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Wyatt KD, Birz S, Castellino SM, Henderson TO, Lucas JT, Pei Q, Zhou Y, Volchenboum SL, Furner B, Watkins M, Kelly KM, Flerlage JE. Accelerating pediatric Hodgkin lymphoma research: the Hodgkin Lymphoma Data Collaboration (NODAL). J Natl Cancer Inst 2024; 116:642-646. [PMID: 38273668 PMCID: PMC11077302 DOI: 10.1093/jnci/djae013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Data commons have proven to be an indispensable avenue for advancing pediatric cancer research by serving as unified information technology platforms that, when coupled with data standards, facilitate data sharing. The Pediatric Cancer Data Commons, the flagship project of Data for the Common Good (D4CG), collaborates with disease-based consortia to facilitate development of clinical data standards, harmonization and pooling of clinical data from disparate sources, establishment of governance structure, and sharing of clinical data. In the interest of international collaboration, researchers developed the Hodgkin Lymphoma Data Collaboration and forged a relationship with the Pediatric Cancer Data Commons to establish a data commons for pediatric Hodgkin lymphoma. Herein, we describe the progress made in the formation of Hodgkin Lymphoma Data Collaboration and foundational goals to advance pediatric Hodgkin lymphoma research.
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Affiliation(s)
- Kirk D Wyatt
- Department of Pediatric Hematology/Oncology, Roger Maris Cancer Center, Sanford Health, Fargo, ND, USA
| | - Suzi Birz
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Cancer and Blood Disorders Center, Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - John T Lucas
- Department of Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Qinglin Pei
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Yiwang Zhou
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Brian Furner
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Michael Watkins
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Jamie E Flerlage
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
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Tie X, Shin M, Lee C, Perlman SB, Huemann Z, Weisman AJ, Castellino SM, Kelly KM, McCarten KM, Alazraki AL, Hu J, Cho SY, Bradshaw TJ. Automatic Quantification of Serial PET/CT Images for Pediatric Hodgkin Lymphoma Patients Using a Longitudinally-Aware Segmentation Network. ArXiv 2024:arXiv:2404.08611v1. [PMID: 38659641 PMCID: PMC11042444] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Purpose Automatic quantification of longitudinal changes in PET scans for lymphoma patients has proven challenging, as residual disease in interim-therapy scans is often subtle and difficult to detect. Our goal was to develop a longitudinally-aware segmentation network (LAS-Net) that can quantify serial PET/CT images for pediatric Hodgkin lymphoma patients. Materials and Methods This retrospective study included baseline (PET1) and interim (PET2) PET/CT images from 297 patients enrolled in two Children's Oncology Group clinical trials (AHOD1331 and AHOD0831). LAS-Net incorporates longitudinal cross-attention, allowing relevant features from PET1 to inform the analysis of PET2. Model performance was evaluated using Dice coefficients for PET1 and detection F1 scores for PET2. Additionally, we extracted and compared quantitative PET metrics, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in PET1, as well as qPET and ΔSUVmax in PET2, against physician measurements. We quantified their agreement using Spearman's ρ correlations and employed bootstrap resampling for statistical analysis. Results LAS-Net detected residual lymphoma in PET2 with an F1 score of 0.606 (precision/recall: 0.615/0.600), outperforming all comparator methods (P<0.01). For baseline segmentation, LAS-Net achieved a mean Dice score of 0.772. In PET quantification, LAS-Net's measurements of qPET, ΔSUVmax, MTV and TLG were strongly correlated with physician measurements, with Spearman's ρ of 0.78, 0.80, 0.93 and 0.96, respectively. The performance remained high, with a slight decrease, in an external testing cohort. Conclusion LAS-Net achieved high performance in quantifying PET metrics across serial scans, highlighting the value of longitudinal awareness in evaluating multi-time-point imaging datasets.
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Affiliation(s)
- Xin Tie
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Muheon Shin
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Changhee Lee
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Scott B Perlman
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA
| | - Zachary Huemann
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Amy J Weisman
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Kathleen M McCarten
- Pediatric Radiology, Imaging and Radiation Oncology Core Rhode Island, Lincoln, RI, USA
| | - Adina L Alazraki
- Department of Radiology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Junjie Hu
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
- Department of Computer Science, School of Computer, University of Wisconsin, Madison, WI, USA
| | - Steve Y Cho
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA
| | - Tyler J Bradshaw
- Department of Radiology, University of Wisconsin, Madison, WI, USA
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Tie X, Shin M, Pirasteh A, Ibrahim N, Huemann Z, Castellino SM, Kelly KM, Garrett J, Hu J, Cho SY, Bradshaw TJ. Personalized Impression Generation for PET Reports Using Large Language Models. J Imaging Inform Med 2024; 37:471-488. [PMID: 38308070 PMCID: PMC11031527 DOI: 10.1007/s10278-024-00985-3] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
Large language models (LLMs) have shown promise in accelerating radiology reporting by summarizing clinical findings into impressions. However, automatic impression generation for whole-body PET reports presents unique challenges and has received little attention. Our study aimed to evaluate whether LLMs can create clinically useful impressions for PET reporting. To this end, we fine-tuned twelve open-source language models on a corpus of 37,370 retrospective PET reports collected from our institution. All models were trained using the teacher-forcing algorithm, with the report findings and patient information as input and the original clinical impressions as reference. An extra input token encoded the reading physician's identity, allowing models to learn physician-specific reporting styles. To compare the performances of different models, we computed various automatic evaluation metrics and benchmarked them against physician preferences, ultimately selecting PEGASUS as the top LLM. To evaluate its clinical utility, three nuclear medicine physicians assessed the PEGASUS-generated impressions and original clinical impressions across 6 quality dimensions (3-point scales) and an overall utility score (5-point scale). Each physician reviewed 12 of their own reports and 12 reports from other physicians. When physicians assessed LLM impressions generated in their own style, 89% were considered clinically acceptable, with a mean utility score of 4.08/5. On average, physicians rated these personalized impressions as comparable in overall utility to the impressions dictated by other physicians (4.03, P = 0.41). In summary, our study demonstrated that personalized impressions generated by PEGASUS were clinically useful in most cases, highlighting its potential to expedite PET reporting by automatically drafting impressions.
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Affiliation(s)
- Xin Tie
- Department of Radiology, School of Medicine and Public Health, University of Wissconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Muheon Shin
- Department of Radiology, School of Medicine and Public Health, University of Wissconsin, Madison, WI, USA
| | - Ali Pirasteh
- Department of Radiology, School of Medicine and Public Health, University of Wissconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Nevein Ibrahim
- Department of Radiology, School of Medicine and Public Health, University of Wissconsin, Madison, WI, USA
| | - Zachary Huemann
- Department of Radiology, School of Medicine and Public Health, University of Wissconsin, Madison, WI, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Childrens Healthcare of Atlanta, Atlanta, GA, USA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - John Garrett
- Department of Radiology, School of Medicine and Public Health, University of Wissconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Junjie Hu
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Computer Science, School of Computer, Data and Information Sciences, University of Wisconsin, Madison, WI, USA
| | - Steve Y Cho
- Department of Radiology, School of Medicine and Public Health, University of Wissconsin, Madison, WI, USA
- University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA
| | - Tyler J Bradshaw
- Department of Radiology, School of Medicine and Public Health, University of Wissconsin, Madison, WI, USA.
