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Axelrod ML, Wang Y, Xu Y, Sun X, Bejan CA, Gonzalez-Ericsson PI, Nunnery S, Bergman RE, Donaldson J, Guerrero-Zotano AL, Massa C, Seliger B, Sanders M, Mayer IA, Balko JM. Peripheral Blood Monocyte Abundance Predicts Outcomes in Patients with Breast Cancer. Cancer Res Commun 2022; 2:286-292. [PMID: 36304942 PMCID: PMC9604512 DOI: 10.1158/2767-9764.crc-22-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 04/21/2022] [Indexed: 04/27/2023]
Abstract
Biomarkers of response are needed in breast cancer to stratify patients to appropriate therapies and avoid unnecessary toxicity. We used peripheral blood gene expression and cell type abundance to identify biomarkers of response and recurrence in neoadjuvant chemotherapy treated breast cancer patients. We identified a signature of interferon and complement response that was higher in the blood of patients with pathologic complete response. This signature was preferentially expressed by monocytes in single cell RNA sequencing. Monocytes are routinely measured clinically, enabling examination of clinically measured monocytes in multiple independent cohorts. We found that peripheral monocytes were higher in patients with good outcomes in four cohorts of breast cancer patients. Blood gene expression and cell type abundance biomarkers may be useful for prognostication in breast cancer. Significance Biomarkers are needed in breast cancer to identify patients at risk for recurrence. Blood is an attractive site for biomarker identification due to the relative ease of longitudinal sampling. Our study suggests that blood-based gene expression and cell type abundance biomarkers may have clinical utility in breast cancer.
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Affiliation(s)
- Margaret L. Axelrod
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yu Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xiaopeng Sun
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cosmin A. Bejan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sara Nunnery
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Riley E. Bergman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua Donaldson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Chiara Massa
- Institute of Medical Immunology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Barbara Seliger
- Institute of Medical Immunology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Melinda Sanders
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ingrid A. Mayer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin M. Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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Nunnery S, Bottinor W, Das S. Cardiac Masses in a Patient With Pancreatic Adenocarcinoma and a History of Breast Carcinoma. JAMA Oncol 2020; 6:917-918. [PMID: 32324203 DOI: 10.1001/jamaoncol.2020.0086] [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: 11/14/2022]
Affiliation(s)
- Sara Nunnery
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wendy Bottinor
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Satya Das
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Nunnery S, Wang D, Tan M, Fong R, Lo MM, Olin RL. Efficacy and cost-effectiveness of clofarabine with high-dose cytarabine for treatment of relapsed/refractory acute myeloid leukemia (R/R AML). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e19009] [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: 11/20/2022] Open
Affiliation(s)
- Sara Nunnery
- University of California, San Francisco, San Francisco, CA
| | - Dorothy Wang
- University of California, San Francisco, San Francisco, CA
| | - Marisela Tan
- University of California, San Francisco, San Francisco, CA
| | - Richard Fong
- University of California, San Francisco, San Francisco, CA
| | - Mimi Ming Lo
- University of California, San Francisco, San Francisco, CA
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Yaghmour G, Wiedower E, Yaghmour B, Nunnery S, Duncavage E, Martin MG. Sweet's syndrome associated with clonal hematopoiesis of indeterminate potential responsive to 5-azacitidine. Ther Adv Hematol 2016; 8:91-95. [PMID: 28203345 DOI: 10.1177/2040620716680330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sweet's syndrome (SS) is a rare condition characterized by the abrupt appearance of painful skin lesions due to neutrophilic dermal infiltration. Hematologic neoplasms, particularly acute myeloid leukemia (AML) and myelodysplastic syndromes (MDSs), have been commonly reported in association with SS. Clonal hematopoiesis of indeterminate potential (CHIP) is an emerging entity that is a precursor state to myeloid neoplasms. CHIP has not been previously associated with SS. We report the case of a 71-year-old man who presented with recurrent, painful edematous and erythematous papules and nodules for 18 months despite treatment with corticosteroids. He had normal blood counts, but a macrocytosis was noted (110 fl). Alternative causes of macrocytosis were ruled out. A skin biopsy confirmed a diagnosis of SS. Bone marrow biopsy specimen yielded a normal karyotype except for loss of the Y chromosome and equivocal morphologic findings. Polymerase chain reaction (PCR) and reverse transcription polymerase chain reaction (RT-PCR) of selected genes from the peripheral blood demonstrated a mixed lineage leukemia (MLL) partial tandem duplication (PTD) and sequence variant in CCAAT/enhancer binding protein alpha (CEBPA). These findings were consistent with a diagnosis of CHIP. The patient was treated with 5-azacitidine and achieved a complete remission of his skin lesions and was able to discontinue corticosteroids. To our knowledge, this is the first report of a patient with recurrent SS associated with CHIP. In addition to other myeloid neoplasms like AML and MDS, CHIP should be considered as a potential etiology in cases of recurrent SS. Treatment with a hypomethylating agents such as azacitidine could also serve as an alternative to systemic corticosteroid therapy.
