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Wu K, Ozomaro U, Flavell R, Pampaloni M, Liu C. Causes of False-Positive Radioactive Iodine Uptake in Patients with Differentiated Thyroid Cancer. Curr Radiol Rep 2021. [DOI: 10.1007/s40134-021-00381-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose
Radioactive iodine (RAI) whole-body scan is a sensitive imaging modality routinely used in patients with differentiated thyroid cancer to detect persistent and recurrent disease. However, there can be false-positive RAI uptake that can lead to misdiagnosis and misclassification of a patient’s cancer stage. Recognizing the causes of false positivity can avoid unnecessary testing and treatment as well as emotional stress. In this review, we discuss causes and summarize various mechanisms for false-positive uptake.
Recent Findings
We report a patient with differentiated thyroid cancer who was found to have Mycobacterium avium complex infection as the cause of false-positive RAI uptake in the lungs. Using this case example, we discuss and summarize findings from the literature on etiologies of false-positive RAI uptake. We also supplement additional original images illustrating other examples of false RAI uptake.
Summary
False-positive RAI uptake may arise from different causes and RAI scans need to be interpreted in the context of the patient’s history and corresponding cross-sectional imaging findings on workup. Understanding the potential pitfalls of the RAI scan and the mechanisms underlying false uptake are vital in the care of patients with differentiated thyroid cancer.
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Kambhampati S, Hunter B, Varnavski A, Fakhri B, Kaplan L, Ai WZ, Pampaloni M, Huang CY, Martin T, Damon L, Andreadis CB. Ofatumumab, Etoposide, and Cytarabine Intensive Mobilization Regimen in Patients with High-risk Relapsed/Refractory Diffuse Large B-Cell Lymphoma Undergoing Autologous Stem Cell Transplantation. Clin Lymphoma Myeloma Leuk 2020; 21:246-256.e2. [PMID: 33288485 DOI: 10.1016/j.clml.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND More than one-half of high-risk patients with relapsed/refractory (rr) diffuse large B-cell lymphoma (DLBCL) relapse after autologous hematopoietic cell transplantation (auto-HCT). In this phase II study, we investigate the long-term outcomes of high-risk patients with rrDLBCL receiving intensive consolidation therapy (ICT) with OVA (ofatumumab, etoposide, and high-dose cytarabine) prior to auto-HCT. PATIENTS AND METHODS The primary endpoints were the ability of OVA to mobilize peripheral stem cells and the 2-year progression-free survival (PFS) rate following OVA. Secondary endpoints included safety, 2-year overall survival (OS), impact of cell of origin (COO), and the prognostic utility of next-generation sequencing minimal residual disease (MRD) testing. We simultaneously retrospectively assessed the outcomes of DLBCL patients who underwent ICT with a similar regimen at our institution. RESULTS Twenty-seven patients received salvage chemotherapy, with a response rate of 25% in patients with germinal center B-cell (GCB)-DLBCL versus 92% in patients with non-GCB-DLBCL (P = .003). Nineteen responding patients underwent ICT with OVA (100% successful stem cell mobilization). The 2-year PFS and OS rate was 47% and 59%, respectively, with no difference based on COO. Similar findings were observed when the study and retrospective cohorts were combined. Neutropenia was the most common toxicity (47%). MRD-negative patients at the completion of salvage had a median OS of not reached versus 3.5 months in MRD-positive patients (P = .02). CONCLUSIONS OVA followed by auto-HCT is effective and safe for high-risk rrDLBCL. Patients with GCB-DLBCL had a lower response to salvage chemotherapy, but no difference in outcomes based on COO was seen after auto-HCT. MRD testing in the relapsed setting was predictive of long-term survival.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Cytarabine/administration & dosage
- Cytarabine/adverse effects
- Drug Resistance, Neoplasm
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Female
- Germinal Center/pathology
- Hematopoietic Stem Cell Transplantation
- Humans
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasm, Residual
- Prognosis
- Progression-Free Survival
- Retrospective Studies
- Salvage Therapy/adverse effects
- Salvage Therapy/methods
- Survival Rate
- Transplantation, Autologous/methods
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Affiliation(s)
- Swetha Kambhampati
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Bradley Hunter
- Department of Hematology, Intermountain Healthcare, Salt Lake City, UT
| | | | - Bita Fakhri
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Lawrence Kaplan
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Weiyun Z Ai
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | | | - Chiung-Yu Huang
- UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA; Department of Epidemiology and Biostatistics, UCSF Medical Center, San Francisco, CA
| | - Thomas Martin
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Lloyd Damon
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Charalambos B Andreadis
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA.