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Kelly KM, Friedberg JW. Classic Hodgkin Lymphoma in Adolescents and Young Adults. J Clin Oncol 2024; 42:653-664. [PMID: 37983570 DOI: 10.1200/jco.23.01799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 11/22/2023] Open
Abstract
Hodgkin lymphoma (HL) represents one of the more common cancers occurring in adolescent and young adults (AYAs) age 15-39 years. Despite a generally high cure rate, age-related differences in HL biology and the optimal therapeutic approaches including supportive care and risks for long-term adverse effects in the AYA population remain understudied. After an overview of HL epidemiology and biology in the AYA population, this review will cover frontline pediatric and adult treatment approaches. Recently completed and ongoing studies will foster harmonization of risk group definition and trial eligibility criteria across the AYA spectrum, enabling more rapid progress. In addition to treatment approaches, an evolving holistic care approach to AYA HL will result in enhanced understanding of unique challenges, and continued improved short- and long-term outcome for these patients.
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Affiliation(s)
- Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center., Buffalo, NY
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
- Pediatric Hematology/Oncology, Oishei Children's Hospital, Buffalo, NY
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Karvonen KA, Umaretiya PJ, Koch VB, Flamand Y, Aziz-Bose R, Ilcisin L, Valenzuela A, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Tran TH, Michon B, Welch JJ, Wolfe J, Silverman LB, Rosenberg AR, Bona K. Inequitable Poverty Exposures: A Subspecialty Opportunity to Address Disparities. Hosp Pediatr 2024; 14:e104-e106. [PMID: 38239110 PMCID: PMC10823182 DOI: 10.1542/hpeds.2023-007482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Kristine A. Karvonen
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rahela Aziz-Bose
- Department of Pediatric Oncology
- Division of Population Sciences
- Division of Pediatric Hematology/Oncology
- Harvard Medical School, Boston, Massachusetts
| | - Lenka Ilcisin
- Department of Pediatric Oncology
- Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Peter D. Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Justine M. Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | - Kara M. Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Thai Hoa Tran
- Division of Pediatric Hematology Oncology, Charles-Bruneau Cancer Center, CHU Ste-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Saint-Foy, Quebec, Canada
| | - Jennifer J.G. Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children’s Hospital, Brown University, Providence, Rhode Island
| | - Joanne Wolfe
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Lewis B. Silverman
- Department of Pediatric Oncology
- Division of Pediatric Hematology/Oncology
- Harvard Medical School, Boston, Massachusetts
| | - Abby R. Rosenberg
- Division of Pediatric Hematology/Oncology
- Harvard Medical School, Boston, Massachusetts
| | - Kira Bona
- Department of Pediatric Oncology
- Division of Population Sciences
- Division of Pediatric Hematology/Oncology
- Harvard Medical School, Boston, Massachusetts
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Lo AC, Liu A, Liu Q, Yasui Y, Castellino SM, Kelly KM, Hererra AF, Friedberg JW, Friedman DL, Schwartz CL, Pei Q, Kessel S, Bergeron-Gravel S, Dama H, Roberts K, Constine LS, Hodgson DC. Late Cardiac Toxic Effects Associated With Treatment Protocols for Hodgkin Lymphoma in Children. JAMA Netw Open 2024; 7:e2351062. [PMID: 38241048 PMCID: PMC10799264 DOI: 10.1001/jamanetworkopen.2023.51062] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/20/2023] [Indexed: 01/22/2024] Open
Abstract
Importance Contemporary North American trials for children with Hodgkin lymphoma (HL) have decreased radiation therapy (RT) use and increased pharmacologic cardioprotection but also increased the cumulative doxorubicin dose, making overall treatment consequences for late cardiac toxic effects uncertain. Objective To estimate the risk of cardiac toxic effects associated with treatments used in modern pediatric HL clinical trials. Design, Setting, and Participants For this cohort study, Fine and Gray models were fitted using survivors in the Childhood Cancer Survivor Study who were diagnosed with HL between January 1, 1970, and December 31, 1999, and were followed for a median of 23.5 (range, 5.0-46.3) years. These models were applied to the exposures in the study population to estimate the 30-year cumulative incidence of cardiac disease. The study population comprised patients with intermediate-risk or high-risk HL treated in 4 consecutive Children's Oncology Group clinical trials from September 2002 to October 2022: AHOD0031, AHOD0831, AHOD1331, and S1826. Data analysis was performed from April 2020 to February 2023. Exposures All patients received chemotherapy including doxorubicin, and some patients received mediastinal RT, dexrazoxane, or mediastinal RT and dexrazoxane. Main Outcomes and Measures Estimated 30-year cumulative incidence of grade 3 to 5 cardiac disease. Results The study cohort comprised 2563 patients, with a median age at diagnosis of 15 (range, 1-22) years. More than half of the patients were male (1357 [52.9%]). All 2563 patients received doxorubicin, 1362 patients (53.1%) received mediastinal RT, and 307 patients (12.0%) received dexrazoxane. Radiation therapy use and the median mean heart dose among patients receiving RT decreased, whereas the planned cumulative dose of doxorubicin and use of dexrazoxane cardioprotection increased. For patients treated at age 15 years, the estimated 30-year cumulative incidence of severe or fatal cardiac disease was 9.6% (95% CI, 4.2%-16.4%) in the AHOD0031 standard treatment group (enrolled 2002-2009), 8.6% (95% CI, 3.8%-14.9%) in the AHOD0831 trial (enrolled 2009-2012), 8.2% (95% CI, 3.6%-14.3%) in the AHOD1331 trial (enrolled 2015-2019), and 6.2% (95% CI, 2.7%-10.9%) in the S1826 trial (enrolled 2019-2022), whereas the expected rate in an untreated population was 5.0% (95% CI, 2.1%-9.3%). Despite the estimated reduction in late cardiac morbidity, the frequency of recommended echocardiographic screening among survivors will increase based on current guidelines. Conclusions and Relevance In this cohort study of sequential HL trials, reductions in the proportion of children receiving mediastinal RT and increases in dexrazoxane use were estimated to offset the increased doxorubicin dose and produce a net reduction in late cardiac disease. Further studies on dexrazoxane are warranted to confirm whether its role in reducing cardiac toxic effects is maintained long term. These findings suggest that survivorship follow-up guidelines should be refined to align with the risks associated with treatment.
