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McIver TA, Craig W, Bosma RL, Chiarella J, Klassen J, Sandra A, Goegan S, Booij L. Empathy, Defending, and Functional Connectivity While Witnessing Social Exclusion. Soc Neurosci 2022; 17:352-367. [PMID: 35659207 DOI: 10.1080/17470919.2022.2086618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Peers are present for most bullying episodes. Peers who witness bullying can play an important role in either stopping or perpetuating the behaviour. Defending can greatly benefit victimized peers. Empathy is strongly associated with defending. Yet, less is known about defenders' neural response to witnessing social distress, and how this response may relate to the link between empathy and defending. Forty-six first-year undergraduate students (Mage = 17.7; 37 women), with varied history of peer defending, underwent fMRI scanning while witnessing a depiction of social exclusion. Functional connectivity analysis was performed across brain regions that are involved in cognitive empathy, empathetic distress, and compassion. History of defending was positively associated with functional connectivity (Exclusion > Inclusion) between the left orbitofrontal cortex (OFC) - medial prefrontal cortex (MPFC), and right OFC - left and right amygdalae. Defending was negatively associated with functional connectivity between the left OFC - anterior cingulate cortex. The relationship between history of defending and empathy (specifically, empathetic perspective taking) was moderated by functional connectivity of the right OFC - left amygdala. These findings suggest that coactivation of brain regions involved in compassionate emotion regulation and empathetic distress play a role in the relationship between empathy and peer defending.
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Affiliation(s)
- Theresa A McIver
- Queen's University, Centre for Neuroscience Studies, Kingston, Ontario, Canada
| | - Wendy Craig
- Queen's University, Department of Psychology, Kingston, Ontario, Canada
| | - Rachael L Bosma
- Queen's University, Centre for Neuroscience Studies, Kingston, Ontario, Canada
| | - Julian Chiarella
- Concordia University, Department of Psychology, Montreal, Quebec, Canada
| | - Janell Klassen
- Queen's University, Department of Psychology, Kingston, Ontario, Canada
| | - Aislinn Sandra
- Queen's University, Department of Psychology, Kingston, Ontario, Canada
| | - Sarah Goegan
- Queen's University, Department of Psychology, Kingston, Ontario, Canada
| | - Linda Booij
- Queen's University, Department of Psychology, Kingston, Ontario, Canada.,Concordia University, Department of Psychology, Montreal, Quebec, Canada
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McIver TA, Bosma RL, Goegan S, Sandre A, Klassen J, Chiarella J, Booij L, Craig W. Functional connectivity across social inclusion and exclusion is related to peer victimization and depressive symptoms in young adults. J Affect Disord 2019; 253:366-375. [PMID: 31078837 DOI: 10.1016/j.jad.2019.04.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Peer victimization is associated with increased risk for depression, as well as increased neural response to social exclusion in the anterior cingulate cortex (ACC) and the amygdala. Altered functional connectivity (FxC) of fronto-limbic circuitry is associated with risk for various affective disorders. The present study examined the relationship between fronto-limbic FxC during social exclusion, prior peer victimization experience and depressive symptoms. METHODS Three mutually exclusive groups were formed: peer victimized (with a history of peer victimization), defenders (history of defending peers), and controls (no prior peer victimization experience) (n = 15/group; Mage = 17.7 years). Functional Magnetic Resonance Imaging data were collected while participants completed the Cyberball paradigm (simulating the experience of social exclusion). FxC between the Medial Prefrontal Cortex (MPFC), ACC, right insula and left amygdala, was compared between groups and examined in relation to depressive symptoms. RESULTS Prior peer victimization experience was associated with differences in fronto-limbic FxC across social inclusion and exclusion. Defenders displayed distinct shifts in FxC across the transition from being included to excluded. Peer victimized individuals exhibited a unique pattern of amygdala-specific FxC during inclusive interaction with peers, and in the continuous FxC across inclusion and exclusion. FxC of the MPFC-amygdala across inclusion and exclusion moderated the relationship between peer victimization and depressive symptoms. LIMITATIONS Small sample size and cross-sectional design limit interpretation of the findings. CONCLUSIONS Peer victimized individuals who exhibit continuous positive FxC of the MPFC-left amygdala across inclusion and exclusion may be at greater risk for depressive symptoms.
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Affiliation(s)
- Theresa A McIver
- Centre for Neuroscience Studies, Queen's University, Botterell Hall, 18 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Rachael L Bosma
- Centre for Neuroscience Studies, Queen's University, Botterell Hall, 18 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Sarah Goegan
- Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, Ontario, K7L 3N6, Canada
| | - Aislinn Sandre
- Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, Ontario, K7L 3N6, Canada
| | - Janell Klassen
- Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, Ontario, K7L 3N6, Canada
| | - Julian Chiarella
- Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, Ontario, K7L 3N6, Canada
| | - Linda Booij
- Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, Ontario, K7L 3N6, Canada; Department of Psychology, Concordia University, 7141 Sherbrooke Street West, Montreal, Québec H4B 1R6, Canada.
| | - Wendy Craig
- Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, Ontario, K7L 3N6, Canada
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Stewart S, Klassen J, Tohvner G. Validation of the interRAI Risk of School Disruption Scale: A Measurement of School Disengagement and Disruption. Personality and Individual Differences 2016. [DOI: 10.1016/j.paid.2016.05.311] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stewart S, Tohver G, Klassen J. The validation of the interRAI ChYMH Internalizing Subscale in Canadian Children and Youth. Personality and Individual Differences 2016. [DOI: 10.1016/j.paid.2016.05.312] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stewart DA, Guo D, Luider J, Auer I, Klassen J, Morris D, Chaudhry A, Brown C, Glück S, Russell JA. A Low CD34+ Cell Dose Predicts Relapse and Death Early following Autologous Blood Stem Cell Transplantation. Hematology 2016; 6:19-27. [DOI: 10.1080/10245332.2001.11746549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- D. A. Stewart
- Department of Medicine, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
| | - D. Guo
- Department of Epidemiology, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
| | - J. Luider
- Department of Flow Cytometry, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
| | - I. Auer
- Department of Pathology Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
| | - J. Klassen
- Department of Apheresis, and Alberta Bone Marrow Transplant Program, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
| | - D. Morris
- Department of Medicine, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
| | - A. Chaudhry
- Department of Medicine, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
| | - C. Brown
- Department of Medicine, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
| | - S. Glück
- Department of Medicine, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
| | - J. A. Russell
- Department of Medicine, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
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Abstract
Hematopoietic stem-cell transplantation [...]
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Affiliation(s)
- J Klassen
- Department of Internal Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB
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Karlsson L, Quinlan D, Guo D, Brown C, Selinger S, Klassen J, Russell JA. Mobilized blood cells vs bone marrow harvest: experience compared in 171 donors with particular reference to pain and fatigue. Bone Marrow Transplant 2004; 33:709-13. [PMID: 14755321 DOI: 10.1038/sj.bmt.1704418] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This prospective study compared the donor experience of blood cell (BC) mobilization and leukapheresis (n=116) with that of bone marrow (BM) harvest (n=55). Internal jugular catheters were inserted electively in 89% of BC donors. Most (80%) BM donors had a harvest with general anesthesia; 20% had epidural or spinal anesthesia. Pain and fatigue were frequent with both procedures and were compared in responses to questionnaires. A total of 85% of BM donors reported moderate or severe pain compared with 68% of BC donors (P=0.02). The median duration of pain was 14 days for BM donors compared with 3 days after BC mobilization (P<0.0001). More BM donors had pain for more than 7 days (75% vs 0%, P<0.0001). Severe fatigue was experienced by more BM donors (49 vs 16%, P<0.0001). Fatigue lasted significantly longer in BM donors (median 11 vs 4 days, P<0.0001) and more BM donors were fatigued for more than 1 week (69 vs 0%, P<0.0001). A total of 11 donors had both BM and BC collection; seven preferred the latter. Simply considered with respect to pain and fatigue, BC donation appears better tolerated by donors. However, there are other sequelae of both influencing the acceptability for individual donors.