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Jimenez C, Grewal R, Ravizzini G, Chin B, Pampaloni M, Matthay K, Jensen J, Lin T, Apfel S, White T, Stambler N, DiPippo V, Mahmood S, Wong V, Pryma D. SUN-345 Safety Analysis of High-Specific-Activity I-131 MIBG (AZEDRA®) in Patients with Iobenguane Scan Positive Cancers. J Endocr Soc 2019. [PMCID: PMC6553226 DOI: 10.1210/js.2019-sun-345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Iobenguane scan positive cancers including pheochromocytoma/paraganglioma (PPGL), neuroblastoma, and gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are heterogeneous tumors that arise from neuroendocrine cells. Recently, high-specific-activity I-131 meta-iodobenzylguanidine (HSA I-131 MIBG, AZEDRA®) was approved in the US for treatment of adult and pediatric patients 12 years and older with iobenguane scan positive, unresectable, locally advanced or metastatic PPGL. We present a pooled analysis of all available clinical trials to further assess the safety profile of HSA I-131 MIBG. Methods: 118 patients from four HSA I-131 MIBG clinical trials (NCT00339131; NCT00458952; NCT00874614; NCT00659984) were included in a pooled analysis for safety assessments. Adverse events (AEs), laboratory tests, number and quantity of HSA I-131 MIBG doses, hypertensive events, blood pressure (BP), heart rate, ECG, and AEs of special interest (AESI) were analyzed using descriptive statistics. Results: Gastrointestinal (GI) toxicities, especially nausea and vomiting, were the most common AEs associated with HSA I-131 MIBG. GI toxicities were not reported after dosimetry doses. GI, blood and lymphatic system, and vascular disorders were higher in PPGL than in neuroblastoma after therapeutic dose 1 when compared to therapeutic dose 2. The incidence of potentially clinically significant changes in BP was similar following dosimetric and therapeutic doses and are consistent with the underlying hypertension associated with PPGL. No spike in systolic and diastolic BP was observed within the first 4 hours of HSA I-131 MIBG administration, and there were no acute hypertensive crises following dosing. A possibly drug-related mild increase in BP within 48 hours of therapeutic dosing was observed in 1 subject with PPGL. Variations in heart rate (>20 beats/min) were higher after therapeutic dose 1 than after other doses. No clinically significant trends were seen in mean ECG results or mean changes from baseline. All patients received at least one concomitant medication. About 40% of patients received β-blockers, 39% α-blockers, and about 27% other peripheral vasodilators. 87.3% of patients reported an AESI, defined as AEs that are related to the acute and/or chronic effects of radiation toxicity seen any time post dosing. The most common AESIs were nausea (66.1%), thrombocytopenia (50.0%), fatigue (50.0%), neutropenia (42.4%), and diarrhea (22.9%). The incidence of most AESIs were similar after each therapeutic dose. Conclusions: HSA I-131 MIBG demonstrated a favorable safety profile in iobenguane scan positive cancers. AEs followed an expected pattern comparable to other radioactive therapeutic agents. Most cardiovascular events, including hypertensive events mostly commonly observed in PPGL, were not considered related to HSA I-131 MIBG.