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Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Qi Liu
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Cancer Institute and Oishei Children's Hospital, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Alex F Hererra
- Department of Hematology, City of Hope, Duarte, California
| | | | - Debra L Friedman
- Division of Pediatric Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cindy L Schwartz
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Qinglin Pei
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville
| | - Sandy Kessel
- Imaging and Radiation Oncology Core, Lincoln, Rhode Island
| | | | - Hitesh Dama
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kenneth Roberts
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Louis S Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - David C Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Ontario, Canada
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Parsons SK, Rodday AM, Pei Q, Keller FG, Wu Y, Henderson TO, Cella D, Kelly KM, Castellino SM. Performance of the FACT-GOG-Ntx to assess chemotherapy-induced peripheral neuropathy (CIPN) in pediatric high risk Hodgkin lymphoma: report from the Children's Oncology Group AHOD 1331 study. J Patient Rep Outcomes 2023; 7:113. [PMID: 37947987 PMCID: PMC10638179 DOI: 10.1186/s41687-023-00653-0] [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: 05/15/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is an under-recognized complication of several chemotherapy agents used as part of curative-intent therapy for Hodgkin Lymphoma (HL). In the absence of validated self- or proxy-report measures for children and adolescents, CIPN reporting has relied on clinician rating, with grading scales often restricted to severe manifestations. In a proof-of-concept study, we assessed the feasibility and psychometric performance of the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity (FACT-GOG-Ntx), a unidimensional CIPN symptom scale widely used adults with CIPN, in pediatric HL at risk for CIPN. METHODS Youth (11+ years) and parents of all children (5-17.9 years) with newly diagnosed high-risk HL enrolled on Children's Oncology Group AHOD1331 (NCT02166463) were invited to complete the FACT-GOG-Ntx and a health-related quality of life (HRQL) measure at pre-treatment (Time 1), and during cycles 2 (Time 2) and 5 (Time 3) of chemotherapy during the first half of study accrual. Clinical grading of CIPN by providers was also assessed using the Balis Pediatric Neuropathy Scale. We evaluated Cronbach's alpha, construct validity, and agreement between raters. Change in FACT-GOG-Ntx scores over time was assessed using a repeated measures model. RESULTS 306 patients had at least one completed FACT-GOG-Ntx with time-specific completion rates of > 90% for both raters. Cronbach's alpha was > 0.7 for youth and parent-proxy report at all time points. Correlations between FACT-GOG-Ntx and HRQL scores were moderate (0.41-0.48) for youth and parent-proxy raters across all times. Youth and parent-proxy raters both reported worse FACT-GOG-Ntx scores at Time 3 for those who had clinically-reported CIPN compared to those who did not. Agreement between raters was moderate to high. Compared to baseline scores, those at Time 3 were significantly lower for youth (β = - 2.83, p < 0.001) and parent-proxy raters (β = - 1.99, p < 0.001). CONCLUSIONS High completion rates at all time points indicated feasibility of eliciting youth and parent report. Psychometric performance of the FACT-GOG-Ntx revealed acceptable reliability, evidence of validity, and strong inter-rater agreement, supporting the use of this self- or proxy-reported measure of CIPN in youth with high-risk HL exposed to tubulin inhibitors, as part of a Phase 3 clinical trial. CLINICAL TRIAL INFORMATION Clinical Trials Registry, NCT02166463. Registered 18 June 2014, https://clinicaltrials.gov/ct2/show/study/NCT02166463.
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Affiliation(s)
- Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA.
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Qinglin Pei
- Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Frank G Keller
- Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA
| | - Yue Wu
- Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - David Cella
- Department of Medical Social Sciences, Institute for Public Health and Medicine, Center for Patient-Centered Outcomes, Northwestern University, 420 E. Superior St, Chicago, IL, 60611, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 665 Elm St, Buffalo, NY, 14203, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA
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Welch JJG, Flamand Y, Stevenson KE, Neuberg DS, Athale UH, Kelly KM, Laverdiere C, Michon B, Place AE, Sallan SE, Silverman LB, Vrooman LM. Impairment of health-related quality of life for children with acute lymphoblastic leukemia over the first year of therapy: A report from the DFCI ALL Consortium. Pediatr Blood Cancer 2023; 70:e30560. [PMID: 37461125 DOI: 10.1002/pbc.30560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Children treated for acute lymphoblastic leukemia (ALL) receive prolonged treatment, resulting in toxicities that affect health-related quality of life (HR-QoL). Longitudinal assessment of HR-QoL allows improved understanding of experiences with ALL. PROCEDURE Parent-proxy and child self-report HR-QoL over the first year of chemotherapy were evaluated in the context of DFCI Protocol 05-001, a phase 3 therapeutic trial for childhood ALL. HR-QoL was assessed with the Pediatric Quality-of-Life inventory (PedsQL) domains for Pain and Hurt, Procedural Anxiety, Treatment Anxiety, Emotional Functioning, General Fatigue, and Sleep/Rest Fatigue. RESULTS Total of 281 subjects participated, with 141 contributing at least one child report and 280 at least one parent report. Children with ALL experienced impairment in HR-QoL by both patient and parent report compared to the published PedsQL reference population at each time point on each subscale. Agreement between parent and child assessment of HR-QoL impairment was high, particularly among those for whom HR-QoL was not impaired. During the consolidation phase, which included intensive asparaginase administration, multivariable models demonstrated more impairment in Treatment Anxiety and Procedural Anxiety for children treated with intramuscular asparaginase than intravenous asparaginase, but randomized groups were otherwise similar in HR-QoL. Impairments in fatigue, both General and Sleep/Rest, were evident throughout and worse during intensive asparaginase therapy. CONCLUSIONS This report examines HR-QoL for children with ALL during treatment longitudinally by parent and patient report across multiple domains. Children with ALL demonstrated substantial impairment in HR-QoL, particularly related to fatigue during intensive consolidation therapy including asparaginase.
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Affiliation(s)
- Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kristen E Stevenson
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donna S Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Uma H Athale
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Caroline Laverdiere
- Department of Pediatrics, Division of Pediatric Hematology Oncology, Charles Bruneau Cancer Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada
| | - Bruno Michon
- Division of Hematology-Oncology, Centre Hospitalier Universitaire de Quebec, Quebec City, Quebec, Canada
| | - Andrew E Place
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Stephen E Sallan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lynda M Vrooman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Evens AM, Kelly KM. Lymphoma in adolescents and young adults: Navigating a path forward together. EJHaem 2023; 4:889-891. [PMID: 38024600 PMCID: PMC10660594 DOI: 10.1002/jha2.793] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Andrew M. Evens
- Rutgers Cancer Institute of New JerseyRobert Wood Johnson Medical School and Rutgers HealthNew BrunswickNew JerseyUSA
| | - Kara M. Kelly
- Roswell Park Comprehensive Cancer CenterUniversity at Buffalo Jacobs School of Medicine and Biomedical SciencesBuffaloNew YorkUSA
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10
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Zijtregtop EAM, Zeal J, Metzger ML, Kelly KM, Mauz-Koerholz C, Voss SD, McCarten K, Flerlage JE, Beishuizen A. Significance of E-lesions in Hodgkin lymphoma and the creation of a new consensus definition: a report from SEARCH. Blood Adv 2023; 7:6303-6319. [PMID: 37522740 PMCID: PMC10589789 DOI: 10.1182/bloodadvances.2023010024] [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: 02/27/2023] [Revised: 05/05/2023] [Accepted: 05/25/2023] [Indexed: 08/01/2023] Open
Abstract
The International Staging Evaluation and Response Criteria Harmonization for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (SEARCH for CAYAHL) seeks to provide an appropriate, universal differentiation between E-lesions and stage IV extranodal disease in Hodgkin lymphoma (HL). A literature search was performed through the PubMed and Google Scholar databases using the terms "Hodgkin disease," and "extranodal," "extralymphatic," "E lesions," "E stage," or "E disease." Publications were reviewed for the number of participants; median age and age range; diagnostic modalities used for staging; and the definition, incidence, and prognostic significance of E-lesions. Thirty-six articles describing 12 640 patients met the inclusion criteria. Most articles reported staging per the Ann Arbor (72%, 26/36) or Cotswolds modification of the Ann Arbor staging criteria (25%, 9/36), and articles rarely defined E-lesions or disambiguated "extranodal disease." The overall incidence of E-lesions for patients with stage I-III HL was 11.5% (1330/11 602 unique patients). Available stage-specific incidence analysis of 3888 patients showed a similar incidence of E-lesions in stage II (21.2%) and stage III (21.9%), with E-lesions rarely seen with stage I disease (1.1%). E-lesions likely remain predictive, but we cannot unequivocally conclude that identifying E-lesions in HL imparts prognostic value in the modern era of the more selective use of targeted radiation therapy. A harmonized E-lesion definition was reached based on the available evidence and the consensus of the SEARCH working group. We recommend that this definition of E-lesion be applied in future clinical trials with explicit reporting to confirm the prognostic value of E-lesions.
