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Jain T, Tsai HL, Elmariah H, Vachhani P, Karantanos T, Wall SA, Gondek LP, Bashey A, Keyzner A, Tamari R, Grunwald MR, Abedin S, Nadiminti KV, Iqbal M, Gerds AT, Viswabandya A, McCurdy SR, Al Malki MM, Varadhan R, Ali H, Gupta V, Jones RJ, Otoukesh S. Haploidentical donor hematopoietic cell transplantation for myelodysplastic/myeloproliferative overlap neoplasms: results from a North American collaboration. Haematologica 2023; 108:3321-3332. [PMID: 37408464 PMCID: PMC10690921 DOI: 10.3324/haematol.2023.283426] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023] Open
Abstract
Haploidentical donors offer a potentially readily available donor, especially for non-White patients, for hematopoietic cell transplantation (HCT). In this North American collaboration, we retrospectively analyzed outcomes of first HCT using haploidentical donor and post-transplantation cyclophosphamide (PTCy) in myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) overlap neoplasms (MDS/MPN). We included 120 consecutive patients who underwent HCT using a haploidentical donor for MDS/MPN across 15 centers. Median age was 62.5 years and 38% were of non-White/Caucasian ethnicity. The median follow-up was 2.4 years. Graft failure was reported in seven of 120 (6%) patients. At 3 years, nonrelapse mortality (NRM) was 25% (95% confidence interval [CI]: 17-34), relapse 27% (95% CI: 18-36), grade 3-4 acute graftversus- host disease 12% (95% CI: 6-18), chronic graft-versus-host disease requiring systemic immunosuppression 14% (95% CI: 7-20), progression-free survival (PFS) 48% (95% CI: 39-59), and overall survival (OS) 56% (95% CI: 47-67). On multivariable analysis, NRM was statistically significantly associated with advancing age at HCT (per decade increment, subdistribution hazard ratio [sdHR] =3.28; 95% CI: 1.30-8.25); relapse with the presence of mutation in EZH2/RUNX1/SETBP1 (sdHR=2.61; 95% CI: 1.06-6.44); PFS with advancing age at HCT (per decade increment, HR=1.98, 95% CI: 1.13-3.45); and OS with advancing age at HCT (per decade increment, HR=2.01; 95% CI: 1.11-3.63) and splenomegaly at HCT/prior splenectomy (HR=2.20; 95% CI: 1.04-4.65). Haploidentical donors are a viable option for HCT in MDS/MPN, especially for those disproportionately represented in the unrelated donor registry. Hence, donor mismatch should not preclude HCT for patients with MDS/MPN, an otherwise incurable malignancy. In addition to patient age, disease-related factors including splenomegaly and high-risk mutations dominate outcomes following HCT.
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Affiliation(s)
- Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans street, Baltimore, MD, USA 21287.
| | - Hua-Ling Tsai
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 550 North Broadway, Baltimore, MD, USA 21287
| | - Hany Elmariah
- Department of Bone Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA 33612
| | - Pankit Vachhani
- Division of Hematology and Oncology, O'Neal Comprehensive Cancer Center, University of Alabama, 1802 6th Ave S, Birmingham, AL, USA 35294
| | - Theodoros Karantanos
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans street, Baltimore, MD, USA 21287
| | - Sarah A Wall
- Division of Hematology, The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, 11th Floor, Columbus, OH, USA 43210
| | - Lukasz P Gondek
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans street, Baltimore, MD, USA 21287
| | - Asad Bashey
- Blood and Marrow Transplant Program, Northside Hospital, 5670 Peachtree Dunwoody Road, Atlanta, GA, USA 30342
| | - Alla Keyzner
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place P.O. Box 1410, New York, NY, USA 10029
| | - Roni Tamari
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, 1275 York avenue, New York, NY, USA 10065
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, LCI Building 2, Suite 60100, Charlotte, NC, USA 28204
| | - Sameem Abedin
- Division of Hematology/Oncology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, USA 53226
| | - Kalyan Vg Nadiminti
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, USA 53792
| | - Madiha Iqbal
- Department of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA 32224
| | - Aaron T Gerds
- Department of Hematology and Medical Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA 44195
| | - Auro Viswabandya
- Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, Canada M5G 2C1
| | - Shannon R McCurdy
- University of Pennsylvania, 3400 Civic center road, 12 South Pavilion, Philadelphia, PA 19104
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, 1500 East Duarte Road, Duarte, CA, USA 91010
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 550 North Broadway, Baltimore, MD, USA 21287
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, 1500 East Duarte Road, Duarte, CA, USA 91010
| | - Vikas Gupta
- Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, Canada M5G 2C1
| | - Richard J Jones
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans street, Baltimore, MD, USA 21287
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, 1500 East Duarte Road, Duarte, CA, USA 91010
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Wall SA, Olin R, Bhatt V, Chhabra S, Munshi P, Hacker E, Hashmi S, Hassel H, Howard D, Jayani R, Lin R, McCurdy S, Mishra A, Murthy H, Popat U, Wood W, Rosko AE, Artz A. The Transplantation Ecosystem: A New Concept to Improve Access and Outcomes for Older Allogeneic Hematopoietic Cell Transplantation Patients. Transplant Cell Ther 2023; 29:632.e1-632.e10. [PMID: 37137442 DOI: 10.1016/j.jtct.2023.04.020] [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: 02/16/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is increasingly offered to older adults with hematologic malignancies, even though nonrelapse mortality remains a major concern in older patients owing to more comorbidities and greater frailty compared with their younger counterparts. The importance of patient fitness, a well-matched donor, and disease control to the success of allogeneic HCT have been well documented; however, these factors fail to account for the impact of the complex transplantation ecosystem (TE) that older adult HCT candidates must navigate. We propose a definition of the TE modeled after the social determinants of health. Furthermore, we outline a research agenda aimed at increasing understanding of the roles of individual social determinants of transplantation health in the larger ecosystem and how they may benefit or harm older adult HCT candidates. Herein we define the TE and its individual tenets, the social determinants of transplantation health. We review the available literature while incorporating the expertise of the membership of the American Society for Transplantation and Cellular Therapy (ASTCT) Special Interest Group for Aging. The membership of the ASTCT Special Interest Group for Aging identify knowledge gaps and strategies to address them for each of the described social determinants of transplantation health. The ecosystem is an essential but underappreciated pillar for transplant access and success. We put forth this novel research agenda seeking to gain a better understanding of the complexity of HCT in older adults and develop strategies to improve access to HCT, survival, and quality of life.
