RL. Romidepsin in peripheral and cutaneous T-cell lymphoma: mechanistic implications from clinical and correlative data. Br J Haematol 2015; 170:96-109. [PMID: 25891346 PMCID: PMC4675455 DOI: 10.1111/bjh.13400] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 11/10/2014] [Accepted: 02/04/2015] [Indexed: 01/02/2023]
Abstract
Romidepsin is an epigenetic agent approved for the treatment of patients with cutaneous or peripheral T-cell lymphoma (CTCL and PTCL). Here we report data in all patients treated on the National Cancer Institute 1312 trial, demonstrating long-term disease control and the ability to retreat patients relapsing off-therapy. In all, 84 patients with CTCL and 47 with PTCL were enrolled. Responses occurred early, were clinically meaningful and of very long duration in some cases. Notably, patients with PTCL receiving romidepsin as third-line therapy or later had a comparable response rate (32%) of similar duration as the total population (38%). Eight patients had treatment breaks of 3.5 months to 10 years; in four of six patients, re-initiation of treatment led to clear benefit. Safety data show slightly greater haematological and constitutional toxicity in PTCL. cDNA microarray studies show unique individual gene expression profiles, minimal overlap between patients, and both induction and repression of gene expression that reversed within 24 h. These data argue against cell death occurring as a result of an epigenetics-mediated gene induction programme. Together this work supports the safety and activity of romidepsin in T-cell lymphoma, but suggests a complex mechanism of action.
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Affiliation(s)
- Susan E. Bates
- Developmental Therapeutics Branch, NCI, NIH, Bethesda, MD
| | - Robin Eisch
- Developmental Therapeutics Branch, NCI, NIH, Bethesda, MD
| | - Alex Ling
- Department of Radiology, Warren G Magnuson Clinical Center, NIH, Bethesda, MD
| | | | | | | | - H. Miles Prince
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Mark H. Kirschbaum
- Hematological Malignancies, Penn State Hershey Medical Center, Hershey, PA
| | - Steven L. Allen
- Hofstra North Shore-LIJ School of Medicine and Monter Cancer Center, Lake Success, NY
| | | | - Larisa J. Geskin
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Joske
- Sir Charles Gairdner Hospital, Nedlands, Western Australia
| | | | | | | | | | | | | | | | | | | | - John Wright
- Cancer Therapy Evaluation Program, DCTDC, NCI, Bethesda, MD
| | - Tito Fojo
- Center for Cancer Research, NCI, Bethesda, MD
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Forster L, McCooke J, Bellgard M, Joske D, Finlayson J, Ghassemifar R. Differential gene expression analysis in early and late erythroid progenitor cells in β-thalassaemia. Br J Haematol 2015; 170:257-67. [DOI: 10.1111/bjh.13432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Luke Forster
- School of Pathology and Laboratory Medicine; University of Western Australia; Nedlands WA Australia
| | - John McCooke
- Centre for Comparative Genomics; Murdoch University; Murdoch WA Australia
| | - Matthew Bellgard
- Centre for Comparative Genomics; Murdoch University; Murdoch WA Australia
| | - David Joske
- Department of Haematology; PathWest Laboratory Medicine; Queen Elizabeth II Medical Centre; Nedlands WA Australia
| | - Jill Finlayson
- School of Pathology and Laboratory Medicine; University of Western Australia; Nedlands WA Australia
- Department of Haematology; PathWest Laboratory Medicine; Queen Elizabeth II Medical Centre; Nedlands WA Australia
| | - Reza Ghassemifar
- School of Pathology and Laboratory Medicine; University of Western Australia; Nedlands WA Australia
- Department of Haematology; PathWest Laboratory Medicine; Queen Elizabeth II Medical Centre; Nedlands WA Australia
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Chai SM, Kavangh S, Ooi SS, Sterrett GF, Cull G, Plunkett M, Spagnolo D, Amanuel B, Joske D, Leslie C, Barham T, Frost F. Anaplastic large-cell lymphoma associated with breast implants: A unique entity within the spectrum of peri-implant effusions. Diagn Cytopathol 2014; 42:929-38. [DOI: 10.1002/dc.23152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 03/09/2014] [Accepted: 03/13/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Siaw Ming Chai
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Simon Kavangh
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Sin Sin Ooi
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Gregory F. Sterrett
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - Gavin Cull
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Myfanwy Plunkett
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Dominic Spagnolo
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - Benhur Amanuel
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - David Joske
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - Connull Leslie
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Tony Barham
- Perth Medical Laboratories; Fremantle Western Australia Australia
| | - Felicity Frost
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