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Affiliation(s)
- Eline A. M. Zijtregtop
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jamie Zeal
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - Monika L. Metzger
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kara M. Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Christine Mauz-Koerholz
- Department of Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Giessen, Giessen, Germany
- Medical Faculty, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Stephan D. Voss
- Department of Radiology, Boston Children’s Hospital Dana-Farber Cancer Institute, Boston, MA
| | | | - Jamie E. Flerlage
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Auke Beishuizen
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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11
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Tie X, Shin M, Pirasteh A, Ibrahim N, Huemann Z, Castellino SM, Kelly KM, Garrett J, Hu J, Cho SY, Bradshaw TJ. Automatic Personalized Impression Generation for PET Reports Using Large Language Models. ArXiv 2023:arXiv:2309.10066v2. [PMID: 37904738 PMCID: PMC10614982] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Purpose To determine if fine-tuned large language models (LLMs) can generate accurate, personalized impressions for whole-body PET reports. Materials and Methods Twelve language models were trained on a corpus of PET reports using the teacher-forcing algorithm, with the report findings as input and the clinical impressions as reference. An extra input token encodes the reading physician's identity, allowing models to learn physician-specific reporting styles. Our corpus comprised 37,370 retrospective PET reports collected from our institution between 2010 and 2022. To identify the best LLM, 30 evaluation metrics were benchmarked against quality scores from two nuclear medicine (NM) physicians, with the most aligned metrics selecting the model for expert evaluation. In a subset of data, model-generated impressions and original clinical impressions were assessed by three NM physicians according to 6 quality dimensions (3-point scale) and an overall utility score (5-point scale). Each physician reviewed 12 of their own reports and 12 reports from other physicians. Bootstrap resampling was used for statistical analysis. Results Of all evaluation metrics, domain-adapted BARTScore and PEGASUSScore showed the highest Spearman's ρ correlations (ρ=0.568 and 0.563) with physician preferences. Based on these metrics, the fine-tuned PEGASUS model was selected as the top LLM. When physicians reviewed PEGASUS-generated impressions in their own style, 89% were considered clinically acceptable, with a mean utility score of 4.08 out of 5. Physicians rated these personalized impressions as comparable in overall utility to the impressions dictated by other physicians (4.03, P=0.41). Conclusion Personalized impressions generated by PEGASUS were clinically useful, highlighting its potential to expedite PET reporting.
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Affiliation(s)
- Xin Tie
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Muheon Shin
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Ali Pirasteh
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Nevein Ibrahim
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Zachary Huemann
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Sharon M. Castellino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - John Garrett
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Junjie Hu
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
- Department of Computer Science, University of Wisconsin, Madison, WI, USA
| | - Steve Y. Cho
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA
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12
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Umaretiya PJ, Koch VB, Flamand Y, Aziz-Bose R, Ilcisin L, Valenzuela A, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Tran TH, Michon B, Welch JJG, Wolfe J, Silverman LB, Bona K. Disparities in parental distress in a multicenter clinical trial for pediatric acute lymphoblastic leukemia. J Natl Cancer Inst 2023; 115:1179-1187. [PMID: 37261858 PMCID: PMC10560600 DOI: 10.1093/jnci/djad099] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Parent psychological distress during childhood cancer treatment has short- and long-term implications for parent, child, and family well-being. Identifying targetable predictors of parental distress is essential to inform interventions. We investigated the association between household material hardship (HMH), a modifiable poverty-exposure defined as housing, food, or utility insecurity, and severe psychological distress among parents of children aged 1-17 years with acute lymphoblastic leukemia (ALL) enrolled on the multicenter Dana-Farber ALL Consortium Trial 16-001. METHODS This was a secondary analysis of parent-reported data. Parents completed an HMH survey within 32 days of clinical trial enrollment (T0) and again at 6 months into therapy (T1). The primary exposure was HMH at T0 and primary outcome was severe parental distress at T0 and T1, defined as a score greater than or equal to 13 on the Kessler-6 Psychological Distress Scale. Multivariable models were adjusted for ALL risk group and single parent status. RESULTS Among 375 evaluable parents, one-third (32%; n = 120/375) reported HMH at T0. In multivariable analyses, T0 HMH was associated with over twice the odds of severe psychological distress at T0 and T1 HMH was associated with over 5 times the odds of severe distress at T1. CONCLUSIONS Despite uniform clinical trial treatment of their children at well-resourced pediatric centers, HMH-exposed parents-compared with unexposed parents-experienced statistically significantly increased odds of severe psychological distress at the time of their child's leukemia diagnosis, which worsened 6 months into therapy. These data identify a high-risk parental population who may benefit from early psychosocial and HMH-targeted interventions to mitigate disparities in well-being.
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Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Victoria B Koch
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rahela Aziz-Bose
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Ariana Valenzuela
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Justine M Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia, University Medical Center, New York, NY, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Thai Hoa Tran
- Division of Pediatric Hematology Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Saint-Foy, QC, Canada
| | - Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children’s Hospital, Brown University, Providence, RI, USA
| | - Joanne Wolfe
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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13
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Hoppe BS, Castellino S, Pei Q, Charpentier AM, Keller F, Vega RM, Roberts KB, Parikh RR, Punnett A, Parsons S, McCarten KM, Flampouri S, Kessel S, Wu Y, Cho SY, Kelly KM, Hodgson D. Radiotherapy Utilization and Outcomes on a Contemporary Trial for Pediatric High-Risk Hodgkin Lymphoma Study. Int J Radiat Oncol Biol Phys 2023; 117:S62-S63. [PMID: 37784541 DOI: 10.1016/j.ijrobp.2023.06.362] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Contemporary trials in pediatric Hodgkin lymphoma (cHL) evaluate strategies to reduce radiotherapy (RT) utilization while maintaining excellent progression-free survival (PFS). An alternative strategy is to irradiate selective sites at higher risk of relapse, and/or use proton therapy (PT) to minimize exposure to healthy tissue. We investigated the use of PT and photon therapy (XRT) and associated early outcomes among patients receiving involved site RT (ISRT) to high-risk sites on the Children's Oncology Group (COG) trial AHOD1331 (NCT021664643). MATERIALS/METHODS This multicenter randomized, open-label phase 3 study enrolled patients 2-21 years (yrs) with previously untreated cHL: stages IIB + bulk, IIIB, IVA, IVB. Patients were randomized to 5 cycles of either ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide) or the brentuximab vedotin (BV) containing regimen BV-AVE-PC given every 21 days. ISRT to 21 Gy was given to bulky mediastinal adenopathy and slow responding lesions (SRL) defined by 5-point score 4 or 5 on PET-CT after 2 cycles. ISRT could be delivered as 3D conformal XRT (3D), intensity modulated XRT (IMRT), or proton therapy (PT). Utilization of RT was compared by mode and by study enrollment midpoint among irradiated patients. Severe acute toxicity assessment included any incident grade 3 or higher toxicity during the ISRT period, except for neuropathy. RESULTS Among 587 eligible patients who were enrolled across 153 institutions between March 2015 and August 2019 with a median follow up of 43.1 months, the 3-yr PFS was 82.5% (90% CI, 78.3%-85.9%) with ABVE-PC and 92.5% (90% CI 89.5%-94.6%) with BV-AVE-PC (p = 0.0002). There was no difference in ISRT receipt or modality by study arm (p = 0.33). Among those who received RT 69.7% received it due to bulky mediastinal adenopathy, 6.6% due to SRL, and 23.7% for both. Overall, 317 (54.0%) patients received protocol RT of which 28.7% received 3D, 44.8% received IMRT, and 26.5% received PT. PT utilization increased over the course of the study from 21.5% among the first 50% of irradiated patients to 31.5% in the second half of irradiated patients (p = 0.045). The 3-yr progression-free survival rates overall by RT were comparable: PT (88.0%, 90% CI 80.6% - 92.7%%); XRT (87.1%, 90% CI 82.9%-90.4%) (p = 0.85). No difference in PFS was observed between 3D versus IMRT (p = 0.65). No differences were observed in severe acute toxicities (8.33% vs. 8.15%, p = 0.96) between PT and XRT. CONCLUSION Selective use of RT results in excellent outcomes for pediatric patients with high-risk HL and combination chemotherapy inclusive of the novel agent BV. Over the course of the study, PT utilization increased as an RT modality. Early results suggest that PT does not compromise disease control and has similar acute toxicity as XRT. Long term follow-up (>10 years) is needed to evaluate for secondary malignancies and cardiac toxicity among the different RT modalities.