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Affiliation(s)
- George Yaghmour
- Department of Hematology and Oncology, Keck Hospital of USC, USC Norris Cancer Hospital, 1441 Eastlake Avenue, NTT suite 3467, Los Angeles, CA 90033-458, USA
| | - Eric Wiedower
- Department of Hematology/Oncology, The West Clinic, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Bassam Yaghmour
- Department of Pulmonary and Critical Care, Keck Hospital of USC, Los Angeles, CA, USA
| | - Sara Nunnery
- Department if Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Eric Duncavage
- Department of Pathology and Immunology Division of Anatomic and Molecular Pathology, Washington University in St. Louis, St. Louis, MO, USA
| | - Mike G Martin
- Department of Hematology/Oncology, The West Clinic, The University of Tennessee Health Science Center, Memphis, TN, USA
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Nasir SS, Giri S, Nunnery S, Martin MG. Outcome of Adolescents and Young Adults Compared With Pediatric Patients With Acute Myeloid and Promyelocytic Leukemia. Clin Lymphoma Myeloma Leuk 2016; 17:126-132.e1. [PMID: 27836483 DOI: 10.1016/j.clml.2016.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/31/2016] [Accepted: 09/08/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Studies on the outcome of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) and acute promyelocytic leukemia (APL) are limited. METHODS We compared the outcome of AYA (19-30 years) patients with AML and PML and pediatric (0-18 years) patients with AML (pAMLs) and APL (pAPLs) utilizing the Surveillance Epidemiology and End Results-18 registry. Early mortality rate (EMR), defined as mortality within 1 month of diagnosis, was used as a surrogate for treatment-related mortality. Survival statistics were computed using the Kaplan-Meier method. Multivariate analysis was done using logistic regression and the Cox proportional hazard regression model. RESULTS A total of 6343 patients with AML were identified; 44.7% were AYAs. pAMLs had lower EMR (6.2% vs. 9.2%; P < .01) and higher overall survival (OS) (1-year, 70.3% vs. 62.1%; 5-year, 48.2% vs. 36.4%; P < .01). Nine hundred twenty patients with APL were also identified; 59.5% were AYAs. No statistically significant difference was found between AYAs with APL and pAPLs in EMR (11.4% vs. 14.1%; P = .23) and OS (1-year, 83.8% vs. 81.2%; P = .31 and 5-year, 68.2% vs. 73.1%; P = .11]. Comparing all patients with AML and APL, AYAs with APL and pAPLs had higher EMR (11.4% and 14.1% vs. 6.2% and 9.2%; P ≤ .01) but better OS than AYAs with AML and pAMLs (5-year OS, 68.2% and 73.1% vs. 48.2% and 36.4%; P ≤ .01). CONCLUSION Our analysis shows AYAs with AML have worse EMR and OS compared with pAMLs. AYAs with APL and pAPLs have similar outcomes. To our knowledge, this is the first study reporting outcomes of AYAs with APL and pAPLs using a large population-based registry and their comparison with same age patients with AML.
