1
|
Dvorak K, Funderburg A, Zhao Q, Sharma N, Cottini F, Bumma N, Devarakonda SS, Benson DM, Rosko AE, Khan AM. Step-up titration dosing (TD) of carfilzomib (K) is associated with prolonged duration of therapy and improved treatment outcomes compared to standard dosing (SD) in patients with multiple myeloma (MM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e20016] [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] [Indexed: 11/20/2022] Open
Abstract
e20016 Background: K is a 2nd-generation proteasome inhibitor (PI) approved for the treatment of multiple myeloma (MM). K-based regimens are associated with higher rates of CV toxicity compared with other PIs. We conducted a retrospective analysis to assess incidence of CV adverse events (AE) and outcomes of MM patients (pts) treated with K using a step-up TD schedule compared to SD protocol. Methods: A retrospective chart review was performed of MM pts treated with K at The Ohio State University Comprehensive Cancer Center (OSUCCC) from 1/1/13 to 9/1/19. Pt demographics, disease and K-related characteristics, CV AE, and follow-up information were collected. Pts were excluded if treated at both local center and at OSUCCC, not K-naïve when receiving treatment at OSUCCC, received a single dose of K while inpatient with no intent to continue treatment outpatient, or had a treatment plan entered but never received it. Results: Of the 166 pt charts analyzed, 36 were treated using a TD method (ex. step-wise C1D1 20mg/m2, C1D8 27mg/m2, C1D15 36mg/m2, for goal C2D1 56mg/m2 onwards) and 130 pts were treated using a standard dosing method (ex. C1D1 20mg/m2 and C1D8 56mg/m2 onwards). Pre-existing CV risk factors were similar between the two groups. There was a slight difference in baseline renal function (TD: median CrCl 94mL/min, SD: 76mL/min; p=0.01) and prior PI use (TD: 86.1%, SD: 95%; p=0.048) between the two groups. In pts treated with TD, hypertension (HTN) developed earlier compared with SD (p=0.02). There was a lower incidence of onset of dyspnea in the TD group compared to SD group (16.7% vs 36.2%, respectively; p=0.03). There were no differences in incidence of HTN, congestive heart failure, ischemic heart disease, arrythmias, or pulmonary HTN. The median number of cycles administered to titrated pts was 7 (range: 2-56) compared to 3 (range: 1-44) for standard pts (p<0.001). There was no statistical difference in CV AE being the cause for treatment discontinuation between the two groups. The overall response rate (ORR) was higher in the TD group compared to the SD group (63.9% vs 42.8%, respectively; p=0.04). Five-year overall survival (OS) was improved in patients treated with TD than with SD (43.8% vs 17.5%, respectively; p<0.001). By multivariable analysis, TD was associated with improved OS compared to SD (HR 0.47; 95% CI 0.29-0.77-3.58; P=0.003). Conclusions: A simple modification of K titration dosing improved the tolerability of MM therapy without compromising efficacy. Although there were no differences in AE being the cause of treatment discontinuation between the two groups, an improvement in duration of therapy, ORR, and OS was observed in the TD group. As a result, TD is the standard-of-care dosing for MM pts treated with K at the OSUCCC. Prospective trials are needed to confirm the safety and efficacy of this dosing regimen.
