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Glimelius I, Ekberg S, Ekström Smedby K, Wästerlid T. Stable use of radiotherapy in lymphoma patients over time - A comprehensive national overview of radiotherapy use in Sweden with focus on older patients. Clin Transl Radiat Oncol 2024; 46:100785. [PMID: 38694236 PMCID: PMC11061694 DOI: 10.1016/j.ctro.2024.100785] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/20/2024] [Indexed: 05/04/2024] Open
Abstract
Background and purpose The role of radiotherapy (RT) in lymphoma is constantly refined with the advent of novel treatments. However, RT is still an effective treatment and tolerability is high. Therefore, we aimed to describe the use of RT in primary treatment of lymphoma over calendar time, with a specific focus on older patients (age ≥ 70 years) with non-Hodgkin lymphoma (NHL) subtypes. Materials & Methods All adult patients diagnosed with lymphoma from 2007 to 2018 in Sweden were included and followed for survival until end of 2020. Patient characteristics and relative survival (RS) were described for patients with NHL by subtype and RT use. Results In the cohort of lymphoma patients aged ≥ 70 years (n = 12,698) 11 % received RT as part of primary treatment. No decline in use of RT over calendar period was seen. Use of RT as monotherapy was associated with stage I-II disease and older age among patients with stage III-IV disease. Patients with indolent lymphomas aged ≥ 70 years who were selected for treatment with RT as monotherapy with a dose of ≥ 20 Gy had 2-year RS rate of 100 % which remained similar at five years. For patients with DLBCL, RT as monotherapy with a dose of ≥ 20 Gy was mostly administered to patients aged ≥ 85 years with a 2-year RS rate of 68 %. Conclusion The use of RT in first-line lymphoma treatment was stable over calendar time. RT monotherapy is associated with encouraging outcomes among patients with NHL aged ≥ 70 years who were selected to receive this.
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Affiliation(s)
- Ingrid Glimelius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden
| | - Sara Ekberg
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin Ekström Smedby
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Tove Wästerlid
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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Ekberg S, Molin D, Pahnke S, Bergström F, Brånvall E, Smedby KE, Wästerlid T. Impact of the COVID-19 pandemic on lymphoma incidence and short-term survival - a Swedish Lymphoma Register Study. Acta Oncol 2024; 63:164-168. [PMID: 38591352 DOI: 10.2340/1651-226x.2024.35238] [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] [Received: 12/21/2023] [Accepted: 03/02/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND & PURPOSE The COVID-19 pandemic posed a large challenge for healthcare systems across the world. Comprehensive data on the impact of the COVID-19 pandemic on incidence and mortality in lymphoma are lacking. PATIENTS/METHODS Using data from the Swedish lymphoma register, we compare incidence and 1-year survival of lymphoma patients in Sweden before (2017-2019) and during the pandemic (2020 and 2021). RESULTS Fewer patients were diagnosed with lymphomas during March-June 2020, but the annual incidence rates for 2020 and 2021 were similar to those of 2017-2019. A larger proportion of patients presented with stage IV disease during 2021. There were no differences in other base-line characteristics nor application of active treatment in pre-pandemic and pandemic years. One-year overall survival was not inferior among lymphoma patients during the pandemic years compared to pre-pandemic years i.e., 2017-2019. INTERPRETATION The COVID-19 pandemic had limited impact on the incidence and mortality of lymphoma in Sweden.
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Affiliation(s)
- Sara Ekberg
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Molin
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; cDepartment of Cancer Immunotherapy, Uppsala University, Uppsala, Sweden
| | - Simon Pahnke
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; cDepartment of Cancer Immunotherapy, Uppsala University, Uppsala, Sweden
| | - Fanny Bergström
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elsa Brånvall
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Capio St Göran Hospital, Stockholm, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Tove Wästerlid
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
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Harrysson S, Eloranta S, Ekberg S, Enblad G, Andersson PO, Sonnevi K, Ljungqvist M, Sander B, Jerkeman M, Smedby KE. Outcomes for patients with secondary CNS involvement in relapsed/refractory diffuse large B-cell lymphoma and estimation of eligibility for CAR T-cell therapy. Leuk Lymphoma 2024; 65:534-537. [PMID: 38134325 DOI: 10.1080/10428194.2023.2296361] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Sara Harrysson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sara Ekberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Per-Ola Andersson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kristina Sonnevi
- Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Maria Ljungqvist
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Birgitta Sander
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Jerkeman
- Department of Oncology, Lund University, Lund, Sweden
| | - Karin E Smedby
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Solna, Sweden
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4
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Abalo KD, Smedby KE, Ekberg S, Eloranta S, Pahnke S, Albertsson-Lindblad A, Jerkeman M, Glimelius I. Secondary malignancies among mantle cell lymphoma patients. Eur J Cancer 2023; 195:113403. [PMID: 37952281 DOI: 10.1016/j.ejca.2023.113403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE With modern treatments, mantle cell lymphoma (MCL) patients more frequently experience long-lasting remission resulting in a growing population of long-term survivors. Follow-up care includes identification and management of treatment-related late-effects, such as secondary malignancies (SM). We conducted a population-based study to describe the burden of SM in MCL patients. METHODS All patients with a primary diagnosis of MCL, aged ≥ 18 years and diagnosed between 2000 and 2017 in Sweden were included along with up to 10 individually matched population comparators. Follow-up was from twelve months after diagnosis/matching until death, emigration, or December 2019, whichever occurred first. Rates of SM among patients and comparators were estimated using the Anderson-Gill method (accounting for repeated events) and presented as hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age at diagnosis, calendar year, sex, and the number of previous events. RESULTS Overall, 1 452 patients and 13 992 comparators were followed for 6.6 years on average. Among patients, 230 (16%) developed at least one SM, and 264 SM were observed. Relative to comparators, patients had a higher rate of SM, HRadj= 1.6 (95%CI:1.4-1.8), and higher rates were observed across all primary treatment groups: the Nordic-MCL2 protocol, R-CHOP, R-bendamustine, ibrutinib, lenalidomide, and R-CHOP/Cytarabine. Compared to Nordic-MCL2, treatment with R-bendamustine was independently associated with an increased risk of SM, HRadj= 2.0 (95%CI:1.3-3.2). Risk groups among patients were those with a higher age at diagnosis (p < 0.001), males (p = 0.006), and having a family history of lymphoma (p = 0.009). Patients had preferably higher risk of melanoma, other neoplasms of the skin and other hematopoietic and lymphoid malignancies. CONCLUSIONS MCL survivors have an increased risk of SM, particularly if treated with R-bendamustine. The intensive treatments needed for long-term remissions are a concern, and transition to treatment protocols with sustained efficacy but with a lower risk of SM is needed.
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Affiliation(s)
- Kossi D Abalo
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden; Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Ekberg
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Simon Pahnke
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden
| | - Alexandra Albertsson-Lindblad
- Division of Oncology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mats Jerkeman
- Division of Oncology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden; Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Lysenkova Wiklander M, Övernäs E, Lagensjö J, Raine A, Petri A, Wiman AC, Ramsell J, Marincevic-Zuniga Y, Gezelius H, Martin T, Bunikis I, Ekberg S, Erlandsson R, Larsson P, Mosbech MB, Häggqvist S, Hellstedt Kerje S, Feuk L, Ameur A, Liljedahl U, Nordlund J. Genomic, transcriptomic and epigenomic sequencing data of the B-cell leukemia cell line REH. BMC Res Notes 2023; 16:265. [PMID: 37817248 PMCID: PMC10566058 DOI: 10.1186/s13104-023-06537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES The aim of this data paper is to describe a collection of 33 genomic, transcriptomic and epigenomic sequencing datasets of the B-cell acute lymphoblastic leukemia (ALL) cell line REH. REH is one of the most frequently used cell lines for functional studies of pediatric ALL, and these data provide a multi-faceted characterization of its molecular features. The datasets described herein, generated with short- and long-read sequencing technologies, can both provide insights into the complex aberrant karyotype of REH, and be used as reference datasets for sequencing data quality assessment or for methods development. DATA DESCRIPTION This paper describes 33 datasets corresponding to 867 gigabases of raw sequencing data generated from the REH cell line. These datasets include five different approaches for whole genome sequencing (WGS) on four sequencing platforms, two RNA sequencing (RNA-seq) techniques on two different sequencing platforms, DNA methylation sequencing, and single-cell ATAC-sequencing.
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Affiliation(s)
- Mariya Lysenkova Wiklander
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Elin Övernäs
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Johanna Lagensjö
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Amanda Raine
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Anna Petri
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Ann-Christin Wiman
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Jon Ramsell
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Yanara Marincevic-Zuniga
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Henrik Gezelius
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Tom Martin
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Ignas Bunikis
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Sara Ekberg
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Rikard Erlandsson
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Pontus Larsson
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Mai-Britt Mosbech
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Susana Häggqvist
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Susanne Hellstedt Kerje
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lars Feuk
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Adam Ameur
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Ulrika Liljedahl
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden
| | - Jessica Nordlund
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Box 1432, Uppsala, SE-751 44, Sweden.
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Jerkeman M, Ekberg S, Glimelius I, Albertsson-Lindblad A, Entrop JP, Ellin F, Sonnevi K, Lewerin C, Brandefors L, Smedby KE. Nationwide Assessment of Patient Trajectories in Mantle Cell Lymphoma: The Swedish MCL complete Project. Hemasphere 2023; 7:e928. [PMID: 37529083 PMCID: PMC10389756 DOI: 10.1097/hs9.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/13/2023] [Indexed: 08/03/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a B-cell malignancy currently considered incurable. Although some patients obtain prolonged remission after first-line chemoimmunotherapy, many will need several treatment lines. Here, we present a nationwide assessment of treatment strategies, time to progression and survival in MCL. All patients diagnosed with MCL 2006-2018 were identified in the Swedish Lymphoma Register. Information on all lines of therapy was extracted from the medical records. Overall and progression-free survival (OS and PFS) were assessed through August 2021. In total, 1367 patients were included (median age, 71 years) and median follow-up was 6.8 years. Two hundred and one (15%) were managed initially with watch-and-wait, but 1235 (90%) eventually received treatment. The most frequently used first-line regimens were rituximab-bendamustine (BR) (n = 368; 30%) and Nordic MCL2 (n = 342; 28%). During follow-up, 630 patients (46%) experienced relapse/progression and 546 (40%) received second-line treatment. The most frequently used second-line regimen was BR (n = 185; 34%) but otherwise a wide variety of second-line treatments were used. Further, 382 and 228 patients experienced a second or third relapse/progression, respectively. Median PFS after first (PFS-1), second (PFS-2), third (PFS-3), and fourth (PFS-4) treatment lines was 29.4, 8.9, 4.3, and 2.7 months. Patients with early progression, defined as a PFS-1 <24 months, had an inferior median OS of 13 versus 37 months in patients with later relapse. For patients treated with frontline BR, however, time to relapse had no impact on later outcome. By use of nationwide population-based data, we provide important benchmarks for future studies of all treatment lines in MCL.