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Affiliation(s)
- L Karlsson
- Alberta Bone Marrow Transplant Program and Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Syme R, Stewart D, Rodriguez-Galvez M, Luider J, Auer Y, Klassen J, Morris D, Brown C, Russell J, Glück S. Micrometastases in apheresis products predict shorter progression-free and overall survival in patients with breast cancer undergoing high-dose chemotherapy (HDCT) and autologous blood stem cell transplantation (ABSCT). Bone Marrow Transplant 2003; 32:307-11. [PMID: 12858203 DOI: 10.1038/sj.bmt.1704133] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The presence of cancer cells in autografts of breast cancer patients has been described to have prognostic value or directly lead to relapse. Previously, we demonstrated that apheresis products (APs) collected after induction chemotherapy have a significantly lower likelihood of tumor cell contamination. Here, we examine the prognostic value of micrometastases in autografts. Data from 83 patients with breast cancer treated with autologous blood stem cell transplantation were analyzed. Pan-cytokeratin-FITC conjugated antibodies were used to detect contaminating breast cancer cells in the APs. Progression and survival data analyzed on the basis of three or fewer cancer cells showed no significant differences in outcomes. Of the 83 patients, 11 had more than three cancer cells detectable in their APs. In total, 72 patients were shown to have less than three cells detectable. When patients with more than three cells were compared to patients with 0-3, we found statistically significant differences in progression-free survival. We also found a significant difference in overall survival (OS) between the two groups. No difference was observed in OS since the time of diagnosis. We conclude that patients with more than three contaminating cells in their APs have micrometastases and represent a poor prognosis group.
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Affiliation(s)
- R Syme
- Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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Sasal J, Naimark D, Klassen J, Shea J, Bargman JM. Late renal transplant failure: an adverse prognostic factor at initiation of peritoneal dialysis. Perit Dial Int 2001; 21:405-10. [PMID: 11587406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Early renal transplant failure necessitating a return to dialysis has been shown to be a poor prognostic factor for survival. Little is known about the outcome of patients with late transplant failure returning to dialysis. It was our clinical impression that late transplant failure (>2 months) carries an increased morbidity and mortality risk in patients returning to dialysis. OBJECTIVE To determine whether patients with a failed renal transplant have an outcome different to those on dialysis who have never received a kidney transplant. SETTING Peritoneal dialysis (PD) unit in a teaching hospital. PATIENTS AND DESIGN All failed renal transplant patients (fTx) in the Toronto Hospital Peritoneal Dialysis program between 1989 and 1996 were identified. This cohort of 42 fTx patients was compared with a cohort of randomly selected never-transplanted PD patients (non-Tx). The PD program was selected because of the availability of well-documented patient archival material. The non-Tx group was matched for age and presence of diabetes. Data were collected until retransplantation, change of dialysis modality or center, death, or until June 1998. RESULTS There was no difference at initiation of PD between groups in serum albumin, residual renal function, or mean serum parathyroid hormone level. The mean low-density lipoprotein level was significantly higher in the fTx cohort. The duration of dialysis before Tx in fTx patients accounted for the increased total length of dialysis in fTx (mean 15 months). However, post-Tx the duration of PD was similar for both groups (30.7 months for fTx vs 31.6 months for non-Tx). The fTx group had a considerably worse outcome than the non-Tx group. The time to first peritonitis, subsequent episodes of peritonitis, catheter change, or transfer to hemodialysis occurred at a much faster rate in fTx patients. The most dramatic difference was in survival. There were 3 deaths in the non-Tx group and 12 in the fTx group (p < 0.01). The mean age at time of death in the fTx group was 47.5 years. Deaths were due mainly to gram-negative peritonitis and cardiovascular disease. CONCLUSIONS We conclude that late failed renal transplant patients starting dialysis are at increased risk of complications and have strikingly higher mortality rates than non-Tx patients. A previously failed kidney transplant can be considered an adverse prognostic factor for patients commencing PD; these patients need to be closely monitored. Although this study was limited to PD patients, the same principles likely apply to fTx patients returning to any form of renal replacement therapy.
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Affiliation(s)
- J Sasal
- Division of Nephrology, The University Health Network, Toronto, Ontario, Canada
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Stewart DA, Guo D, Luider J, Auer I, Klassen J, Morris D, Brown CB, Chaudhry A, Glück S, Russell JA. The CD3- 16+ 56+ NK cell count independently predicts autologous blood stem cell mobilization. Bone Marrow Transplant 2001; 27:1237-43. [PMID: 11548841 DOI: 10.1038/sj.bmt.1703070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/09/2022]
Abstract
Better predictive factors for autologous blood stem cell mobilization (BSCM) are needed. The purpose of this study was to determine if an independent association exists between lymphocyte or NK cell counts and BSCM. Data were analyzed on 141 consecutive patients aged 19-69 years (median 45) who received combined chemotherapy plus G-CSF for BSCM, and who had measurements of immune cells prior to BSCM. Of the 141 patients, 41% had breast cancer, 14% Hodgkin's disease, 34% non-Hodgkin's lymphoma, and 11% other diagnoses. BSCM involved dose-intensive cyclophosphamide, etoposide, cisplatin (DICEP) plus G-CSF 300 microg (<70 kg) or 480 microg (>70 kg) for 45% of patients, while the remaining 55% received other chemotherapy plus similar doses of G-CSF. Only a single apheresis was performed for 94% of patients. The following factors were analyzed for predictors of BSCM: age, gender, prior chemotherapy, prior radiotherapy, diagnosis, disease status, marrow involvement, mobilization regimen, Hb, WBC, platelet count, B cell, T cell, and NK cell counts. The peripheral blood CD34+ counts on the first day of apheresis (PBCD34) were 6-1783 x 10(6)/l (median 150). The PBCD34 count correlated strongly with the number of CD34+ cells collected/l blood apheresed and with the number of CD34+ cells collected/kg. By multivariate analysis using continuous variables, relapsed status (P = 0.0003), not using DICEP mobilization (P = 0.0001), female gender (P = 0.0057), low platelet count (P = 0.051), and low CD3- 16+ 56+ count (P = 0.0158) were associated with low PBCD34 counts. Using categorical variables, the only factors that independently predicted a PBCD34 count <150 x 10(6)/l were: >1 prior chemotherapy regimen (odds ratio = 5.12, P = 0.0003), not using DICEP mobilization (odds ratio = 4.94, P = 0.0001), and CD3- 16+ 56+ count <125 x 10(6)/l (odds ratio= 2.58, P = 0.0157). In conclusion, the CD3- 16+ 56+ count may be a useful additional predictor of BSCM and warrants further study.
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Affiliation(s)
- D A Stewart
- Department of Medicine, Tom Baker Cancer Centre, University of Calgary, Alberta, Canada
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Duggan PR, Guo D, Luider J, Auer I, Klassen J, Chaudhry A, Morris D, Glück S, Brown CB, Russell JA, Stewart DA. Predictive factors for long-term engraftment of autologous blood stem cells. Bone Marrow Transplant 2000; 26:1299-304. [PMID: 11223969 DOI: 10.1038/sj.bmt.1702708] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Data from 170 consecutive patients aged 19-66 years (median age 46 years) who underwent unmanipulated autologous blood stem cell transplant (ASCT) were analyzed to determine if total CD34+ cells/kg infused, CD34+ subsets (CD34+41+, CD34+90+, CD34+33-, CD34+38-, CD34+38-DR-), peripheral blood CD34+ cell (PBCD34+) count on first apheresis day, or various clinical factors were associated with low blood counts 6 months post ASCT. Thirty-four patients were excluded from analysis either because of death (n = 17) or re-induction chemotherapy prior to 6 months post ASCT (n = 13), or because of lack of follow-up data (n = 4). Of the remaining 136 patients, 46% had low WBC ( < 4 x 10(9)/l), 41% low platelets (<150 x 10(9)/l), and 34% low hemoglobin ( < 120 g/l) at a median of 6 months following ASCT. By Spearman's rank correlation, both the total CD34+ cell dose/kg and the PBCD34+ count correlated with 6 month blood counts better than any subset of CD34+ cells or any clinical factor. The PBCD34+ count was overall a stronger predictor of 6 month blood counts than was the total CD34+ cells/kg infused. Both factors retained their significance in multivariate analysis, controlling for clinical factors. In conclusion, subsets of CD34+ cells and clinical factors are inferior to the total CD34+ cell dose/kg and PBCD34+ count in predicting 6 month blood counts following ASCT.