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Affiliation(s)
- Sarah A Wall
- Division of Hematology, Ohio State University, Columbus, OH.
| | - Rebecca Olin
- Division of Hematology & Oncology, University of California San Francisco, San Francisco, CA
| | - Vijaya Bhatt
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Saurabh Chhabra
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Pashna Munshi
- Division of Oncology, Georgetown University Medical Center, Washington, DC
| | - Eileen Hacker
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shahrukh Hashmi
- Division of Hematology, Mayo Clinic Minnesota, Rochester, MN
| | - Hailey Hassel
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Dianna Howard
- Division of Hematology & Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Reena Jayani
- Division of Hematology & Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Richard Lin
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shannon McCurdy
- Division of Hematology & Oncology, University of Pennsylvania, Philadelphia, PA
| | - Asmita Mishra
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Hemant Murthy
- Division of Hematology & Oncology, Mayo Clinic, Jacksonville, FL
| | - Uday Popat
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Wood
- Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ashley E Rosko
- Division of Hematology, Ohio State University, Columbus, OH
| | - Andrew Artz
- Division of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA
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Miller EG, Pietrzak M, Pearson R, Brammer JE, de Lima M, Jaglowski S, Penza S, Vasu S, Wall SA, Lozanski G, Choe H. Evaluating Diversity of Tcrvb Repertoire and Steroid Responsiveness in Acute Graft Versus Host Disease. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00439-6] [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: 02/07/2023]
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4
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Vasu S, Kromer M, Zhao Q, Choe H, Larkin K, Wall SA, Jaglowski S, Penza S, Brammer JE, Sharma N, Jacob N, De Lima M, Welliver M. Utilizing Organ-Sparing Marrow Irradiation to Condition Patients Prior to Allogeneic Hematopoietic Cell Transplant with High-Risk Hematologic Malignancies: Results of a Pilot Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00461-4] [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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Vasu S, Sharma N, Walker A, Wall SA, Blachly J, Behbehani G, Choe H, Thakkar A, Nakkula RJ, Troy EC, Szuminski N, De Lima M, ODonnell L, Lee DA. A Phase I Clinical Trial Testing the Safety of IL-21-Expanded, Third-Party Donor-Derived Natural Killer Cells for Relapsed/Refractory Acute Myeloid Leukemia and Myelodysplastic Syndrome. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00437-7] [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: 10/18/2022]
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Sahasrabudhe K, Rebechi M, Huang Y, Elder P, Choe H, Larkin K, Saad A, Vasu S, Wall SA. Survival and Post-Transplant Outcomes in Acute Myeloid Leukemia (AML) Patients Aged 60-75 Treated with High Intensity Chemotherapy (HiC) Vs Low Intensity Targeted Therapy (LITT). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00726-6] [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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DeFilipp Z, Kim HT, Knight L, Kelley D, Byrne MT, Schroeder MA, Tamari R, Wall SA, Vasu S, Abedin S, El-Jawahri AR, McAfee SL, Chen YB, Hobbs G. Prolonged Post-Transplant Ruxolitinib Therapy is Associated with Protection from Severe Gvhd after Allogeneic HCT. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00553-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sigmund AM, Jiang J, Zhao Q, Elder P, Rosko A, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, De Lima M, Benson DM, Efebera Y, Sharma N. Allogenic Transplantation in Older Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00303-7] [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: 10/18/2022]
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Wall SA, Funderburg A, Artz A, Rosko A. Optimization of Older Adults Allogeneic Stem Cell Transplant (allo-SCT) Candidates to Improve Survival (OTIS): A Novel Study Design Incorporating Geriatric Assessment with Targeted Intervention. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wall SA, Funderburg A, Huang Y, Elder P, Stevens E, Folefac E, Presley C, Rosko A. Pre-Transplant Geriatric Assessment (GA) with Intervention Among Allogeneic Transplant Recipients. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00729-1] [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: 10/18/2022]
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11
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Wall SA, Huang Y, Keiter A, Funderburg A, Kloock C, Yuhasz N, Gure TR, Folefac E, Stevens E, Presley CJ, Williams NO, Krok-Schoen JL, Naughton MJ, Rosko AE. Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies. Front Oncol 2021; 11:775050. [PMID: 34956894 PMCID: PMC8692664 DOI: 10.3389/fonc.2021.775050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022] Open
Abstract
The incidence of hematologic malignancies (HMs) is highest in the seventh decade of life and coincides with increasing occult, age-related vulnerabilities. Identification of frailty is useful in prognostication and treatment decision-making for older adults with HMs. This real-world analysis describes 311 older adults with HMs evaluated in a multidisciplinary oncogeriatric clinic. The accumulation of geriatric conditions [1-unit increase, hazards ratio (HR) = 1.13, 95% CI 1.00-1.27, p = 0.04] and frailty assessed by the Rockwood Clinical Frailty Scale (CFS, mild/moderate/severe frailty vs. very fit/well, HR = 2.59, 95% CI 1.41-4.78, p = 0.002) were predictive of worse overall survival. In multivariate analysis, HM type [acute leukemia, HR = 3.84, 95% CI 1.60-9.22, p = 0.003; myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN)/bone marrow failure, HR = 2.65, 95% CI 1.10-6.35, p = 0.03], age (per 5-year increase, HR = 1.46, 95% CI 1.21-1.76, p < 0.001), hemoglobin (per 1 g/dl decrease, HR = 1.21, 95% CI 1.05-1.40, p = 0.009), deficit in activities of daily living (HR = 2.20, 95% CI 1.11-4.34, p = 0.02), and Mini Nutrition Assessment score (at-risk of malnutrition vs. normal, HR = 2.00, 95% CI 1.07-3.73, p = 0.03) were independently associated with risk of death. The most commonly prescribed geriatric interventions were in the domains of audiology (56%) and pharmacy (54%). The Rockwood CFS correlated with prescribed interventions in nutrition (p = 0.01) and physical function (p < 0.001) domains. Geriatric assessment with geriatric intervention can be practically integrated into the routine care of older adults with HMs.