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Affiliation(s)
- Mats Jerkeman
- Department of Clinical Sciences Lund, Division of Oncology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sara Ekberg
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden
| | - Alexandra Albertsson-Lindblad
- Department of Clinical Sciences Lund, Division of Oncology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Joshua P. Entrop
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Ellin
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Internal Medicine, Kalmar Hospital, Kalmar, Sweden
| | - Kristina Sonnevi
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Catharina Lewerin
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Lena Brandefors
- Department of Internal Medicine, Sunderbyn Hospital, Luleå, Sweden
| | - Karin E. Smedby
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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Ekberg S, Crowther M, Harrysson S, Jerkeman M, E. Smedby K, Eloranta S. Patient trajectories after diagnosis of diffuse large B-cell lymphoma-a multistate modelling approach to estimate the chance of lasting remission. Br J Cancer 2022; 127:1642-1649. [PMID: 35999271 PMCID: PMC9596493 DOI: 10.1038/s41416-022-01931-2] [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] [Received: 01/17/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Achieving lasting remission for at least 2 years is a good indicator for favourable prognosis long term after Diffuse large B-cell lymphoma (DLBCL). The aim of this study was to provide real-world probabilities, useful in risk communication and clinical decision-making, of the chance for lasting remissions by clinical characteristics. METHODS DLBCL patients in remission after primary treatment recorded in the Swedish Lymphoma register 2007-2014 (n = 2941) were followed for relapse and death using multistate models to study patient trajectories. Flexible parametric models were used to estimate transition rates. RESULTS At 2 years, 80.7% (95% CI: 79.0-82.2) of the patients were predicted to remain in remission and 13.2% (95% CI: 11.9-14.6) to have relapsed. The relapse risk peaked at 7 months, and the annual decline of patients in remission stabilised after 2 years. The majority of patients in the second remission transitioned into a new relapse. The probability of a lasting remission was reduced by 20.4% units for patients with IPI 4-5 compared to patients with IPI 0-1, and time in remission was shortened by 3.5 months. CONCLUSION The long-term prognosis was overall favourable with 80% achieving durable first remissions. However, prognosis varied by clinical subgroups and relapsing patients seldom achieved durable second remissions.
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Affiliation(s)
- Sara Ekberg
- grid.465198.7Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Solna, Sweden
| | - Michael Crowther
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska institutet, Solna, Sweden ,Red Door Analytics, Stockholm, Sweden
| | - Sara Harrysson
- grid.465198.7Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Mats Jerkeman
- grid.411843.b0000 0004 0623 9987Division of Oncology, Lund University and Skane University Hospital, Lund, Sweden
| | - Karin E. Smedby
- grid.465198.7Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Sandra Eloranta
- grid.465198.7Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Solna, Sweden
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8
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Harrysson S, Eloranta S, Ekberg S, Enblad G, El-Galaly TC, Sander B, Sonnevi K, Andersson PO, Jerkeman M, Smedby KE. Outcomes of relapsed/refractory diffuse large B-cell lymphoma and influence of chimaeric antigen receptor T trial eligibility criteria in second line-A population-based study of 736 patients. Br J Haematol 2022; 198:267-277. [PMID: 35468219 PMCID: PMC9545648 DOI: 10.1111/bjh.18197] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Received: 02/03/2022] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 02/02/2023]
Abstract
Several recently published trials investigate novel therapies for relapsed/refractory diffuse large B‐cell lymphoma (R/R DLBCL). To estimate the benefit of these therapies in the real‐world setting, comprehensive data on patients treated in clinical routine are needed. We report outcomes for 736 R/R DLBCL patients identified among all curatively treated DLBCL patients in Sweden in the period 2007–2014. Survival and associations with disease characteristics, second‐line treatment and fulfilment of chimaeric antigen receptor (CAR) T‐cell trial criteria were assessed. Median overall survival (OS) was 6.6 months (≤70 years 9.6 months, >70 years 4.9 months). Early relapse (≤12 months) was strongly associated with selection of less intensive treatment and poor survival. Among patients of at most 70 years of age, 63% started intensive second‐line treatment and 34% received autologous stem cell transplantation (ASCT). Two‐year OS among transplanted patients was 56% (early relapse ≤12 months 40%, late relapse >12 months 66%). A minority of patients 76 years (n = 178/506, 35%) fitted CAR T trial criteria. Median progression‐free survival (PFS) for patients with early relapse fitting trial criteria was 4.8 months. In conclusion, most R/R DLBCL manifest early and are often ineligible for or cannot complete intensive regimens resulting in dismal survival. Real‐world patients eligible for CAR T trials also did poorly, providing a benchmark for efficacy of novel therapies.
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Affiliation(s)
- Sara Harrysson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sara Ekberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tarec C El-Galaly
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Birgitta Sander
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Sonnevi
- Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Per-Ola Andersson
- Department of Hematology, South Älvsborg Hospital, Borås, Sweden.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Mats Jerkeman
- Department of Oncology, Lund University, Lund, Sweden
| | - Karin E Smedby
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Solna, Sweden
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9
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Ekberg S, Harrysson S, Jernberg T, Szummer K, Andersson PO, Jerkeman M, Smedby KE, Eloranta S. Myocardial infarction in diffuse large B-cell lymphoma patients - a population-based matched cohort study. J Intern Med 2021; 290:1048-1060. [PMID: 34003533 DOI: 10.1111/joim.13303] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The outcome for diffuse large B-cell lymphoma (DLBCL) patients has improved with the immunochemotherapy combination R-CHOP. An increased rate of heart failure is well documented following this treatment, whereas incidence and outcome of other cardiac complications, for example myocardial infarction, are less well known. METHOD We identified 3548 curatively treated DLBCL patients in Sweden diagnosed between 2007 and 2014, and 35474 matched lymphoma-free general population comparators. The incidence, characteristics and outcome of acute myocardial infarctions (AMIs) were assessed using population-based registers up to 11 years after diagnosis. The rate of AMI was estimated using flexible parametric models. RESULTS Overall, a 33% excess rate of AMI was observed among DLBCL patients compared with the general population (HR: 1.33, 95% CI: 1.14-1.55). The excess rate was highest during the first year after diagnosis and diminished after 2 years. High age, male sex and comorbidity were the strongest risk factors for AMI. Older patients (>70 years) with mild comorbidities (i.e. hypertension or diabetes) had a 61% higher AMI rate than comparators (HR: 1.61, 95% CI: 1.10-2.35), whereas the corresponding excess rate was 28% for patients with severe comorbidities (HR: 1.28, 95% CI: 1.01-1.64). Among younger patients (≤70), a short-term excess rate of AMI was limited to those with severe comorbidities. There was no difference in AMI characteristics, pharmacological treatment or 30-day survival among patients and comparators. CONCLUSION DLBCL patients have an increased risk of AMI, especially during the first 2 years, which calls for improved cardiac monitoring guided by age and comorbidities. Importantly, DLBCL was not associated with differential AMI management or survival.
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Affiliation(s)
- S Ekberg
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - S Harrysson
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - T Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - K Szummer
- Section of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - P-O Andersson
- Department of Hematology, South Älvsborg Hospital, Borås, Sweden.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - M Jerkeman
- Division of Oncology, Lund University and Skane University Hospital, Lund, Sweden
| | - K E Smedby
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - S Eloranta
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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10
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Fjordén K, Ekberg S, Kuric N, Smedby KE, Lagerlöf I, Larsen TS, Jørgensen JM, de Nully Brown P, Jerkeman M. Idelalisib in relapsed/refractory diffuse large B-cell lymphoma: results from a Nordic Lymphoma Group phase II trial. Br J Haematol 2021; 196:437-440. [PMID: 34435356 DOI: 10.1111/bjh.17792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Karin Fjordén
- Department of Oncology, Lund University, Skane University Hospital, Lund, Sweden
| | - Sara Ekberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Nevzeta Kuric
- Department of Hematology, Halmstad Hospital, Halmstad, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Division of Hematology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Ingemar Lagerlöf
- Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Thomas S Larsen
- Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Judit M Jørgensen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter de Nully Brown
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mats Jerkeman
- Department of Oncology, Lund University, Skane University Hospital, Lund, Sweden
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11
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Brånvall E, Ekberg S, Eloranta S, Wästerlid T, Birmann BM, Smedby KE. Statin use and survival in 16 098 patients with non-Hodgkin lymphoma or chronic lymphocytic leukaemia treated in the rituximab era. Br J Haematol 2021; 195:552-560. [PMID: 34331461 DOI: 10.1111/bjh.17733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 01/09/2023]
Abstract
Statin use has been associated with reduced mortality from several cancers but also suggested, in vitro, to diminish the effectiveness of lymphoma treatments including rituximab. The present study aimed to assess the association of statin use with mortality in patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukaemia (CLL). We identified all incident NHLs and CLLs in Sweden from 2007 to 2013 with subtype information in the Swedish Lymphoma and Cancer Registers. Using Cox regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of pre- or post-diagnosis statin use (yes/no, intensity) with lymphoma-specific, cardiovascular, or all-cause mortality; and for follicular lymphoma (FL) by initial treatment strategy (active/watch-and-wait). Among 16 098 incident NHL/CLL patients, 20% used statins at diagnosis. Pre- and post-diagnosis statin use, and statin intensity were not consistently associated with any mortality outcome in patients with NHL, overall or for any subtype. For actively treated patients with FL, statin use did not appear to increase lymphoma-specific mortality (vs. non-users, HR [95% CI]after diagnosis 0·87 [0·45-1·67]). For CLL, statin use was associated with all-cause and cardiovascular but not consistently with lymphoma-specific mortality. In conclusion, statin use was not associated with improved lymphoma survival but appears safe to use during lymphoma treatment.
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Affiliation(s)
- Elsa Brånvall
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Division of Hematology, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Sara Ekberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Tove Wästerlid
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Karin E Smedby
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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12
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Baecklund F, Ekberg S, Rosenquist R, Askling J, Eloranta S, Smedby KE. Concordance in survival among first-degree relatives diagnosed with indolent lymphoid malignancies including chronic lymphocytic leukemia. Eur J Haematol 2020; 105:779-785. [PMID: 32871627 PMCID: PMC7702025 DOI: 10.1111/ejh.13510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022]
Abstract
Objectives To investigate concordance in survival time among first‐degree relatives with lymphoid malignancies. Methods By linkage of national Swedish registers, we identified 66 430 patients diagnosed with a lymphoid malignancy 1958‐2016 with information on first‐degree relationships and follow‐up until 2017. Among these, we identified pairs of first‐degree relatives with any (N = 3326) or a similar (N = 690) lymphoid malignancy subtype. We defined survival in the first‐degree relative as good, expected, or poor based on tertiles of deviance residuals from a multivariable Cox regression model. Next, we used Cox regression to estimate hazard ratios (HR) of death with 95% confidence intervals (CI) among patients, using the survival of their first‐degree relative as exposure and adjusting for confounders. Results There was no concordance in survival among first‐degree relatives with any lymphoid malignancy (HRgood = 1.00 (reference), HRExpected = 1.02, 95% CI: 0.89‐1.17, HRPoor = 1.12, 95% CI: 0.98‐1.27, Ptrend = .08). Among first‐degree relatives with indolent lymphoma, including chronic lymphocytic leukemia, those with a first‐degree relative to an expected or poor survival had worse outcome compared to those with a first‐degree relative with good survival (HRExpected = 1.44, 95% CI: 0.82‐2.53, HRPoor = 1.79, 95% CI: 1.07‐3.00, Ptrend = .03). Conclusion Our results support a role of inherited factors in the outcome of indolent lymphoma, including chronic lymphocytic leukemia.