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Affiliation(s)
- B S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Q Pei
- University of Florida, Gainesville, FL
| | - A M Charpentier
- Centre hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - F Keller
- Children Hospital of Atlanta, Atlanta, GA
| | | | | | - R R Parikh
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - A Punnett
- University of Toronto, Toronto, ON, Canada
| | | | | | - S Flampouri
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - S Kessel
- Imaging and Radiation Oncology Core, Lincoln, RI
| | - Y Wu
- University of Florida, Gainesville, FL
| | - S Y Cho
- Department of Radiology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - K M Kelly
- Roswell Park Cancer Institute, Buffalo, NY
| | - D Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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14
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Mailhot Vega RB, Harker-Murray PD, Forlenza CJ, Cole P, Kelly KM, Milgrom SA, Parikh RR, Hodgson DC, Castellino SM, Kahn J, Roberts KB, Constine LS, Hoppe BS. Radiation Therapy Use in Refractory and Relapsed Adolescent and Young Adult Hodgkin Lymphoma: A Report from the Children's Oncology Group. Int J Radiat Oncol Biol Phys 2023; 117:400-403. [PMID: 37116589 PMCID: PMC10655744 DOI: 10.1016/j.ijrobp.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
| | - Paul D Harker-Murray
- Department of Pediatric Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher J Forlenza
- Department of Pediatric Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Cole
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Justine Kahn
- Department of Pediatrics Hematology-Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Kenneth B Roberts
- Department of Therapeutic Radiology; Yale School of Medicine, New Haven, Connecticut
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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15
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Hoppe BS, Daw S, Cole P, Hodgson D, Beishuizen A, Garnier N, Buffardi S, Mascarin M, Ebeling T, Akyol A, Crowe R, Xu Y, Drachtman R, Kelly KM, Leblanc T, Harker-Murray PD. Consolidative Radio therapy in Place of Autologous Stem Cell Transplant in Patients with Low-Risk Relapsed/Refractory (R/R) Classic Hodgkin Lymphoma (cHL) Treated with Nivolumab plus Brentuximab Vedotin: CheckMate 744. Int J Radiat Oncol Biol Phys 2023; 117:S1-S2. [PMID: 37784262 DOI: 10.1016/j.ijrobp.2023.06.206] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Standard of care treatment for patients with relapsed and refractory classic Hodgkin lymphoma (RRHL) involves second line therapy followed by high dose therapy and autologous stem cell transplant (HDT/ASCT) and carries with it significant costs and toxicities to the patient. Some patients with RRHL may not require such intensive therapy, especially in the era of targeted chemotherapy and checkpoint inhibitors. CheckMate 744 (NCT02927769) evaluated a novel second-line therapy that omits HDT/ASCT by combining brentuximab vedotin (BV) and a nivolumab (N) followed by consolidative ISRT for low risk RRHL. MATERIALS/METHODS Pts were aged 5-30 y and had one prior treatment without HDT/ASCT. Low-risk RRHL were those at relapse without B symptoms or extranodal disease, limited sites of relapse (≤4 sites of disease above the diaphragm or ≤3 sites above/below the diaphragm) AND with initial Stage IA, IIA with relapse <1 year if they received ≤3 cycles of chemotherapy and no RT OR Stage IA/B, IIA/B, IIIA ≥ 1 year. Patients received 4 cycles of N + BV induction. Patients with complete metabolic response (CMR) received an additional 2 cycles of N + BV before RT consolidation. Patients with suboptimal response received 2 cycles of BV + bendamustine intensification. Those patients achieving CMR proceeded to RT consolidation. RT was delivered to a dose of 30-30.6 Gy at 1.5-1.8 Gy/fraction to an ISRT volume. RESULTS Among 28 pts treated, the median age (range) was 17 (6-27) years old and 64% of patients were aged < 18 y. Most (79%) pts had stage II disease at diagnosis and 82% had relapsed ≥ 12 months after first line treatment. Of 27 pts continuing in study after induction N + BV, 6 received bendamustine + BV intensification, and 92.9% achieved complete metabolic response. Twenty-two patients received RT consolidation. RT consolidation was delivered using 3D-CRT, IMRT, or proton therapy. After a median (range) follow-up of 31.8 (2.2-55.1) months, the 3-y event-free survival rate and progression-free survival were 86.9% (69.5-94.7%) and 95% (76.7-99%), respectively. CONCLUSION A novel combination of N + BV followed by ISRT was an effective second line therapy. This treatment regimen allowed patients to forgo high dose therapy and transplant in favor of consolidative radiotherapy using ISRT. Larger studies challenging the role of high dose therapy and transplant are needed for RRHL.
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Affiliation(s)
- B S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - S Daw
- University College Hospital, London, United Kingdom
| | - P Cole
- Rutgers Cancer Institute of New Jersey, Section of Pediatric Hematology and Oncology, New Brunswick, NJ
| | - D Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Beishuizen
- Princess Máxima Center for Pediatric Oncology, Rotterdam, Netherlands
| | - N Garnier
- Institut d'hematologie et d'onologie dediatrique, Lyon, France
| | - S Buffardi
- Santobono-Pausilipon Hospital, Naples, Italy
| | - M Mascarin
- Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - T Ebeling
- Charite Universitats Medizin, Berlin, Germany
| | - A Akyol
- Bristol Myers Squibb, Princeton, NJ
| | - R Crowe
- Bristol Myers Squibb, Boudry, Switzerland
| | - Y Xu
- Bristol Myers Squibb, Princeton, NJ
| | - R Drachtman
- Rutgers Cancer Institute of New Jersey, Section of Pediatric Hematology and Oncology, New Brunswick, NJ
| | - K M Kelly
- Roswell Park Cancer Institute, Buffalo, NY
| | - T Leblanc
- Hôpital Robert-Debré APHP, Paris, France
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16
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Castellino SM, Giulino-Roth L, Harker-Murray P, Kahn J, Forlenza C, Cho S, Hoppe B, Parsons SK, Kelly KM. Children's Oncology Group's 2023 blueprint for research: Hodgkin lymphoma. Pediatr Blood Cancer 2023; 70 Suppl 6:e30580. [PMID: 37505794 PMCID: PMC10660893 DOI: 10.1002/pbc.30580] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023]
Abstract
The goal of therapy in pediatric Hodgkin lymphoma (HL) is to maximize overall survival while minimizing the morbidity of curative therapy. Key findings from recent Children's Oncology Group (COG) trials include: (i) superior event-free survival with the addition of brentuximab vedotin (Bv) in frontline regimens for high-risk disease, (ii) successful reduction in myeloablative regimens with demonstrated safety and efficacy of Bv and checkpoint inhibitor therapy in relapsed disease, and (ii) the potential to select a population that can be salvaged after relapse without receiving a stem cell transplant. The COG HL committee will lead a National cancer Institute National Clinical Trials Network phase 3 trial to evaluate the combination of Bv/nivolumab in early-stage disease. Ongoing advances in technology and blood biomarkers are increasing the ability to deliver biologically driven, personalized treatment for HL.