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Chow A, Phillips M, Siew T, Cull G, Augustson B, Ward M, Joske D. Prognostic nomogram for diffuse large B-cell lymphoma incorporating the International Prognostic Index with interim-positron emission tomography findings. Intern Med J 2014; 43:932-9. [PMID: 23692386 DOI: 10.1111/imj.12194] [Citation(s) in RCA: 13] [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: 11/08/2012] [Accepted: 05/06/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND/AIMS Results from interim-positron emission tomography (PET) studies in diffuse large B-cell lymphoma (DLBCL) patients are varied. We evaluated the prognostic value of interim-PET in our centre. To improve concordance, interim-PET was combined with the International Prognostic Index (IPI). METHODS We retrospectively reviewed 100 new consecutive DLBCL patients treated with immunochemotherapy from 2005 to 2010. Twenty-four patients did not receive interim-PET and were excluded. Interim-PET images were re-examined using a qualitative assessment technique. Progression-free survival (PFS) and overall survival (OS) were analysed by the Cox proportional hazards model and prognostic accuracy was assessed using Harrell's C statistics (C). RESULTS Eleven patients were positive, and 65 were negative at interim-PET. The 2-year OS and PFS were 70.8% and 60.0%, respectively, in the PET-negative group, 36.4% and 36.4% for the PET-positive group (log-rank P-value 0.0008 for PFS, 0.0001 for OS). The IPI and interim-PET were minimally correlated. On Cox regression analysis, both were significant indicators of PFS (P < 0.001 and P = 0.002 respectively). The prognostic accuracy for PFS of a negative PET result was limited (C = 0.63), as it was for IPI (C = 0.75), but with the two indicators combined, the predictive accuracy was improved (C = 0.81). A nomogram, predictive for relapse-free survival at 2 years, was constructed. CONCLUSION In DLBCL patients treated with immunochemotherapy, the IPI and interim-PET provide independent prognostic information. In combination, a more powerful predictive model may be created as a nomogram. This can be refined in prospective trials and may help clinical decision making.
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Affiliation(s)
- A Chow
- Haematology Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Gangatharan SA, Grove CS, P'ng S, O'Reilly J, Joske D, Leahy MF, Threlfall T, Wright MP. Acute myeloid leukaemia in Western Australia 1991-2005: a retrospective population-based study of 898 patients regarding epidemiology, cytogenetics, treatment and outcome. Intern Med J 2014; 43:903-11. [PMID: 23611681 DOI: 10.1111/imj.12169] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/18/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patient characteristics and cytogenetics of acute myeloid leukaemia (AML) in clinical trials do not reflect that of the general population. There has not been a large population-based study that has examined cytogenetic features and outcomes of AML in Australia. AIM Investigation of epidemiological, prognostic, treatment and outcome data in adults diagnosed with AML in Western Australia between 1991 and 2005. METHODS Patients were identified utilising the Western Australia Cancer Registry, cytogenetic databases and hospital inpatient discharge diagnoses. Data were retrospectively collected from patients presenting to tertiary hospitals on patient characteristics, karyotype, induction therapy, remission, transplantation and survival. RESULTS A total of 987 patients with AML was identified, of which 91% (898) attended a tertiary hospital. Median age was 67 years and 45% of cases represented secondary AML. Cytogenetic analysis was available in 81% of patients. Frequent karyotypes were normal (38.8%), complex (13.8%) and -7/add(7q)/del(7q) (12.1%). Aggressive therapy was initiated in 62.6%. Less than 15% were enrolled in clinical trials. Overall 16.5% received a stem cell transplant. Median overall survival for all patients was 5.6 months. In patients treated aggressively, complete remission was achieved in 56.9% and median overall survival was 12.2 months. Age, secondary disease and karyotype were significantly predictive of remission and overall survival. CONCLUSION Age distribution, remission and survival rates were comparable with published population-based studies. High median age was reflected in the rate of secondary AML and trial eligibility. These findings highlight the need for prospective data collection.
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Affiliation(s)
- S A Gangatharan
- Department of Haematology, Royal Perth Hospital, Perth, Australia.
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Iacobelli J, Singh G, Joske D, Spagnolo D, Giardina T, Wood BA. 19. Folliculotropic mycosis fungoides with cysts and comedones. Pathology 2013. [DOI: 10.1097/01.pat.0000427019.49170.02] [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: 11/25/2022]
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Abstract
AIMS AND OBJECTIVES This paper describes further testing of the instrument Patient Evaluation of Emotional Care during Hospitalisation. BACKGROUND In 2005, a questionnaire was developed that could be completed by patients to evaluate the quality of emotional care received during their time in hospital. This questionnaire was tested at an acute care private hospital in Perth, Western Australia, with encouraging estimates of reliability and validity. The purpose of this study was to further test this questionnaire in a larger sample of inpatients at a public hospital in the same state. DESIGN Psychometric evaluation. METHOD A hospital-wide survey of 13 wards of a public hospital was conducted. Two hundred and fifty-one patients completed the questionnaire. RESULTS Psychometric testing of the Patient Evaluation of Emotional Care during Hospitalisation demonstrated acceptable internal consistency reliability. Confirmatory factor analysis substantiated the four sub-scales as follows: Level of Security, Level of Knowing, Level of Personal Value and Level of Connection. The Level of Connection sub-scale was assessed for the first time in this study. This sub-scale had the lowest mean score of all the sub-scales across the hospital as well as in each of the wards surveyed. Qualitative data substantiated, from the patients’ perspective, a lack of connection with hospital staff. CONCLUSIONS Further psychometric testing of the Patient Evaluation of Emotional Care during Hospitalisation instrument has confirmed its psychometric properties and usefulness as an instrument to measure emotional care during hospitalisation. RELEVANCE TO CLINICAL PRACTICE The Patient Evaluation of Emotional Care during Hospitalisation is a reliable and valid tool with which the emotional care of patients in hospital can be measured and the effectiveness of interventions assessed.
