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Dhawale TM, Johnson PC, Gaballa MR, Nelson AM, Lavoie MW, Boateng KY, Greydanus C, Frigault MJ, El-Jawahri A. Perception of prognosis, quality of life, and distress in patients receiving chimeric antigen receptor T-cell therapy. Cancer 2023; 129:441-449. [PMID: 36457279 DOI: 10.1002/cncr.34557] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/29/2022] [Accepted: 10/14/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T-cell is potentially curative therapy for patients with hematologic malignancies but can cause life-threatening toxicities. Data on perceptions of prognosis and psychological distress are lacking. METHODS The authors conducted a cross-sectional study of patients receiving CAR-T. Before hospitalization for CAR-T, patients completed assessments of quality of life (QOL) (Functional Assessment of Cancer Therapy-General), anxiety and depression symptoms (Hospital Anxiety and Depression Scale) and post-traumatic stress disorder symptoms (Post-Traumatic Stress Checklist). Patients also completed the Prognostic Awareness Impact Scale (PAIS), which measures three domains: cognitive understanding of prognosis, emotional coping with prognosis, and adaptive response. RESULTS A total of 71.8% (102 of 142) of eligible patients were enrolled. A total of 34% of patients reported that their oncologist said their cancer is curable and 64% reported there was >50% chance of cure. Overall, 26%, 30%, and 21% of patients reported clinically significant depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, respectively. We found no association between patients' cognitive understanding of prognosis and QOL or mood. Higher emotional coping with prognosis was associated with better QOL (Β = 0.72; SE = 0.10; p = <.001) and lower depression (Β = -0.17; SE = 0.02; p = <.001), anxiety (Β = -0.21; SE = 0.02; p = <.001), and PTSD (Β = -0.43; SE = 0.06; p = <.001) symptoms. Higher adaptive response was associated with better QOL (Β = 0.19; SE = 0.09; p = .028) and lower depression (Β = -0.05; SE = 0.02; p = .023), anxiety (Β = -0.09; SE = 0.02; p = <.001), and PTSD (Β = -0.19; SE = 0.05; p = <.001) symptoms. CONCLUSIONS Patients undergoing CAR-T report overly optimistic perception of their prognosis and have high rates of psychological distress. Higher emotional coping with prognosis and adaptive response were associated with better QOL and less psychological distress, underscoring the need to develop interventions to promote coping with this treatment. PLAIN LANGUAGE SUMMARY Patients undergoing chimeric antigen receptor T-cell therapy experience report overly optimistic perceptions of their prognosis and have high rates of psychological distress. Notably, higher emotional coping with prognosis and adaptive response were associated with better quality of life and less psychological distress.
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Affiliation(s)
- Tejaswini M Dhawale
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - P Connor Johnson
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Mahmoud R Gaballa
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashley M Nelson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mitchell W Lavoie
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kofi Y Boateng
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire Greydanus
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew J Frigault
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Amonoo HL, Daskalakis E, Deary EC, Bodd MH, Reynolds MJ, Nelson AM, Newcomb R, Dhawale TM, Yang D, Luger SM, Gustin JL, Brunner A, Fathi AT, LeBlanc TW, El-Jawahri A. Relationship Between Longitudinal Coping Strategies and Outcomes in Patients With Acute Myeloid Leukemia. J Natl Compr Canc Netw 2022; 20:1116-1123. [DOI: 10.6004/jnccn.2022.7045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/15/2022] [Indexed: 11/06/2022]
Abstract
Background: Patients with acute myeloid leukemia (AML) face an abrupt life-threatening illness and experience immense physical and psychological symptoms. However, no data describe how patients with AML cope longitudinally with their illness or the relationship between longitudinal coping and outcomes. Methods: We conducted a secondary analysis of longitudinal data from 160 patients with high-risk AML enrolled in a supportive care intervention trial to describe coping strategies longitudinally across the illness course. We used the Brief COPE questionnaire, the Hospital Anxiety and Depression Scale, the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, and the Functional Assessment of Cancer Therapy-Leukemia to measure coping strategies, psychological distress, and quality of life (QoL) at baseline and at weeks 2, 4, 12, and 24 after diagnosis. Electronic health records were used to assess healthcare utilization and end-of-life (EoL) outcomes, and multivariate analyses were used to assess the relationship between coping and outcomes. Results: Longitudinal utilization of approach-oriented coping strategies was significantly associated with less distress (anxiety: β, –0.18; P<.001; depression symptoms: β, –0.42; P<.001; PTSD symptoms: β, –0.60; P<.001) and better QoL (β, 2.00; P<.001). Longitudinal utilization of avoidant coping strategies was significantly associated with greater distress (anxiety: β, 0.64; depression symptoms: β, 0.54; PTSD symptoms: β, 2.13; P<.001 for all) and worse QoL (β, –4.27; P<.001). Although the use of approach-oriented and avoidant coping strategies was not significantly associated with hospitalization, chemotherapy administration, or hospice use in the last 30 days of life, approach-oriented coping was associated with lower odds of ICU admissions (odds ratio, 0.92; P=.049). Conclusions: Longitudinal use of approach-oriented coping strategies was associated with less psychological distress, better QoL, and a lower likelihood of ICU admission, suggesting a possible target for supportive oncology interventions. Coping strategies did not impact EoL outcomes, and further research is needed to elucidate which patient factors impact EoL decision-making.