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Affiliation(s)
- Syed Sameer Nasir
- Division of Hematology and Oncology, Department of Medicine, University of Health Science Center, Memphis, TN; The West Cancer Center, Memphis, TN.
| | - Smith Giri
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Sara Nunnery
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Mike G Martin
- Division of Hematology and Oncology, Department of Medicine, University of Health Science Center, Memphis, TN; The West Cancer Center, Memphis, TN
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Yaghmour G, Pandey M, Ireland C, Patel K, Nunnery S, Powell D, Baum S, Wiedower E, Schwartzberg LS, Martin MG. Role of Genomic Instability in Immunotherapy with Checkpoint Inhibitors. Anticancer Res 2016; 36:4033-4038. [PMID: 27466509] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/24/2016] [Indexed: 06/06/2023]
Abstract
AIM We evaluated whether tumor genome sequencing to detect the number and type of alterations could be used as a valuable biomarker for judging the potential utility of immune checkpoint inhibitors in patients with advanced cancers. MATERIALS AND METHODS We identified patients with solid tumors who were treated with checkpoint inibitors and had received commercially available next generation sequencing (NGS). Tumors profiled by Caris Life Sciences, Foundation Medicine and Guardant360 between 2013 and 2015. Patients were divided into 5 quintiles based on mutational load (pathogenic mutations plus variants of undetermined significance). RESULTS Fifty patients with solid tumors on immunotherapy that had NGS reports available were identified. Top quintile patients had more genomic alterations (median=16.5) than the others (median=2) and had more pathogenic mutations in cell-cycle regulatory genes (100% versus 48%). The overall survival (OS) was significantly superior for patients in the top quintile (722 days) versus the others (432 days). We found no significant difference in progression-free survival (PFS) between the two groups. The objective response rate was numerically higher for the top quintile (50%) vs. others (20%). Programmed cell death protein 1 (PD1) and programmed death-ligand 1 (PDL1) status by immunohistochemistry was not associated with outcomes. CONCLUSION The use of immune checkpoint blockade in tumors with higher mutational load was associated with improved OS. Our results suggest that the evaluation of tumor genomes may be predictive of immunotherapy benefit.
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Affiliation(s)
- George Yaghmour
- Department of Hematology/Oncology, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A.
| | - Manjari Pandey
- Department of Hematology/Oncology, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Catherine Ireland
- Department of Internal Medicine, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Kruti Patel
- Department of Internal Medicine, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Sara Nunnery
- Department of Internal Medicine, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Daniel Powell
- Department of Oncologic Radiology, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Scott Baum
- Department of Oncologic Radiology, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Eric Wiedower
- Department of Hematology/Oncology, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Lee S Schwartzberg
- Department of Hematology/Oncology, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Michael G Martin
- Department of Hematology/Oncology, The West Cancer Center, The University of Tennessee Health Science Center, Memphis, TN, U.S.A
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Jamy O, Nunnery S, Giri S, Wiedower E, Johnson B, Yaghmour G, Martin MG. Under-recognition of hemophagocytic syndrome in United States’ rural, non-teaching hospitals. Leuk Lymphoma 2016; 57:2911-2913. [DOI: 10.3109/10428194.2016.1169407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hahn AW, Jamy O, Nunnery S, Yaghmour G, Giri S, Pathak R, Martin MG. How Center Volumes Affect Early Outcomes in Acute Myeloid Leukemia. Clin Lymphoma Myeloma Leuk 2015; 15:646-54. [PMID: 26386907 DOI: 10.1016/j.clml.2015.07.646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/28/2015] [Accepted: 07/28/2015] [Indexed: 01/28/2023]
Abstract
Early mortality (EM) is all too frequent during induction chemotherapy for acute myeloid leukemia. Older patients shoulder an undue amount of this burden as a result of the inherent biology of their disease and increased comorbidities. EM rates in academic centers have seen a sharp decline over the past 20 years; however, data from population-based registries show that EM rates for the general population have significantly lagged behind. In this review, we analyze the data available on EM in academic centers and the general population, explore recent improvements in supportive care and the use of predictive models, and finally investigate the relationship between case volume and complications during chemotherapy.