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Affiliation(s)
- Fredrik Baecklund
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Pediatric Oncology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Ekberg
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Askling
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Rheumatology, Theme Inflammation & Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Eloranta
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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13
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Wästerlid T, Harrysson S, Andersson TM, Ekberg S, Enblad G, Andersson P, Jerkeman M, Eloranta S, Smedby KE. Outcome and determinants of failure to complete primary R-CHOP treatment for reasons other than non-response among patients with diffuse large B-cell lymphoma. Am J Hematol 2020; 95:740-748. [PMID: 32180274 DOI: 10.1002/ajh.25789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/04/2020] [Accepted: 03/12/2020] [Indexed: 12/12/2022]
Abstract
Patients with diffuse large B-cell lymphoma (DLBCL) who fail to complete planned treatment with R-CHOP due to toxicity are sparsely described. We investigated the extent of failure to complete treatment (six cycles or more, or three cycles + RT for patients with stage I disease) with R-CHOP for reasons unrelated to non-response, the determinants of such failure and the outcome among these patients. Three thousand one hundred and forty nine adult DLBCL patients who started primary treatment with R-CHOP were identified through the Swedish lymphoma register 2007-2014. Of these, 147 (5%) stopped prematurely after 1-3 cycles of R-CHOP for reasons unrelated to non-response, 168 (5%) after 4-5 cycles and 2639 patients (84%) completed planned treatment. Additionally, 195 (6%) patients did not complete treatment due to non-response or death before treatment end. In a multivariable logistic regression model, age > 75 years, poor performance status, extranodal disease and Charlson Comorbidity Index ≥1 were significantly associated with failure to complete planned R-CHOP treatment for other reasons than non-response. Non-completion of treatment strongly correlated with survival. Five-year overall survival for patients who received 1-3 cycles was 26% (95% CI: 19%-33%), 49% (95% CI: 41%-57%) for 4-5 cycles and 76% (74%-77%) for patients who completed treatment. Failure to complete planned R-CHOP treatment is an important clinical issue associated with inferior survival. Old age and poor performance status most strongly predict such failure. These results indicate a need for improved treatment tailoring for patients with certain baseline demographics to improve tolerability and chance for treatment completion.
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Affiliation(s)
- Tove Wästerlid
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
- Department of HematologyKarolinska University Hospital Solna Sweden
| | - Sara Harrysson
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
- Department of HematologyKarolinska University Hospital Solna Sweden
| | | | - Sara Ekberg
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
| | - Gunilla Enblad
- Department of OncologyAkademiska University Hospital Uppsala Sweden
| | - Per‐Ola Andersson
- Department of HematologySouth Älvsborg Hospital Borås Sweden
- Sahlgrenska AcademyGothenburg University Gothenburg Sweden
| | - Mats Jerkeman
- Department of Oncology and Pathology, Institute of Clinical SciencesLund University Lund Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
| | - Karin E. Smedby
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
- Department of HematologyKarolinska University Hospital Solna Sweden
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14
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Brånvall E, Ekberg S, Eloranta S, Wästerlid T, Birmann BM, Smedby KE. Statin use is associated with improved survival in multiple myeloma: A Swedish population-based study of 4315 patients. Am J Hematol 2020; 95:652-661. [PMID: 32141627 DOI: 10.1002/ajh.25778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 01/24/2023]
Abstract
Statin use has been associated with reduced cancer-specific mortality among patients with several cancer types, including multiple myeloma (MM). We aimed to further elucidate the association of statin use and dose intensity with MM survival. Using Swedish population-based national health registers, we identified all incident MM diagnoses occurring January 1, 2007 to December 31, 2013 and their drug dispensations and comorbidities. We assessed statin exposure in 6-month periods pre- and post-diagnosis, treated diagnosis as baseline for calculating survival time, and calculated hazard ratios (HR) and 95% confidence intervals (CI) of exposure-related MM-specific and all-cause mortality using Cox regression. We assessed statin exposure during the entire follow-up and risk of MM-specific mortality in a nested case-control analysis. We classified dose intensity according to American College of Cardiology/American Heart Association recommendations. We ascertained 4315 MM cases during follow-up. Statin use was associated with reduced MM-specific mortality (pre-diagnosis use multivariate-adjusted HR, 95% CI: 0.83, 0.71-0.96; 6 months post-diagnosis: 0.73, 0.60-0.89; entire follow-up: 0.65, 0.52-0.80) and (more weakly) with all-cause mortality. Intensity analyses suggested a dose-response; MM-specific mortality decreased with increasing statin intensity in all time windows (eg, 6 months post-diagnosis: low [0.76 (0.56-1.03)], medium [0.73 (0.58-0.92)], high [0.33 (0.08-1.32)] intensity). However, relatively few patients received high intensity treatment, and the trend was statistically significant only for unadjusted pre-diagnosis use. In this large population-based MM cohort, statin use was associated with improved MM-specific survival in both sexes. Randomized prospective studies are warranted to evaluate statins as adjuvant treatment in MM.
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Affiliation(s)
- Elsa Brånvall
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
- Department of Medicine, Division of HematologyCapio S:t Görans Hospital Stockholm Sweden
| | - Sara Ekberg
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
| | - Tove Wästerlid
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
- Department of Medicine, Division of HematologyKarolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - Brenda M. Birmann
- Channing Division of Network Medicine, Department of MedicineBrigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA
| | - Karin E. Smedby
- Department of Medicine, Division of HematologyKarolinska University Hospital and Karolinska Institutet Stockholm Sweden
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15
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Rodriguez-Wallberg KA, Lundberg FE, Ekberg S, Johansson ALV, Ludvigsson JF, Almqvist C, Cnattingius S, Iliadou AN. Mortality from infancy to adolescence in singleton children conceived from assisted reproductive techniques versus naturally conceived singletons in Sweden. Fertil Steril 2020; 113:524-532. [PMID: 32081362 DOI: 10.1016/j.fertnstert.2019.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess infant (<1 year) and childhood (1-18 years) mortality in singletons conceived through assisted reproductive techniques (ART) versus naturally conceived singletons. DESIGN Nationwide prospective study. SETTING Sweden. PATIENT(S) All singleton liveborn infants born from 1983 to 2012 in Sweden identified using the Medical Birth Register (N = 2,847,108), of whom 43,506 were conceived through ART treatments including in vitro fertilization with and without intracytoplasmic sperm injection. INTERVENTION(S) None. MAIN OUTCOME MEASURES(S) Infant (<1 year) and childhood (1-18 years) mortality. RESULT(S) Data on ART treatment and covariates were retrieved from population-based registers using the unique personal identity number assigned to all permanent residents in Sweden. Cox proportional hazards models estimated the hazard ratios (HRs) with 95% confidence intervals (CIs) as measures of association between ART treatments and death. The analyses were adjusted for maternal characteristics, infertility, child sex, and birth cohort and were restricted to individuals with complete information on covariates for fully adjusted analysis. Compared with naturally conceived singletons, higher infant mortality risks were seen in infants conceived through ART (adjusted HR 1.45; 95% CI, 1.19-1.77), especially after transfer of cryopreserved embryos (adjusted HR 2.30; 95% CI, 1.46-3.64). Early neonatal mortality risk (deaths during the first week) was increased in children born after transfer of blastocysts (HR 2.40; 95% CI, 1.05-5.48). No increased mortality risk was observed between the ages of 1 and 18 years. CONCLUSION(S) Singletons conceived through ART had an increased risk of infant mortality from birth up to 1 year of life, predominantly in the early neonatal period and in pregnancies after transfer of frozen and thawed embryos.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden.
| | - Frida E Lundberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Ekberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anastasia N Iliadou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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16
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Ekberg S, E Smedby K, Glimelius I, Nilsson-Ehle H, Goldkuhl C, Lewerin C, Jerkeman M, Eloranta S. Trends in the prevalence, incidence and survival of non-Hodgkin lymphoma subtypes during the 21st century - a Swedish lymphoma register study. Br J Haematol 2020; 189:1083-1092. [PMID: 32065396 DOI: 10.1111/bjh.16489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/24/2019] [Indexed: 12/19/2022]
Abstract
Non-Hodgkin lymphoma (NHL) prognosis has improved in recent years, yet the number of patients living with the diagnosis, i.e. the prevalence, has seldom been reported. The prevalence provides a measure of the burden of disease, useful for healthcare planning and to optimise resource allocation. We provide a systematic presentation of temporal trends in absolute numbers of prevalent patients by NHL subtypes, linking them to trends in incidence, survival and mortality. Patients diagnosed 2000-2016 were identified in the national Swedish lymphoma register. Incidence and mortality rates, relative survival and prevalence were estimated for NHL overall and for major clinical and morphological subtypes. Poisson regression was used to test for temporal trends. Increasing incidence and improved survival have led to a 47% increase in the five-year prevalence of NHL overall in 2016 compared to 2004. An increasing prevalence was observed for all investigated subtypes during the study period, but most notably for diffuse large B cell lymphomas among aggressive subtypes (66%), and marginal zone lymphomas among indolent subtypes (135%). This dramatic increase in NHL prevalence underscores the need to develop and evaluate alternative follow-up schemes to use resources efficiently and still ensure optimal care of lymphoma survivors.
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Affiliation(s)
- Sara Ekberg
- Clinical Epidemiology Division, Department of Medicin Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Division, Department of Medicin Solna, Karolinska Institutet, Stockholm, Sweden.,Center for Hematology, Karolinska University Hospital, Solna, Sweden
| | - Ingrid Glimelius
- Clinical Epidemiology Division, Department of Medicin Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Unit of Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - Herman Nilsson-Ehle
- Section of Hematology and Coagulation, Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christina Goldkuhl
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Catharina Lewerin
- Section of Hematology and Coagulation, Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Jerkeman
- Department of Oncology, Lund University, Lund, Sweden
| | - Sandra Eloranta
- Clinical Epidemiology Division, Department of Medicin Solna, Karolinska Institutet, Stockholm, Sweden
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17
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Almqvist C, Ekberg S, Rhedin S, Fang F, Fall T, Lundholm C. Season of birth, childhood asthma and allergy in a nationwide cohort-Mediation through lower respiratory infections. Clin Exp Allergy 2019; 50:222-230. [PMID: 31782836 DOI: 10.1111/cea.13542] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/26/2019] [Accepted: 11/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have suggested an association between season of birth and risk of childhood asthma and allergic disease. The association may be modified by birth year and region, or mediated by respiratory tract infections. OBJECTIVE We aimed to estimate the association between season of birth and risk of childhood asthma/wheeze or allergic rhinoconjunctivitis in a population-based setting, and the mediating effect of lower respiratory infections. METHODS Two population-based cohorts were identified from the nationwide Swedish Medical Birth, Patient and Prescribed Drug Registers. The association between birth month/season and asthma/wheeze incidence was analysed using Cox proportional regression in the younger cohort born 2005-2010 (n = 582 494) and asthma/allergic rhinoconjunctivitis prevalence during the 7th year of life using log-binomial models in the older cohort born 2001-2004 (n = 367 583). Interactions were formally tested. Mediation analyses to address the effect of lower respiratory infections were performed in the older cohort using the R package "medflex." RESULTS Children born during fall and winter had an increased risk of asthma/wheeze after 2 years of age in the younger cohort: hazard ratio 1.24 (95% confidence interval, CI 1.17, 1.33) for winter and risk of prevalent asthma during their 7th year of life in the older cohort; prevalence ratio (PR) 1.12 (95% CI 1.08, 1.16) for winter. These estimates were partly mediated by lower respiratory infections; the indirect effect for winter compared with summer was PR 1.03 (95% CI 1.03, 1.04). The association was similar for allergic rhinoconjunctivitis in the 7th year of life, but not mediated by respiratory infections. CONCLUSION We found that the association between season of birth and risk of childhood asthma/wheeze, but not allergic rhinoconjunctivitis, is partly mediated through lower respiratory infections. CLINICAL RELEVANCE This has important implications for patient care, such as asthma management programmes to notify timing of seasonality for viral respiratory tract infections.