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Affiliation(s)
- Sharon M. Castellino
- Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta/ Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Lisa Giulino-Roth
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | | | - Justine Kahn
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | | | - Steve Cho
- Department of Radiology, University of Wisconsin/ University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI
| | - Bradford Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - Susan K. Parsons
- Department of Medicine, Tufts University School of Medicine/ Department of Pediatrics, Tufts University School of Medicine/ Institute for Clinical Research and Health Policy Studies, Reid R. Sacco AYA Cancer Program/ Division of Hematology/Oncology, Tufts Medical Center, Boston, MA
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center/ Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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17
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Lo AC, Lee I, Pei Q, Wu Y, McCarten KM, Hoppe BS, Hodgson DC, Roberts K, Milgrom S, Kessel S, Cole PD, Kelly KM, Cho SY. Prognostic value of chest x-ray- and CT-defined large mediastinal adenopathy in high-risk pediatric Hodgkin lymphoma: A report from the Children's Oncology Group Study AHOD0831. Pediatr Blood Cancer 2023; 70:e30452. [PMID: 37243975 PMCID: PMC10546608 DOI: 10.1002/pbc.30452] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE/OBJECTIVE We compared the prognostic value of chest radiograph (CXR)- and computed tomography (CT)-derived definition of large mediastinal adenopathy (LMA) in pediatric Hodgkin lymphoma (HL). MATERIALS/METHODS Total 143 patients treated for stage IIIB/IVB HL on COG AHOD0831 were included in this study. Six definitions of LMA were investigated: (i) mediastinal mass ratio on CXR (MRCXR ) > 1/3; (ii) mediastinal mass ratio on CT (MRCT ) > 1/3; (iii) mediastinal mass volume on CT (MVCT ) > 200 mL; (iv) normalized mediastinal mass volume (MVCT /thoracic diameter [TD]) > 1 mL/mm; (v) mediastinal mass diameter on CT (MDCT ) > 10 cm; and (vi) normalized mediastinal mass diameter (MDCT /TD) > 1/3. RESULTS Median age at diagnosis was 15.8 years (range: 5.2-21.3 years). In patients with a slow early response (SER) to chemotherapy, MVCT > 200 mL, MDCT > 10 cm, and MDCT /TD > 1/3 were associated with worse relapse-free survival (RFS) on MVA, while MRCXR > 1/3, MRCT > 1/3, and MVCT /TD > 1 mL/mm trended toward worse RFS; MDCT /TD was the most strongly prognostic for inferior RFS, with a hazard ratio of 6.41 for MDCT /TD > 1/3 versus ≤1/3 on MVA (p = .02). CONCLUSION LMA according to MVCT > 200 mL, MDCT > 10 cm, and MDCT /TD > 1/3 is associated with poor prognosis in advanced-stage HL patients with SER. The normalized mediastinal diameter, MDCT /TD > 1/3 appears to be the strongest predictor of inferior RFS.
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Affiliation(s)
- Andrea C. Lo
- Department of Radiation Oncology, BC Cancer Vancouver Centre, Vancouver, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Inki Lee
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Qinglin Pei
- Children’s Oncology Group, Statistics and Data Center, Monrovia, CA, USA
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Yue Wu
- Children’s Oncology Group, Statistics and Data Center, Monrovia, CA, USA
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | | | | | - David C. Hodgson
- Radiation Oncology, Princess Margaret Cancer Center and University of Toronto, Toronto, Canada
| | - Kenneth Roberts
- Department of Radiation Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, CO
| | - Sandy Kessel
- Imaging and Radiation Oncology Core, Lincoln, RI, USA
| | - Peter D. Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Kara M. Kelly
- Pediatric Hematology/Oncology, Roswell Park Comprehensive Cancer Center, University at Buffalo, Buffalo, NY, USA
| | - Steve Y. Cho
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
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18
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Milgrom SA, Kim J, Pei Q, Lee I, Hoppe BS, Wu Y, Hodgson D, Kessel S, McCarten KM, Roberts K, Lo AC, Cole PD, Kelly KM, Cho SY. Baseline metabolic tumour burden improves risk stratification in Hodgkin lymphoma: A Children's Oncology Group study. Br J Haematol 2023; 201:1192-1199. [PMID: 36922022 PMCID: PMC10247420 DOI: 10.1111/bjh.18734] [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: 01/05/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/17/2023]
Abstract
The Children's Oncology Group AHOD0831 study used a positron emission tomography (PET) response-adapted approach in high-risk Hodgkin lymphoma, whereby slow early responders (SERs) received more intensive therapy than rapid early responders (RERs). We explored if baseline PET-based characteristics would improve risk stratification. Of 166 patients enrolled in the COG AHOD0831 study, 94 (57%) had baseline PET scans evaluable for quantitative analysis. For these patients, total body metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUVmax ) and peak SUV (SUVpeak ) were obtained. MTV/TLG thresholds were an SUV of 2.5 (MTV2.5 /TLG2.5 ) and 40% of the tumour SUVmax (MTV40% /TLG40% ). TLG2.5 was associated with event-free survival (EFS) in the complete cohort (p = 0.04) and in RERs (p = 0.01), but not in SERs (p = 0.8). The Youden index cut-off for TLG2.5 was 1841. Four-year EFS was 92% for RER/TLG2.5 up to 1841, 60% for RER/TLG2.5 greater than 1841, 74% for SER/TLG2.5 up to 1841 and 79% for SER/TLG2.5 greater than 1841. Second EFS for RER/TLG2.5 up to 1841 was 100%. Thus, RERs with a low baseline TLG2.5 experienced excellent EFS with less intensive therapy, whereas RERs with a high baseline TLG2.5 experienced poor EFS. These findings suggest that patients with a high upfront tumour burden may benefit from intensified therapy, even if they achieve a RER.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado, USA
| | - Jihyun Kim
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Qinglin Pei
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Inki Lee
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Yue Wu
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | | | - Sandy Kessel
- Imaging and Radiation Oncology Core, Lincoln, Rhode Island, USA
| | | | - Kenneth Roberts
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrea C Lo
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Kara M Kelly
- Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Steve Y Cho
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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19
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Werk RS, Koyama T, Sun L, Wolden S, Kelly KM, Constine LS, Schwartz CL, Friedman DL. Post-Traumatic Stress Symptoms in Adolescent Hodgkin Lymphoma Survivors: A Report from Children's Oncology Group AHOD0031. J Adolesc Young Adult Oncol 2023; 12:359-365. [PMID: 36094417 PMCID: PMC10282797 DOI: 10.1089/jayao.2022.0053] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: The intrusive thoughts of cancer diagnosis, treatments, re-experiencing, and avoidance associated with post-traumatic stress symptoms (PTSS) can negatively affect Hodgkin lymphoma (HL) survivors. This study investigates the associations between experiences and beliefs and PTSS among adolescent survivors of intermediate-risk HL treated on the Children's Oncology Group (COG) AHOD0031 study. Methods: COG AHOD0031 participants completed self-report surveys at end of therapy concerning post-treatment medical conditions, activity limitations, fatigue, future concerns, exercise, and PTSS. Results: One thousand one hundred ten of 1721 participants in AHOD0031 completed the first survey at a median of 6.7 months post-diagnosis (interquartile range: 5.3-11.5 months), and of these, 736 (66.3%) completed a second survey at a median of 12.4 (10.1-17.6) months following the first. The mean PTSS score (ranging from 0 to 20) was 5.5 (standard deviation [SD] = 5.1) on survey 1 and 4.4 (SD = 4.8) on survey 2. Increased fatigue (odds ratio [OR] = 1.14, p < 0.01), concerns for the future (OR = 1.13, p < 0.01), activity limitations (OR = 1.05, p < 0.01), and relapse history (OR = 2.18, p < 0.05) were associated with higher PTSS scores in the initial survey. Increased fatigue (OR = 1.16, p < 0.01), concerns for the future (OR = 1.14, p < 0.01), activity limitations (OR = 1.05, p < 0.05), and higher PTSS scores on the first survey (OR = 1.19, p < 0.01) were associated with higher PTSS scores in the subsequent survey. Longer time since diagnosis (OR = 0.85, p < 0.05; OR = 0.84, p < 0.05) was associated with lower PTSS scores on both surveys. Conclusions: Based on our findings, future research should examine the onset and trajectory of PTSS among HL survivors, focusing on early recognition and intervention to improve quality of life.