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Affiliation(s)
- Sarah A. Wall
- Division of Hematology, The Ohio State University, Columbus, OH, United States
- The James Comprehensive Cancer Center, Columbus, OH, United States
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | - Ashleigh Keiter
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | | | - Colin Kloock
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Nicholas Yuhasz
- The James Comprehensive Cancer Center, Columbus, OH, United States
| | - Tanya R. Gure
- Division of Geriatric Medicine, The Ohio State University, Columbus, OH, United States
| | - Edmund Folefac
- The James Comprehensive Cancer Center, Columbus, OH, United States
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States
| | - Erin Stevens
- Division of Palliative Medicine, The Ohio State University, Columbus, OH, United States
| | - Carolyn J. Presley
- The James Comprehensive Cancer Center, Columbus, OH, United States
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States
| | - Nicole O. Williams
- The James Comprehensive Cancer Center, Columbus, OH, United States
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States
| | | | - Michelle J. Naughton
- Division of Cancer Control and Prevention, The Ohio State University, Columbus, OH, United States
| | - Ashley E. Rosko
- Division of Hematology, The Ohio State University, Columbus, OH, United States
- The James Comprehensive Cancer Center, Columbus, OH, United States
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Koenig KL, Curley TP, Mani S, Keiter A, Zhao Q, Behbehani GK, Bhatnagar B, Blachly JS, Haque TZ, Larkin KTM, Long M, Mims AS, Vasu S, Wall SA, Byrd JC, Lustberg M, Walker AR, Grieselhuber NR. Diagnostic utility of bronchoscopy in newly diagnosed acute leukemia patients. Hematol Oncol 2021; 40:115-118. [PMID: 34713477 DOI: 10.1002/hon.2941] [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: 11/11/2022]
Affiliation(s)
- Kristin L Koenig
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Thomas P Curley
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Shylaja Mani
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Ashleigh Keiter
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Qiuhong Zhao
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | | | - Bhavana Bhatnagar
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - James S Blachly
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Tamanna Z Haque
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | | | - Meixiao Long
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Alice S Mims
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Sumithira Vasu
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Sarah A Wall
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Mark Lustberg
- Division of Infectious Diseases, The Ohio State University, Columbus, Ohio, USA
| | - Alison R Walker
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
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Rasor B, Dickerson T, Zhao Q, Elder P, Brammer JE, Larkin K, Jaglowski S, Mims A, Penza S, Vasu S, Wall SA, William B, Saad A, Roddy JVF, Choe H, Puto M. Comparison of fixed dose reduced-intensity conditioning with fludarabine and busulfan to PK-guided busulfan AUC (FluBu4K) in hematopoietic stem cell transplant for AML/MDS. Leuk Lymphoma 2021; 62:944-951. [PMID: 33231122 PMCID: PMC8012251 DOI: 10.1080/10428194.2020.1849677] [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: 08/01/2020] [Revised: 11/01/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
A retrospective cohort study was conducted to assess differences in efficacy and tolerability between a busulfan AUC target of 16.4 mg × Hr/L per day (FluBu4K) and a conventional RIC regimen (FluBu2). Adult patients with a diagnosis of AML or MDS who received fludarabine + busulfan conditioning with or without antithymocyte globulin between 2015 and 2018 were included. The primary outcome was relapse free survival. Overall, 74 patients received conditioning with either FluBu4K or FluBu2. At 18 months, relapse-free survival was not significantly different, at 63.9% with FluBu4k compared to 57.5% with FluBu2 (p = 0.49). There was a statistically significant difference in the cumulative incidence of relapse at 18 months in favor of the FluBu4K regimen, at 12.0% vs 32.5% (p = 0.047). The results of this study indicate that for select patients, there may be benefit in choosing targeted FluBu4K over FluBu2. Adverse effects other than mucositis were not significantly different.