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Affiliation(s)
- Anne M Williams
- Clinical Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Faculty of Computing, Health and Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.
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Royle JA, Baade PD, Joske D, Girschik J, Fritschi L. Second cancer incidence and cancer mortality among chronic lymphocytic leukaemia patients: a population-based study. Br J Cancer 2011; 105:1076-81. [PMID: 21847118 PMCID: PMC3185934 DOI: 10.1038/bjc.2011.313] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Patients with chronic lymphocytic leukaemia (CLL) are known to have increased risks of second cancer. The incidence of second cancers after CLL has not been reported in detail for Australia, a country with particularly high levels of ultraviolet radiation (UVR). Methods: The study cohort comprised of all people diagnosed with a primary CLL between 1983 and 2005 in Australia. Standardised incidence ratios (SIRs) and standardised mortality ratios (SMRs) were calculated using Australian population rates. Results: Overall, the risk of any second incident cancer was more than double that of the general population (SIR=2.17, 95% confidence interval (CI)=2.07, 2.27) and remained elevated for at least 9 years after CLL. Risks were increased for many cancers, particularly melanoma (SIR=7.74, 95% CI=6.85, 8.72). The risk of melanoma increased at younger ages, but was constant across >9 years of follow-up. Chronic lymphocytic leukaemia patients also had an increased risk of death because of melanoma (SMR=4.79, 95% CI=3.83, 5.90) and non-melanoma skin cancer (NMSC; SMR=17.0, 95% CI=14.4, 19.8), suggesting that these skin cancers may be more aggressive in CLL patients. Conclusion: We speculate that a shared risk factor, such as general immune suppression, modulated by UVR exposure may explain the increased risk of melanoma and NMSC in CLL patients.
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Affiliation(s)
- J A Royle
- Western Australian Institute for Medical Research, University of Western Australia, Hospital Avenue, Nedlands WA 6009, Perth, Western Australia, Australia
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McGrath P, Joske D, Bouwman M. Benefits from Participation in the Chemo Club: Psychosocial Insights on an Exercise Program for Cancer Patients. J Psychosoc Oncol 2011; 29:103-19. [DOI: 10.1080/07347332.2010.532301] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Pam McGrath
- International Program of Psycho-Social Health Research (IPP-SHR), Central Queensland University, Brisbane, Australia
| | - David Joske
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Michael Bouwman
- International Program of Psycho-Social Health Research, Central Queensland University, Brisbane, Australia
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Royle JS, Baade P, Joske D, Fritschi L. Risk of second cancer after lymphohematopoietic neoplasm. Int J Cancer 2010; 129:910-9. [PMID: 20886600 DOI: 10.1002/ijc.25706] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 09/14/2010] [Indexed: 01/23/2023]
Abstract
People living with lymphohematopoietic neoplasms (LHNs) are known to have increased risks of second cancer; however, the incidence of second cancers after LHNs has not been studied extensively in Australia. The Australian Cancer Database was used to analyze site-specific risk of second primary cancer after LHNs in 127,707 patients diagnosed between 1983 and 2005. Standardized incidence ratios (SIRs) were calculated using population rates. Overall, patients with an LHN had nearly twice the risk of developing a second cancer compared to the Australian population. Among 40,321 patients with non-Hodgkin's lymphoma (NHL), there was over a fourfold significant increase in melanoma, Kaposi sarcoma, cancer of the lip, connective tissue and peripheral nerves, eye, thyroid, Hodgkin's disease (HD) and myeloid leukemia. Among 6,396 patients with HD, there was over a fourfold significant increase in melanoma, Kaposi sarcoma, cancer of the lip, oral cavity and pharynx, female breast, uterine cervix, testis, thyroid, NHL and myeloid leukemia. Among the 33,025 patients with lymphoid and myeloid leukemia, significant excess were seen for cancers of the lip, eye, connective tissue and peripheral nerves, NHL and HD. Among the 13,856 patients with plasma cell tumors, there was over fourfold significant increase for melanoma, cancer of the connective tissue and peripheral nerves and myeloid leukemia. Our findings provide evidence of an increased risk of cancer, particularly ultraviolet radiation- and immunosuppression-related cancers, after an LHN in Australia.