Collapse
Affiliation(s)
- Kaitlyn Dvorak
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Nidhi Sharma
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Naresh Bumma
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Cleveland, OH
| | | | - Don M. Benson
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | |
Collapse
|
2
|
Cottini F, Bao A, Sharma N, Khan AM, Bumma N, Chaudhry M, Devarakonda SS, Efebera YA, Rosko AE, Benson DM. Race as a predictor of outcome in young patients with myeloma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e20019] [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] [Indexed: 11/20/2022] Open
Abstract
e20019 Background: Multiple myeloma (MM) is a malignancy that affects Black Americans (BA) more often and at earlier age than White Americans (WA). BAs still frequently receive suboptimal care and are underrepresented in clinical trials or retrospective analyses. However, recent studies have shown that BA MM patients treated with standard-of-care regimens have similar if not superior outcomes than WA patients. The median age of MM diagnosis is 69 years; but ten percent of individuals develop MM before age of 50 years. Limited data are available regarding the outcomes and characteristics of this younger patient population. Herein, we specifically investigate the outcome of young MM patients. Methods: We retrospectively analyzed young MM patients (age < 50) diagnosed between 1992 and 2016 at The Ohio State University Comprehensive Cancer Center. After informed consent, data pertaining to patient demographics and MM characteristics were collected in a coded database. Descriptive statistics was used to summarize disease characteristics; chi-square or Wilcoxon rank-sum tests were used to compare outcomes between BA and WA patients. Overall Survival (OS) was estimated by Kaplan-Meier method, with log-rank test applied to test the statistical differences between survival curves. Two-sided p-values <0.05 were considered statistically significant. Results: In our institutional database, we identified 264 individuals who developed MM before age of 50 years (median age=46; range: 17-50 years). 211 of them had matched cytogenetic studies and were included in the final analysis. The majority of these patients were male (66%), had IgG disease (47%), and stage II-III at presentation (52%). 196 of patients (93%) underwent at least one autologous stem cell transplant-ASCT, with 23 of them receiving more than one ASCT (15%) and 9 of them undergoing allogeneic stem cell transplant (4%). In all, median OS was 9.84 years (95% CI, 6.75-12.92 years), which is higher than in unselected older MM patients. 24% of the patients (n=51) were BA while the remaining (n=160) were WA. We observed no statistical differences in terms of patient characteristics, disease stage, or cytogenetics between BA or WA, except for a statistically significant prevalence of del(13q) in WA patients (39% vs. 30%; p= 0.012). In our cohort, BA and WA patients received transplant at similar rates (94% vs. 88%, p-value=0.137). Finally, we observed an inferior median OS of 8.59 years (95% CI, 6.40-10.78 years) in WA compared with BA patients (median OS: not reached; p-value= 0.038), with 5-year OS of 86% in BA compared with 65% in WA patients. Conclusions: We report a retrospective cohort of young MM patients. In our cohort, we observed less prevalence of del(13q) and superior OS of BA compared with age-matched WA patients. This suggests that young BA MM patients benefit from standard-of-care approaches and strategies should continue to be pursued to improve access to care and optimize treatments.
Collapse
Affiliation(s)
| | - Alicia Bao
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nidhi Sharma
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Naresh Bumma
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Maria Chaudhry
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Don M. Benson
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| |
Collapse
|
3
|
Sigmund AM, Rosko AE, Janse SA, Pisegna J, Krok-Schoen JL, Presley CJ. Patterns of physical and mental health well-being in older female cancer survivors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.173] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