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Affiliation(s)
- Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Ekberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samuel Rhedin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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18
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Dahlén E, Ekberg S, Lundholm C, Jonsson EW, Kull I, Wettermark B, Almqvist C. Sibship and dispensing patterns of asthma medication in young children-a population-based study. Pharmacoepidemiol Drug Saf 2019; 28:1109-1116. [PMID: 31271484 DOI: 10.1002/pds.4802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 04/02/2019] [Accepted: 04/23/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE Our aim was to study the association between sibship and dispensing patterns of asthma medication in young children, focusing on incidence and persistence, and taking sibship status, asthma diagnoses, and siblings' medication into account. METHODS A register-based cohort study including all children (n = 50 546) born in Stockholm, Sweden 2006 to 2007, followed up during 2006 to 2014. Exposure was sibling status; outcome was incidence of dispensed asthma medication and persistence over time. A Cox model was used to study the association between sibship and asthma medication. Persistence was defined using two different time windows (4 and 18 months) in a refill sequence model including siblings' and unrelated control children's medication. RESULTS After 1 year of age, the adjusted hazard ratio of dispensed asthma medication was 0.85 (95% CI 0.80-0.90) among children with siblings compared with singletons. The estimated proportion of children with persistent controller medication was 7.2% (4-month model) and 64.5% (18-month model). When including the siblings' controller medication, the estimated proportion was 8.8% (4 months) and 7.8% for control children (relative risk (RR) 0.89, 95% CI 0.81-0.98). The persistence was lower for those with siblings compared with singletons (adj. RR 0.72, 95% CI 0.62-0.85 for 4 months) with similar estimates for older, younger, and full siblings and regardless of asthma diagnoses. CONCLUSIONS Siblings have different dispensing patterns of asthma medications compared with singletons regardless of asthma diagnoses. After including the siblings' asthma medication and compared with control children, the proportion of children with persistent medication increased which may indicate that siblings share asthma medications.
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Affiliation(s)
- Elin Dahlén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sara Ekberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Eva Wikström Jonsson
- Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Björn Wettermark
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
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19
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Fox J, Langbecker D, Rosenberg J, Ekberg S. Qualitative study of bereaved carers’ experiences in advanced melanoma. Br J Dermatol 2019. [DOI: 10.1111/bjd.17951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fox J, Langbecker D, Rosenberg J, Ekberg S. 丧失亲人的照顾者晚期黑色素瘤经验的定性研究. Br J Dermatol 2019. [DOI: 10.1111/bjd.17968] [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]
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Fox JA, Langbecker D, Rosenberg J, Ekberg S. Uncertain diagnosis and prognosis in advanced melanoma: a qualitative study of the experiences of bereaved carers in a time of immune and targeted therapies. Br J Dermatol 2019; 180:1368-1376. [PMID: 30515757 DOI: 10.1111/bjd.17511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent advances in advanced melanoma therapies are associated with improved survival for some patients. However, how patients with diagnoses of advanced disease and their carers experience this expanding treatment paradigm is not well understood. OBJECTIVES To explore bereaved carers' accounts of the trajectory of advanced melanoma involving treatment by immune or targeted therapies, to build an understanding of their experiences of care relating to diagnosis and prognosis. METHODS A qualitative exploratory design, using methods drawn from grounded theory, was adopted. Analyses drew on in-depth interviews with 20 bereaved carers from three metropolitan melanoma treatment centres in Australia. A flexible interview guide and structured approach to concurrent data collection and analysis were applied. RESULTS Carers described qualities of the experience, including the shock of diagnosis after a sometimes-innocuous presentation with vague symptoms. They reported an unclear prognosis with complexity arising from interplay between an uncertain disease trajectory and often ambiguous expectations of outcomes of emerging immune and targeted therapies. Uncertainty dominated carers' experiences, increasing the complexity of care planning. CONCLUSIONS Effective communication of an advanced melanoma diagnosis and prognosis is critical. Recognition of the uncertainty inherent in the benefit of immune and targeted therapies in a constructive manner may facilitate more timely and effective care-planning conversations between patients, carers and medical specialists.
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Affiliation(s)
- J A Fox
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, Australia
| | - D Langbecker
- The University of Queensland, Centre for Health Services Research, St Lucia, QLD, Australia
| | - J Rosenberg
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, Australia
| | - S Ekberg
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, Australia
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Frisk G, Ekberg S, Lidbrink E, Eloranta S, Sund M, Fredriksson I, Lambe M, Smedby KE. No association between low-dose aspirin use and breast cancer outcomes overall: a Swedish population-based study. Breast Cancer Res 2018; 20:142. [PMID: 30458873 PMCID: PMC6247765 DOI: 10.1186/s13058-018-1065-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/19/2018] [Indexed: 01/05/2023] Open
Abstract
Background Results from previous studies indicate that use of low-dose aspirin may improve breast cancer prognosis. We evaluated aspirin use and breast cancer outcomes in relation to clinical characteristics as well as dose and duration of aspirin use. Methods We used information from the Regional Breast Cancer Quality-of-Care Registries in three Swedish regions to identify 21,414 women diagnosed with a first stage I–III breast cancer between 1 April 2006 and 31 December 2012. The cohort was further linked to nationwide registers to retrieve information about dispensing low-dose aspirin before and after breast cancer diagnosis, comorbidity and causes of death. In a separate analysis, we investigated time to breast cancer death among 621 women with stage IV disease at diagnosis. Associations were evaluated using a multivariable Cox proportional hazards model. Results Among women with stage I–III breast cancer, 2660 (12.4%) used low-dose aspirin shortly before breast cancer diagnosis and 4091 (19.1%) were users during follow-up. Women were followed for a median of 3.8 years after diagnosis. There was no association between aspirin use and breast cancer-specific death in multivariable analyses (use before diagnosis: hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.77–1.12; use after diagnosis: HR 1.00, 95% CI 0.74–1.37). Similarly, aspirin use was not associated with risk of first recurrence/metastases in a subgroup of stage I–III breast cancer patients (HR 0.97, 95% CI 0.86–1.10). However, in analyses stratified by stage, an inverse association between low-dose aspirin use after diagnosis and breast cancer death was found for women with stage I tumors (HR 0.53, 95% CI 0.29–0.96). Among women with stage IV disease at diagnosis, aspirin use was not associated with time to breast cancer death (HR 0.91, 95% CI 0.67–1.23). Conclusion In this large population-based cohort study there was no evidence that low-dose aspirin use before or after breast cancer diagnosis is associated with a reduced risk of adverse outcomes overall in breast cancer. However, a potential benefit was noted among women with stage I tumors, warranting further investigation. Electronic supplementary material The online version of this article (10.1186/s13058-018-1065-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gabriella Frisk
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
| | - Sara Ekberg
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Elisabet Lidbrink
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Irma Fredriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
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Rodriguez-Wallberg K, Ekberg S, Johansson A, Iliadou A. A population-based register study of infant and late child mortality in singletons born after assisted reproductive techniques (ART) vs natural conceptions. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ekberg S, Jerkeman M, Andersson PO, Enblad G, Wahlin BE, Hasselblom S, Andersson TM, Eloranta S, Smedby KE. Long-term survival and loss in expectancy of life in a population-based cohort of 7114 patients with diffuse large B-cell lymphoma. Am J Hematol 2018; 93:1020-1028. [PMID: 29770496 DOI: 10.1002/ajh.25147] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/09/2022]
Abstract
Survival has improved among patients with diffuse large B-cell lymphoma (DLBCL) with the addition of anti-CD20 antibody therapy. We aimed to quantify trends and remaining loss in expectation of life (LEL) due to DLBCL at a national population-based level. Patients diagnosed with DLBCL 2000-2013 (N = 7114) were identified through the Swedish Lymphoma Registry and classified according to the age-adjusted International Prognostic Index (aaIPI). The novel measure LEL is the difference between remaining life years among patients and the general population and was predicted using flexible parametric models from diagnosis and among 2-year survivors, by age and sex. Median age at DLBCL-diagnosis was 70 (18-105) years and 54.8% presented with stage III-IV disease. On average, LEL due to DLBCL decreased from 8.0 (95% CI: 7.7-8.3) to 4.6 (95% CI: 4.5-4.6) years over the study period. By risk group, LEL was most reduced among patients with aaIPI ≥2 aged 50-60 years. However, these patients were still estimated to lose >8 years in 2013 (eg, LELmales50years 8.6 years (95% CI: 5.0-12.3)). Among 2-year survivors, LEL was reduced from 6.1 years (95% CI: 5.6-6.5) (aaIPI ≥ 2) and 3.8 years (95% CI: 3.6-4.1) (aaIPI < 2) to 1.1 (95% CI: 1.1-1.2) and 1.0 year (95% CI: 0.8-1.1), respectively. The reduction was observed across all ages. Results for females were similar. By using LEL we illustrate the improvement of DLBCL survival over time. Despite adequate immunochemotherapy, substantial LEL among patients with IPI ≥ 2 points to remaining unmet medical needs. We speculate that observed reduced losses among 2-year survivors indicate a reduction of late relapses.