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Affiliation(s)
- Brendan Rasor
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Pharmacy, Kettering Health Network, Kettering, OH, USA
| | - Tyler Dickerson
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jonathan E Brammer
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Karilyn Larkin
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samantha Jaglowski
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alice Mims
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sam Penza
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sarah A Wall
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Basem William
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ayman Saad
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julianna V F Roddy
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hannah Choe
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marcin Puto
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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14
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Sigmund AM, Jiang J, Zhao Q, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Efebera YA, Sharma N. Trends in Survival of AML and MDS Patients Following Allogeneic Transplant. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00192-5] [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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15
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Soror N, Keiter A, Zhao Q, Elder P, Puto M, Penza S, Brammer JE, Efebera YA, Benson DM, Vasu S, Mims A, Blaser B, Choe H, Larkin K, Grieselhuber N, Wall SA, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Saad A, Jaglowski S, William BM. Impact of Opioid Use after Blood and Marrow Transplantation (BMT): A Single-Center Analysis. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00492-9] [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: 10/22/2022]
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Sharma N, Jiang J, Zhao Q, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Sigmund AM, Efebera YA. Impact of Bone Marrow Versus Peripheral Blood on Outcomes in Haploidentical Transplantation. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Jiang J, Sigmund AM, Zhao Q, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Efebera YA, Sharma N. Longitudinal Survival Outcomes in Allogeneic Stem Cell Transplantation: An Institutional Experience. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00187-1] [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: 11/26/2022]
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Jiang J, Zhao Q, Sigmund AM, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Efebera YA, Sharma N. Impact of Chronic Graft-Versus-Host Disease on Non-Relapse Mortality and Survival. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00362-6] [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: 11/17/2022]
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19
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Wall SA, Huang Y, Keiter A, Kloock C, Yuhasz N, Funderburg A, Presley C, Folefac E, Vasu S, Jaglowski S, Saad A, Larkin K, Penza S, Benson DM, Rosko A. Increasing Number of Geriatric Assessment-Identified Deficits Associated with Non-Receipt of Transplant Among Older Adults. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00565-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Wall SA, Zhao Q, Vasu S, Rosko A. Discharge Disposition Following Hematopoietic Cell Transplantation: Predicting the Need for Rehabilitation and Association with Survival. Transplant Cell Ther 2020; 27:337.e1-337.e7. [PMID: 33836883 DOI: 10.1016/j.jtct.2020.11.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
Many hematopoietic cell transplantation (HCT) recipients require rehabilitation due to deconditioning following intensive conditioning regimens and immune reconstitution. HCT recipients are preferentially discharged to home to avoid the risk of exposure to healthcare-associated infection in a rehabilitation facility (RF), with a caregiver who has been provided specific education about the complexity of post-HCT care. This study was conducted to determine the incidence of discharge to an RF following HCT, identify pre-HCT and peri-HCT risk factors for discharge to an RF, and estimate the effect of discharge disposition on overall survival (OS). This retrospective, matched 1:4 case-control study included 56 cases over a 10-year period from a single institution. Controls were matched by transplantation type (autologous versus allogeneic) and date of transplantation. The incidence of discharge to an RF was 2.2%. Controlling for disease, increasing age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04 to 1.15; P < .001), female sex (OR, 3.11; 95% CI, 1.32 to 7.32; P = .01), high-risk HCT Comorbidity Index (HCT-CI) score (≥3) (OR, 3.44; 95% CI, 1.39 to 8.52; P = .008), decreasing pre-HCT serum albumin (OR, 2.60; 95% CI, 1.07 to 6.38; P = .037), and development of acute kidney injury during HCT (OR, 4.10; 95% CI, 1.36 to 12.40; P = .012) were associated with discharge to an RF. Discharge to an RF was associated with worse OS and higher nonrelapse mortality (NRM) compared with discharge to home (1-year OS, 70.5% [95% CI, 55.8% to 81.1%] versus 88.8% [95% CI, 83.6% to 92.4%], P < .001; 100-day NRM: 9.5% [95% CI, 3.5% to 19.2%] versus 1.8% [95% CI, 0.6% to 4.3%]; P = .03). Discharge to an RF following HCT is a rare event but associated with poor OS. Modifiable risk factors for discharge to an RF, including serum albumin as a measure of nutrition and reversible HCT-CI components, should be prospectively studied to determine the effect of mitigation on discharge disposition and survival.
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Affiliation(s)
- Sarah A Wall
- Division of Hematology, The Ohio State University, Columbus, Ohio.
| | - Qiuhong Zhao
- Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Sumithira Vasu
- Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Ashley Rosko
- Division of Hematology, The Ohio State University, Columbus, Ohio
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21
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Underwood B, Zhao Q, Walker AR, Mims AS, Vasu S, Long M, Z. Haque T, Blaser BW, Grieselhuber NR, Wall SA, Behbehani GK, Blachly JS, Larkin K, Byrd JC, Garzon R, Wang TF, Bhatnagar B. Incidence of venous thrombosis after peg-asparaginase in adolescent and young adults with acute lymphoblastic leukemia. Int J Hematol Oncol 2020; 9:IJH28. [PMID: 33014332 PMCID: PMC7521187 DOI: 10.2217/ijh-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM There are limited data describing incidence of symptomatic venous thromboembolism (VTE) in adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL) patients receiving peg-asparaginase. MATERIALS & METHODS Single-institution retrospective analysis of 44 AYA ALL patients treated with peg-asparaginase. Rates of VTE and proposed risk factors were assessed. RESULTS 18 patients (41%) had a symptomatic VTE following peg-asparaginase. The cumulative incidence rate was 25% (95% CI: 13-38%) within 30 days of the initial dose. Personal history of thrombosis was statistically significantly associated with an increased risk of VTE with HR of 2.73 (95% CI: 1.40-5.33, p = 0.003) after adjusting for gender. CONCLUSION These data indicate a high rate of VTE in the AYA ALL population following treatment with peg-asparaginase.
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Affiliation(s)
- Brynne Underwood
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Alison R Walker
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Alice S Mims
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Meixiao Long
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Tamanna Z. Haque
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Bradley W Blaser
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Nicole R Grieselhuber
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Sarah A Wall
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Gregory K Behbehani
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Karilyn Larkin
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Ramiro Garzon
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Tzu-Fei Wang
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA
| | - Bhavana Bhatnagar
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA,The Ohio State University Comprehensive Cancer Center, Columbus OH 43210, USA,Author for correspondence: Tel.: +614 688 7939;
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22
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Presley CJ, Krok-Schoen JL, Wall SA, Noonan AM, Jones DC, Folefac E, Williams N, Overcash J, Rosko AE. Implementing a multidisciplinary approach for older adults with Cancer: geriatric oncology in practice. BMC Geriatr 2020; 20:231. [PMID: 32631254 PMCID: PMC7336473 DOI: 10.1186/s12877-020-01625-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/22/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Evidence-based practice in geriatric oncology is growing, and national initiatives have focused on expanding cancer care and research to improve health outcomes for older adults. However, there are still gaps between knowledge and practice for older adults with cancer. MAIN TEXT Here we provide a detailed methodology of geriatric oncology care delivery within a single institution. The Cancer and Aging Resiliency (CARE) clinic is a multidisciplinary approach for implementing geriatric-driven health care for older adults with cancer. The CARE clinic was developed as a direct response to recommendations targeting key multifactorial geriatric health conditions (e.g. falls, nutritional deficits, sensory loss, cognitive impairment, frailty, multiple chronic conditions, and functional status). The multidisciplinary team assesses and delivers a comprehensive set of recommendations, all in one clinic visit, to minimize burden on the patient and the caregiver. The CARE clinic consultative model is a novel approach integrating cancer subspecialties with geriatric oncology healthcare delivery. CONCLUSIONS Older adults with cancer have unique needs that are independent of routine oncology care. The CARE clinic model provides specific assessments and interventions to improve health outcomes among older adults with cancer.