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Affiliation(s)
- Jill S Royle
- Western Australian Institute for Medical Research, University of Western Australia, Hospital Avenue, Nedlands, Perth, WA 6009, Australia
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Piekarz RL, Frye R, Turner M, Wright JJ, Allen SL, Kirschbaum MH, Zain J, Prince HM, Leonard JP, Geskin LJ, Reeder C, Joske D, Figg WD, Gardner ER, Steinberg SM, Jaffe ES, Stetler-Stevenson M, Lade S, Fojo AT, Bates SE. Phase II multi-institutional trial of the histone deacetylase inhibitor romidepsin as monotherapy for patients with cutaneous T-cell lymphoma. J Clin Oncol 2009; 27:5410-7. [PMID: 19826128 DOI: 10.1200/jco.2008.21.6150] [Citation(s) in RCA: 536] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Romidepsin (depsipeptide or FK228) is a member of a new class of antineoplastic agents active in T-cell lymphoma, the histone deacetylase inhibitors. On the basis of observed responses in a phase I trial, a phase II trial of romidepsin in patients with T-cell lymphoma was initiated. PATIENTS AND METHODS The initial cohort was limited to patients with cutaneous T-cell lymphoma (CTCL), or subtypes mycosis fungoides or Sézary syndrome, who had received no more than two prior cytotoxic regimens. There were no limits on other types of therapy. Subsequently, the protocol was expanded to enroll patients who had received more than two prior cytotoxic regimens. Results Twenty-seven patients were enrolled onto the first cohort, and a total of 71 patients are included in this analysis. These patients had undergone a median of four prior treatments, and 62 patients (87%) had advanced-stage disease (stage IIB, n = 15; stage III, n= 6; or stage IV, n = 41). Toxicities included nausea, vomiting, fatigue, and transient thrombocytopenia and granulocytopenia. Pharmacokinetics were evaluated with the first administration of romidepsin. Complete responses were observed in four patients, and partial responses were observed in 20 patients for an overall response rate of 34% (95% CI, 23% to 46%). The median duration of response was 13.7 months. CONCLUSION The histone deacetylase inhibitor romidepsin has single-agent clinical activity with significant and durable responses in patients with CTCL.
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Affiliation(s)
- Richard L Piekarz
- Departmentof Health and Human Services, Center for Cancer Researchand Cancer Therapy EvaluationProgram, National Cancer Institute,National Institutes of Health, Bethesda, USA.
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Lobb EA, Joske D, Butow P, Kristjanson LJ, Cannell P, Cull G, Augustson B. When the safety net of treatment has been removed: patients' unmet needs at the completion of treatment for haematological malignancies. Patient Educ Couns 2009; 77:103-108. [PMID: 19272749 DOI: 10.1016/j.pec.2009.02.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 12/18/2008] [Accepted: 02/01/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine patients' information, emotional and support needs at the completion of treatment for a haematological malignancy. METHODS A self-report questionnaire was mailed to 113 adult patients. RESULTS Sixty-six questionnaires were returned. The most frequently endorsed patient needs related to care co-ordination and help to manage the fear of recurrence. The most frequently endorsed unmet needs included managing the fear of recurrence, the need for a case-manager and the need for communication between treating doctors. Predictors of unmet needs included younger patients (p=0.01), marital status (p=0.03) and employment (p=0.03). Almost two-thirds of patients (59%) reported they would have found it helpful to talk with a health care professional about their experience of diagnosis and treatment at the completion of treatment and endorsed significantly more need in the arenas of Quality of Life (p=0.03) and Emotional and Relationships (p=0.04). CONCLUSION This study provides valuable data on haematological cancer patients' needs in the first 12 months of finishing treatment. It appears that many needs emerge or remain unresolved at this time. PRACTICE IMPLICATIONS An opportunity for patients to talk with a health professional about making the transition from active treatment to extended survivorship may be helpful.
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Affiliation(s)
- E A Lobb
- Calvary Health Care Sydney, Australia.
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Joske D. Clinical Hematology - By N. S. Young, S. L. Gerson and K. A. High. Intern Med J 2007. [DOI: 10.1111/j.1445-5994.2006.01284.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: 11/29/2022]
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Willson A, Cannell P, Joske D, Augustson B. Imatinib-induced cytogenetic remission in chronic eosinophilic leukaemia. Intern Med J 2006; 36:537-8. [PMID: 16866664 DOI: 10.1111/j.1445-5994.2006.01122.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Joske D. Cytokines in lymphoma. Leuk Lymphoma 2006; 47:570-2. [PMID: 16886266] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- David Joske
- Sir Charles Gairdner Hospital, University of Western Australia, Department of Medicine, Australia.