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Affiliation(s)
- Camilo Jimenez
- Dept of Endo Neoplasia HD, UT MD Anderson Cancer Cntr, Houston, TX, United States
| | - Ravinder Grewal
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Bennett Chin
- University of Colorado Anschutz Medical Campus, Denver, CO, United States
| | - Miguel Pampaloni
- University of California at San Francisco School of Medicine, San Francisco, CA, United States
| | | | - Jessica Jensen
- Progenics Pharmaceuticals, Progenics Pharmaceuticals, New York, NY, United States
| | - Tess Lin
- Progenics Pharmaceuticals, Inc., New York, NY, United States
| | - Stuart Apfel
- Progenics Pharmaceuticals, Inc., New York, NY, United States
| | - Theresa White
- Progenics Pharmaceuticals, Inc., New York, NY, United States
| | - Nancy Stambler
- Progenics Pharmaceuticals, Inc., New York, NY, United States
| | - Vincent DiPippo
- Progenics Pharmaceuticals, Inc., New York, NY, United States
| | - Syed Mahmood
- Progenics Pharmaceuticals, Inc, New York, NY, United States
| | - Vivien Wong
- Progenics Pharmaceuticals, Inc., New York, NY, United States
| | - Daniel Pryma
- Dept of Radiology, Univ of Pennsylvania Perelman Sch of Med, Philadelphia, PA, United States
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4
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Wadhwa EL, Franc BL, Aboian M, Kim JY, Pampaloni M, Nicolaides T. Delayed Fluorodeoxyglucose Positron Emission Tomography Imaging in the Differentiation of Tumor Recurrence and Radiation Necrosis in Pediatric Central Nervous System Tumors: Case Report and Review of the Literature. Cureus 2018; 10:e3364. [PMID: 30510874 PMCID: PMC6257469 DOI: 10.7759/cureus.3364] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Malignant central nervous system (CNS) tumors are often treated with radiation therapy, after which clinical and radiographic sequelae can lead to difficulties differentiating tumor recurrence from treatment effect. Magnetic resonance imaging (MRI) is often unable to distinguish between these two entities. The improved ability to delineate concerning foci could lead to earlier tumor detection with quicker access to new therapies and/or clinical trials; conversely, it could alleviate patient concerns in the case of radiation necrosis as the etiology. The utility of positron emission tomography with computed tomography (PET/CT) imaging with fluorodeoxyglucose (FDG) has been explored in CNS tumors in the past, as this imaging modality is widely used in oncologic practices. As there are concerns with false positive imaging in the case of cells with a high metabolic uptake due to causes other than malignancy (i.e. infection, inflammation), delayed FDG PET imaging has been proposed as a mechanism to reduce this confusion. Delayed FDG PET imaging has been explored in several adult and pediatric malignancies, including adult CNS tumors, though there are no current publications applying its use in pediatric CNS tumors. We present two cases of pediatric CNS tumors, where delayed FDG PET imaging helped in the early diagnosis of a recurrence through a distinguishing tumor from the treatment effect.
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Affiliation(s)
| | | | - Mariam Aboian
- Radiology, University of California, San Francisco, USA
| | - John Y Kim
- Neurosurgery, Kaiser Permanente, Oakland, USA
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5
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Villablanca JG, Ji L, Shapira-Lewinson A, Marachelian A, Shimada H, Hawkins RA, Pampaloni M, Lai H, Goodarzian F, Sposto R, Park JR, Matthay KK. Predictors of response, progression-free survival, and overall survival using NANT Response Criteria (v1.0) in relapsed and refractory high-risk neuroblastoma. Pediatr Blood Cancer 2018; 65:e26940. [PMID: 29350464 PMCID: PMC7456604 DOI: 10.1002/pbc.26940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/19/2017] [Revised: 11/08/2017] [Accepted: 11/22/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE The New Approaches to Neuroblastoma Therapy Response Criteria (NANTRC) were developed to optimize response assessment in patients with recurrent/refractory neuroblastoma. Response predictors and associations of the NANTRC version 1.0 (NANTRCv1.0) and prognostic factors with outcome were analyzed. METHODS A retrospective analysis was performed of patients with recurrent/refractory neuroblastoma enrolled from 2000 to 2009 on 13 NANT Phase 1/2 trials. NANTRC overall response integrated CT/MRI (Response Evaluation Criteria in Solid Tumors [RECIST]), metaiodobenzylguanidine (MIBG; Curie scoring), and percent bone marrow (BM) tumor (morphology). RESULTS Fourteen (6.9%) complete response (CR) and 14 (6.9%) partial response (PR) occurred among 203 patients evaluable for response. Five-year progression-free survival (PFS) was 16 ± 3%; overall survival (OS) was 27 ± 3%. Disease sites at enrollment included MIBG-avid lesions (100% MIBG trials; 84% non-MIBG trials), measurable CT/MRI lesions (48%), and BM (49%). By multivariable analysis, Curie score of 0 (P < 0.001), lower Curie score (P = 0.003), no measurable CT/MRI lesions (P = 0.044), and treatment on peripheral blood stem cell (PBSC) supported trials (P = 0.005) were associated with achieving CR/PR. Overall response of stable disease (SD) or better was associated with better OS (P < 0.001). In multivariable analysis, MYCN amplification (P = 0.037) was associated with worse PFS; measurable CT/MRI lesions (P = 0.041) were associated with worse OS; prior progressive disease (PD; P < 0.001/P < 0.001), Curie score ≥ 1 (P < 0.001; P = 0.001), higher Curie score (P = 0.048/0.037), and treatment on non-PBSC trials (P = < 0.001/0.003) were associated with worse PFS and OS. CONCLUSIONS NANTRCv1.0 response of at least SD is associated with better OS in patients with recurrent/refractory neuroblastoma. Patient and tumor characteristics may predict response and outcome. Identifying these variables can optimize Phase 1/2 trial design to select novel agents for further testing.