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Affiliation(s)
- Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- The James Cancer Hospital/Solove Research Institute, Columbus, USA
| | - Jessica L Krok-Schoen
- The James Cancer Hospital/Solove Research Institute, Columbus, USA
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Sarah A Wall
- The James Cancer Hospital/Solove Research Institute, Columbus, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Anne M Noonan
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- The James Cancer Hospital/Solove Research Institute, Columbus, USA
| | - Desiree C Jones
- The James Cancer Hospital/Solove Research Institute, Columbus, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Edmund Folefac
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- The James Cancer Hospital/Solove Research Institute, Columbus, USA
| | - Nicole Williams
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Janine Overcash
- The James Cancer Hospital/Solove Research Institute, Columbus, USA
- The College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Ashley E Rosko
- The James Cancer Hospital/Solove Research Institute, Columbus, USA.
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
- A345 Starling Loving Hall, 320 W. 10th Ave, Columbus, OH, 43210, USA.
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23
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Wall SA, Knauss B, Compston A, Redder E, Folefac E, Presley C, Rosko A. Multidisciplinary telemedicine and the importance of being seen. J Geriatr Oncol 2020; 11:1349-1351. [PMID: 32482554 PMCID: PMC7260477 DOI: 10.1016/j.jgo.2020.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah A Wall
- Division of Hematology, The Ohio State University, Columbus, OH, United States of America.
| | - Brittany Knauss
- The James Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Amy Compston
- The James Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Elyse Redder
- The James Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Edmund Folefac
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Carolyn Presley
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Ashley Rosko
- Division of Hematology, The Ohio State University, Columbus, OH, United States of America
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24
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Wall SA, Huang Y, Jones D, Grogan M, Bittoni AM, Compston A, Custer A, Erdeljac HP, Foster S, Holt K, Johns H, Mitchell K, Owens R, Redder E, Ricketts W, Yager S, Rosko A. Not So Fast: Geriatric Syndromes Can Be Identified and Intervened upon Prior to Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Rasor B, Dickerson T, Zhao Q, Brammer JE, Larkin K, Jaglowski S, Mims A, Penza S, Vasu S, Wall SA, William BM, Saad A, Roddy J, Choe H, Puto M. Comparison of Fixed Dose, Reduced-Intensity Conditioning with Busulfan and Fludarabine to Reduced PK-Guided Busulfan AUC Conditioning in Patients Undergoing Hematopoietic Stem Cell Transplant for AML/MDS. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.709] [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: 11/16/2022]
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26
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Sharma N, Ni Ni B, Zhao Q, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Efebera YA. Relationship of Tacrolimus Concentration and Incidence of Acute Graft-Versus-Host Disease after Allogenic Stem Cell Transplantation. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.730] [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: 11/28/2022]
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27
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Ozga MP, Schaefer A, Huang Y, Parekh H, Penza S, Brammer JE, Efebera YA, Benson DM, Vasu S, Mims A, Blaser B, Choe H, Larkin K, Grieselhuber N, Wall SA, Lozanski G, Jaglowski S, Saad A, William BM. Predictors of Relapse after Haploidentical Hematopoietic Progenitor Cell Transplantation (Haplo-HCT); A Single-Institution Experience. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Wall SA, Devine S, Vasu S. The who, how and why: Allogeneic transplant for acute myeloid leukemia in patients older than 60years. Blood Rev 2017; 31:362-369. [PMID: 28802907 DOI: 10.1016/j.blre.2017.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/26/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
Acute myelogenous leukemia (AML) is primarily a disease of the elderly, and as such, our approach to treatment needs to be tailored to address an aging population. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only potentially curative treatment for intermediate and high risk AML, and until recently, its use had been limited to a younger population and dependent on availability of a donor. Advances in conditioning regimens, supportive care, and the use of alternative donor sources have greatly expanded access to this therapy. In this review, we summarize the challenges and unique biological aspects of treatment with allogeneic stem cell transplantation in this group of patients older than 60years. We also highlight areas of ongoing research including measurement of residual disease prior to and following transplant, post-remission maintenance therapy, and natural killer cell immunotherapy. Finally, we propose future directions for AML treatment in an elderly and aging population.
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Affiliation(s)
- Sarah A Wall
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | - Steven Devine
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | - Sumithira Vasu
- Division of Hematology, Ohio State University, Columbus, OH, USA.
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29
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Affiliation(s)
- N R Saeed
- Oxford Craniofacial Unit, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK.
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30
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Jehee FS, Johnson D, Alonso LG, Cavalcanti DP, de Sá Moreira E, Alberto FL, Kok F, Kim C, Wall SA, Jabs EW, Boyadjiev SA, Wilkie AOM, Passos-Bueno MR. Molecular screening for microdeletions at 9p22-p24 and 11q23-q24 in a large cohort of patients with trigonocephaly. Clin Genet 2005; 67:503-10. [PMID: 15857417 DOI: 10.1111/j.1399-0004.2005.00438.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Trigonocephaly is a rare form of craniosynostosis characterized by the premature closure of the metopic suture. To contribute to a better understanding of the genetic basis of metopic synostosis and in an attempt to restrict the candidate regions related to metopic suture fusion, we studied 76 unrelated patients with syndromic and non-syndromic trigonocephaly. We found a larger proportion of syndromic cases in our population and the ratio of affected male to female was 1.8 : 1 and 5 : 1 in the non-syndromic and syndromic groups, respectively. A microdeletion screening at 9p22-p24 and 11q23-q24 was carried out for all patients and deletions in seven of them were detected, corresponding to 19.4% of all syndromic cases. Deletions were not found in non-syndromic patients. We suggest that a molecular screening for microdeletions at 9p22-p24 and 11q23-q24 should be offered to all syndromic cases with an apparently normal karyotype because it can potentially elucidate the cause of trigonocephaly in this subset of patients. We also suggest that genes on the X-chromosome play a major role in syndromic trigonocephaly.