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Affiliation(s)
- Hermioni L. Amonoo
- 1Department of Psychiatry, Brigham and Women’s Hospital,
- 2Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and
- 3Harvard Medical School, Boston, Massachusetts
| | | | - Emma C. Deary
- 1Department of Psychiatry, Brigham and Women’s Hospital,
| | - Monica H. Bodd
- 4Duke University School of Medicine, Durham, North Carolina
| | | | - Ashley M. Nelson
- 3Harvard Medical School, Boston, Massachusetts
- 6Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Newcomb
- 5Division of Hematology and Oncology, Department of Medicine, and
| | | | - Daniel Yang
- 5Division of Hematology and Oncology, Department of Medicine, and
| | - Selina M. Luger
- 7Division of Hematology Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jillian L. Gustin
- 8Division of Palliative Medicine, The James Cancer Hospital, Ohio State University, Columbus, Ohio; and
| | - Andrew Brunner
- 3Harvard Medical School, Boston, Massachusetts
- 5Division of Hematology and Oncology, Department of Medicine, and
| | - Amir T. Fathi
- 3Harvard Medical School, Boston, Massachusetts
- 5Division of Hematology and Oncology, Department of Medicine, and
| | - Thomas W. LeBlanc
- 9Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Areej El-Jawahri
- 3Harvard Medical School, Boston, Massachusetts
- 5Division of Hematology and Oncology, Department of Medicine, and
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Johnson PC, Bhatt S, Reynolds MJ, Dhawale TM, Ufere N, Jagielo AD, Lavoie MW, Topping CEW, Clay MA, Rice J, Yi A, DeFilipp Z, Chen YB, El-Jawahri A. Association Between Baseline Patient-Reported Outcomes and Complications of Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2021; 27:496.e1-496.e5. [PMID: 33789836 PMCID: PMC10637282 DOI: 10.1016/j.jtct.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/10/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Hematopoietic cell transplantation (HCT) is a potentially curative therapy for hematologic malignancies, but it often results in significant toxicities and impaired quality of life (QOL). Although the value of patient-reported outcomes (PROs) is increasingly recognized in HCT, data are limited regarding the relationship between PROs and HCT complications. We conducted a secondary data analysis of 250 patients who were hospitalized for autologous or allogeneic HCT at Massachusetts General Hospital from 2011 through 2016. We assessed QOL (Functional Assessment of Cancer Therapy-General), mood (Hospital Anxiety and Depression Scale), and fatigue (FACT-Fatigue) at baseline. We abstracted from the Electronic Health Record (1) hospitalization during the first 100 days after HCT, (2) days alive and out of the hospital in the first 100 days after HCT, and (3) cumulative incidence of acute graft-versus-host disease (GVHD) among allogeneic HCT recipients. We assessed the association of baseline PROs with HCT complications using multivariable models adjusting for patient and transplant characteristics. Overall, 44.4% (111/250) of patients underwent an autologous HCT, 25.2% (63/250) received a myeloablative allogeneic HCT, and 30.4% (76/250) underwent a reduced-intensity allogeneic HCT. In multivariable logistic regression, higher anxiety (odds ratio [OR] = 1.14, P = .004) was associated with higher likelihood of rehospitalization within 100 days after HCT. In multivariable Poisson regression, lower fatigue (β = 0.003, P = .015) was associated with increased days alive and out of the hospital in the first 100 days post-HCT. In multivariable logistic regression, lower baseline QOL (OR = 0.97, P = .034), higher fatigue (OR = 0.95, P = .004), and higher depression (OR = 1.15, P = .020) were associated with increased likelihood of acute GVHD. Baseline PROs are associated with health care utilization after HCT and risk of acute GVHD in allogeneic HCT recipients. These findings underscore the potential utility of pretransplantation PROs as important prognostic factors for HCT.