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Affiliation(s)
- Judith G. Villablanca
- Department of Pediatrics, Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Lingyun Ji
- Department of Preventative Medicine Statistics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Adi Shapira-Lewinson
- Department of Pediatric Hematology- Oncology, The Ruth Rappaport Children’s Hospital, Haifa, Israel
| | - Araz Marachelian
- Department of Pediatrics, Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Hiroyuki Shimada
- Department of Pathology, Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Randall A. Hawkins
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Miguel Pampaloni
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Hollie Lai
- Department of Pediatric Radiology, Children’s Hospital Orange County, Orange, California
| | - Fariba Goodarzian
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Richard Sposto
- Department of Preventative Medicine Statistics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Julie R. Park
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - Katherine K. Matthay
- Department of Pediatrics, University of California San Francisco, San Francisco, California
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6
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Loo K, Tsai KK, Mahuron K, Liu J, Pauli ML, Sandoval PM, Nosrati A, Lee J, Chen L, Hwang J, Levine LS, Krummel MF, Algazi AP, Pampaloni M, Alvarado MD, Rosenblum MD, Daud AI. Partially exhausted tumor-infiltrating lymphocytes predict response to combination immunotherapy. JCI Insight 2017; 2:93433. [PMID: 28724802 DOI: 10.1172/jci.insight.93433] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 03/14/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Programmed death 1 (PD-1) inhibition activates partially exhausted cytotoxic T lymphocytes (peCTLs) and induces tumor regression. We previously showed that the peCTL fraction predicts response to anti-PD-1 monotherapy. Here, we sought to correlate peCTL and regulatory T lymphocyte (Treg) levels with response to combination immunotherapy, and with demographic/disease characteristics, in metastatic melanoma patients. METHODS Pretreatment melanoma samples underwent multiparameter flow cytometric analysis. Patients were treated with anti-PD-1 monotherapy or combination therapy, and responses determined by Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria. peCTL and Treg levels across demographic/disease variables were compared. Low versus high peCTL (≤20% vs. >20%) were defined from a previous study. RESULTS One hundred and two melanoma patients were identified. The peCTL fraction was higher in responders than nonresponders. Low peCTL correlated with female sex and liver metastasis, but not with lactate dehydrogenase (LDH), tumor stage, or age. While overall response rates (ORRs) to anti-PD-1 monotherapy and combination therapy were similar in high-peCTL patients, low-peCTL patients given combination therapy demonstrated higher ORRs than those who received monotherapy. Treg levels were not associated with these factors nor with response. CONCLUSION In melanoma, pretreatment peCTL fraction is reduced in women and in patients with liver metastasis. In low-peCTL patients, anti-PD-1 combination therapy is associated with significantly higher ORR than anti-PD-1 monotherapy. Fewer tumor-infiltrating peCTLs may be required to achieve response to combination immunotherapy. TRIAL REGISTRATION UCSF IRB Protocol 138510FUNDING. NIH DP2-AR068130, K08-AR062064, AR066821, and Burroughs Wellcome CAMS-1010934 (M.D.R.). Amoroso and Cook Fund, and the Parker Institute for Cancer Immunotherapy (A.I.D.).