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42
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Bulsara C, Ward AM, Joske D. Patient perceptions of the GP role in cancer management. Aust Fam Physician 2005; 34:299-300, 302. [PMID: 15861760] [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: 05/02/2023]
Abstract
BACKGROUND During the course of their cancer treatment, patients have to deal with a number of health professionals. We investigated patients' perceptions of the role of the general practitioner, with particular reference to GPs' ability to manage patients' cancer outside of the hospital setting. METHOD We took a phenomenological approach, focussing on empowerment, and any central role of the GP. In depth interviews were conducted on the same haematological cancer patients over a 2 year period. Results were analysed for main themes regarding support and management of illness. RESULTS Many patients had a long term relationship with an individual GP. They perceived GPs as providing a primarily supportive rather than treatment role outside of the hospital setting, and relied on them for clarification and reassurance. DISCUSSION The personal, confiding relationship between the GP and cancer patient might be better exploited by specialists. Patients could feel more empowered in relation to their condition if provided with information by their GP that is more relevant and explicit. For this to occur, specialists must first provide GPs with timely and pertinent information about their cancer management.
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Affiliation(s)
- Caroline Bulsara
- Department of General Practice, University of Western Australia.
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43
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Spencer A, Horvath N, Gibson J, Prince HM, Herrmann R, Bashford J, Joske D, Grigg A, McKendrick J, Prosser I, Lowenthal R, Deveridge S, Taylor K. Prospective randomised trial of amifostine cytoprotection in myeloma patients undergoing high-dose melphalan conditioned autologous stem cell transplantation. Bone Marrow Transplant 2005; 35:971-7. [PMID: 15778725 DOI: 10.1038/sj.bmt.1704946] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this prospective multicentre trial, 90 patients undergoing autologous stem cell transplantation (ASCT) were randomised to receive (n=43) or not receive (n=47) amifostine 910 mg/m(2) prior to melphalan 200 mg/m(2). Patients were monitored for regimen-related toxicity, engraftment, supportive care, response and survival. Both groups underwent ASCT at a median of 8 months from diagnosis and were matched for disease characteristics, prior therapy and pre-ASCT disease responsiveness. Amifostine infusional side-effects were frequent, occurring in 65% of patients, but of mild severity. Amifostine use was associated with a reduction in the median grade of oral mucositis (1 vs 2, P=0.01) and the frequency of severe (WHO grades 3 or 4) mucositis (12 vs 33%, P=0.02), but no reduction in the requirement for parenteral nutrition or analgesic use. Conversion to complete remission post-ASCT occurred in 30 and 14% of the amifostine and control groups, respectively (P=0.09). With a median follow-up of 35 months, there was no statistically significant difference between the median progression-free or overall survival times for the two groups. We conclude that amifostine can be safely administered prior to high-dose melphalan and significantly reduces the frequency and severity of therapy-induced oral mucositis.
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Affiliation(s)
- A Spencer
- Clinical Haematology & BMT, The Alfred Hospital, Melbourne, Australia.
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44
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Branford S, Rudzki Z, Parkinson I, Grigg A, Taylor K, Seymour JF, Durrant S, Browett P, Schwarer AP, Arthur C, Catalano J, Leahy MF, Filshie R, Bradstock K, Herrmann R, Joske D, Lynch K, Hughes T. Real-time quantitative PCR analysis can be used as a primary screen to identify patients with CML treated with imatinib who have BCR-ABL kinase domain mutations. Blood 2004; 104:2926-32. [PMID: 15256429 DOI: 10.1182/blood-2004-03-1134] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mutations within the BCR-ABL kinase domain in imatinib-treated chronic myeloid leukemia (CML) are the main mechanism of acquired resistance. The early detection of mutations should provide clinical benefit by allowing early intervention. Quantitative polymerase chain reaction (RQ-PCR) results of BCR-ABL mRNA were correlated with mutation analysis in 214 patients treated with imatinib. We determined whether there was a difference in the incidence of mutations between the patients with a more than 2-fold rise in BCR-ABL and patients with stable or decreasing levels. Of the 56 patients with a more than 2-fold rise, 34 (61%) had detectable mutations (median rise, 3.0-fold; 25th-75th percentiles, 2.3-5.2). In 31 (91%) of these 34 patients, the mutation was present at the time of the rise and became detectable within 3 months in the remaining patients. Only 1 (0.6%) of 158 patients with stable or decreasing BCR-ABL levels had a detectable mutation, P less than .0001. Thus, a more than 2-fold rise identified 34 (97%) of 35 patients with a mutation. We conclude that a rise in BCR-ABL of more than 2-fold can be used as a primary indicator to test patients for BCR-ABL kinase domain mutations.
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MESH Headings
- Benzamides
- DNA Mutational Analysis/methods
- Drug Monitoring/methods
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl/blood
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Piperazines/therapeutic use
- Polymerase Chain Reaction/methods
- Predictive Value of Tests
- Protein Structure, Tertiary/genetics
- Pyrimidines/therapeutic use
- RNA, Messenger/blood
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Affiliation(s)
- Susan Branford
- Division of Molecular Pathology, Institute of Medical and Veterinary Science, Adelaide, Australia.