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Affiliation(s)
- P R Duggan
- Department of Medicine, Tom Baker Cancer Center, Foothills Hospital, and University of Calgary, Calgary, Alberta, Canada
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Abstract
Peripheral blood stem cell harvest by apheresis is an increasingly important procedure utilized in the treatment of many malignancies. Whether autologous or allogeneic, it is frequently performed via peripheral access because of concern over major complications associated with central venous catheter placement. This study was to determine the safety and success, complications and premature failure rates for radiolocally placed ultrasound-guided non-tunneled central venous catheters placed for apheresis in a donor (allogeneic) population. One hundred central venous catheters were placed in ninety-one individuals for allogeneic stem cell harvest. Procedural success and complications relating to placement were noted in all. In 97 cases the number of needle passes required for venous cannulation and whether this was achieved with a single wall puncture was noted. Duration of catheterization and reason for removal were recorded in all cases. All catheters were placed by a right transjugular route. Venous cannulation and functioning line placement was achieved in every case; 92/97 (95%) required only a single needle pass and 84/97 (87%) only a single wall puncture. There were no placement related complications; 94 catheters were removed the same day with the remainder removed within 48 hr. All completed apheresis. Our study demonstrates the safe use of central venous catheters for apheresis in normal donors if ultrasound guidance is used for the puncture and the duration of catheterization is short.
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Affiliation(s)
- D J Sadler
- Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
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Stewart DA, Guo D, Glück S, Morris D, Chaudhry A, deMetz C, Klassen J, Brown CB, Russell JA. Double high-dose therapy for Hodgkin's disease with dose-intensive cyclophosphamide, etoposide, and cisplatin (DICEP) prior to high-dose melphalan and autologous stem cell transplantation. Bone Marrow Transplant 2000; 26:383-8. [PMID: 10982284 DOI: 10.1038/sj.bmt.1702541] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We previously reported a 50% (95% CI = 33-76%) 5 year event-free survival (EFS) rate for 23 patients with Hodgkin's disease (HD) who received salvage therapy with single agent high-dose melphalan (HDM) and autologous stem cell transplantation (ASCT). Predictors of poor outcome included bulky disease and initial remission <1 year. Since 1995, similar poor prognosis patients have been treated with double high-dose therapy consisting of dose-intensive cyclophosphamide 5.25 g/m2, etoposide 1.05 g/m2, cisplatin 105 mg/m2 (DICEP) for tumor cytoreduction and stem cell mobilization followed by HDM/ASCT. The purpose of the present study is to determine if the use of DICEP is associated with improved event-free (EFS) and overall survival (OAS) for patients treated with HDM/ASCT. From February 1981 to June 1999, 46 consecutive patients received HDM/ASCT for relapsed (n = 35) or refractory (n = 11) HD. DICEP re-induction and blood stem cell mobilization was used for 21 patients. Factors considered for univariate and multivariate analyses included age at transplant, number of failed chemotherapy regimens, prior radiotherapy, length of initial remission, relapsed or refractory disease status, extranodal relapse, B symptoms at relapse, bulk, post-ASCT radiotherapy, and DICEP re-induction therapy. Cox proportional hazards models were constructed for both event and death. DICEP and HDM were well tolerated with no early treatment-related mortality or toxicity requiring life-sustaining measures. For all 46 patients, the projected 5 year EFS was 52% (95% CI = 38-72%) and OAS was 57% (95% CI = 40-82). Factors independently associated with relapse in multivariate analysis included bulk >5 cm (RR = 6.38, P = 0.002), prior radiotherapy (RR = 3.59, P = 0.027), and not using DICEP (RR = 5.29, P = 0.005). Factors independently associated with death included bulk >5 cm (RR = 5.13, P = 0.009), > or =3 prior chemotherapy regimens (RR = 4.72, P = 0.019), and not using DICEP (RR = 7.49, P = 0.015). This study demonstrates that DICEP re-induction prior to HDM/ASCT is feasible. The preliminary data are sufficiently encouraging to warrant a multicenter phase II or a phase III trial evaluating DICEP followed by HDM/ASCT as salvage therapy for HD.
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Affiliation(s)
- D A Stewart
- Department of Medicine, Tom Baker Cancer Centre, Foothills Hospital and University of Calgary, Alberta, Canada
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Rock G, Chin-Yee I, Cantin G, Giulivi A, Gluck S, Keating A, Keeny M, Klassen J, Sutherland R. Quality assurance of progenitor cell content of apheresis products: a comparison of clonogenic assays and CD34+ enumeration. The Canadian Apheresis Group and Canadian Bone Marrow. Transfus Med 2000; 10:67-75. [PMID: 10760205 DOI: 10.1046/j.1365-3148.2000.00233.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The most common methods used for evaluation of the haematopoietic stem cell content of peripheral blood apheresis products are the colony forming cell assay and the enumeration of CD34+ cells by flow cytometry. The Canadian Apheresis Group and the Canadian Bone Marrow Transplant Group established a multicentre study to compare the reproducibility of colony forming cell assays and CD34+ enumeration by flow cytometry in six transplant centres routinely performing haematopoietic stem cell apheresis. Over a 5-month period in 1996, 31 fresh apheresis samples were shipped by overnight courier for testing at six centres to perform CD34+ enumeration by flow cytometry and clonogenic assays. The mean coefficient of variation and range for the following assays were: cell count 36% (2.6-148%), CFU-GM 82% (46-123%), CD34+ absolute/kg 60% (14-174%) and CD34+ per cent 42% (12-84%). The wide variation in cell count in this pilot study highlights the difficulties related to provision of samples for quality assessment programmes. Results showed poor interinstitutional reproducibility even among selected samples with similar cell counts for both CFC and CD34+ assays demonstrating the need for development and implementation of an interinstitutional quality assurance programme for haematopoietic stem cell assessment. Provision of a reliable source of testing material will be a necessary next step.
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Affiliation(s)
- G Rock
- Department of Pathology, University of Ottawa, Ottawa, Ontario, Canada
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Stewart DA, Guo D, Luider J, Auer I, Klassen J, Morris D, Chaudhry A, Brown C, Russell JA, Gluck S. The CD34+90+ cell dose does not predict early engraftment of autologous blood stem cells as well as the total CD34+ cell dose. Bone Marrow Transplant 2000; 25:435-40. [PMID: 10723588 DOI: 10.1038/sj.bmt.1702171] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CD90 or Thy-1 is an antigen co-expressed with CD34+ on putative immature hematopoietic stem cells. Peak mobilization of CD34+90+ cells into the blood occurs a few days earlier than peak mobilization of total CD34+ cells. Because it is not known which cell type best correlates with engraftment, the optimal timing of apheresis remains unclear. The purpose of the study was to determine if the CD34+90+ cell dose predicts engraftment of autologous blood stem cells independent of the total CD34+ cell dose/kg, the dose of other CD34+ cell subsets (CD34+33-, CD34+38-, CD34+41+), or various clinical factors. Data were analyzed on 125 consecutive patients ranging in age from 19 to 66 years (median 46) who underwent autologous blood stem cell transplantation (ABSCT) for breast cancer (54), lymphoma (59), or other malignancies (12). By univariate analysis, neutrophil (> or = 0.5 x 10(9)/l) and platelet (> or = 20 x 10(9)/l or > or = 100 x 10(9)/l) engraftment correlated better with the total CD34+ cell dose than with the CD34+90+ cell subset. Using Cox proportional hazards models, factors independently associated with both neutrophil engraftment (> or = 0.5 x 10(9)/l) and platelet engraftment (> or = 20 x 10(9)/l and > or = 100 x 10(9)/l) were higher total CD34+ dose/kg and high-dose regimen (melphalan-containing slower than other regimens). In conclusion, the total CD34+ dose/kg was a better predictor of hematopoietic engraftment following ABSCT than the dose of any CD34+ subset, including CD34+90+ cells. Apheresis should continue to be timed according to peak CD34+ levels.