173 Background: The majority of cancer survivors are older adults (≥65 years), but their lifestyle behaviors are understudied. Factors associated with improved physical and mental well-being in older female cancer survivors are not well understood. The objective of this study was to evaluate the factors associated with physical and mental well-being in older female cancer survivors, including the role of malnutrition, physical activity, and level of emotional support. Methods: Older female cancer survivors (n=171) completed surveys to assess health related quality of life (HRQoL) using SF-36, malnutrition screening tool (MST), and physical activity. Demographics were also collected. The data was analyzed using descriptive analyses, correlations, and ANCOVAs. Survivors were divided into four phenotypes for analysis using the SF-36 physical and mental composite scores (PCS; MCS) stratified based on the sample’s mean scores (table). Factors associated with the four groups were assessed including demographic characteristics, cancer type, level of emotional support, risk for malnutrition, and physical activity. Results: The majority of the cohort (mean age=74.5 years) were white and highly educated. 68.4% were breast cancer survivors, with 10.5% hematologic malignancy survivors, 5.3% gynecologic malignancy survivors, and 15.8% other. Mean PCS and MCS were 41.94 and 48.47, respectively, comparable to general older adult population means. When divided into four groups based on PCS/MCS, there were no significant differences by demographic characteristics or cancer type. Survivors with higher emotional support scores had significantly higher PCS/MCS scores (p<0.001). There was also a significant difference in risk for malnutrition, as those with high PCS/MCS were at lower risk for malnutrition (p≤0.001). Survivors with low PCS/MCS engaged in less moderate exercise as compared to those with high PCS/MCS (p=0.028). Conclusions: This study suggests that lower risk for malnutrition as well as higher levels of emotional support are associated with higher physical and mental well-being in older female cancer survivors. These are two potential modifiable targets for interventional studies to optimize physical and mental well-being among older cancer survivors. [Table: see text]
Collapse
Affiliation(s)
- Audrey M Sigmund
- Divisions of Hematology and Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, Columbus, OH
| | - Ashley Elizabeth Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, Columbus, OH
| | - Sarah A Janse
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Janell Pisegna
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH
| | - Jessica L. Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, Columbus, OH
| |
Collapse
|
4
|
Krok-Schoen JL, Pisegna J, Arthur E, Ridgway E, Stephens C, Rosko AE. Healthy lifestyle challenges among older female cancer survivors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.156] [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] [Indexed: 11/20/2022] Open
Abstract
156 Background: Healthy lifestyles including consuming a healthy diet, being physically active, and maintaining a normal weight can improve prognosis and health-related quality of life (HRQoL) among cancer survivors. The largest proportion of cancer survivors are older adults (≥65 years), yet their lifestyle behaviors are understudied. This study examined the lifestyle behaviors (diet quality, physical activity, maintaining healthy weight) of older female cancer survivors and associations with HRQoL. Methods: Women aged 65 years or older, with all cancer subtypes and stages, who had completed primary cancer treatment (i.e., chemotherapy, surgery, radiation) within the past five years, were eligible to participate. Older female cancer survivors (n = 171) completed one-time surveys to assess HRQoL (RAND-36), unintentional weight loss, body mass index (BMI), diet quality (Diet History Questionnaire II), and physical activity. Demographic information and medical record data were also collected. Diet History Questionnaire II results were converted to Healthy Eating Index (HEI)-2015 scores. Descriptive analyses, correlations, and stepwise linear regressions were utilized. Results: The majority of the sample (median age = 74.50±8.43 years) were white (90%), married (54.7%), breast cancer survivors (67.7%), and completed at least a bachelor’s degree (54.7%). Physical and mental HRQoL of the sample were low; 41.94±10.50 and 48.47±7.18, respectively, out of 100. Physical activity was low; 75.3%, 54.2%, and 68.1% reported no strenuous, moderate, and mild physical activity, respectively. Mean BMI was 27.71±6.24 (overweight), with 64% of the participants being overweight or obese. Mean HEI-2015 scores were 66.54+10.0 out of 100 and below the cutoff score of 80, which represents a “good diet”. Participating in moderate physical activity was associated with higher physical HRQoL (β = 0.42, p = 0.004). Being older (β = 0.27, p = 0.025), white (β = 0.53, p < 0.001), and having higher HEI scores (β = 0.30, p = 0.011) was associated with higher mental HRQoL. Conclusions: Older female cancer survivors reported lifestyle challenges including poor diet quality, low levels of physical activity, and high rates of being overweight or obese, which were associated with HRQoL. Results indicate the need for tailored health interventions for older female cancer survivors regarding their lifestyle behaviors to improve prognosis and HRQoL.