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Affiliation(s)
- P Connor Johnson
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston Massachusetts.
| | - Sunil Bhatt
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew J Reynolds
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Tejaswini M Dhawale
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston Massachusetts
| | - Nneka Ufere
- Harvard Medical School, Boston Massachusetts; Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Annemarie D Jagielo
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Mitchell W Lavoie
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Carlisle E W Topping
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Madison A Clay
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Julia Rice
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Alisha Yi
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Zachariah DeFilipp
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston Massachusetts
| | - Yi-Bin Chen
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston Massachusetts
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston Massachusetts
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Johnson PC, Jacobson C, Yi A, Saucier A, Dhawale TM, Nelson A, Lavoie MW, Reynolds MJ, Topping CEW, Frigault MJ, El-Jawahri A. Healthcare Utilization and End-of-Life Outcomes in Patients Receiving CAR T-Cell Therapy. J Natl Compr Canc Netw 2021; 19:928-934. [PMID: 33706257 DOI: 10.6004/jnccn.2020.7678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND CAR T-cell therapy has revolutionized the treatment of patients with hematologic malignancies, but it can result in prolonged hospitalizations and serious toxicities. However, data on the impact of CAR T-cell therapy on healthcare utilization and end-of-life (EoL) outcomes are lacking. METHODS We conducted a retrospective analysis of 236 patients who received CAR T-cell therapy at 2 tertiary care centers from February 2016 through December 2019. We abstracted healthcare utilization and EoL outcomes from the electronic health record, including hospitalizations, receipt of ICU care, hospitalization and receipt of systemic therapy in the last 30 days of life, palliative care, and hospice referrals. RESULTS Most patients (81.4%; n=192) received axicabtagene ciloleucel. Overall, 28.1% of patients experienced a hospital readmission and 15.5% required admission to the ICU within 3 months of CAR T-cell therapy. Among the deceased cohort, 58.3% (49/84) were hospitalized and 32.5% (26/80) received systemic therapy in the last 30 days of life. Rates of palliative care and hospice referrals were 47.6% and 30.9%, respectively. In multivariable logistic regression, receipt of bridging therapy (odds ratio [OR], 3.15; P=.041), index CAR-T hospitalization length of stay >14 days (OR, 4.76; P=.009), hospital admission within 3 months of CAR T-cell infusion (OR, 4.29; P=.013), and indolent lymphoma transformed to diffuse large B-cell lymphoma (OR, 9.83; P=.012) were associated with likelihood of hospitalization in the last 30 days of life. CONCLUSIONS A substantial minority of patients receiving CAR T-cell therapy experienced hospital readmission or ICU utilization in the first 3 months after CAR T-cell therapy, and most deceased recipients of CAR T-cell therapy received intensive EoL care. These findings underscore the need for interventions to optimize healthcare delivery and EoL care for this population.