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Affiliation(s)
- D A Stewart
- Department of Medicine, Tom Baker Cancer Centre, Foothills Hospital, Alberta, Canada
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Russell JA, Larratt L, Brown C, Turner AR, Chaudhry A, Booth K, Woodman RC, Wolff J, Valentine K, Stewart D, Ruether JD, Ruether BA, Klassen J, Jones AR, Gyonyor E, Egeler M, Dunsmore J, Desai S, Coppes MJ, Bowen T, Anderson R, Poon MC. Allogeneic blood stem cell and bone marrow transplantation for acute myelogenous leukemia and myelodysplasia: influence of stem cell source on outcome. Bone Marrow Transplant 1999; 24:1177-83. [PMID: 10642805 DOI: 10.1038/sj.bmt.1702051] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have compared the outcomes of 87 patients with acute myelogenous leukemia (AML) and myelodysplasia (MDS) receiving matched sibling transplants with stem cells from peripheral blood (blood cell transplant, BCT) or bone marrow (BMT). In good risk patients (AML in CR1) granulocytes recovered to 0.5 x 10(9)/l a median of 14 days after BCT compared with 19 days after BMT (P < 0.0001). For patients with poor risk disease (AML beyond CR1 and MDS) corresponding figures were 16 vs 26 days (P < 0.0001). Platelet recovery to 20 x 10(9)/l was also faster after BCT (good risk 12 vs 20 days, P < 0.0001; poor risk 17 vs 22 days, P = 0.04). Red cell transfusions were unaffected by cell source, but BCT recipients required less platelet transfusions (good risk 1 vs 5, P = 0.002; poor risk 5 vs 11, P = 0.004). Blood cell transplants resulted in more chronic GVHD (86% vs 48%, P = 0.005) and a significantly higher proportion of recipients with KPS of 80% or less (48% vs 5%, P = 0.004). Disease-free survival at 4 years was 23% for both groups of poor risk patients but outcome in good risk patients was better after BCT (93% vs 62%, P = 0.047) related mainly to less relapse. While disease-free survival may be better after BCT than BMT for AML in CR1, quality of life may be relatively impaired.
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Affiliation(s)
- J A Russell
- Alberta Bone Marrow Transplant Program, Foothills Hospital, Edmonton, Canada
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18
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Stewart DA, Guo D, Luider J, Auer I, Klassen J, Ching E, Morris D, Chaudhry A, Brown C, Russell JA. Factors predicting engraftment of autologous blood stem cells: CD34+ subsets inferior to the total CD34+ cell dose. Bone Marrow Transplant 1999; 23:1237-43. [PMID: 10414909 DOI: 10.1038/sj.bmt.1701800] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Data were analyzed on 178 consecutive patients (median age 43 years) who underwent autologous blood stem cell transplantation (ABSCT) at a single institution to determine if CD34+ subsets (CD34+38-, CD34+33-, CD34+33+, CD34+41+) or various clinical factors affect hematopoietic engraftment independent of the total CD34+ cell dose/kg. Using Cox proportional hazards models, the factors independently associated with rapid neutrophil engraftment were higher CD34+ dose/kg, use of G-CSF post-ABSCT, and conditioning regimen (single-agent melphalan +/- TBI slower). Factors independently associated with rapid platelet engraftment were higher CD34+ cell dose/kg, higher ratio of CD34+33-/total CD34+ cells infused, conditioning regimen (mitoxantrone, vinblastine, cyclophosphamide faster), and no CD34+ cell selection of the autograft. The CD34+ cell selection process seemed to deplete CD34+41+ cells to a greater extent than total CD34+ cells which may explain our observation that it resulted in slower platelet engraftment. In conclusion, the total CD34+ dose/kg was a better predictor of hematopoietic engraftment following ABSCT than the dose of any CD34+ subset. Platelet engraftment, however, was also influenced by the ratio of CD34+33-/total CD34+ cells for unmanipulated autografts, and possibly by the CD34+41+ dose for autografts manipulated by CD34+ selection. The use of CD34+ subsets requires further investigation in predicting engraftment of autografts which undergo ex vivo manipulation.
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Affiliation(s)
- D A Stewart
- Department of Medicine, Tom Baker Cancer Centre, Foothills Hospital and University of Calgary, Alberta, Canada
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19
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Stewart DA, Guo D, Morris D, Poon MC, Ruether BA, Jones AR, Klassen J, Auer I, Luider J, Chaudhry A, Brown C, Russell JA. Superior autologous blood stem cell mobilization from dose-intensive cyclophosphamide, etoposide, cisplatin plus G-CSF than from less intensive chemotherapy regimens. Bone Marrow Transplant 1999; 23:111-7. [PMID: 10197794 DOI: 10.1038/sj.bmt.1701536] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The study purpose was to determine if G-CSF plus dose-intensive cyclophosphamide 5.25 g/m2, etoposide 1.05 g/m2 and cisplatin 105 mg/m2 (DICEP) results in superior autologous blood stem cell mobilization (BSCM) than less intensive chemotherapy. From January 1993 until May 1997, 152 consecutive patients with non-Hodgkin's lymphoma (n = 55), breast cancer (n = 47), Hodgkin's disease (n = 14), multiple myeloma (n = 9), AML (n = 9), or other cancers (n = 18) initially underwent BSCM by one of three methods: Group 1: G-CSF alone x 4 days (n = 30). Group 2: disease-oriented chemotherapy, dosed to avoid blood transfusions, followed by G-CSF starting day 7 or 8, and apheresis day 13 or 14 (n = 82). Group 3: DICEP days 1-3, G-CSF starting day 14, and apheresis planned day 19, 20 or 21 (n = 40). A multivariate analysis was performed to determine which factors independently predicted BSCM. The median peripheral blood CD34+ (PB CD34+) cell count the morning of apheresis linearly correlated with the number of CD34+ cells removed per litre of apheresis that day. The median PB CD34+ cell count and median CD34+ cells x 10(6) removed per litre of apheresis were highest for Group 3, intermediate for Group 2, and lowest for Group 1. By multivariate analysis, mobilization group (3 > 2 > 1), disease other than AML, no prior melphalan or mitomycin-C, and less than two prior chemotherapy regimens predicted better BSCM. Out of 15 Group 3 patients who had infiltrated marrows, 11 had no detectable cancer in marrow and apheresis products after DICEP. These data suggest that DICEP results in superior BSCM than less intensive chemotherapy regimens.
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Affiliation(s)
- D A Stewart
- Department of Medical Oncology, Tom Baker Cancer Centre, Foothills Hospital, and University of Calgary, Alberta, Canada
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20
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Abstract
Apheresis is an increasingly important procedure in the treatment of a variety of conditions, sometimes performed via peripheral access because of concern over major complications associated with central venous catheter (CVC) placement. This study sought to determine the safety and success for ultrasound and fluoroscopically guided, non-tunneled dual lumen CVCs placed for apheresis. Prospective data collection was made of 200 attempted CVC placements in the radiology department utilizing real time sonographic guidance. The complications relating to placement were noted in all and the number of passes required for venepuncture and whether a single wall puncture was achieved was recorded in 185 cases. Duration of catheterization and reason for line removal were recorded in all. Our study group included 71 donors providing peripheral blood stem cells for allogeneic transplant. CVCs were successfully placed in all patients, 191 lines in the internal jugular and seven in the femoral vein. 86.5% required only a single pass and 80.5% with only anterior wall puncture. Inadvertent but clinically insignificant arterial puncture occurred in six (3%) cases. In no case did this prevent line placement. There were no other procedure-related complications. 173 (87.4%) catheters were removed the same day. No catheters were removed prematurely. There was one case of prolonged venous bleeding. Our study demonstrates the safety of central venous catheters for apheresis provided that duration of catheterization is short and real-time sonographic guidance is used for the puncture, and guide wire and catheter placement are confirmed fluoroscopically.
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Affiliation(s)
- D J Sadler
- Department of Diagnostic Imaging, University of Calgary, Foothills Hospital, Alberta, Canada
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21
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Corbalan R, Acevedo M, Godoy I, Jalil J, Campusano C, Klassen J. Enalapril restores depressed circulating insulin-like growth factor 1 in patients with chronic heart failure. J Card Fail 1998; 4:115-9. [PMID: 9730104 DOI: 10.1016/s1071-9164(98)90251-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Congestive heart failure (CHF) is characterized by increased activity of the renin-angiotensin system. Recent experimental studies have shown that infusion of angiotensin II results in depressed plasma levels of insulin-like growth factor 1 (IGF-1) and weight loss. We have previously reported that stable patients with CHF have decreased activity of the growth hormone (GH)-IGF1 axis. We have hypothesized, therefore, that angiotensin-converting enzyme (ACE) inhibition therapy should restore GH-IGF1 activity in CHF patients. METHODS AND RESULTS Nine patients with stable CHF who were taking digitalis and diuretics, New York Heart Association functional class III were studied before and after 8 weeks of therapy with Enalapril (10 mg twice daily). We measured IGF1 levels, radionuclide left ventricular ejection fraction (EF) and peak oxygen consumption (PVO2). We found that 7 of 9 patients had abnormally low levels of IGF1 (0.2-0.5 mU/ml). IGF1 levels reverted to normal after Enalapril therapy (0.36 +/- 0.03 to 0.8 +/- 0.14 mU/ml, P = .004). This was associated with a significant increase in EF (27.4 +/- 1.1 to 31.4 +/- 0.9%) and PVO2 (14.8 +/- 1.2 to 18.6 +/- 1.5 ml/kg/min) values (P < .05). CONCLUSION Chronic ACE inhibition therapy restored previously reduced IGF1 plasma levels in patients with CHF, most likely by reducing angiotensin II activity.