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Affiliation(s)
- F S Jehee
- Centro de Estudos do Genoma Humano, Departamento de Biologia, Instituto de Biociências, Universidade de São Paulo, SP, Brazil
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Abstract
Congenital craniofacial dermoid cysts are hamartomas of ectodermal and mesodermal origin, made up of keratinizing epithelium lining a cavity containing dermal skin appendages. They usually present as an asymptomatic, firm, round mass, usually noticed at birth or in the first year. They are thought to occur as a result of ectodermal sequestration at lines of fusion during embryological development. Although nasal and epibulbar dermoid cysts have occurred in families and have been associated with inheritable gene defects, there has previously been no evidence for a similar etiology in external angular cases. We present the first description of external angular dermoids occurring in siblings suggesting that this subgroup may, in some instances, also have a genetic origin.
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Affiliation(s)
- J D McIntyre
- Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, Oxford OX2 6HE, England, UK
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32
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Elanko N, Sibbring JS, Metcalfe KA, Clayton-Smith J, Donnai D, Temple IK, Wall SA, Wilkie AO. A survey of TWIST for mutations in craniosynostosis reveals a variable length polyglycine tract in asymptomatic individuals. Hum Mutat 2001; 18:535-41. [PMID: 11748846 DOI: 10.1002/humu.1230] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The human TWIST gene encodes a 202 amino acid transcription factor characterized by a highly conserved basic-helix-loop-helix motif in the C-terminal half, and a less conserved N-terminal half that has binding activity toward the histone acetyltransferase p300. Between these domains is a repeat region of unknown function that encodes the glycine-rich sequence (Gly)5Ala(Gly)5. Heterozygous mutations of TWIST were previously described in Saethre-Chotzen craniosynostosis syndrome [El Ghouzzi et al., 1997; Howard et al., 1997]. During a search for TWIST mutations in patients with craniosynostosis, we identified, in addition to 11 novel and one previously described bona fide mutations, several individuals with rearrangements of the glycine-rich region, involving either deletion of 18 nucleotides or insertion of three, 15, or 21 nucleotides. None of these rearrangements was consistently associated with clinical disease and we conclude that they are at most weakly pathogenic. The glycine stretch may serve as a flexible linker between the functional domains of the TWIST protein, and as such may be subject to reduced evolutionary constraint.
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Affiliation(s)
- N Elanko
- Weatherall Institute of Molecular Medicine, The John Radcliffe, Oxford, UK
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33
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Mavrogiannis LA, Antonopoulou I, Baxová A, Kutílek S, Kim CA, Sugayama SM, Salamanca A, Wall SA, Morriss-Kay GM, Wilkie AO. Haploinsufficiency of the human homeobox gene ALX4 causes skull ossification defects. Nat Genet 2001; 27:17-8. [PMID: 11137991 DOI: 10.1038/83703] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Inherited defects of skull ossification often manifest as symmetric parietal foramina (PFM; MIM 168500). We previously identified mutations of MSX2 in non-syndromic PFM and demonstrated genetic heterogeneity. Deletions of 11p11-p12 (proximal 11p deletion syndrome, P11pDS; MIM 601224) are characterized by multiple exostoses, attributable to haploinsufficiency of EXT2 and PFM. Here we identify ALX4, which encodes a paired-related homeodomain transcription factor, as the PFM disease gene in P11pDS.
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Affiliation(s)
- L A Mavrogiannis
- Institute of Molecular Medicine, The John Radcliffe, Headington, Oxford, UK
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34
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Blair EM, Walsh S, Oldridge M, Wall SA, Wilkie AO. Newly recognised craniosynostosis syndrome that does not map to known disease loci. Am J Med Genet 2000; 95:4-9. [PMID: 11074486 DOI: 10.1002/1096-8628(20001106)95:1<4::aid-ajmg2>3.0.co;2-4] [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: 11/09/2022]
Abstract
We describe a consanguineous family of Pakistani origin with five sibs, three of whom were affected by craniosynostosis of variable presentation. In addition, they had other congenital abnormalities principally affecting neurological, ocular, and limb development. We provide linkage evidence using intragenic and flanking microsatellite markers suggesting that the disease in this family was not caused by a mutation in one of the known craniosynostosis loci (FGFR1, FGFR2, FGFR3, MSX2, TWIST). Given the clinical novelty and parental consanguinity, we hypothesise that the affected individuals were autozygous for a recessively inherited mutation, at a novel locus, predisposing to craniosynostosis.
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Affiliation(s)
- E M Blair
- Department of Clinical Genetics, Oxford Radcliffe Hospital NHS Trust, The Churchill, United Kingdom.
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35
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Abstract
Mutations in the fibroblast growth factor receptor 1, 2 and 3 (FGFR1, -2 and -3) and TWIST genes have been identified in several syndromic forms of craniosynostosis. There remains, however, a significant number of patients with non-syndromic craniosynostosis in whom no genetic cause can be identified. We describe a novel heterozygous mutation of FGFR2 (943G --> T, encoding the amino acid substitution Ala315Ser) in a girl with non-syndromic unicoronal craniosynostosis. The mutation is also present in her mother and her maternal grandfather who have mild facial asymmetry but do not have craniosynostosis. None of these individuals has the Crouzonoid appearance typically associated with FGFR2 mutations. However, the obstetric history revealed that the proband was in persistent breech presentation in utero and was delivered by Caesarean section, at which time compression of the skull was apparent. We propose that this particular FGFR2 mutation only confers a predisposition to craniosynostosis and that an additional environmental insult (in this case foetal head constraint associated with breech position) is necessary for craniosynostosis to occur. To our knowledge, this is the first report of an interaction between a weakly pathogenic mutation and intrauterine constraint, leading to craniosynostosis.