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45
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Snowden JA, Passweg J, Moore JJ, Milliken S, Cannell P, Van Laar J, Verburg R, Szer J, Taylor K, Joske D, Rule S, Bingham SJ, Emery P, Burt RK, Lowenthal RM, Durez P, McKendry RJ, Pavletic SZ, Espigado I, Jantunen E, Kashyap A, Rabusin M, Brooks P, Bredeson C, Tyndall A. Autologous hemopoietic stem cell transplantation in severe rheumatoid arthritis: a report from the EBMT and ABMTR. J Rheumatol 2004; 31:482-8. [PMID: 14994391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Since 1996, autologous hemopoietic stem cell transplantation (HSCT) has been used to treat severe rheumatoid arthritis (RA). To date, published reports have been individual cases or series containing small numbers. This study combined the worldwide experience in a single analysis. METHODS The Autoimmune Disease Databases of the European Group for Blood and Marrow Transplantation (EBMT) and the Autologous Blood and Marrow Transplant Registry (ABMTR) were used to identify patients with RA treated with autologous HSCT. Further information relating to patient and treatment-specific variables was obtained by questionnaire. RESULTS Seventy-six patients were registered from 15 centers. Seventy-three patients had received autologous HSCT, and in 3 patients hematopoietic stem cells (HSC) were mobilized but not transplanted. Transplanted patients (median age 42 yrs, 74% female, 86% rheumatoid factor positive) had been previously treated with a mean of 5 (range 2-9) disease modifying antirheumatic drugs (DMARD). Significant functional impairment was present, with a median Health Assessment Questionnaire (HAQ) score of 1.4 (range 1.1-2.0) and Steinbrocker score mean 2.39 (SD 0.58). The high dose treatment regimen was cyclophosphamide (CYC) alone in the majority of patients, mostly 200 mg/kg (n = 62). Seven patients received anti-thymocyte globulin (ATG) in addition to CYC, 2 patients busulfan and CYC (BuCYC), and one patient CYC with total body irradiation and ATG. One patient received fludarabine with ATG. Following treatment, one patient received bone marrow but the rest received chemotherapy and/or granulocyte colony-stimulating factor mobilized peripheral blood stem cells. The harvest was unmanipulated in 28 patients, the rest receiving some form of lymphocyte depletion, mostly through CD34+ selection. Median followup was 16 months (range 3-55). Responses were measured using the American College of Rheumatology (ACR) criteria. Forty-nine patients (67%) achieved at least ACR 50% response at some point following transplant. There was a significant reduction in the level of disability measured by the HAQ (p < 0.005). Most patients restarted DMARD within 6 months for persistent or recurrent disease activity, which provided disease control in about half the cases. Response was significantly related to seronegative RA (p = 0.02) but not to duration of disease, number of previous DMARD, presence of HLA-DR4, or removal of lymphocytes from the graft. There was no direct transplant related mortality, although one patient, treated with the BuCYC regimen, died 5 months post-transplant from infection and incidental non-small cell lung cancer. CONCLUSION Autologous HSCT is a relatively safe form of salvage treatment in severe, resistant RA. In these open label studies significant responses were achieved in most patients, with over 50% achieving an ACR 50 or more response at 12 months. Although the procedure is not curative, recurrent or persistent disease activity may be subsequently controlled in some patients with DMARD. Clinical trials are necessary to develop this approach in patients with aggressive disease who have failed conventional treatment including anti-tumor necrosis factor agents.
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Affiliation(s)
- John A Snowden
- Department of Rheumatology, Felix-Platter-Spital, University of Basel, Basel, Switzerland
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46
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Abstract
BACKGROUND The role that empowerment plays through involving haematological cancer patients and their families in their treatment and care is undeniable. It encompasses the implementation of various strategies to achieve a sense of empowerment. AIMS AND OBJECTIVES This phenomenological study sought to identify core strategies used by cancer patients regardless of their illness stage and prognosis who exhibited a strong sense of empowerment in coping with their condition. DESIGN A phenomenological approach using an in depth interviewing technique was used to identify the common factors which patients and spouses believed could enable them to achieve a measure of control in managing their illness. These measures were referred to as coping strategies. METHODS It was decided to conduct a purposive study and re-interview seven of 12 patients who had previously participated in a pilot Haematology Shared Care project and who had developed a high level of ability in coping with their illness. At the patient's discretion, spouses were invited to participate and to contribute to the interview. Three spouses participated in the interviewing process. RESULTS Common strategies emerged regardless of the patient's stage of illness and prognosis. Informants identified the determination to remain in control of the illness and treatment side effects, having the support of family and significant others, illness acceptance and maintaining hope as crucial to their sense of empowerment. RELEVANCE TO CLINICAL PRACTICE It is hoped that clinicians will gain a deeper understanding of the varied and numerous strategies used by cancer patients in coping with their illness. This understanding will ensure that by encouraging these strategies, patients and their families will be supported by health professionals to achieve a greater sense of empowerment. As this and other studies have shown, working alongside health professionals contributes to empowerment for both the cancer patient and significant others in their lives.