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22
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Stewart DA, Guo D, Sutherland JA, Ruether BA, Jones AR, Poon MC, deMetz C, Klassen J, Chaudhry A, Brown CB, Russell JA. Single-agent high-dose melphalan salvage therapy for Hodgkin's disease: cost, safety, and long-term efficacy. Ann Oncol 1997; 8:1277-9. [PMID: 9496396 DOI: 10.1023/a:1008268027332] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few data are available on the cost, safety, and long-term efficacy of single-agent high-dose melphalan (HDM) followed by autologous bone marrow (ABMT) or blood stem cell (ABSCT) transplantation in the salvage therapy of Hodgkin's disease (HD). PATIENTS AND METHODS From February 1981 to September 1996, 23 patients with relapsed (n = 15) or refractory (n = 8) HD received salvage therapy with HDM 140-200 mg/m2 followed by non-cryopreserved ABMT (n = 18) or cryopreserved ABSCT (n = 5). The cost of HDM/ABSCT in 1996, from initial consultation until transfer back to referring physician, was determined and compared to the estimate costs of two multi-agent regimens commonly used for HD. RESULTS HDM was well tolerated with no early transplant-related mortality. The five-year overall and progression-free survival rates were 52% and 50%, respectively. The average total cost in Canadian funds of HDM/ABSCT in 1996 was $34,400/patient. This cost was estimated to be $4,700-6,800 cheaper per patient than the multi-agent high-dose regimens. CONCLUSION These data suggest that HDM is safe, feasible, active, and reasonably inexpensive salvage therapy for patients with relapsed/refractory HD.
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Affiliation(s)
- D A Stewart
- Department of Medical Oncology, Tom Baker Cancer Centre, Foothills Hospital, Calgary, Alberta, Canada
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23
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Luider J, Brown C, Selinger S, Quinlan D, Karlsson L, Ruether D, Stewart D, Klassen J, Russell JA. Factors influencing yields of progenitor cells for allogeneic transplantation: optimization of G-CSF dose, day of collection, and duration of leukapheresis. J Hematother 1997; 6:575-80. [PMID: 9483192 DOI: 10.1089/scd.1.1997.6.575] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mobilization of hematopoietic progenitor cells by G-CSF was attempted on 89 occasions in 85 healthy donors. Three dose ranges of G-CSF were chosen for analysis: low (4-7.4 micrograms/kg), intermediate (7.5-10 micrograms/kg) and high (> 10 micrograms/kg). A target blood level for apheresis of 20 x 10(6)/L CD34+ cells was reached by day 3 in 75 patients (84%) and by day 4 in all but 1 (99%). Target yields above 2.5 x 10(6)/kg for 75 unmanipulated transplants were exceeded in a single collection in 73 donors (97%). Correlation of CD34+ cell yields to blood CD34+ cell level before leukapheresis was moderate only (r2 = 0.32). There was close linear correlation between processed volume and cumulative CD34+ cell yield, with a median r2 value of 0.98 (range 0.74-1.00). Yields of CD34+ cells achieved on day 3 were significantly lower after the high dose than after the intermediate G-CSF dose (21 +/- 3 versus 29 +/- 6 x 10(6)/L blood processed, p = 0.03). After the low dose of G-CSF, yields on day 4 were higher than on day 3 (48 +/- 10 versus 22 +/- 4 x 10(6)/L blood processed, p = 0.01). There was no difference between day 3 and day 4 yields with the intermediate G-CSF dose. In 73 of 93 (78%) leukaphereses, the CD34+ cell yield was more than 100% of the estimated intravascular CD34+ cells at the beginning of collection and ranged up to 342%. These data indicate that a daily dose of 7.5-10 micrograms/kg G-CSF, given as a multiple of 300 and 480 micrograms ampoules, is a convenient regimen giving adequate yields from a single collection on day 3 or 4 in most donors. Measuring blood CD34+ cell levels is of limited value in predicting yields, but monitoring CD34+ cell yields during leukapheresis may help to minimize unnecessary or inefficient collection.
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Affiliation(s)
- J Luider
- Alberta Bone Marrow Transplant Program, Foothills Hospital, Calgary, Canada
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24
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Russell JA, Desai S, Herbut B, Brown C, Luider J, Ruether JD, Stewart D, Chaudhry A, Booth K, Jorgenson K, Coppes MJ, Turner AR, Larratt L, Poon MC, Klassen J. Partially mismatched blood cell transplants for high-risk hematologic malignancy. Bone Marrow Transplant 1997; 19:861-6. [PMID: 9156258 DOI: 10.1038/sj.bmt.1700757] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Eleven patients with high-risk hematologic malignancy received cryopreserved but otherwise unmanipulated blood cell transplants (BCT) from partially mismatched family members in whom progenitor cells had been mobilized by G-CSF. Donors were mismatched by up to one antigen in the GVH direction and up to three antigens in the rejection direction. Outcomes were compared with those of 22 patients receiving BCT from fully matched donors. Two mismatched patients died without engraftment on day 21 and 32. One had rejected bone marrow from the same donor, the other was mismatched by two antigens in the rejection direction and received the lowest dose of CD34+ cells. Median time to granulocyte engraftment was 21.5 (range 16-33) days for the mismatched group compared with 16 (11-28) days for the matched group (P = 0.01). No correlation was found between CD34+ cell dose and time to granulocyte or platelet recovery. In the mismatched and matched BCT groups respectively, the risk of grade II-IV acute graft-versus-host disease (GVHD) was 73% vs 28% (P = 0.001) and of chronic GVHD 100% vs 78% at 18 months (P = 0.01). The relationship of T cell dose to acute GVHD could only be evaluated in the matched group and no correlation was found. One of 11 mismatched patients and eight of 22 matched patients had relapse or persistent disease. Disease-free survival at 1 year was similar at 55% for mismatched and 50% for matched BCT. These results indicate that allogeneic BCT from partially mismatched family members is accompanied by a high incidence of GVHD but may result in comparable survival to BCT from fully matched donors.
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Affiliation(s)
- J A Russell
- Alberta Bone Marrow Transplant Program, Foothills Hospital, Calgary, Edmonton, Canada
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25
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Shoker A, Klassen J, Herbut B. Absence of irreversible rejection in the presence of warm anti-donor-HLA class I cytotoxic IgG antibody. Clin Nephrol 1997; 47:87-91. [PMID: 9049455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Since the initial presentation by Kissmeyer-Nielsen and colleagues [1966] and later by Patel and Terasaki [1969], it has been accepted that renal transplantation should not be performed in the presence of cytotoxic alloreactive antibodies of the IgG fraction performed at room temperature against HLA Class I [Braun 1989] antigens. Such antibodies are feared to induce hyper-acute or accelerated rejection because of the presence of HLA Class I antigens on kidney cells. For this reason, the microlymphocytotoxicity crossmatch (XM test: recipient serum reacted against donor lymphocytes as surrogate for HLA antigens) is now universally used before transplantation [Ting 1983]. A positive XM performed against the recipient T lymphocyte at room temperature after treatment of recipient serum with dithiothreitol (DTT), an agent that removes immunoglobulin M, denotes the presence of cytotoxic alloreactive IgG antibodies against the potential donor HLA class I antigen. Herein, we present the case of a patient who developed positive XM test of the IgG isotype against HLA Class I of the donor antigens performed at room temperature seven days after she received a kidney allograft from her daughter. Although the development of a positive XM was associated clinically with acute rejection, the patient responded remarkably well to anti-rejection therapy and maintained excellent graft function thereafter. Thus, strategies to identify the role played by the different IgG isotypes determined against HLA Class I antigens and their relation to irreversible rejection are needed to differentiate between those potential kidney recipients who may benefit from kidney transplantation in the presence of innocent warm IgG subclass antibodies reactive against HLA Class I antigens and those patients who may not.