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Affiliation(s)
- Sara Ekberg
- Division of Clinical Epidemiology, Department of Medicin Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mats Jerkeman
- Department of Oncology and Pathology, Institute of Clinical Sciences, Lund University, Lund, Sweden
| | - Per-Ola Andersson
- Department of Hematology, South Älvsborg Hospital, Borås and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Gunilla Enblad
- Department of Oncology, Akademiska University Hospital, Uppsala, Sweden
| | - Björn E Wahlin
- Division of Hematology, Deparment of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sverker Hasselblom
- Deparment of Research, Development & Education, Region Halland, Halmstad, Sweden
| | - Therese M Andersson
- Deparment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicin Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Division of Clinical Epidemiology, Department of Medicin Solna, Karolinska Institutet, Stockholm, Sweden
- Center for hematology, Karolinska University Hospital, Solna, Sweden
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25
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Frisk G, Tinge B, Ekberg S, Eloranta S, Bäcklund LM, Lidbrink E, Smedby KE. Survival and level of care among breast cancer patients with brain metastases treated with whole brain radiotherapy. Breast Cancer Res Treat 2017; 166:887-896. [PMID: 28831636 PMCID: PMC5680371 DOI: 10.1007/s10549-017-4466-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/14/2017] [Indexed: 11/08/2022]
Abstract
Purpose The benefit of whole brain radiotherapy (WBRT) for late stage breast cancer patients with brain metastases has been questioned. In this study we evaluated survival and level of care (hospital or home) following WBRT in a population-based cohort by personal and tumor characteristics. Methods We identified 241 consecutive patients with breast cancer and brain metastases receiving WBRT in Stockholm, Sweden, 1999–2012. Through review of medical records, we collected data on prognostic determinants including level of care before and after WBRT. Survival was estimated using Cox regression, and odds ratios (OR) of not coming home using logistic regression. Results Median age at WBRT was 58 years (range 30--–88 years). Most patients (n = 212, 88%) were treated with 4 Gray × 5. Median survival following WBRT was 2.9 months (interquartile range 1.1–6.6 months), and 57 patients (24%) were never discharged from hospital. Poor performance status and triple-negative tumors were associated with short survival (WHO 3–4 median survival 0.9 months, HR = 5.96 (3.88–9.17) versus WHO 0–1; triple-negative tumors median survival 2.0 months, HR = 1.87 (1.23–2.84) versus Luminal A). Poor performance status and being hospitalized before WBRT were associated with increased ORs of not coming home whereas cohabitation with children at home was protective. Conclusion Survival was short following WBRT, and one in four breast cancer patients with brain metastases could never be discharged from hospital. When deciding about WBRT, WHO score, level of care before WBRT, and the patient’s choice of level of care in the end-of-life period should be considered. Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4466-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gabriella Frisk
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute Solna, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Beatrice Tinge
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute Solna, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Sara Ekberg
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute Solna, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Sandra Eloranta
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute Solna, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - L Magnus Bäcklund
- Department of Medicine Solna, Unit for Experimental Cardiovascular Research, Karolinska Institute Solna, 171 76, Stockholm, Sweden
| | - Elisabet Lidbrink
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute Solna, Karolinska University Hospital, 171 76, Stockholm, Sweden
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Smedby K, Ekberg S, Andersson P, Enblad G, Wahlin B, Hasselblom S, Jerkeman M, Eloranta S. LONG-TERM SURVIVAL AND LOSS IN EXPECTANCY OF LIFE IN A POPULATION-BASED COHORT OF 7114 PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- K.E. Smedby
- Dept of Medicine Solna; Karolinska Institutet; Solna Sweden
| | - S. Ekberg
- Dept of Medicine Solna; Karolinska Institutet; Solna Sweden
| | - P. Andersson
- Dept of Medicine; Unit of Hematology; Borås Sweden
| | - G. Enblad
- Dept of Oncology, Genetics and Pathology, Unit of Oncology; Uppsala Sweden
| | - B.E. Wahlin
- Dept of Medicine Huddinge; Div of Hematology; Huddinge Sweden
| | - S. Hasselblom
- Dept of Research; Development & Education, Unit of Research in Hematology; Halmstad Sweden
| | - M. Jerkeman
- Dept of Oncology and Pathology; Institute of Clinical Sciences; Lund Sweden
| | - S. Eloranta
- Dept of Medicine Solna; Karolinska Institutet; Solna Sweden
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Brånvall E, Eloranta S, Ekberg S, Birmann B, Smedby K. STATIN USE AND PROGNOSIS IN 12,865 NON-HODGKIN LYMPHOMA PATIENTS TREATED IN THE RITUXIMAB-ERA. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- E. Brånvall
- Dep of Medicine, Unit for Clinical Epidemiology; Karolinska Institutet; Stockholm Sweden
| | - S. Eloranta
- Dep of Medicine, Unit for Clinical Epidemiology; Karolinska Institutet; Stockholm Sweden
| | - S. Ekberg
- Dep of Medicine, Unit for Clinical Epidemiology; Karolinska Institutet; Stockholm Sweden
| | - B.M. Birmann
- Brigham and Women's Hospital and Harvard Medical School; Channing Laboratory, Dep of Medicine; Boston USA
| | - K.E. Smedby
- Dep of Medicine, Unit for Clinical Epidemiology; Karolinska Institutet; Stockholm Sweden
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Glimelius I, Eloranta S, Ekberg S, Chang ET, Neovius M, Smedby KE. Increased healthcare use up to 10 years among relapse-free Hodgkin lymphoma survivors in the era of intensified chemotherapy and limited radiotherapy. Am J Hematol 2017; 92:251-258. [PMID: 28006849 DOI: 10.1002/ajh.24623] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/21/2016] [Accepted: 12/07/2016] [Indexed: 01/15/2023]
Abstract
With today's excellent cure rates for Hodgkin lymphoma (HL), the number of long-term survivors is increasing. This study aims to provide a global assessment of late adverse effects for working-age HL survivors treated with contemporary protocols (combination chemotherapy and limited radiotherapy). From Swedish nationwide registers we identified 1017 HL survivors diagnosed in 2000-2009, aged 18-60 years (median 32) and surviving at least one year post-diagnosis, and 4031 age-, sex-, and calendar-year-matched population comparators. Incidence rate ratios (IRR) and 95% confidence intervals (95%CI) for outpatient visits and inpatient bed-days after the first year up to 14 years post-diagnosis (through 2013) were estimated across treatment subgroups, considering relapse-free time and using negative binomial regression. Scheduled outpatient visits for HL were excluded. The rate of outpatient visits was nearly double (IRR = 1.8, 95%CI: 1.6-2.0) that among comparators and higher rates persisted up to 10 years post-diagnosis. The rate of inpatient bed-days among relapse-free survivors was more than three-fold (IRR = 3.6, 95%CI: 2.7-4.7) that of comparators and the increase persisted up to four years post-diagnosis. Patients requiring 6-8 chemotherapy courses had higher rates of outpatient visits (IRR = 1.4, 95%CI: 1.1-1.7) and bed-days (IRR = 4.7, 95%CI: 2.9-7.8) than patients treated with 2-4 courses + radiotherapy. Previously seldom reported reasons for the excess healthcare use included chest pain, keratitis, asthma, diabetes mellitus, and depression. Contemporary treatment, chemotherapy in particular, was associated with excess healthcare use among HL survivors during the first decade postdiagnosis. The reasons for healthcare visits reflected a wide range of disorders, indicating the need of broad individualized care in addition to specific screening programs.
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Affiliation(s)
- Ingrid Glimelius
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
- Department of Immunology, Genetics and Pathology, Clinical and Experimental OncologyUppsala University and Uppsala Akademiska Hospital Sweden
| | - Sandra Eloranta
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
| | - Sara Ekberg
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
| | - Ellen T. Chang
- Center for Epidemiology and Computational Biology, Health Sciences Practice, ExponentMenlo ParkCalifornia USA
- Division of Epidemiology, Department of Health Research and PolicyStanford University School of MedicineStanford California USA
| | - Martin Neovius
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
| | - Karin E. Smedby
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
- Department of MedicineKarolinska University Hospital and Karolinska InstitutetStockholm Sweden
- Division of HematologyKarolinska University Hospital and Karolinska InstitutetStockholm Sweden
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Chen L, Glimelius I, Neovius M, Ekberg S, Martling A, Eloranta S, Smedby KE. Work Loss Duration and Predictors Following Rectal Cancer Treatment among Patients with and without Prediagnostic Work Loss. Cancer Epidemiol Biomarkers Prev 2016; 25:987-94. [PMID: 27197302 DOI: 10.1158/1055-9965.epi-16-0112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/01/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The number of working-age rectal cancer survivors is increasing due to early detection and improved treatment. However, work loss duration and predictors among them have not been studied thoroughly. METHODS We identified 3,438 patients with stage I-III rectal cancer, 18 to 61 years of age in the Swedish Colorectal Cancer Register 1996-2009. Information on work loss due to sick leave or disability pension was collected from 2 years before diagnosis to 5 years after (until December 31st, 2013). Incidence rate ratios (IRR) of work loss were estimated in a negative binominal model by clinical characteristics for the 1st and 2nd-5th years after diagnosis. Patients were stratified by prediagnostic work loss. RESULTS Patients without prediagnostic work loss (74%) experienced median 147 days (25th and 75th percentile: 55 and 281) of work loss during the 1st year after diagnosis. Work loss rates (2nd-5th years) were significantly increased among relapse-free patients diagnosed in stage III [IRR = 1.92; 95% confidence interval (CI), 1.52-2.43], operated with abdominoperineal resection (IRR = 1.26; 95% CI, 1.03-1.56), and treated with neoadjuvant (chemo)radiotherapy (IRR = 1.46; 95% CI, 1.06-2.02). Patients with prediagnostic work loss (26%) experienced median 336 days (25th and 75th percentile: 183 and 365) of work loss during the 1st year, and rates did not vary clinically till 5 years. CONCLUSION Without prediagnostic work loss, disease- and treatment-related factors could help identify rectal cancer patients in need of early interventions to facilitate return to work. IMPACT Clinical awareness around prediagnostic and postdiagnostic work loss and individualized cancer rehabilitation programs should be emphasized among cancer survivors. Cancer Epidemiol Biomarkers Prev; 25(6); 987-94. ©2016 AACR.