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Affiliation(s)
- D Johnson
- Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK
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Wilkie AO, Tang Z, Elanko N, Walsh S, Twigg SR, Hurst JA, Wall SA, Chrzanowska KH, Maxson RE. Functional haploinsufficiency of the human homeobox gene MSX2 causes defects in skull ossification. Nat Genet 2000; 24:387-90. [PMID: 10742103 DOI: 10.1038/74224] [Citation(s) in RCA: 240] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The genetic analysis of congenital skull malformations provides insight into normal mechanisms of calvarial osteogenesis. Enlarged parietal foramina (PFM) are oval defects of the parietal bones caused by deficient ossification around the parietal notch, which is normally obliterated during the fifth fetal month. PFM are usually asymptomatic, but may be associated with headache, scalp defects and structural or vascular malformations of the brain. Inheritance is frequently autosomal dominant, but no causative mutations have been identified in non-syndromic cases. We describe here heterozygous mutations of the homeobox gene MSX2 (located on 5q34-q35) in three unrelated families with PFM. One is a deletion of approximately 206 kb including the entire gene and the others are intragenic mutations of the DNA-binding homeodomain (RK159-160del and R172H) that predict disruption of critical intramolecular and DNA contacts. Mouse Msx2 protein with either of the homeodomain mutations exhibited more than 85% reduction in binding to an optimal Msx2 DNA-binding site. Our findings contrast with the only described MSX2 homeodomain mutation (P148H), associated with craniosynostosis, that binds with enhanced affinity to the same target. This demonstrates that MSX2 dosage is critical for human skull development and suggests that PFM and craniosynostosis result, respectively, from loss and gain of activity in an MSX2-mediated pathway of calvarial osteogenic differentiation.
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Affiliation(s)
- A O Wilkie
- Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK.
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Oldridge M, Zackai EH, McDonald-McGinn DM, Iseki S, Morriss-Kay GM, Twigg SR, Johnson D, Wall SA, Jiang W, Theda C, Jabs EW, Wilkie AO. De novo alu-element insertions in FGFR2 identify a distinct pathological basis for Apert syndrome. Am J Hum Genet 1999; 64:446-61. [PMID: 9973282 PMCID: PMC1377754 DOI: 10.1086/302245] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Apert syndrome, one of five craniosynostosis syndromes caused by allelic mutations of fibroblast growth-factor receptor 2 (FGFR2), is characterized by symmetrical bony syndactyly of the hands and feet. We have analyzed 260 unrelated patients, all but 2 of whom have missense mutations in exon 7, which affect a dipeptide in the linker region between the second and third immunoglobulin-like domains. Hence, the molecular mechanism of Apert syndrome is exquisitely specific. FGFR2 mutations in the remaining two patients are distinct in position and nature. Surprisingly, each patient harbors an Alu-element insertion of approximately 360 bp, in one case just upstream of exon 9 and in the other case within exon 9 itself. The insertions are likely to be pathological, because they have arisen de novo; in both cases this occurred on the paternal chromosome. FGFR2 is present in alternatively spliced isoforms characterized by either the IIIb (exon 8) or IIIc (exon 9) domains (keratinocyte growth-factor receptor [KGFR] and bacterially expressed kinase, respectively), which are differentially expressed in mouse limbs on embryonic day 13. Splicing of exon 9 was examined in RNA extracted from fibroblasts and keratinocytes from one patient with an Alu insertion and two patients with Pfeiffer syndrome who had nucleotide substitutions of the exon 9 acceptor splice site. Ectopic expression of KGFR in the fibroblast lines correlated with the severity of limb abnormalities. This provides the first genetic evidence that signaling through KGFR causes syndactyly in Apert syndrome.
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Affiliation(s)
- M Oldridge
- Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
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Johnson D, Horsley SW, Moloney DM, Oldridge M, Twigg SR, Walsh S, Barrow M, Njølstad PR, Kunz J, Ashworth GJ, Wall SA, Kearney L, Wilkie AO. A comprehensive screen for TWIST mutations in patients with craniosynostosis identifies a new microdeletion syndrome of chromosome band 7p21.1. Am J Hum Genet 1998; 63:1282-93. [PMID: 9792856 PMCID: PMC1377539 DOI: 10.1086/302122] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mutations in the coding region of the TWIST gene (encoding a basic helix-loop-helix transcription factor) have been identified in some cases of Saethre-Chotzen syndrome. Haploinsufficiency appears to be the pathogenic mechanism involved. To investigate the possibility that complete deletions of the TWIST gene also contribute to this disorder, we have developed a comprehensive strategy to screen for coding-region mutations and for complete gene deletions. Heterozygous TWIST mutations were identified in 8 of 10 patients with Saethre-Chotzen syndrome and in 2 of 43 craniosynostosis patients with no clear diagnosis. In addition to six coding-region mutations, our strategy revealed four complete TWIST deletions, only one of which associated with a translocation was suspected on the basis of conventional cytogenetic analysis. This case and two interstitial deletions were detectable by analysis of polymorphic microsatellite loci, including a novel (CA)n locus 7.9 kb away from TWIST, combined with FISH; these deletions ranged in size from 3.5 Mb to >11.6 Mb. The remaining, much smaller deletion was detected by Southern blot analysis and removed 2,924 bp, with a 2-bp orphan sequence at the breakpoint. Significant learning difficulties were present in the three patients with megabase-sized deletions, which suggests that haploinsufficiency of genes neighboring TWIST contributes to developmental delay. Our results identify a new microdeletion disorder that maps to chromosome band 7p21.1 and that causes a significant proportion of Saethre-Chotzen syndrome.