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Affiliation(s)
- A Shoker
- Department of Medicine, Royal University Hospital, Saskatoon, Canada
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26
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Scott-Douglas N, Zimmerman D, Klassen J. Treatment of acute renal transplant rejection with FK 506 in patients on cyclosporine after failure of standard antirejection therapy. Transplant Proc 1996; 28:3165. [PMID: 8962226] [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: 02/03/2023]
Affiliation(s)
- N Scott-Douglas
- Division of Nephrology, Foothills Medical Centre, University of Calgary, Alberta, Canada
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27
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Russell JA, Bowen T, Brown C, Luider J, Ruether JD, Stewart D, Jorgenson K, Coppes MJ, Turner AR, Larratt L, Chaudhry A, Booth K, Poon MC, Klassen J. Second allogeneic transplants for leukemia using blood instead of bone marrow as a source of hemopoietic cells. Bone Marrow Transplant 1996; 18:501-5. [PMID: 8879609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There is increasing interest in blood cell transplants (BCT) from normal donors as an alternative to BMT. Ten patients with relapsed or persistent leukemia after BMT received intensive cytotoxic conditioning followed by allogeneic BCT. Three BCT were from single-antigen mismatched donors; two of the corresponding recipients had rejected a BMT from the same donor. Two patients received BCT from a different donor (one matched, one single-antigen mismatched). The other six BCT were from the same, fully matched, bone marrow donors. Donors were given G-CSF to mobilize progenitor cells which were collected by a single 2-4 h leukapheresis. Methotrexate, CsA and folinic acid were used for GVHD prophylaxis for all transplants but CsA was discontinued sooner after BCT than after BMT. One patient died without engraftment having rejected a BMT from the same single-antigen mismatched donor 4 years previously. Nine patients had granulocyte recovery at a median of 14 days, up to 6 days faster than with their previous BMT. Platelet recovery was also 2-6 days faster than with BMT in four previously engrafting patients. Four patients died without platelet recovery after BCT within a year of BMT, three of treatment-related toxicity and one of relapse. Two patients developed grade II acute GVHD. Of six patients given BCT more than a year from BMT, four, all with acute leukemia, survive 7, 14, 29 and 29 months after BCT and one relapsed at 7 months. All four survivors developed chronic GVHD. These results indicate that BCT may be useful therapy for relapse occurring more than a year after BMT.
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Affiliation(s)
- J A Russell
- Alberta Bone Marrow Transplant Program, Foothills Hospital, Edmonton, Canada
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28
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Stewart DA, Gyonyor E, Paterson AH, Arthur K, Temple W, Schachar NS, Klassen J, Brown C, Russell JA. High-dose melphalan +/- total body irradiation and autologous hematopoietic stem cell rescue for adult patients with Ewing's sarcoma or peripheral neuroectodermal tumor. Bone Marrow Transplant 1996; 18:315-8. [PMID: 8864440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The role of high-dose therapy and autologous stem cell transplantation (ASCT) in the treatment of patients with Ewing's sarcoma (EWS) remains uncertain. From November 1985 to September 1994, 13 patients aged 16-30 years (median 20.5) received high-dose melphalan (HDM) 140-200 mg/m2 +/- 500 cGy TBI followed by ASCT for relapsed/refractory (n = 4), metastatic (n = 2), or non-metastatic (n = 6) EWS, or for peripheral neuroectodermal tumor (PNET) (n = 1). This regimen was well tolerated with no transplant-related mortality and no toxicity requiring life sustaining measures. Three of the four patients treated for relapsed/refractory EWS had progression-free survivals (PFS) less than 5 months. The only long-term survivor of these four patients received HDM while in complete remission following pulmonary irradiation. Both patients with pulmonary metastases at presentation died just 5 and 6 months post-ASCT. All four patients with non-metastatic, bulky (> 8 cm) osseous EWS progressed at a median of 11 months (range 7-22 months) while the two patients with non-bulky EWS remain progression-free 25+ and 28+ months post-HDM/TBI + ASCT. The 19-year-old patient with a PNET of the thoracoabdominal wall relapsed 4 months post-ASCT. Overall, only three of these 13 patients remain progression-free at 25+, 28+, and 108+ months following HDM +/- TBI and ASCT. In conclusion, HDM +/- TBI did not obviously improve the outcome of these 13 patients relative to that expected following conventional dose therapy alone.
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Affiliation(s)
- D A Stewart
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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29
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Russell JA, Brown C, Bowen T, Luider J, Ruether JD, Stewart D, Chaudhry A, Booth K, Jorgenson K, Coppes MJ, Turner AR, Larratt L, Desai S, Poon MC, Klassen J. Allogeneic blood cell transplants for haematological malignancy: preliminary comparison of outcomes with bone marrow transplantation. Bone Marrow Transplant 1996; 17:703-8. [PMID: 8733685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Twenty-six patients with haematological malignancy received cryopreserved but otherwise unmanipulated blood cell transplants (BCT) from five- or six-antigen matched siblings in whom progenitor cells had been mobilized by G-CSF. Outcomes were compared with a historical control group of 26 BMT patients matched for age and disease status. Granulocyte counts recovered to 0.5 x 10(9)/l in a median of 16 days after BCT compared with 21.5 days after BMT (P = 0.0002). Platelet counts, unsupported for 3 days, reached 20 x 10(9)/l in a median of 14 days vs 20.5 days (P = 0.0003) after BCT compared with BMT in those patients who engrafted. In the BCT and BMT groups, respectively, the risk of grade II-IV acute GVHD was 37 vs 21% (P = 0.16) and of chronic GVHD at 1 year 53 vs 48% (P = 0.9). There was no significant difference in red cell transfusions but BCT patients required fewer platelet transfusions (median 3 vs 5, P = 0.015) and fewer days in hospital (20.5 vs 25, P = 0.02). These results indicate that allogeneic BCT from matched and partially mismatched family donors result in faster engraftment than BMT without a significant increase in GVHD. Allogeneic BCT may prove to be a more tolerable procedure than BMT for both donor and recipient and there are indications of improved cost-effectiveness.
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Affiliation(s)
- J A Russell
- Alberta Bone Marrow Transplant Program, Foothills Hospital, Calgary, Canada
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30
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Bhardwaj B, Klassen J, Cossette N, Sterns E, Tuck A, Deeley R, Sengupta S, Elliott B. Localization of platelet-derived growth factor beta receptor expression in the periepithelial stroma of human breast carcinoma. Clin Cancer Res 1996; 2:773-82. [PMID: 9816230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Platelet-derived growth factor (PDGF) BB is secreted by most human breast carcinoma cells; however, only recently have PDGF beta receptors been demonstrated in malignant breast tissue. In the present study, the tissue localization of PDGF beta receptor expression was studied in human breast carcinoma and nonmalignant breast tissues stained using both immunofluorescence and immunoperoxidase techniques. We examined a total of 29 cases of breast carcinomas, which showed both in situ and invasive components. PDGF beta receptor staining was localized in the periepithelial stroma and was particularly intense in regions immediately adjacent to carcinoma in situ components in all tumors examined. A diffuse low level of PDGF beta receptor staining was seen throughout the stroma of eight nonmalignant breast tissues as well as of nonmalignant regions of tumor tissues. Image analysis was used to assess the coincidence of staining of PDGF beta receptor with epithelial or stromal cells in 13 of the 29 tumor tissues studied. Less than 5% of malignant ductal epithelium or myoepithelium showed PDGF beta receptor staining. Analysis with stromal cell type-specific markers indicated significant localization of PDGF beta receptor primarily within alpha smooth muscle actin-staining cells (32%) and vascular endothelial cells (41%) in the periepithelial stroma. PDGF beta receptor positivity was strongly associated with periepithelial stromal cells adjacent to the basement membrane surrounding regions of carcinoma in situ but was less intense in regions of invasive carcinoma where basement membrane was degraded. The absence of PDGF beta receptors on carcinoma cells and their presence in the surrounding stroma suggest a paracrine stimulation of adjacent stromal tissue by malignant epithelial cells in human breast tumors.