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Affiliation(s)
- P Connor Johnson
- 1Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School
| | - Caron Jacobson
- 2Department of Medical Oncology, Center for Lymphoma, Dana-Farber Cancer Institute & Harvard Medical School; and
| | - Alisha Yi
- 1Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School
| | - Anna Saucier
- 2Department of Medical Oncology, Center for Lymphoma, Dana-Farber Cancer Institute & Harvard Medical School; and
| | - Tejaswini M Dhawale
- 1Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School
| | - Ashley Nelson
- 3Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Mitchell W Lavoie
- 3Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Mathew J Reynolds
- 3Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Carlisle E W Topping
- 3Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Matthew J Frigault
- 1Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School
| | - Areej El-Jawahri
- 1Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School
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Amonoo HL, Johnson PC, Dhawale TM, Traeger L, Rice J, Lavoie MW, Ufere NN, Longley RM, Harnedy LE, Clay MA, Topping CEW, DeFilipp Z, Chen YBA, El-Jawahri A. Sharing and caring: The impact of social support on quality of life and health outcomes in hematopoietic stem cell transplantation. Cancer 2021; 127:1260-1265. [PMID: 33598938 DOI: 10.1002/cncr.33455] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Social support is crucial for successful recovery after hematopoietic stem cell transplantation (HSCT) and has the potential to affect patient quality of life (QOL) and health outcomes. However, there are limited data on the relationship between a patient's perception of his or her social support and these outcomes. METHODS The authors conducted a secondary analysis of 250 autologous and allogeneic HSCT recipients enrolled in 2 supportive care trials at Massachusetts General Hospital from April 2011 through February 2016. They assessed social support as a patient's perception of his or her social well-being via the social well-being subscale of the Functional Assessment of Cancer Therapy. The authors used multivariate regression analyses to examine the relationship between pretransplant social well-being and QOL (Functional Assessment of Cancer Therapy-Treatment Outcome Index), psychological distress (Hospital Anxiety and Depression Scale), posttraumatic stress disorder [PTSD] symptoms (PTSD Checklist), fatigue (Functional Assessment of Cancer Therapy-Fatigue), and health care utilization (hospitalizations and days alive and out of the hospital) 6 months after HSCT. RESULTS Participants were on average 56.4 years old (SD, 13.3 years); 44% (n = 110) and 56% (n = 140) received autologous and allogeneic HSCT, respectively. Greater pre-HSCT social well-being was associated with higher QOL (B = 0.10; 95% CI, 0.06-0.13; P < .001), lower psychological distress (B = -0.21; 95% CI, -0.29 to -0.12; P < .001), and lower PTSD symptoms (B = -0.12; 95% CI, -0.19 to -0.06; P < .001). Pre-HSCT social well-being was not significantly associated with fatigue or health care utilization 6 months after HSCT. CONCLUSIONS Patients with higher pre-HSCT perceptions of their social support reported better QOL and lower psychological distress 6 months after HSCT. These findings underscore the potential for social support as a modifiable target for future supportive care interventions to improve the QOL and care of HSCT recipients.
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Affiliation(s)
- Hermioni L Amonoo
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - P Connor Johnson
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Tejaswini M Dhawale
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Lara Traeger
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Julia Rice
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Nneka N Ufere
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Zachariah DeFilipp
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Yi-Bin A Chen
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
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Dhawale TM, Shustov AR. Autologous and Allogeneic Hematopoietic Cell Transplantation in Peripheral T/NK-cell Lymphomas: A Histology-Specific Review. Hematol Oncol Clin North Am 2017; 31:335-357. [PMID: 28340882 DOI: 10.1016/j.hoc.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Peripheral T-cell lymphoma and natural killer/T-cell lymphomas (PT/NKCL) make up a diverse subgroup of non-Hodgkin's lymphomas characterized by an aggressive clinical course. The use of hematopoietic stem cell transplantation (HSCT) in the treatment of PT/NKCL remains controversial because of the absence of randomized controlled trials. The best available data suggest that certain subtypes of PT/NKCL may benefit more from the application of HSCT than other subtypes and that this benefit results from their unique clinical characteristics and underlying biology. Ultimately, however, prospective randomized controlled trials are needed to clarify the optimal type and timing of HSCT in patients with PT/NKCL.
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Affiliation(s)
- Tejaswini M Dhawale
- Department of Medicine, University of Washington School of Medicine, SCCA, 825 Eastlake Avenue East, M-Box G3-200, Seattle, WA 98109, USA
| | - Andrei R Shustov
- Department of Medicine, University of Washington School of Medicine, SCCA, 825 Eastlake Avenue East, M-Box G3-200, Seattle, WA 98109, USA.
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