Collapse
Affiliation(s)
- Jessica L. Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Janell Pisegna
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH
| | | | - Emily Ridgway
- College of Nursing, The Ohio State University, Columbus, OH
| | - Christian Stephens
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH
| | | |
Collapse
|
5
|
Cottini F, Williams N, Bumma N, Khan AM, Chaudhry M, Devarakonda SS, Efebera YA, Benson DM, Rosko AE. Daratumumab-induced lymphopenia predicts adverse events and outcomes in patients with myeloma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20534] [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] [Indexed: 11/20/2022] Open
Abstract
e20534 Background: Daratumumab, a monoclonal antibody against CD38, is very effective in patients with Multiple Myeloma (MM). CD38 is expressed on MM cells but also on normal lymphocytes. Therapy-induced lymphopenia has been reported in 30-40% of patients; however its clinical significance is vastly unexplored. Methods: Here, we report the baseline characteristics and clinical course of 100 relapsed/refractory MM patients treated at the Ohio State University with Daratumumab as single agent or in combination. Data pertaining to patient demographics, MM characteristics, absolute lymphocyte count-ALC, infections, and hospital stays were collected. ALC of less or equal to 500 cells/µL is considered severe lymphopenia. Results: Fifty-nine percent of patients who completed treatment with Daratumumab (59%) developed severe lymphopenia. MM type (LLC and IgA), combination with immunomodulatory drugs (IMIDs), and lower baseline ALC count were statistically associated with severe lymphopenia, while stage, age, cytogenetics, number of prior lines of treatment, and autologous stem cell transplant were not. Patients with severe lymphopenia had higher rates of infections (52.5% versus 41.4%) and required hospital stays more frequently (83.8% versus 52.9%) than patients without severe lymphopenia. Upper respiratory tract infections and pneumonias were the most common infections. Sixty-one percent of severely lymphopenic patients recovered to ALC > 500 lymphocyte/μL while on therapy. The median time to recover was 14 days (average 43 days). Older patients have longer ALC recovery time (average: 52 days versus 24 days). No statistically significant difference in progression-free survival (PFS), overall survival (OS), or overall response rate (ORR) was noted between patients who did or did not develop severe lymphopenia. However, when the severe lymphopenic group was stratified based on ALC recovery, those with persistent lymphopenia had worst OS (p = 0.0019) and PFS (p < 0.0001), possibly due to better immune-mediated anti-tumoral effects. Conclusions: In our patient population, we discovered an elevated rate of severe lymphopenia, hospital utilization, and infections. Persistent severe lymphopenia is associated with shorter PFS and worst OS. Combination with IMIDs and low baseline ALC count are risk factors for severe lymphopenia while patients older than 65 has a longer ALC recovery time. These findings underline the importance of monitoring lymphocyte count and considering prophylactic measures in high-risk patients treated with Daratumumab.
Collapse
Affiliation(s)
| | - Nita Williams
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Naresh Bumma
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Maria Chaudhry
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Don M. Benson
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | |
Collapse
|
6
|
Johns A, Grogan M, Hoyd R, Bridges JF, Wei L, Patel S, Li M, Husain M, Kendra KL, Otterson GA, Burkart JT, Rosko AE, Andersen BL, Carbone DP, Owen DH, Spakowicz D, Presley CJ. Is immunotherapy toxicity associated with improved overall survival among older adults with advanced cancer? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6580 Background: There is growing evidence that checkpoint inhibitor immunotherapy (IO) toxicity is associated with improved treatment response. There is a paucity of evidence examining the relationship between toxicity and overall survival (OS) in older adults. Methods: We performed a single institution retrospective cohort study of adults who received IO for advanced cancer from 2011-2017. Baseline clinical characteristics were abstracted from the electronic health record. Immune-related toxicities were graded by physicians based on Common Terminology for Adverse Events criteria, v4.0. Bivariate analysis with chi-squared statistics was used to describe baseline characteristics of patients ≥70 years (y) vs. <70y. Survival outcomes were estimated by the Kaplan-Meier method (time zero = start of first-line IO) and compared using the log-rank test. The association of age and ≥ grade 3 toxicity with OS was tested with a Cox proportional hazards model. Results: Among 676 patients treated with IO, 238 (35.4%) were ≥70y. There was no difference in baseline characteristics of each age group except cancer type (P<0.01). The incidence of ≥ grade 3 toxicity did not differ by age (<70y: 14.5% vs. ≥70y: 13.5%, P=0.71). Median OS was significantly longer for adults <70y (16.4 vs. 13.2 months, P<0.01) or those with ≥ grade 3 toxicity (18.3 vs. 14.7 months, P<0.01). When stratified by age and toxicity, patients <70y with ≥ grade 3 toxicity had longer OS vs. those without ≥ grade 3 toxicity (P<0.01). However, there was no OS difference among adults ≥70y with vs. without ≥ grade 3 toxicity (P=0.78). Adjusted hazard ratios with an interaction term are below. Conclusions: Though the incidence of ≥ grade 3 toxicity did not significantly differ by age, there was no significant OS advantage for older adults with ≥ grade 3 toxicity as compared to younger adults. Caution should be used in considering a toxicity-survival relationship in older adults.[Table: see text]
Collapse
Affiliation(s)
- Andrew Johns
- Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Rebecca Hoyd
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | | | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Sandipkumar Patel
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | - Marium Husain
- The Ohio State University Medical Center, Columbus, OH
| | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | - Gregory Alan Otterson
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Jarred Thomas Burkart
- Division of Medical Oncology, Department of Internal Medicine,Ohio State University, Columbus, OH
| | | | | | | | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine & Department of Biomedical Informatics, Ohio State University, Columbus, OH
| | | |
Collapse
|
7
|
Bhatt G, Benson DM, Efebera YA, Hofmeister CC, Jaglowski SM, Devine SM, Wildes TM, Huang Y, Jones D, Rosko AE. Autologous stem cell transplant (ASCT) in myeloma to improve patient reported physical function and fatigue. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10044 Background: Patients with Multiple Myeloma (MM) report some of the poorest Health-related quality of life (HRQoL). Few studies show how ASCT influences global health outcomes as measured by a Geriatric Assessment (GA). We performed a prospective GA evaluating the dynamic changes in health pre- and post-ASCT. Methods: 100 pts with plasma cell dyscrasia (median (m) = 60 yrs, range (r) = 36-75 yrs) underwent GA pre-ASCT, 90 days and 1-yr post-ASCT. GA included nutritional survey, Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), Medical Outcomes Study-Social Support Survey (MOS-SSS), Short Physical Performance Battery (SPPB), handgrip strength, self-reported Human Activity Profile (HAP) Maximum Activity Score (MAS) and Adjusted Activity Score (AAS). Data were analyzed using paired t-test (p < 0.05). Results: Pts reported moderate fatigue pre-ASCT (m = 4.6, r: 0-9.8) which normalized at 1-yr (m = 2.5, r: 0-7.3; p = 0.008). Self-reported pre-ASCT physical function (MAS) (m = 73, r = 20-94) improved at 1-yr (m = 75.5, r = 52-94; p = 0.014); AAS (m = 64, r = 18-94) also improved at 1-yr (m = 70.5, r = 38-91; p = 0.025). In contrast, MD-reported KPS decreased. Screens for deficits in anxiety, depression, social support, objective physical function, handgrip strength and wt loss did not change significantly at 1-yr. Conclusions: Our data indicate that ASCT significantly improves patient-reported fatigue and physical function, unlike MD-reported KPS. [Table: see text]
Collapse
Affiliation(s)
- Geetika Bhatt
- Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Bhatt G, Hofmeister CC, Efebera YA, Benson DM, Sborov DW, Jaglowski SM, Devine SM, Wildes TM, Jones D, Huang Y, Rosko AE. A feasibility study of electronic geriatric assessment for real-time morbidity evaluation. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Geetika Bhatt
- Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|