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Affiliation(s)
- Caroline Bulsara
- School of Population Health, Department General Practice, University of Western Australia, Perth, Western Australia, Australia.
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47
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Branford S, Rudzki Z, Harper A, Grigg A, Taylor K, Durrant S, Arthur C, Browett P, Schwarer AP, Ma D, Seymour JF, Bradstock K, Joske D, Lynch K, Gathmann I, Hughes TP. Imatinib produces significantly superior molecular responses compared to interferon alfa plus cytarabine in patients with newly diagnosed chronic myeloid leukemia in chronic phase. Leukemia 2004; 17:2401-9. [PMID: 14523461 DOI: 10.1038/sj.leu.2403158] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We analyzed molecular responses in 55 newly diagnosed chronic-phase chronic myeloid leukemia (CML) patients enrolled in a phase 3 study (the IRIS trial) comparing imatinib to interferon-alfa plus cytarabine (IFN+AraC). BCR-ABL/BCR% levels were measured by real-time quantitative RT-PCR and were significantly lower for the imatinib-treated patients at all time points up to 18 months, P<0.0001. The median levels for imatinib-treated patients continued to decrease and had not reached a plateau by 24 months. A total of 24 IFN+AraC-treated patients crossed over to imatinib. Once imatinib commenced, the median BCR-ABL/BCR% levels in these patients were not significantly different to those on first-line imatinib for the equivalent number of months. The incidence of progression in imatinib-treated patients, defined by hematologic, cytogenetic or quantitative PCR criteria, was significantly higher in the patients who failed to achieve a 1 log reduction by 3 months or a 2 log reduction by 6 months, P=0.002. A total of 49 patients were screened for BCR-ABL kinase domain mutations. Mutations were detected in two imatinib-treated patients who crossed over from IFN+AraC and both lost their imatinib response. In conclusion, first-line imatinib-treated patients had profound reductions in BCR-ABL/BCR%, which significantly exceeded those of IFN+AraC-treated patients and early measurements were predictive of subsequent response.
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MESH Headings
- Antimetabolites, Antineoplastic/administration & dosage
- Antineoplastic Agents/administration & dosage
- Benzamides
- Bone Marrow/metabolism
- Cross-Over Studies
- Cytarabine/administration & dosage
- Cytogenetics
- DNA Mutational Analysis
- Fusion Proteins, bcr-abl/blood
- Fusion Proteins, bcr-abl/chemistry
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imatinib Mesylate
- Interferon-alpha/administration & dosage
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Phosphotransferases/chemistry
- Phosphotransferases/genetics
- Piperazines/administration & dosage
- Prognosis
- Protein Structure, Tertiary
- Pyrimidines/administration & dosage
- Treatment Outcome
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Affiliation(s)
- S Branford
- Institute of Medical and Veterinary Science, Adelaide, South Australia
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48
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Abstract
BACKGROUND Patients with haematological malignancies are not referred to palliative care services as frequently as those with solid cancers (non-haematological malignancies). AIMS The present study surveyed haematologists in Australia and New Zealand. We aimed to record theoretical referral times, identify problems with referral to palliative care and clarify elements used to decide whether a patient was "terminally ill". METHODS A questionnaire based on the case-histories of three patients (with acute leukaemia, lymphoma or multiple myeloma) was distributed at the Haematology Society of Australia and New Zealand Congress 2000, Perth, Australia. Each case was divided into stages by transitional points in the illness to include issues or prognostic variables that may stimulate referral to palliative care. Questions were asked about: (i) referral-triggers, (ii) problems previously experienced, (iii) definition of when the patient was "terminally ill", (iv) prognostication difficulties and (v) communication about prognosis. RESULTS The response rate was 11%, which may represent up to 32% of Australian specialists. Eighty per cent had access to all types of palliative care services and refer for symptom control, regardless of illness stage. Twenty-nine per cent had experienced difficulties in referring. There was a variation as to exactly when referral would occur and when each case was considered "terminally ill". Reasons for early or later referral were explored. Prognostication difficulties were common. CONCLUSIONS In theory there is a willingness to refer to palliative care, however this has yet to be translated to day-to-day practice. This may be due to prognostication difficulties, logistical factors and medical concerns. Models of referral are suggested for further study.