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Affiliation(s)
- Rachel S. Werk
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lili Sun
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Louis S. Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - Cindy L. Schwartz
- Department of Pediatrics, Children's Hospital of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Debra L. Friedman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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20
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Harker-Murray P, Mauz-Körholz C, Leblanc T, Mascarin M, Michel G, Cooper S, Beishuizen A, Leger KJ, Amoroso L, Buffardi S, Rigaud C, Hoppe BS, Lisano J, Francis S, Sacchi M, Cole PD, Drachtman RA, Kelly KM, Daw S. Nivolumab and brentuximab vedotin with or without bendamustine for R/R Hodgkin lymphoma in children, adolescents, and young adults. Blood 2023; 141:2075-2084. [PMID: 36564047 PMCID: PMC10646780 DOI: 10.1182/blood.2022017118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/25/2022] Open
Abstract
Children, adolescents, and young adults (CAYA) with relapsed/refractory (R/R) classic Hodgkin lymphoma (cHL) without complete metabolic response (CMR) before autologous hematopoietic cell transplantation (auto-HCT) have poor survival outcomes. CheckMate 744, a phase 2 study for CAYA (aged 5-30 years) with R/R cHL, evaluated a risk-stratified, response-adapted approach with nivolumab plus brentuximab vedotin (BV) followed by BV plus bendamustine for patients with suboptimal response. Risk stratification was primarily based on time to relapse, prior treatment, and presence of B symptoms. We present the primary analysis of the standard-risk cohort. Data from the low-risk cohort are reported separately. Patients received 4 induction cycles with nivolumab plus BV; those without CMR (Deauville score >3, Lugano 2014) received BV plus bendamustine intensification. Patients with CMR after induction or intensification proceeded to consolidation (high-dose chemotherapy/auto-HCT per protocol). Primary end point was CMR any time before consolidation. Forty-four patients were treated. Median age was 16 years. At a minimum follow-up of 15.6 months, 43 patients received 4 induction cycles (1 discontinued), 11 of whom received intensification; 32 proceeded to consolidation. CMR rate was 59% after induction with nivolumab plus BV and 94% any time before consolidation (nivolumab plus BV ± BV plus bendamustine). One-year progression-free survival rate was 91%. During induction, 18% of patients experienced grade 3/4 treatment-related adverse events. This risk-stratified, response-adapted salvage strategy had high CMR rates with limited toxicities in CAYA with R/R cHL. Most patients did not require additional chemotherapy (bendamustine intensification). Additional follow-up is needed to confirm durability of disease control. This trial was registered at www.clinicaltrials.gov as #NCT02927769.
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Affiliation(s)
| | - Christine Mauz-Körholz
- University Hospital Justus Liebig University, Giessen, and Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Thierry Leblanc
- Hôpital Robert-Debré Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Maurizio Mascarin
- Adolescent and Young Adult Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Gérard Michel
- Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France
| | | | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, and Erasmus Medical Centre–Sophia, Rotterdam, The Netherlands
| | | | - Loredana Amoroso
- Department of Pediatric Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genova, Italy
| | | | - Charlotte Rigaud
- Département de Cancérologie de l’Enfant et de l’Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | | | | | - Peter D. Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Kara M. Kelly
- Roswell Park Comprehensive Cancer Center and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Stephen Daw
- University College Hospital, London, United Kingdom
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21
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Vettese E, Sherani F, King AA, Yu L, Aftandilian C, Baggott C, Agarwal V, Nagasubramanian R, Kelly KM, Freyer DR, Orgel E, Bradfield SM, Kyono W, Roth M, Klesges LM, Beauchemin M, Grimes A, Tomlinson G, Dupuis LL, Sung L. Symptom management care pathway adaptation process and specific adaptation decisions. BMC Cancer 2023; 23:350. [PMID: 37069510 PMCID: PMC10108500 DOI: 10.1186/s12885-023-10835-0] [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: 09/26/2022] [Accepted: 04/11/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND There is substantial heterogeneity in symptom management provided to pediatric patients with cancer. The primary objective was to describe the adaptation process and specific adaptation decisions related to symptom management care pathways based on clinical practice guidelines. The secondary objective evaluated if institutional factors were associated with adaptation decisions. METHODS Fourteen previously developed symptom management care pathway templates were reviewed by an institutional adaptation team composed of two clinicians at each of 10 institutions. They worked through each statement for all care pathway templates sequentially. The institutional adaptation team made the decision to adopt, adapt or reject each statement, resulting in institution-specific symptom management care pathway drafts. Institutional adaption teams distributed the 14 care pathway drafts to their respective teams; their feedback led to care pathway modifications. RESULTS Initial care pathway adaptation decision making was completed over a median of 4.2 (interquartile range 2.0-5.3) weeks per institution. Across all institutions and among 1350 statements, 551 (40.8%) were adopted, 657 (48.7%) were adapted, 86 (6.4%) were rejected and 56 (4.1%) were no longer applicable because of a previous decision. Most commonly, the reason for rejection was not agreeing with the statement (70/86, 81.4%). Institutional-level factors were not significantly associated with statement rejection. CONCLUSIONS Acceptability of the 14 care pathways was evident by most statements being adopted or adapted. The adaptation process was accomplished over a relatively short timeframe. Future work should focus on evaluation of care pathway compliance and determination of the impact of care pathway-consistent care on patient outcomes. TRIAL REGISTRATION clinicaltrials.gov, NCT04614662. Registered 04/11/2020, https://clinicaltrials.gov/ct2/show/NCT04614662?term=NCT04614662&draw=2&rank=1 .