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Affiliation(s)
- B Bhardwaj
- Cancer Research Laboratories, Queen's University, and Kingston General Hospital, Kingston, Ontario, K7L 3N6, Canada
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31
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Saulnier R, Bhardwaj B, Klassen J, Leopold D, Rahimi N, Tremblay E, Mosher D, Elliott B. Fibronectin fibrils and growth factors stimulate anchorage-independent growth of a murine mammary carcinoma. Exp Cell Res 1996; 222:360-9. [PMID: 8598224 DOI: 10.1006/excr.1996.0045] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Stromal cells are important regulators of mammary carcinoma growth and metastasis. We have previously shown that a 3T3-L1 adipocyte cell line secretes hepatocyte growth factor (HGF), which stimulates proliferation of a murine mammary carcinoma (SP1) in monolayer cultures (DNA Cell Biol. 13, 1189-1897, 1994). We now examine the role of growth factors and the extracellular matrix protein fibronectin in stimulation of anchorage-independent growth of SP1 cells. Purified transforming growth factor-beta (TGF-beta) stimulated significant colony growth in soft agar cultures, whereas HGF had a lesser effect. Analysis by confocal microscopy revealed that carcinoma cell colonies contained extracellular microfibrils composed of fibronectin. Partial depletion of fibronectin from 7% FBS/agar cultures reduced the number of colonies; colony growth could be recovered by adding back exogenous fibronectin. Addition of the 70-kDa N-terminal fragment of fibronectin, which inhibits fibronectin fibril formation, reduced growth of SP1 cell colonies, but an 85-kDa fragment containing the cell binding domain did not inhibit colony growth. These findings indicate that deposition of extracellular fibronectin fibrils is necessary, but not sufficient, for anchorage-independent growth of SP1 mammary carcinoma cells; growth factors are also required. SP1 cells had less fibronectin mRNA and secreted less fibronectin protein under anchorage-independent conditions than under anchorage-dependent conditions, as determined by Northern blotting and immunoprecipitation analysis. Thus, both growth factors (HGF and TGF-beta) and fibronectin may be important regulators of paracrine stimulation by stromal cells of anchorage-independent growth of mammary carcinoma cells.
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Affiliation(s)
- R Saulnier
- Cancer Research Laboratory, Queen's University, Kingston, Ontario, Canada
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Parsons H, Snyder F, Bowen T, Klassen J, Pinto A. Immune complex disease consistent with systemic lupus erythematosus in a patient with lysinuric protein intolerance. J Inherit Metab Dis 1996; 19:627-34. [PMID: 8892019 DOI: 10.1007/bf01799838] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- H Parsons
- Department of Pediatrics, University of Calgary, Alberta, Canada
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33
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Levin A, Klassen J, Halperin ML. Challenging consults: application of principles of physiology and biochemistry to the bedside. Osmotic diuresis: the importance of counting the number of osmoles excreted. CLIN INVEST MED 1995; 18:401-5. [PMID: 8529323] [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: 01/31/2023]
Abstract
Polyuria is usually the result of a water diuresis or an osmotic diuresis. Traditionally, the assessment of the extracellular fluid (ECF) volume and the concentration of Na+ in plasma is sufficient to differentiate between the two. We present a case and our approach, which is based on calculations and quantitation of osmoles, to demonstrate the utility of this approach. A patient with diabetes mellitus, human T-cell lymphocyte virus, type 1 (HTLV-1) associated lymphoma, and hypercalcemia presented with marked ECF volume contraction and polyuria. A spot urine osmolality was 567 mOsm/kg H2O in the face of urine output of approximately 6 L/d. The initial diagnosis was an osmotic diuresis. However, a quantitative analysis revealed the enormous number of osmoles could not be accounted for physiologically. Hence, we postulated a water diuresis to be the cause of the polyuria. To confirm this hypothesis, we found that at different times during his hospitalization, the urine specific gravity ranged from 1.005 to 1.022, and urine output varied markedly over 8-h periods. Despite a plasma sodium of 147 mmol/L, the patient did not complain of thirst. Taken together, this suggested the presence of a hypothalamic lesion which caused central diabetes insipidus with variable output of antidiuretic hormone together with a blunted thirst response. Illustration of the utility of a quantitative approach to polyuria is the focus of the discussion.
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Affiliation(s)
- A Levin
- Renal Division, St. Paul's Hospital, University of British Columbia, Vancouver
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34
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Geor R, Hope E, Lauper L, Piela S, Klassen J, King V, Murphy M. Effect of glucocorticoids on serum osteocalcin concentration in horses. Am J Vet Res 1995; 56:1201-5. [PMID: 7486399] [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: 01/25/2023]
Abstract
The effects of dexamethasone (0.2 mg/kg of body weight; IV, IM, and PO) and methylprednisolone acetate (120 mg given intra-articularly) on serum osteocalcin and cortisol concentrations were studied in 6 horses. Serum osteocalcin and cortisol concentrations were serially monitored after each treatment. A significant (P < 0.05) decrease in serum osteocalcin and cortisol concentrations was observed from 12 to 24 and 2 to 48 hours, respectively, after IV and IM administrations of dexamethasone. Serum osteocalcin and cortisol concentrations were significantly decreased from 6 to 48 and 3 to 72 hours, respectively, after oral administration. In contrast, a change in serum osteocalcin concentration was not detected after intra-articular administration of methylprednisolone. Oral, IV, or IM treatment with 0.2 mg of dexamethasone/kg caused a decrease in serum osteocalcin concentration in horses.
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Affiliation(s)
- R Geor
- Department of Clinical and Population Sciences, College of Veterinary Medicine, University of Minnesota, St Paul 55108, USA
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35
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Russell JA, Luider J, Weaver M, Brown C, Selinger S, Railton C, Karlsson L, Klassen J. Collection of progenitor cells for allogeneic transplantation from peripheral blood of normal donors. Bone Marrow Transplant 1995; 15:111-5. [PMID: 7537998] [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: 01/25/2023]
Abstract
Fourteen donors were given recombinant G-CSF to mobilize progenitor cells. Circulating CD34+ cells were monitored daily and leukapheresis was performed at 3-5 days when the level exceeded 20 x 10(6)/L. Monitoring of CD34+ cells collected at intervals during apheresis gave results within 20 min. Yields of 2.6-7.4 x 10(6) per kg recipient body weight were achieved in single aphereses of 2-4 h in all but two cases where the donor was substantially smaller than the recipient. These products were sufficient to establish engraftment, at least of granulocytes, in 11 five or six antigen matched recipients with high risk malignancy. Despite some complications donors tolerated the procedure well and the five individuals who had previously given marrow preferred these manoeuvres to bone marrow harvest. The ability to monitor CD34+ cells rapidly in the circulation and leukapheresis product facilitates an efficient collection technique for allogeneic BCT donors. Adequate yields could probably be achieved by a single harvest on days 2-4 in most donors.
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Affiliation(s)
- J A Russell
- Alberta Bone Marrow Transplant Program, Foothills Hospital, Calgary, Alberta, Canada
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Sutherland R, Burgess E, Klassen J, Buckle S, Paul LC. Post-transplant conversion from cyclosporin to azathioprine: effect on cardiovascular risk profile. Transpl Int 1993. [DOI: 10.1111/j.1432-2277.1993.tb00631.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sutherland F, Burgess E, Klassen J, Buckle S, Paul LC. Post-transplant conversion from cyclosporin to azathioprine: effect on cardiovascular risk profile. Transpl Int 1993; 6:129-32. [PMID: 8499063 DOI: 10.1007/bf00336354] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The benefits of long-term cyclosporin (CyA) therapy are not yet established and must be weighed against its toxicity. We studied cardiovascular risk factors in 25 patients who received a kidney transplant between 1985 and 1989 and in whom CyA was discontinued. The protocol for discontinuing CyA involved starting azathioprine (Aza) and then weaning CyA over 6 weeks without changing the prednisone dose. Parameters collected from the patients' charts 3 months before (pre) and 3 months after conversion (post) and at the most current follow-up (cur) included serum creatinine, cholesterol, blood pressure, and anti-hypertensive medication. The severity of the hypertension was graded, based on a hypertension index reflecting the nature and dose of the anti-hypertensive medication. Of the 25 patients in whom CyA was discontinued, 2 experienced a rejection episode during conversion and were switched back to CyA; 1 patient had a rejection episode after conversion but remained on Aza. Converted patients demonstrated improved renal function (1/Cr pre 0.69 +/- 0.20, post 0.84 +/- 0.23, P < 0.05), lower serum cholesterol levels (pre 6.8 +/- 1.0, post 5.8 +/- 1.2, P < 0.05), lower mean arterial pressure (pre 111 +/- 14, post 102 +/- 8, P < 0.05) and a lower hypertension index (pre 2.45 +/- 2.77, cur 1.62 +/- 1.70, P < 0.05). Although conversion may carry some risk of acute rejection, it improves graft function and the cardiovascular risk profile significantly.