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Affiliation(s)
- Lingjing Chen
- Clinical Epidemiology Unit, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.
| | - Ingrid Glimelius
- Clinical Epidemiology Unit, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden. Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Sara Ekberg
- Clinical Epidemiology Unit, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Clinical Epidemiology Unit, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Unit, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
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Glimelius I, Ekberg S, Linderoth J, Jerkeman M, Chang ET, Neovius M, Smedby KE. Erratum to: Sick leave and disability pension in Hodgkin lymphoma survivors by stage, treatment, and follow-up time-a population-based comparative study. J Cancer Surviv 2016; 9:610-1. [PMID: 26130293 DOI: 10.1007/s11764-015-0464-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- I Glimelius
- Section of Oncology, Department of Immunology, Genetics and Pathology, University of Uppsala, Uppsala, Sweden
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - S Ekberg
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Linderoth
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - M Jerkeman
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - E T Chang
- Health Sciences Practice, Exponent, Inc., Menlo Park, CA, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - M Neovius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K E Smedby
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Glimelius I, Ekberg S, Jerkeman M, Chang ET, Björkholm M, Andersson TM, Smedby KE, Eloranta S. Long-term survival in young and middle-aged Hodgkin lymphoma patients in Sweden 1992-2009-trends in cure proportions by clinical characteristics. Am J Hematol 2015; 90:1128-34. [PMID: 26349012 DOI: 10.1002/ajh.24184] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 12/16/2022]
Abstract
Trends in Hodgkin lymphoma (HL) survival among patients treated outside of clinical trials provide real-world benchmark estimates of prognosis and help identify patient subgroups for targeted trials. In a Swedish population-based cohort of 1947 HL patients diagnosed in 1992-2009 at ages 18-59 years, we estimated relative survival (RS), cure proportions (CP), and median survival times using flexible parametric cure models. Overall, the CP was 89% (95% CI: 0.87-0.91) and median survival of the uncured was 4.6 years (95% CI: 3.0-6.3). For patients aged 18-50 years diagnosed after the year 2000, CP was high and stable, whereas for patients of 50-59 years, cure was not reached. The survival of relapse-free patients was similar to that of the general population (RS5-year : 0.99; 95% CI: 0.98-0.99, RS15-year : 0.95; 95% CI: 0.92-0.97). The excess mortality of relapsing patients was 19 times (95% CI: 12-31) that of relapse-free patients. Despite modern treatments, patients with adverse prognostic factors (e.g., advanced stage) still had markedly worse outcomes [CP stage: IIIB 0.82 (95% CI: 0.73-0.89); CP stage: IVB 0.72, (95% CI: 0.60-0.81)] and patients with international prognostic score (IPS) ≥3 had 2.7 times higher excess mortality (95% CI: 1.0-7.0, p = 0.04) than patients with IPS <3. High-risk patients selected for 6-8 courses of BEACOPP (bleomycin, etoposide, doxorubicin, cyclofosphamide, vincristine, procarbazine, prednisone)-chemotherapy had a 15-year relative survival of 87%, (95% CI: 0.80-0.92), whereas the corresponding estimate for patients selected for 6-8 courses of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) was 93% (95% CI: 0.88-0.97). These population-based results indicate limited fatal side-effects in the 15-year perspective with contemporary treatments, while the unmet need of effective relapse treatment remains of concern. BEACOPP-chemotherapy was still not sufficient in high-risk HL patients.
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Affiliation(s)
- Ingrid Glimelius
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
- Department of Immunology, Genetics and Pathology Clinical and Experimental Oncology; Uppsala University and Uppsala Akademiska Hospital; Sweden
| | - Sara Ekberg
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Mats Jerkeman
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - Ellen T. Chang
- California and Department of Health Research and Policy; Health Sciences Practice, Exponent, Inc., Menlo Park, Stanford University School of Medicine; Stanford California
| | - Magnus Björkholm
- Department of Medicine Division of Hematology; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Therese M.L. Andersson
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Karin E. Smedby
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
| | - Sandra Eloranta
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
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Nord C, Olofsson SE, Glimelius I, Cedermark GC, Ekberg S, Cavallin-Ståhl E, Neovius M, Jerkeman M, Smedby KE. Sick leave and disability pension among Swedish testicular cancer survivors according to clinical stage and treatment. Acta Oncol 2015; 54:1770-80. [PMID: 25833328 DOI: 10.3109/0284186x.2015.1020967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate if testicular cancer survivors (TCSs) have a higher incidence of work loss compared with the population, accounting for stage, treatment and relapse. MATERIAL AND METHODS A cohort of 2146 Swedish TCSs diagnosed 1995-2007 (seminoma n = 926, non-seminoma n = 1220) was identified in the SWENOTECA (Swedish-Norwegian Testicular Cancer Group) register, and matched 1:4 to population comparators. Prospectively recorded work loss data (both before and after diagnosis) were obtained from national registers through September 2013. Adjusted relative risks (RR) and 95% confidence intervals (CI) of sick leave and/or disability pension were calculated annually and overall with Poisson- and Cox regression, censoring at relapse. The mean number of annual work days lost was also estimated. RESULTS TCSs were at a modestly increased annual risk of work loss up to the third year of follow-up (RR3rd year 1.25, 95% CI 1.08, 1.43), attributed to a more pronounced risk among extensively treated patients (4 chemotherapy courses: RR3rd year 1.60, 95% CI 1.19, 2.15; > 4 courses: RR3rd year 3.70, 95% CI 2.25, 6.11). Patients on surveillance or limited treatment (radiotherapy, 1-3 chemotherapy courses) did not have an increased risk of work loss beyond the first year. TCSs receiving > 4 chemotherapy courses had higher mean number of annual days of work loss up to the 10th year post-diagnosis, and a five-fold risk of disability pension (RR 5.16, 95% CI 2.00, 10.3). CONCLUSION Extensively treated TCSs, but not those on surveillance or limited treatment, are at increased risk of work loss long-term, not explained by relapse. These patients may benefit from early rehabilitation initiatives.
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Affiliation(s)
- Carina Nord
- a Department of Oncology-Pathology , Radiumhemmet, Karolinska Institute and University Hospital , Stockholm , Sweden
| | - Sven-Erik Olofsson
- b Department of Clinical Sciences , Division of Oncology and Pathology, Lund University, Skåne University Hospital , Lund , Sweden
| | - Ingrid Glimelius
- c Department of Immunology , Genetics and Pathology, Unit of Oncology, Uppsala University Hospital , Uppsala , Sweden
- e Department of Medicine , Karolinska Institutet, Clinical Epidemiology Unit , Stockholm , Sweden
| | - Gabriella Cohn Cedermark
- a Department of Oncology-Pathology , Radiumhemmet, Karolinska Institute and University Hospital , Stockholm , Sweden
| | - Sara Ekberg
- d Department of Medical Epidemiology and Biostatistics , Karolinska Institute , Stockholm , Sweden
- e Department of Medicine , Karolinska Institutet, Clinical Epidemiology Unit , Stockholm , Sweden
| | - Eva Cavallin-Ståhl
- b Department of Clinical Sciences , Division of Oncology and Pathology, Lund University, Skåne University Hospital , Lund , Sweden
| | - Martin Neovius
- e Department of Medicine , Karolinska Institutet, Clinical Epidemiology Unit , Stockholm , Sweden
| | - Mats Jerkeman
- b Department of Clinical Sciences , Division of Oncology and Pathology, Lund University, Skåne University Hospital , Lund , Sweden
| | - Karin E Smedby
- e Department of Medicine , Karolinska Institutet, Clinical Epidemiology Unit , Stockholm , Sweden
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Chen L, Glimelius I, Neovius M, Eloranta S, Ekberg S, Martling A, Smedby KE. Risk of disability pension in patients following rectal cancer treatment and surgery. Br J Surg 2015. [PMID: 26215637 DOI: 10.1002/bjs.9885] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Aspects of survivorship, such as long-term ability to work, are increasingly relevant owing to the improved survival of patients with rectal cancer. The aim of this study was to assess risk and determinants of disability pension (DP) in this patient group. METHODS Using Swedish national clinical and population-based registers, patients with stage I-III rectal cancer aged 18-61 years in 1995-2009 were identified at diagnosis and matched with population comparators. Prospectively registered records of DP during follow-up were retrieved up to 2013. Non-proportional and proportional hazards models were used to estimate the incidence rate ratio (IRR) for DP annually and overall. Potential variations in risk by demographic and clinical factors were calculated, with relapse as a time-varying exposure. RESULTS A total of 2815 patients were identified and compared with 13 465 population comparators. During a median follow-up of 6·0 (range 0-10) years, 23·3 per cent of the relapse-free patients and 10·3 per cent of the population comparators received DP (IRR 2·40, 95 per cent c.i. 2·17 to 2·65). An increased annual risk of DP was evident almost every year until the tenth year of follow-up. Abdominoperineal resection was associated with an increased DP risk compared with anterior resection (IRR 1·44, 1·19 to 1·75). Surgical complications (IRR 1·33, 1·10 to 1·62) and reoperation (IRR 1·42, 1·09 to 1·84), but not radiotherapy or chemotherapy, were associated with risk of DP. CONCLUSION Relapse-free patients with rectal cancer of working age are at risk of disability pension.
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Affiliation(s)
- L Chen
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - I Glimelius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - S Eloranta
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - S Ekberg
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - K E Smedby
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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Simard JF, Ekberg S, Johansson ALV, Askling J. What is the impact of chronic systemic inflammation such as rheumatoid arthritis on mortality following cancer? Ann Rheum Dis 2015; 75:862-6. [DOI: 10.1136/annrheumdis-2014-207155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/12/2015] [Indexed: 01/22/2023]
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Glimelius I, Ekberg S, Linderoth J, Jerkeman M, Chang ET, Neovius M, Smedby KE. Sick leave and disability pension in Hodgkin lymphoma survivors by stage, treatment, and follow-up time—a population-based comparative study. J Cancer Surviv 2015; 9:599-609. [DOI: 10.1007/s11764-015-0436-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
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Nyman Iliadou A, Ekberg S, Cnattingius S, Johansson ALV, Mutsaerts MAQ, Groen H, Buiter-Van der Meer A, Sijtsma A, Kuchenbecker WKH, Mol BW, Sauer PJJ, Land JA, Corpeleijn E, Hoek A, Bhattacharya S, Kurinczuk J, Lee A, Raja EA, Porter M, Hamilton M, Templeton A, Mollison J, Moore VM, Marino JL, Willson KJ, Davies MJ, Chambers GM, Zhu R, Hoang VP. REPRODUCTIVE EPIDEMIOLOGY AND HEALTH ECONOMY. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.89] [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: 11/13/2022] Open
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Wallin A, Ekberg S, Lind K, Milos V, Granérus AK, Granerus G. Posterior cortical brain dysfunction in cognitively impaired patients with Parkinson's disease--a rCBF scintigraphy study. Acta Neurol Scand 2007; 116:347-54. [PMID: 17927803 DOI: 10.1111/j.1600-0404.2007.00887.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the study was to visualize cortical function in Parkinson's patients with various degrees of cognitive impairment. MATERIALS AND METHODS Thirty-seven patients with Parkinson's disease and three with Parkinson plus syndromes underwent cognitive assessment and rCBF using (99m)TC-HMPAO-SPECT. RESULTS Almost no regional reductions in cerebral blood flow were seen in patients without cognitive impairment (n = 16). Limited, mainly posterior, blood flow reductions were seen in patients with mild cognitive impairment (n = 14), whereas the reductions were extensive and bilaterally symmetric, involving both anterior and posterior brain regions in patients with dementia (n = 10). CONCLUSIONS The findings suggest a widespread cortical, mainly posterior type of dysfunction and a relationship between the degree of cognitive impairment and the magnitude of the dysfunction.
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Affiliation(s)
- A Wallin
- Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Goteborg University, Mölndal, Sweden.