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Affiliation(s)
- D Johnson
- Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, OX 9DS, UK
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Moloney DM, Wall SA, Ashworth GJ, Oldridge M, Glass IA, Francomano CA, Muenke M, Wilkie AO. Prevalence of Pro250Arg mutation of fibroblast growth factor receptor 3 in coronal craniosynostosis. Lancet 1997; 349:1059-62. [PMID: 9107244 DOI: 10.1016/s0140-6736(96)09082-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The C749G (Pro250Arg) mutation in the gene for fibroblast growth factor receptor 3 (FGFR3) has been found in patients with various types of craniosynostosis. We aimed to find out the proportion of cases of apparently non-syndromic coronal craniosynostosis attributable to this mutation. METHODS We studied 26 patients with coronal craniosynostosis but no syndromic diagnosis, who were referred to a supra-regional specialist centre. Genomic DNA was analysed by PCR and restriction-enzyme digestion to identify the C749G mutation in FGFR3. Family members of patients found to have the mutation were also tested. FINDINGS Eight (31%) of the 26 probands were heterozygous for the C749G mutation. In two cases, the mutation showed autosomal dominant transmission with evidence of variable expressivity; the remaining six cases were sporadic. We demonstrated in six families that the mutation had arisen de novo from clinically unaffected parents. INTERPRETATION The C749G mutation in FGFR3 is a frequent cause of apparently non-syndromic coronal craniosynostosis. Our finding will aid genetic counselling and prenatal diagnosis. The mutation rate at this nucleotide is one of the highest described in the human genome.
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Affiliation(s)
- D M Moloney
- Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK
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Muenke M, Gripp KW, McDonald-McGinn DM, Gaudenz K, Whitaker LA, Bartlett SP, Markowitz RI, Robin NH, Nwokoro N, Mulvihill JJ, Losken HW, Mulliken JB, Guttmacher AE, Wilroy RS, Clarke LA, Hollway G, Adès LC, Haan EA, Mulley JC, Cohen MM, Bellus GA, Francomano CA, Moloney DM, Wall SA, Wilkie AO. A unique point mutation in the fibroblast growth factor receptor 3 gene (FGFR3) defines a new craniosynostosis syndrome. Am J Hum Genet 1997; 60:555-64. [PMID: 9042914 PMCID: PMC1712518] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The underlying basis of many forms of syndromic craniosynostosis has been defined on a molecular level. However, many patients with familial or sporadic craniosynostosis do not have the classical findings of those craniosynostosis syndromes. Here we present 61 individuals from 20 unrelated families where coronal synostosis is due to an amino acid substitution (Pro250Arg) that results from a single point mutation in the fibroblast growth factor receptor 3 gene on chromosome 4p. In this instance, a new clinical syndrome is being defined on the basis of the molecular finding. In addition to the skull findings, some patients had abnormalities on radiographs of hands and feet, including thimble-like middle phalanges, coned epiphyses, and carpal and tarsal fusions. Brachydactyly was seen in some cases; none had clinically significant syndactyly or deviation of the great toe. Sensorineural hearing loss was present in some, and developmental delay was seen in a minority. While the radiological findings of hands and feet can be very helpful in diagnosing this syndrome, it is not in all cases clearly distinguishable on a clinical basis from other craniosynostosis syndromes. Therefore, this mutation should be tested for in patients with coronal synostosis.
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Affiliation(s)
- M Muenke
- Department of Pediatrics, University of Pennsylvania, Philadelphia, USA.
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Abstract
Apert syndrome results from one or other of two specific nucleotide substitutions, both C-->G transversions, in the fibroblast growth factor receptor 2 (FGFR2) gene. The frequency of new mutations, estimated as 1 per 65,000 live births, implies germline transversion rates at these two positions are currently the highest known in the human genome. Using a novel application of the amplification refractory mutation system (ARMS), we have determined the parental origin of the new mutation in 57 Apert families: in every case, the mutation arose from the father. This identifies the biological basis of the paternal age effect for new mutations previously suggested for this disorder.
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Affiliation(s)
- D M Moloney
- Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK
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Wilkie AO, Wall SA. Craniosynostosis: novel insights into pathogenesis and treatment. Curr Opin Neurol 1996; 9:146-52. [PMID: 8782984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The identification in craniosynostosis syndromes of mutations in genes belonging to the fibroblast growth factor signalling pathway and the transcriptional regulator MSX2 provides important clues to the pathogenesis of these disorders. Although surgery continues to be the mainstay of treatment, new animal models and improved uncerstanding of cranial suture biology and pathology may lead to complementary therapies.
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Affiliation(s)
- A O Wilkie
- Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK
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Abstract
The need for fronto-orbital re-advancement is reported from all cases of craniosynostosis operated on in the Birmingham and Oxford Craniofacial Units since 1979. Analysis of the 219 cases demonstrates a significantly higher re-operation rate in cases of syndromal craniofacial dysostosis or unilateral coronal synostosis initially operated on below the age of 6 months. Mild bicoronal, sagittal and metopic synostotic cases, however, did uniformly well with the timing of initial surgery having little influence on the re-operation rates.
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Affiliation(s)
- S A Wall
- Division of Plastic Surgery, University of the Witwatersrand, South Africa
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Wall SA, Chait LA, Temlett JA, Perkins B, Hillen G, Becker P. Botulinum A chemodenervation: a new modality in cerebral palsied hands. Br J Plast Surg 1993; 46:703-6. [PMID: 8298785 DOI: 10.1016/0007-1226(93)90203-n] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Botulinum A chemodenervation of the Adductor Pollicis muscle for the treatment of the thumb-in-palm deformity in cerebral palsied hands is presented as a new therapeutic option. Early results of a clinical trial in five hemiparetic Cerebral Palsied (C.P.) children are assessed using a prospective nontrialist-biased study design based on an independent panel assessment of pre- and post-intervention photographic and videotaped records of hand function and appearance, in combination with grip dynamometry and goniometry. All cases are shown to improve in terms of both function and appearance with results approaching statistical significance (p = 0.06) when assessed by the Wilcoxon's matched-pairs signed rank test, despite the small study group. The modality is shown to be simple, safe and effective over the period reported (229 days). The benefit is sustained beyond the period of muscle paresis and ongoing long term follow-up will document the need for, and timing of, reinjection.
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Affiliation(s)
- S A Wall
- Division of Plastic and Reconstructive Surgery, University of the Witwatersrand, South Africa
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