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Affiliation(s)
- F Sutherland
- Department of Surgery, University of Calgary Foothills Hospital, Alberta, Canada
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Paul LC, Sutherland F, Klassen J, Buckle S, Burgess E. Cardiovascular risk impact of cyclosporine immunosuppression in renal transplant recipients. Transplant Proc 1992; 24:2740-1. [PMID: 1465922] [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: 12/27/2022]
Affiliation(s)
- L C Paul
- Department of Medicine, University of Calgary, Alberta, Canada
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Devins GM, Mandin H, Hons RB, Burgess ED, Klassen J, Taub K, Schorr S, Letourneau PK, Buckle S. Illness intrusiveness and quality of life in end-stage renal disease: Comparison and stability across treatment modalities. Health Psychol 1990; 9:117-42. [PMID: 2331973 DOI: 10.1037/0278-6133.9.2.117] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.3] [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
Investigated the degree to which chronic, life-threatening illness and its treatment interfere with continued involvements in valued activities and interests--that is, illness intrusiveness--and its impact on quality of life in end-stage renal disease. Data were collected on two occasions separated by a lag of 6 weeks. Mixed analyses of variance indicated that life domains were affected differentially across treatments. Perceived illness intrusiveness correlated significantly with treatment time requirements, uremic symptoms, intercurrent nonrenal illnesses, fatigue, and difficulties in daily activities. Significant quality-of-life differences were observed across treatment modalities for satisfaction/happiness and pessimism/illness-related concerns but not for depression/distress. Perceived illness intrusiveness correlated significantly with each of these quality-of-life measures. Results were stable over time. These findings substantiate the construct of illness intrusiveness as a mediator of the psychosocial impact of chronic, life-threatening illness.
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Affiliation(s)
- G M Devins
- Department of Psychology, University of Calgary, Alberta, Canada
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Abstract
Microscopic colitis associated with gluten-resistant partial villous atrophy was documented in a 21-year-old woman with chronic nonbloody diarrhea. Electron microscopic examination of the colonic and duodenal biopsies showed focal separations of basal lamina from cryptal epithelial cells forming subepithelial blebs in which were mast cells and fibroblasts. These morphologic features have not been previously described in any inflammatory bowel disease and are reminiscent of bullous pemphigoid of the skin. The findings suggest that not all cases of microscopic colitis lie within the spectrum of collagenous colitis.
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Affiliation(s)
- W S Hwang
- Department of Pathology, University of Calgary, Alberta, Canada
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41
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MacDonald AS, Daloze P, Dandavino R, Jindal S, Bear L, Dossetor JB, Klassen J, Stiller CR, Lockwood B, Reeve CE. A randomized study of cyclosporine with and without prednisone in renal allograft recipients. Canadian Transplant Group. Transplant Proc 1987; 19:1865-6. [PMID: 3079054] [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: 01/04/2023]
Abstract
Sixty-nine patients receiving Cs after cadaveric or LRD renal transplants were randomly allocated to receive prednisone or no prednisone beginning on the day of transplant. There were 36 in the prednisone group and 33 in the group assigned to no prednisone. Of these latter, only seven (21%) never received prednisone and an additional four had one short course for rejection episodes (11%). Of the remaining 22 who were placed on continuous steroids, only 12 met rejection criteria and either some or all of the remainder probably had Cs nephrotoxicity. The patient and graft survival were better but not statistically so in the no-prednisone group (97% v 89%) and (88% v 78%), and the number of infections was only half that of the prednisone-treated group (22% v 42%). A policy of withholding steroids except for rejection episodes does not prejudice graft or patient survival in Cs-treated patients.
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Affiliation(s)
- A S MacDonald
- Ambulatory Care Centre, Victoria General Hospital Halifax, Nova Scotia, Canada
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Klassen J. Suction assisted lipectomy. Can Oper Room Nurs J 1986; 4:17-20. [PMID: 3639747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Familial hypopituitarism in the Hutterite Brethren is an autosomal recessive disorder involving sequential loss of anterior pituitary tropic hormones. Five individuals from two closely related families have been followed for 19 years. Both families are well integrated into the Hutterite community. Three sibs elected not to be treated with growth hormone and sex steroids. These sibs developed growth hormone and gonadotropin deficiency in the first decade of life, with subsequent loss of TSH function and finally ACTH deficiency in the third decade. The pattern of hormone loss differed in the second family, in that deficiency of growth hormone, gonadotropins, and TSH was evident in the first decade. A third family has been reported to have the same disorder and is from a different endogamous subdivision from that of the two families described here. Genealogical analysis of the three families shows that there are four ancestral couples common to the six parents. Thus all affected individuals are likely to be identical by descent for the same ancestral allele. The gene for hypopituitarism is not closely linked to the gene for growth hormone nor to the HLA region.
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Chang-Poon VY, Hwang WS, Wong A, Berry J, Klassen J, Poon MC. Pulmonary angiomatoid vascular changes in mitomycin C-associated hemolytic-uremic syndrome. Arch Pathol Lab Med 1985; 109:877-8. [PMID: 3927871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Angiomatoid vascular changes in lungs and pulmonary hemorrhage are described in a woman in whom mitomycin C-associated hemolytic-uremiclike syndrome developed. These changes represent part of the spectrum of vascular damage that may complicate mitomycin therapy. Patients receiving mitomycin C chemotherapy require careful monitoring for possible development of these complications.
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Abstract
A solid-phase immunoassay has been developed for the detection of anti-glomerular basement membrane (GBM) antibodies in the circulation of patients with Goodpasture's syndrome and one form of rapidly progressive glomerulonephritis. The procedure involves the formation of a covalent linkage between the antigen and a solid support disc. Antibodies bound to the antigen are then detected on a fluorometer using fluorescein-labeled antisera to human immunoglobulins. The assay is easy to perform, fast, inexpensive and has been optimized with respect to sensitivity, range and reproducibility.
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Krcek JP, Dickson A, Biddle F, Klassen J. Greater accumulation of mononuclear cells in the trophoblastic giant cell layer of congenically than of isogenically mated mice. J Reprod Immunol 1981. [DOI: 10.1016/0165-0378(81)90093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Masri M, Boyd ND, Alexander F, Barabas AZ, Klassen J. Irreversible attachment of immunoglobulins and F(ab')2 fragments to their specific cell membrane antigens. Transplantation 1980; 30:373-6. [PMID: 6256927 DOI: 10.1097/00007890-198011000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Antiserum was raised in sheep against rat kidney glomerular basement membrane, and the antibodies and their F(ab')2 fragments were prepared. These were reacted with one arm of the bifunctional reagent toluene diisocyanate at pH 7.5 and injected into the tail vein of rats. Kidney sections were taken from the rats and, after washing, incubated at pH 8.5 to permit the other arm of the toluene diisocyanate to become reactive. This procedure resulted in the specific irreversible attachment of the antibodies and their F(ab')2 fragments to their corresponding glomerular basement membrane antigens.
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Sugisaki T, Yoshida T, McCluskey RT, Andres GA, Klassen J. Autoimmune cell-mediated tubulointerstitial nephritis induced in Lewis rats by renal antigens. Clin Immunol Immunopathol 1980; 15:33-43. [PMID: 6987017 DOI: 10.1016/0090-1229(80)90018-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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49
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Abstract
Serum beta-2 microglobulin levels were measured in normal individuals and in breast cancer patients. It was observed that there was a significant rise in levels especially in advanced stages of the disease. It was concluded that patients with a beta-2 microglobulin/creatinine ratio of greater than 3.8 were likely to have metastatic breast cancer.
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50
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Boye E, Morse M, Huttner I, Erlanger BF, MacKinnon KJ, Klassen J. Immune complex-mediated interstitial cystitis as a major manifestation of systemic lupus erythematosus. Clin Immunol Immunopathol 1979; 13:67-76. [PMID: 313295 DOI: 10.1016/0090-1229(79)90021-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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