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Affiliation(s)
| | | | - Kelly Mahuron
- Department of Surgery, Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, California, USA
| | | | | | | | | | | | | | - Jimmy Hwang
- Department of Epidemiology & Biostatistics, Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, California, USA
| | | | | | | | | | - Michael D Alvarado
- Department of Surgery, Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, California, USA
| | | | - Adil I Daud
- Department of Medicine and.,Department of Dermatology
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7
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Tawakol A, Ishai A, Li D, Takx RA, Hur S, Kaiser Y, Pampaloni M, Rupert A, Hsu D, Sereti I, Fromentin R, Chomont N, Ganz P, Deeks SG, Hsue PY. Association of Arterial and Lymph Node Inflammation With Distinct Inflammatory Pathways in Human Immunodeficiency Virus Infection. JAMA Cardiol 2017; 2:163-171. [PMID: 27926762 PMCID: PMC5310978 DOI: 10.1001/jamacardio.2016.4728] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Human immunodeficiency virus (HIV) infection is associated with a high risk of cardiovascular disease and increased arterial inflammation. In HIV, inflammation is also increased within lymph nodes (LNs), tissues known to harbor the virus even among treated and suppressed individuals. Objective To test the hypothesis that arterial inflammation is linked to HIV disease activity and to inflammation within HIV-infected tissues (LNs). Design, Setting, and Participants For this case-control study, participants were recruited from the SCOPE (Observational Study of the Consequences of the Protease Inhibitor Era) cohort, a clinic-based cohort of individuals receiving care at San Francisco General Hospital and the San Francisco Veteran's Affairs Medical Center. Arterial and LN inflammation were measured using 18F-fluorodeoxyglucose positron emission tomography. Detailed immunophenotyping was performed, along with measurement of viral activity/persistence and of circulating inflammatory biomarkers. Main Outcomes and Measures Arterial and LN inflammation. Results A total of 74 men were studied (45 HIV-infected men with a median age of 53 years [interquartile range, 49-59 years] and 29 uninfected male controls with a median age of 52 years [interquartile range, 46-56 years]). Lymph node inflammation was higher in HIV-infected individuals and correlated with markers of viral disease activity (viral load, CD8+ T cells, and CD4/CD8 ratio) and CD4+ T-cell activation. Uninfected controls had the lowest LN activity (mean [SD] maximum axillary LN standardized uptake value, 1.53 [0.56]), the elite controller and ART-suppressed groups had intermediate levels of LN (mean [SD] maximum axillary LN standardized uptake value, 2.12 [0.87] and 2.32 [1.79], respectively), and the noncontrollers had the highest activity (mean [SD] maximum axillary LN standardized uptake value, 8.82 [3.08]). Arterial inflammation was modestly increased in HIV-infected individuals and was positively correlated with circulating inflammatory biomarkers (high-sensitivity C-reactive protein and IL-6) and activated monocytes (CD14dimCD16+; nonclassical) but not with markers of HIV. While LN and arterial inflammation were increased in HIV, inflammatory activity in these tissues was not related (r = 0.09, P = .56). Conclusions and Relevance While LNs and, to a lesser degree, the arterial wall are inflamed in HIV, inflammation in these tissues is not closely linked. Namely, measures of HIV disease activity are strongly associated with LN inflammation but not with arterial inflammation. These data suggest that LN and arterial inflammation do not share underlying pathways of immune activation and also that therapeutic interventions that reduce viral disease activity may not predictably reduce arterial inflammation in HIV or its downstream consequence (ie, cardiovascular disease).
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Affiliation(s)
- Ahmed Tawakol
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Amorina Ishai
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Danny Li
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Richard A.P. Takx
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Sophia Hur
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Yannick Kaiser
- Department of Vascular Medicine, Academic Medical Center, Amsterdam
| | - Miguel Pampaloni
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Adam Rupert
- Leidos Biomedical Research, Inc, Frederick, MD, USA
| | - Denise Hsu
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Irini Sereti
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Rémi Fromentin
- Centre de Recherche du CHUM and Department of Microbiology, Infectiology, and Immunology, Université de Montréal, Montreal, Canada
| | - Nicolas Chomont
- Centre de Recherche du CHUM and Department of Microbiology, Infectiology, and Immunology, Université de Montréal, Montreal, Canada
| | - Peter Ganz
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Steven G. Deeks
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Priscilla Y. Hsue
- University of California San Francisco (UCSF), San Francisco, CA, USA
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8
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Fidelman N, Kerlan RK, Hawkins RA, Pampaloni M, Taylor AG, Kohi MP, Kolli KP, Atreya CE, Bergsland EK, Kelley RK, Ko AH, Korn WM, Van Loon K, McWhirter RM, Luan J, Johanson C, Venook AP. Radioembolization with 90Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study. J Gastrointest Oncol 2016; 7:860-874. [PMID: 28078110 DOI: 10.21037/jgo.2016.08.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 12/11/2022] Open
Abstract
BACKGROUND This prospective pilot single-institution study was undertaken to document the feasibility, safety, and efficacy of radioembolization of liver-dominant metastatic gastrointestinal cancer using 90Y glass microspheres. METHODS Between June 2010 and October 2013, 42 adult patients (26 men, 16 women; median age 60 years) with metastatic chemotherapy-refractory unresectable colorectal (n=21), neuroendocrine (n=11), intrahepatic bile duct (n=7), pancreas (n=2), and esophageal (n=1) carcinomas underwent 60 lobar or segmental administrations of 90Y glass microspheres. Data regarding clinical and laboratory adverse events (AE) were collected prospectively for up to 5.5 years after radioembolization. Radiographic responses were evaluated using Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1. Time to maximum response, response duration, progression-free survival (PFS) (hepatic and extrahepatic), and overall survival (OS) were measured. RESULTS Median target dose and activity were 109.4 Gy and 2.6 GBq per treatment session, respectively. Majority of clinical AE were grade 1 or 2 in severity. Patients with colorectal cancer had hepatic objective response rate (ORR) of 25% and a hepatic disease control rate (DCR) of 80%. Median PFS and OS were 1.0 and 4.4 months, respectively. Patients with neuroendocrine tumors (NET) had hepatic ORR and DCR of 73% and 100%, respectively. Median PFS was 8.9 months for this cohort. DCR and median PFS and OS for patients with cholangiocarcinoma were 86%, 1.1 months, and 6.7 months, respectively. CONCLUSIONS 90Y glass microspheres device has a favorable safety profile, and achieved prolonged disease control of hepatic tumor burden in a subset of patients, including all patients enrolled in the neuroendocrine cohort.