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Lundell AC, Adlerberth I, Lindberg E, Karlsson H, Ekberg S, Aberg N, Saalman R, Hock B, Steinkasserer A, Hesselmar B, Wold AE, Rudin A. Increased levels of circulating soluble CD14 but not CD83 in infants are associated with early intestinal colonization with Staphylococcus aureus. Clin Exp Allergy 2007; 37:62-71. [PMID: 17210043 DOI: 10.1111/j.1365-2222.2006.02625.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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: 11/25/2022]
Abstract
BACKGROUND Soluble forms of the monocyte marker CD14 and the mature dendritic cell marker CD83 are plasma proteins with immunoregulatory functions. The physiological stimulus for their production is unclear and their possible role in allergy development is unknown. METHODS We measured the plasma levels of soluble CD14 (sCD14) and soluble CD83 (sCD83) in 64 Swedish children in relation to intestinal bacterial colonization pattern in a prospective birth cohort. Soluble CD14 and sCD83 levels were quantified by enzyme linked immunosorbent assay in plasma obtained at birth and at 4, 18 and 36 months of age. All major aerobic and anaerobic bacteria were quantified in faecal samples obtained regularly over the first 8 weeks of life. Clinical allergy and IgE levels were evaluated at 18 months of age. RESULTS Soluble CD14 in plasma increased during the first 18 months of life while sCD83 peaked at 4 months of age. Children who were perinatally colonized with Staphylococcus aureus had significantly higher levels of sCD14 in plasma at 4 months of age relative to non-colonized children. The levels of sCD14 were unrelated to colonization with Escherichia coli, other enterobacteria, enterococci, clostridia, Bacteroides, bifidobacteria or lactobacilli. Further, children with food allergy by 18 months tended to have lower levels of sCD14 than healthy children. Plasma levels of sCD83 were not related to either bacterial colonization pattern or allergy development. CONCLUSIONS Perinatal colonization with S. aureus may trigger the occurrence of sCD14 in plasma, which may influence development of the infantile immune system and risk of allergy development.
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Affiliation(s)
- A-C Lundell
- Department of Rheumatology and Inflammation Research, The Sahigrenska Adademy, Göteborg, Sweden.
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Abstract
Parkinson's disease (PD) is characterised by a loss of dopaminergic neurones in the basal ganglia. These neurones may be visualised by single photon emission computed tomography (SPECT) with the cocaine analogue 2beta-carboxymethyl-3-beta-(4-iodophenyl)tropane ([123I]beta-CIT), which labels the dopamine reuptake sites in the nerve terminals. In order to evaluate the possibility to predict the outcome of ECT a prospective study was performed with six PD patients in whom the [123I]beta-CIT uptake was measured before and after an electroconvulsive therapy (ECT) series. The side-to-side difference in the radiotracer uptake was found to be significantly lower in striatum located contralaterally to the part of the body with the most pronounced symptomatology. No significant change in uptake of the radioligand was seen after ECT. Patients with best uptake and thus with less advanced PD improved most after ECT. The possibility to use the [123I]beta-CIT uptake to predict the outcome of ECT treatment has to be further evaluated.
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Affiliation(s)
- P A Fall
- Department of Neuroscience and Locomotion, Faculty of Health Sciences, Linköping University, Sweden.
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Gunnarsson M, Jakobsson AM, Ekberg S, Albinsson Y, Ahlberg E. Sorption Studies of Cobalt(II) on Colloidal Hematite Using Potentiometry and Radioactive Tracer Technique. J Colloid Interface Sci 2000; 231:326-336. [PMID: 11049683 DOI: 10.1006/jcis.2000.7149] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The sorption of Co(II) on colloidal hematite was studied as a function of pH, ionic strength, and Co(II) concentration. Two different techniques were used, yielding two different sets of information: (i) potentiometric titrations that provide information on the number of protons released as a function of pH owing to the sorption of Co(II) and (ii) measurement of the amount of cobalt sorbed on the surface as a function of pH using a radioactive tracer, (60)Co. At low Co(II) concentrations (10(-8) M), the sorption was found to be independent of ionic strength but there seems to be a weak ionic strength dependence at higher Co(II) concentrations (10(-4) M). The adsorption edge moved to higher pH with increasing Co(II) concentration. For the high Co(II) concentration, the number of protons released per cobalt sorbed increased from zero to approximately 1.5. The basic charging properties of hematite were modeled with four different surface complexation models. The 1-pK Basic Stern Model (BSM), with binding of electrolyte ions to the Stern plane, seems to be the most reasonable model if the ambition is to describe experimental data at different ionic strengths. The sorption of cobalt was modeled with the 1-pK BSM. By introducing a low concentration of high affinity surface sites for cobalt sorption it was possible to model the sorption in very wide cobalt concentrations, ranging from 10(-8) M to 10(-4) M. Copyright 2000 Academic Press.
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Affiliation(s)
- M Gunnarsson
- Department of Chemistry, Göteborg University, Göteborg, SE-412 96, Sweden
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Strand P, Carlsson L, Rask K, Skrtic S, Ekberg S, Hedin L, Oscarsson J, Jansson JO. Growth hormone induces CCAAT/enhancer binding protein alpha (C/EBPalpha) in cultured rat hepatocytes. J Hepatol 2000; 32:618-26. [PMID: 10782911 DOI: 10.1016/s0168-8278(00)80224-x] [Citation(s) in RCA: 6] [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: 02/01/2023]
Abstract
BACKGROUND/AIMS The transcription factor CCAAT/enhancer binding protein alpha (C/EBPalpha) is a transactivator of several genes in the liver, which are regulated by growth hormone. METHODS Growth hormone (100 ng/ml) was added to primary rat hepatocytes cultured on a laminin-rich matrix. C/EBP mRNA and protein levels were measured by RNase protection assay and Western blotting, respectively. DNA binding activity was measured by electrophoretic mobility shift assay (EMSA). RESULTS Growth hormone treatment for 6 h to 3 days increased C/EBPalpha mRNA levels. Addition of growth hormone for 24 h and 4 days also enhanced the levels of the 42 and 30 kDa isoforms of immunoreactive C/EBPalpha. EMSA showed that addition of growth hormone for 24 h enhanced the abundance of a protein complex binding to a consensus C/EBP binding DNA oligonucleotide. This protein complex was supershifted by antibodies directed against C/EBPalpha but not against C/EBPbeta. There were no consistent effects on C/EBPbeta mRNA or protein at any timepoint. The growth hormone effect on C/EBPalpha expression was not affected by simultaneous incubation with insulin or glucocorticoids, two hormones that previously have been reported to affect C/EBPs. CONCLUSIONS Growth hormone enhances the levels of C/EBPalpha mRNA and protein as well as the DNA binding activity of C/EBPalpha in cultured rat hepatocytes.
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Affiliation(s)
- P Strand
- RCEM, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
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Bielenstein M, Astner L, Ekberg S. Determination of 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione in plasma by direct injection into a coupled column liquid chromatographic system. J Chromatogr B Biomed Sci Appl 1999; 730:177-82. [PMID: 10448952 DOI: 10.1016/s0378-4347(99)00199-1] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The chemical substance 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC) is in clinical use for the treatment of hereditary tyrosinemia type 1. In the present study, the plasma concentration of NTBC was determined by a coupled column liquid chromatographic method. A 20-microl volume of plasma was diluted with phosphate buffer, pH 2, and injected into a small precolumn (BioTrapAcid C18) with a mobile phase containing sulfuric acid. The precolumn was based on the restricted access principle, i.e., retention of NTBC within the lipophilic pores, while polar and large endogenous compounds were eluted with the void volume. NTBC was transferred to the analytical column using a mobile phase with a high content of acetonitrile. The compound was monitored by UV detection at 278 nm. The standard curve was linear between 0.3 and 69 microM, and the between-day precision (RSD) was 3% (n=6 days) at 13.8 microM and 14% (n=6 days) at 0.3 microM NTBC in plasma. The quantitation limit was approximately 0.3 microM using 20 microl of plasma.
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Affiliation(s)
- M Bielenstein
- Central Laboratory, The National Corporation of Swedish Pharmacies, Stockholm
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Skrtic S, Wallenius V, Ekberg S, Brenzel A, Gressner AM, Jansson JO. Hepatocyte-stimulated expression of hepatocyte growth factor (HGF) in cultured rat hepatic stellate cells. J Hepatol 1999; 30:115-24. [PMID: 9927158 DOI: 10.1016/s0168-8278(99)80015-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS Hepatic stellate cells appear to be the main producers of hepatocyte growth factor of the normal liver. Insulin-like growth factors in doses over 20 ng/ml have been reported to stimulate hepatocyte growth factor production in cultured hepatic stellate cells. The aim of the present study was to investigate whether parenchymal cell conditioned medium had insulin-like growth factor-independent effects on hepatic stellate cells. METHODS Primary rat hepatic stellate cells were cultured for 1-7 days. DNA synthesis was measured by 3H-thymidine incorporation. Hepatocyte growth factor and transforming growth factor beta1 immunoreactivity was quantified by ELISA. Hepatocyte growth factor mRNA levels were determined with gel RNase protection assay. Parenchymal cell conditioned medium was obtained from hepatocytes cultured for 2 days in medium without added serum or hormones. RESULTS Incubation of 1-7-day-old hepatic stellate cells for 2 days with parenchymal cell conditioned medium enhanced the medium content of hepatocyte growth factor. Parenchymal cell conditioned medium contained less than 5.0 ng/ml immunoreactive insulin-like growth factor-1 as measured by radio immunoassay. Parenchymal cell conditioned medium did not contain any insulin-like growth factor bioactivity measured as phosphorylation of type 1 insulin-like growth factor receptor beta subunit and a protein with a size consistent with that of insulin receptor substrate-1. The stimulatory effect of parenchymal cell conditioned medium on hepatocyte growth factor was time- and dose-dependent. The effects of a high dose of parenchymal cell conditioned medium (dilution 1:2 containing less than 2.5 ng/ml insulin-like growth factor-1) were additive to that of high doses (100 ng/ml) of insulin-like growth factor-1 or des (1-3) insulin-like growth factor-1, an analogue with low affinity to insulin-like growth factor binding proteins. Neither parenchymal cell conditioned medium nor insulin-like growth factor-1 enhanced transforming growth factor beta1 immunoreactivity in the medium. Both parenchymal cell conditioned medium and insulin-like growth factor-1 stimulated DNA synthesis in hepatic stellate cells, confirming previous reports. CONCLUSIONS The present results indicate that both insulin-like growth factor-1 and insulin-like growth factor-1-independent factors from hepatocytes can stimulate hepatocyte growth factor production by hepatic stellate cells. Therefore, insulin-like growth factor-1 and other hepatocyte-derived factors may indirectly affect hepatocytes via a paracrine loop.
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Affiliation(s)
- S Skrtic
- Research Center for Endocrinology and Metabolism, Sahlgrenska University Hospital, Göteborg, Sweden.