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Affiliation(s)
- Andrew W Hahn
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN.
| | - Omer Jamy
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Sara Nunnery
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - George Yaghmour
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN; Department of Hematology/Oncology, The West Cancer Center, Memphis, TN
| | - Smith Giri
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Ranjan Pathak
- Department of Internal Medicine, Reading Health System, West Reading, PA
| | - Mike G Martin
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN; Department of Hematology/Oncology, The West Cancer Center, Memphis, TN
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Mulrooney DA, Nunnery S, Armstrong GT, Ness KK, Srivastava K, Donovan FD, Kurt BA, Metzger ML, Krasin MJ, Joshi V, Durand JB, Robison LL, Hudson MM, Flamm SD. Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma. Cancer 2014; 120:3536-44. [PMID: 25041978 PMCID: PMC4221540 DOI: 10.1002/cncr.28925] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 04/03/2014] [Revised: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivors of Hodgkin lymphoma (HL) have significant cardiovascular risk and require long-term surveillance. The current study assessed the prevalence of coronary artery disease (CAD) by coronary computed tomography angiography (CCTA) in adult survivors of childhood HL. METHODS Thirty-one survivors of HL, 13 of whom (42%) were treated with radiotherapy (RT) only and 18 of whom (58%) were treated with multimodal therapy, underwent CCTA, echocardiography, electrocardiography (ECG), and treadmill stress testing. Obstructive CAD was defined as ≥50% occlusion of the left main or ≥70% occlusion of the left anterior descending, left circumflex, or right coronary arteries on CCTA. Echocardiograms with resting wall motion abnormalities or an ejection fraction <50%; ECGs with Q waves, ST abnormalities without Q waves, or T-wave abnormalities without Q waves; and a J-point depression of ≥1 mm with a horizontal or downsloping ST segment on stress testing were considered abnormal. RESULTS The prevalence of disease in participants (median age, 40 years [range, 26 years-55 years]; median time from cancer diagnosis, 24 years [range, 17 years-39 years]) was 39%, with 39 plaques detected among 12 survivors. Three participants (10%) treated with RT only had 4 obstructive lesions; 9 patients (29%; 5 of whom were treated with RT only and 4 of whom were treated with multimodal therapy) had nonobstructive lesions. Approximately 15% of lesions involved the left main, 21% involved the proximal left anterior descending, 18% involved the proximal right coronary, and 13% involved the proximal left circumflex arteries. Of the 12 participants found to have CAD by CCTA, 7 had a positive ECG, 1 had a positive echocardiogram, and 1 had a positive stress test. CONCLUSIONS CCTA identified CAD in a substantial percentage of survivors of HL and may be an effective screening modality for this population.
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Affiliation(s)
- Daniel A. Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Departments of Pediatrics and Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Sara Nunnery
- Departments of Pediatrics and Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - F. Daniel Donovan
- Methodist Hospitals of Memphis, Memphis, Tennessee
- Department of Radiology, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Beth A. Kurt
- Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - Monika L. Metzger
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew J. Krasin
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Vijaya Joshi
- Departments of Pediatrics and Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | | | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Mulrooney D, Nunnery S, Armstrong G, Ness K, Srivastava K, Donovan D, Metzger M, Krasin M, Joshi V, Durand JB, Robison L, Hudson M, Flamm S. Coronary Artery Disease Detected by Coronary Computed Tomographic Angiography (CCTA) in Adult Survivors of Childhood Hodgkin Lymphoma. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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