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Affiliation(s)
- K Auret
- School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
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49
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Branford S, Rudzki Z, Walsh S, Parkinson I, Grigg A, Szer J, Taylor K, Herrmann R, Seymour JF, Arthur C, Joske D, Lynch K, Hughes T. Detection of BCR-ABL mutations in patients with CML treated with imatinib is virtually always accompanied by clinical resistance, and mutations in the ATP phosphate-binding loop (P-loop) are associated with a poor prognosis. Blood 2003; 102:276-83. [PMID: 12623848 DOI: 10.1182/blood-2002-09-2896] [Citation(s) in RCA: 538] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Imatinib-treated chronic myeloid leukemia (CML) patients with acquired resistance commonly have detectable BCR-ABL kinase domain mutations. It is unclear whether patients who remain sensitive to imatinib also have a significant incidence of mutations. We evaluated 144 patients treated with imatinib for BCR-ABL kinase domain mutations by direct sequencing of 40 accelerated phase (AP), 64 late chronic phase (> or = 12 months from diagnosis, late-CP), and 40 early-CP patients. Mutations were detected in 27 patients at 17 different residues, 13 (33%) of 40 in AP, 14 (22%) of 64 in late-CP, and 0 of 40 in early-CP. Acquired resistance was evident in 24 (89%) of 27 patients with mutations. Twelve (92%) of 13 patients with mutations in the adenosine triphosphate (ATP) binding loop (P-loop) died (median survival of 4.5 months after the mutation was detected). In contrast, only 3 (21%) of 14 patients with mutations outside the P-loop died (median follow-up of 11 months). As the detection of mutations was strongly associated with imatinib resistance, we analyzed features that predicted for their detection. Patients who commenced imatinib more than 4 years from diagnosis had a significantly higher incidence of mutations (18 [41%] of 44) compared with those treated within 4 years (9 [9%] of 100), P <.0001. Lack of a major cytogenetic response (MCR) was also associated with a higher likelihood of detecting a mutation; 19 (38%) of 50 patients without a MCR had mutations compared with 8 (8.5%) of 94 with an MCR, P <.0001. In conclusion, the detection of kinase domain mutations using a direct sequencing technique was almost always associated with imatinib resistance, and patients with mutations in the P-loop had a particularly poor prognosis.
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MESH Headings
- Adenosine Triphosphate
- Adult
- Aged
- Benzamides
- Binding Sites/genetics
- DNA Mutational Analysis
- Disease Progression
- Drug Resistance, Neoplasm/genetics
- Female
- Fusion Proteins, bcr-abl/genetics
- Genes, abl/genetics
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Mutation
- Piperazines/therapeutic use
- Prognosis
- Protein Structure, Tertiary
- Pyrimidines/therapeutic use
- Survival Analysis
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Affiliation(s)
- Susan Branford
- Division of Molecular Pathology, Institute of Medical and Veterinary Science, South Australia 5000, Australia.
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50
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Moore J, Brooks P, Milliken S, Biggs J, Ma D, Handel M, Cannell P, Will R, Rule S, Joske D, Langlands B, Taylor K, O'Callaghan J, Szer J, Wicks I, McColl G, Passeullo F, Snowden J. A pilot randomized trial comparing CD34-selected versus unmanipulated hemopoietic stem cell transplantation for severe, refractory rheumatoid arthritis. Arthritis Rheum 2002; 46:2301-9. [PMID: 12355477 DOI: 10.1002/art.10495] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Evidence from animal studies, case reports, and phase I studies suggests that hemopoietic stem cell transplantation (HSCT) can be effective in the treatment of rheumatoid arthritis (RA). It is unclear, however, if depletion of T cells in the stem cell product infused after high-dose chemotherapy is beneficial in prolonging responses by reducing the number of infused autoreactive T cells. This pilot multicenter, randomized trial was undertaken to obtain feasibility data on whether CD34 selection (as a form of T cell depletion) of an autologous stem cell graft is of benefit in the HSCT procedure in patients with severe, refractory RA. METHODS Thirty-three patients with severe RA who had been treated unsuccessfully with methotrexate and at least 1 other disease-modifying agent were enrolled in the trial. The patients received high-dose immunosuppressive treatment with 200 mg/kg cyclophosphamide followed by an infusion of autologous stem cells that were CD34 selected or unmanipulated. Safety, efficacy (based on American College of Rheumatology [ACR] response criteria), and time to recurrence of disease were assessed on a monthly basis for up to 12 months. RESULTS All patients were living at the end of the study, with no major unexpected toxicities. Overall, on an intent-to-treat basis, ACR 20% response (ACR20) was achieved in 70% of the patients. An ACR70 response was attained in 27.7% of the 18 patients who had received CD34-selected cells and 53.3% of the 15 who had received unmanipulated cells (P = 0.20). The median time to disease recurrence was 147 days in the CD34-selected cell group and 201 days in the unmanipulated cell group (P = 0.28). There was no relationship between CD4 lymphopenia and response, but 72% of rheumatoid factor (RF)-positive patients had an increase in RF titer prior to recurrence of disease. CONCLUSION HSCT can be performed safely in patients with RA, and initial results indicate significant responses in patients with severe, treatment-resistant disease. Similar outcomes were observed in patients undergoing HSCT with unmanipulated cells and those receiving CD34-selected cells. Larger studies are needed to confirm these findings.
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Affiliation(s)
- John Moore
- St. Vincents Hospital, Sydney, Australia.
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