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Janerot-Sjöberg B, Ekberg S, Areskog M, Nylander E, Swahn E. Quantitative digital evaluation of myocardial exercise thallium-201 single-photon emission tomography in post-menopausal women. Clin Physiol 1998; 18:169-77. [PMID: 9649904 DOI: 10.1046/j.1365-2281.1998.00090.x] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Quantitative computerized analysis of data from myocardial thallium-201 (201Tl) single-photon emission tomography (SPET) may improve the diagnostic accuracy of coronary heart disease. The reference ranges for post-menopausal women are, however, limited and obtained mainly from patients. To compare reference values from healthy post-menopausal women and to improve the quantitative analysis, 20 women (10 patients with coronary heart disease and previous infarction and 10 age-matched healthy volunteers) were examined immediately post exercise and after a delay. A nine-segment 'bull's-eye' model was used for analysis. At visual evaluation, reproducibility was high (93%), no false-positive results were obtained and in 70% of the patients the SPET was interpreted as abnormal. Using reported reference values for quantitative analysis, all the healthy women had an abnormal result. New reference values based on three different methods of 'normalization' were calculated: the relative activity of segment 3 set to 100%, the segment with the highest activity set to 100% and a least-squares method. They all differed significantly from those that had previously been reported. The frequencies of agreement between visual and quantitative analysis were 84-92% and were highest when segment 3 was used as a reference, but in this case only 40% of the patients with coronary heart disease had an abnormal SPET. Using the least-squares method for handling digital information, the SD of the normal values decreased and 90% of the patients with coronary heart disease were accurately diagnosed. These results provide quantitative digital reference values for healthy post-menopausal women. They verify that quantitative analysis is in diagnostic agreement with visual evaluation, stress the need for local verification of reference ranges and suggest a least-square normalization method for the analysis.
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Affiliation(s)
- B Janerot-Sjöberg
- Department of Clinical Physiology, Linköping University Hospital, Sweden
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Vidal NO, Ekberg S, Enerbäck S, Lindahl A, Ohlsson C. The CCAAT/enhancer-binding protein-alpha is expressed in the germinal layer of the growth plate: colocalisation with the growth hormone receptor. J Endocrinol 1997; 155:433-41. [PMID: 9487988 DOI: 10.1677/joe.0.1550433] [Citation(s) in RCA: 7] [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: 02/06/2023]
Abstract
The transcription factor C/EBP alpha, a member of the CCAAT/enhancer-binding protein family, is highly expressed in the liver and in adipose tissue. The aim of this study was to determine if C/EBP alpha is expressed in rat growth cartilage. The expression pattern of C/EBP alpha in monolayer-cultured growth plate chondrocytes was similar to that of C/EBP alpha during hepatocyte and preadipocyte differentiation. Immunohistochemistry with a polyclonal antibody for C/EBP alpha revealed that the C/EBP alpha protein is present in the perichondrial ring, in the germinal layer of the growth plate and on the surface of the articular cartilage. The growth hormone (GH) receptor has a similar distribution in the rat tibial growth plate, and hypophysectomised rats were used to investigate a possible connection between C/EBP alpha and GH. C/EBP alpha mRNA levels were decreased in rib cartilage after hypophysectomy. However, GH treatment did not counteract this effect, indicating that other pituitary hormones regulate the C/EBP alpha mRNA levels in growth plate cartilage. We thus demonstrate, for the first time, that C/EBP alpha is expressed in cartilage. The finding that C/EBP alpha, like the GH receptor, is predominantly expressed in stem cell areas of the rat growth plate indicates a possible functional role for C/EBP alpha during early chondrogenic differentiation.
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Affiliation(s)
- N O Vidal
- Department of Clinical Chemistry, Sahlgrenska University Hospital, University of Gothenburg, Sweden
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Skrtic S, Wallenius V, Ekberg S, Brenzel A, Gressner AM, Jansson JO. Insulin-like growth factors stimulate expression of hepatocyte growth factor but not transforming growth factor beta1 in cultured hepatic stellate cells. Endocrinology 1997; 138:4683-9. [PMID: 9348194 DOI: 10.1210/endo.138.11.5540] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [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: 02/05/2023]
Abstract
Hepatic stellate cells (HSC) are located adjacent to hepatocytes and produce hepatocyte growth factor (HGF) in the normal liver, whereas transformed HSC in fibrotic livers produce transforming growth factor beta1 (TGFbeta1), an inhibitor ofhepatocyte proliferation. In addition to the endocrine actions of hepatic insulin-like growth factor-I (IGF-I), it also stimulates the proliferation of HSC. In this study we found that addition of IGF-1 (20-500 ng/ml) for 48 h to 2- to 7-day-old primary cultures of rat HSC resulted in a time- and dose-dependent increase by 50-190% of the concentrations of immunoreactive HGF in the medium. The levels of HGF as well as DNA synthesis measured as thymidine incorporation were also enhanced by IGF-II and des(1-3)IGF-I, which has reduced binding to IGF binding proteins. There was no consistent effect of the IGFs on the levels of immunoreactive TGFbeta1 or on the total DNA content of the cultures. There was no effect of human GH on medium levels of HGF or TGFbeta1, thymidine incorporation, or total DNA content. IGF-I increased the abundance of HGF messenger RNA, as measured by the RNase protection/solution hybridization technique, whereas there was no effect on TGFbeta1 or glyceraldehyde phosphate dehydrogenase messenger RNA. The results suggest that IGFs stimulate the production of HGF but not TGFbeta1 by HSC in vitro.
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Affiliation(s)
- S Skrtic
- Research Center for Endocrinology and Metabolism, Sahlgrenska University Hospital, Göteborg, Sweden
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Skrtic S, Ekberg S, Wallenius V, Enerbäck S, Hedin L, Jansson JO. Changes in expression of CCAAT/enhancer binding protein alpha (C/EBP alpha) and C/EBP beta in rat liver after partial hepatectomy but not after treatment with cyproterone acetate. J Hepatol 1997; 27:903-11. [PMID: 9382979 DOI: 10.1016/s0168-8278(97)80329-7] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/AIMS The proliferation rate of adult rat liver is normally very low. It is markedly enhanced during compensatory regeneration, e.g. after partial hepatectomy, or after administration of certain growth promoters, e.g. cyproterone acetate. These two types of liver cell proliferation appear to differ, since the expression of immediate early genes is induced during compensatory regeneration but not after cyproterone acetate treatment. The transcription factor C/EBP alpha, which has been associated with hepatocyte differentiation and growth arrest, is suppressed during compensatory regeneration. In contrast, C/EBP beta, associated with acute phase reaction, is increased during regeneration. We have investigated the effects of the liver growth promoter cyproterone acetate on the hepatic expression of C/EBP alpha and C/EBP beta. METHODS Adult male rats received either cyproterone acetate treatment or were subjected to partial hepatectomy. Livers were obtained at different time intervals for measurement of C/EBP alpha and C/EBP beta mRNA with solution hybridization/RNAse protection assay, and C/EBP alpha and C/EBP beta content with immunoblotting. RESULTS The levels of both C/EBP alpha and C/EBP beta mRNA and the corresponding immunoreactivities were unchanged 2-48 h after injection of cyproterone acetate. The levels of C/EBP alpha mRNA and immunoreactivity were significantly suppressed 10-18 h and 18-26 h after partial hepatectomy, respectively. The levels of C/EBP beta mRNA and immunoreactivity were enhanced during compensatory regeneration 2 h after partial hepatectomy. CONCLUSIONS Liver cell proliferation during regeneration, but not in response to cyproterone acetate treatment, is associated with changes in C/EBP alpha and C/EBP beta expression. This further supports the notion that changes in expression of transcription factors during liver growth in vivo are dependent on the growth inducer.
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Affiliation(s)
- S Skrtic
- Research Center for Endocrinology and Metabolism, Sahlgrenska University Hospital, University of Göteborg, Sweden
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Wallenius VR, Rawet H, Skrtic S, Helou K, Qiu Y, Levan G, Ekberg S, Carlsson B, Isaksson OG, Nakamura T, Jansson JO. Chromosomal localization of rat hepatocyte growth factor (Hgf) and HGF receptor (Met) and characterization of HGF receptor cDNA. Mamm Genome 1997; 8:661-7. [PMID: 9271668 DOI: 10.1007/s003359900533] [Citation(s) in RCA: 16] [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: 02/05/2023]
Abstract
The Met protooncogene encodes the tyrosine kinase receptor for the hepatocyte growth factor (HGF), a potent mitogen for hepatocytes and other epithelial cells produced by mesenchymal cells. Many of the studies on the physiologic and neoplastic growth of the liver, as well as other organs, have been performed in the rat. Therefore, chromosomal mapping of the rat Hgf gene and the gene of its receptor is of particular value. To achieve this, a probe of the coding part of rat HGF cDNA was used to isolate four genomic probes from a lambda phage rat genomic library. These probes were used to map the Hgf gene to Chromosome (Chr) 4q12 by the FISH technique. To obtain a probe for the mapping of the HGF receptor/Met gene, we cloned the complete coding region of the rat HGF receptor mRNA. Complementary DNA (cDNA) was synthesized with reverse transcriptase from total RNA for use as a template for the PCR. The two PCR primers were designed based on human and mouse sequences and were located in the flanking regions of the open reading frame of the HGF receptor mRNA. Amplification resulted in a band of an estimated size of 4.1 kb, which was cloned and sequenced. The nucleotide sequence showed about 93% and 85% homology compared with mouse and human HGF receptor sequences, respectively. A full-length probe of the coding part of the cDNA was used to map the rat HGF receptor/Met gene to Chr 4q21 by the FISH technique. Therefore, the rat Hgf and HGF receptor/Met genes are located relatively close to each other, in a way similar to humans but not mice.
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Affiliation(s)
- V R Wallenius
- Research Centre for Endocrinology and Metabolism (RCEM), Department of Internal Medicine, Gröna strâket 8, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
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Almer S, Peters AM, Ekberg S, Franzén L, Granerus G, Ström M. Is computer-aided interpretation of 99Tcm-HMPAO leukocyte scans better than the naked eye? Nucl Med Commun 1995; 16:290-8. [PMID: 7624110 DOI: 10.1097/00006231-199504000-00161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In order to compare visual interpretation of inflammation detected by leukocyte scintigraphy with that of different computer-aided quantification methods, 34 patients (25 with ulcerative colitis and 9 with endoscopically verified non-inflamed colonic mucosa), were investigated using 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO) leukocyte scintigraphy and colonoscopy with biopsies. Scintigrams were obtained 45 min and 4 h after the injection of labelled cells. Computer-generated grading of seven colon segments using four different methods was performed on each scintigram for each patient. The same segments were graded independently using a 4-point visual scale. Endoscopic and histological inflammation were scored on 4-point scales. At 45 min, a positive correlation was found between endoscopic and scan gradings in individual colon segments when using visual grading and three of the four computer-aided methods (Spearman's rs = 0.30-0.64, P < 0.001). Histological grading correlated with visual grading and with two of the four computer-aided methods at 45 min (rs = 0.42-0.54, P < 0.001). At 4 h, all grading methods correlated positively with both endoscopic and histological assessment. The correlation coefficients were, in all but one instance, highest for the visual grading. As an inter-observer comparison to assess agreement between the visual gradings of two nuclear physicians, 14 additional patients (9 ulcerative colitis, 5 infectious enterocolitis) underwent leukocyte scintigraphy. Agreement assessed using kappa statistics was 0.54 at 45 min (P < 0.001). Separate data concerning the presence/absence of active inflammation showed a high kappa value (0.74, P < 0.001). Our results showed that a simple scintigraphic scoring system based on assessment using the human eye reflects colonic inflammation at least as well as computer-aided grading, and that highly correlated results can be achieved between different investigators.
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Affiliation(s)
- S Almer
- Department of Internal Medicine, Faculty of Health Sciences, Linköping University, Sweden
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