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Affiliation(s)
- Nicholas Fidelman
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Robert K Kerlan
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Randall A Hawkins
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Miguel Pampaloni
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Andrew G Taylor
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Maureen P Kohi
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - K Pallav Kolli
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Chloe E Atreya
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Emily K Bergsland
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - R Kate Kelley
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Andrew H Ko
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - W Michael Korn
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Katherine Van Loon
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ryan M McWhirter
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Luan
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Curt Johanson
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Alan P Venook
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Collisson E, Ohliger M, Yeh B, Kelly D, Pampaloni M, Ko A, Tempero M, Wang Z. P-221 PET-MR Imaging to Assess early treatment response in Pancreatic Adenocarcinoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.213] [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: 11/14/2022] Open
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Fidelman N, Kerlan R, Taylor A, Kolli K, Kohi M, Hawkins R, Pampaloni M, Atreya C, Bergsland E, Kelley R, Ko A, Korn W, Van Loon K, Luan J, McWhirter R, Johanson C, Venook A. Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.511] [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: 11/30/2022] Open
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Porzig A, Matthay KK, Dubois S, Pampaloni M, Damon L, Hawkins R, Goldsby R, Hollinger F, Fitzgerald P. Proteinuria in metastatic pheochromocytoma is associated with an increased risk of Acute Respiratory Distress Syndrome, spontaneously or after therapy with 131I-meta-iodobenzylguanidine (131I-MIBG). Horm Metab Res 2012; 44:539-42. [PMID: 22588707 DOI: 10.1055/s-0032-1311634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Acute Respiratory Distress Syndrome (ARDS) has been reported rarely in pheochromocytoma, occurring spontaneously or after therapy with 131I-meta-iodobenzylguanidine (131I-MIBG). Our objective was to determine whether proteinuria is associated with an increased risk of ARDS. This was a retrospective analysis of a prospective cohort study of 64 patients with metastatic pheochromocytoma or paraganglioma treated with 131I-MIBG on institutional protocols. Proteinuria was defined as at least one urinalysis positive for at least trace protein within 1 month prior to 131I-MIBG or within 1 month prior to spontaneous ARDS. Proportions were compared using Fisher's exact test. Urinalyses within the defined time period were available for 48 patients, 8 of whom had proteinuria. Of the 8 patients with proteinuria, 5 developed ARDS: 3 within 10 days following 131I-MIBG, two 6 months following 131I-MIBG. Both patients who developed ARDS 6 months after 131I-MIBG had proteinuria within 1 month before apparently spontaneous ARDS. None of the 40 patients whose urinalyses were all negative for protein developed ARDS. None of the 16 patients with missing urinalyses developed ARDS. Patients with antecedent proteinuria were more likely to develop ARDS than those without proteinuria (63% vs. 0%; p<0.0001). The following variables were not significantly associated with ARDS: 131I-MIBG activities administered, number of 131I-MIBG administrations, age, hypertension, or secretion of catecholamines or metanephrines. In patients with metastatic pheochromocytoma or paraganglioma, proteinuria is associated with ARDS and urine protein should be examined prior to administering 131I-MIBG.
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Affiliation(s)
- A Porzig
- Department of Medicine, University of California, San Francisco, California 94117, USA
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