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Affiliation(s)
- Emily Vettese
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Farha Sherani
- Driscoll Children's Hospital, Cancer and Blood Disorders Center, 3533 S. Alameda Street, Corpus Christi, TX, 78411, US
- Texas A&M University, College Station, TX, US
| | - Allison A King
- Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO, 63110, US
| | - Lolie Yu
- Louisiana State University Health Sciences Center/Children's Hospital, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA
| | | | | | - Vibhuti Agarwal
- Nemours Children's Hospital of The Nemours Foundation, 6535 Nemours Parkway, Orlando, FL, 32827, US
| | | | - Kara M Kelly
- Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 665 Elm St., Buffalo, NY, 14203, US
| | - David R Freyer
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, US
| | - Etan Orgel
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, US
| | - Scott M Bradfield
- Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32207, US
| | - Wade Kyono
- Kapi'olani Medical Center for Women & Children, 1319 Punahou Street, Honolulu, Hawai'i, 96826, US
| | - Michael Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, US
| | - Lisa M Klesges
- Division of Public Health Sciences, Washington University School of Medicine, 600 So Taylor Ave, St. Louis, MO, 63110, US
| | - Melissa Beauchemin
- Columbia University School of Nursing/Herbert Irving Cancer Center, 560 West 168th Street, New York, NY, 10032, USA
| | - Allison Grimes
- Pediatric Hematology Oncology, University of Texas Health, The Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, US
| | - George Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M5S 3M2, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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22
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Turco GM, Gupta A, Monteleone P, Kelly KM, Klein RD, Wiltsie L, Barth M. An institutional review of genomic sequencing in pediatric solid tumors. Pediatr Blood Cancer 2023; 70:e30324. [PMID: 37017066 DOI: 10.1002/pbc.30324] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/24/2023] [Accepted: 03/09/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Although tumor genomic profiling has aided the advancement of targeted genetic therapy, its clinical integration remains a challenge in pediatric cancers due to lower mutation frequency and less available targeted drugs. There have been multiple novel studies examining molecular sequencing in pediatrics; however, many of these studies primarily utilized large-scale, genome-wide screening applications that limit applicable use due to the availability of testing. This study examined the institutional use of a targeted, clinically available approach to tumor genomic sequencing. METHODS A retrospective chart review was performed on pediatric patients with solid tumors who were managed at Roswell Park Comprehensive Cancer Center and underwent molecular testing of their tumor biopsy via OmniSeq from August 2016 to July 2021. Results were reviewed for mutations considered to be "actionable" by targeted therapy. Patients with actionable mutations were further examined to evaluate treatment course, receival of targeted therapy, and clinical outcomes. RESULTS We identified 64 pediatric patients consisting of 20 (31%) with CNS tumors and 44 (69%) with non-CNS tumors, ranging in age from 9 months to 21 years. Thirty-five total actionable mutations were identified amongst 27 patients (42%). Of these 27, 12 patients (44%) received at least 1 targeted drug against a respective actionable mutation, of which 6 patients (50%) achieved clinical benefit to therapy, including 1 complete response. CONCLUSIONS The use of a clinically focused and readily available targeted molecular sequencing panel identified actionable mutations at a comparable rate to the large-scale, less readily available sequencing panels utilized in other studies. Half of our patients who received targeted therapy achieved a complete response or clinical benefit from therapy. Although targeted therapy has a role in pediatric cancer treatment, many newer drugs require further research on their safety and efficacy.
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Affiliation(s)
- George M Turco
- Pediatric Hematology/Oncology Fellow, Duke University, Durham, North Carolina, USA
| | - Ajay Gupta
- Division of Pediatric Hematology/Oncology, Roswell Park Oishei Children's Cancer and Blood Disorders Program, Buffalo, New York, USA
| | - Philip Monteleone
- Division of Pediatric Hematology/Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Kara M Kelly
- Division of Pediatric Hematology/Oncology, Roswell Park Oishei Children's Cancer and Blood Disorders Program, Buffalo, New York, USA
| | | | - Laura Wiltsie
- Division of Pediatric Hematology/Oncology, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Matthew Barth
- Division of Pediatric Hematology/Oncology, Roswell Park Oishei Children's Cancer and Blood Disorders Program, Buffalo, New York, USA
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23
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Wen J, Duggimpudi A, Li S, Ladas E, Kelly KM, Cole PD. Abstract 5216: The effect of polymorphisms in DAT1 and DRD4 on dietary intake during chemotherapy for childhood leukemia. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5216] [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: 04/07/2023]
Abstract
Abstract
Outcomes of acute lymphoblastic leukemia (ALL) are associated with both host and environmental factors. We hypothesized that there is also an interaction between them, with genetic variants influencing dietary choices. The dopamine transporter 1 (DAT1) and D4 subtype of the dopamine receptor (DRD4) genes are polymorphic, with a variable number of nucleotide repeats (VNTR) that affect dopaminergic neurotransmission, and reward circuitry for food cravings. Specifically, the 9-tandem repeats (9R) allele of DAT1 and the 7-tandem repeats (7R) allele of DRD4 are risk factors for eating disorders or undereating behavior in children. The goal of this study was to determine whether these polymorphisms are associated with altered dietary intake during therapy for childhood ALL. DNA was isolated from peripheral blood mononuclear cells collected from 439 children being treated on Dana Farber Cancer Institute ALL Consortium Protocol 05-001 (NCT00400946). Target alleles in DAT1 and DRD4 were determined using PCR product length analysis. Each subject was classified as having either zero or at least one copy of the target alleles. Dietary intake was previously determined using food frequency questionnaires collected at three timepoints: time of diagnosis, end of induction, and continuation therapy. As previously published dietary composition in fat and carbohydrate differed significantly among three timepoints. There was no significant difference between those with or without the target alleles in DAT1 or DRD4 in percent from fat or percent from carbohydrate at any of the three timepoints. However, significant differences were observed when dietary intake was compared to the Dietary Reference Intake (DRI). Notably, a greater portion of male participants with DAT1 9R polymorphism had fat consumption below the DRI at the time of diagnosis. On the contrary, significantly decreased portion of females with DAT1 9R had fat consumption below the DRI during continuation therapy. When compared to normative values, a significantly increased number of children had total calorie consumption below DRI during induction therapy. The DRD4 7R polymorphism was associated with fat intake below DRI during induction therapy in males. However, neither DAT1 nor DRD4 polymorphisms were related to variation in carbohydrates consumption. In addition, a greater portion of participants that carry both DAT1 and DRD4 polymorphism exhibited a trend toward undereating behavior in fat intake compared to the controls. Our results are the first to indicate that DAT1 and DRD4 polymorphisms are associated with altered dietary intake during chemotherapy for childhood ALL. Future study will further elucidate whether this modulation is associated with changes in their body weight, BMI, glucose level, and disease relapse.
Citation Format: Jing Wen, Arul Duggimpudi, Shengguo Li, Elena Ladas, Kara M. Kelly, Peter D. Cole. The effect of polymorphisms in DAT1 and DRD4 on dietary intake during chemotherapy for childhood leukemia. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5216.
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Affiliation(s)
- Jing Wen
- 1Goryeb Children's Hospital, Morristown Medical center, Morristown, NJ
| | - Arul Duggimpudi
- 2Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Shengguo Li
- 3Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Elena Ladas
- 4Columbia University Medical Center, New York, NY
| | - Kara M. Kelly
- 5Roswell Park Cancer Institute and University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Peter D. Cole
- 3Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
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24
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Park H, Uhlemann AC, Jacobs SS, Mowbray C, Jubelirer T, Kelly KM, Walters M, Ladas EJ. Title: Obesogenic microbial signatures and the development of obesity in childhood acute lymphoblastic leukemia. Leuk Res 2023; 126:107017. [PMID: 36641874 DOI: 10.1016/j.leukres.2023.107017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/28/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Childhood acute lymphoblastic leukemia (ALL) is the most common childhood cancer with survival exceeding 90% for standard-risk groups. A debilitating side-effect of treatment is the development of overweight/obesity (OW/OB), which develops in approximately 40% of children by the end of treatment. The microbiome has been associated with the development of OW/OB. We examined fluctuations in the microbiome with the development of OW/OB during the first six months of treatment at diagnosis, and two subsequent timepoints (N = 62). Shotgun metagenomic sequencing was performed on Illumina Nextseq system, and taxa and functional pathways were extracted from sequences using kraken2 and humann2, respectively. An association of increased presence of several species (e.g., Klebsiella pneumoniae, Escherichia coli) was observed in children with OW/OB, while lean-promoting species (Veillonella, Haemophilus, and Akkermansia) were increased in children who maintained a normal weight. Pathway analysis revealed purine nucleotide biosynthesis, sugar nucleotide biosynthesis, and enzyme cofactor biosynthesis were positively correlated with Bacteroides spp. among children with OW/OB. We identified several taxa and functional pathways that may confer increased risk for the development of OW/OB. The associations observed in this pilot are preliminary and warrant further research in the microbiome and the development of OW/OB in childhood ALL.
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Affiliation(s)
- Heekuk Park
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA; Microbiome and Pathogen Genomics Collaborative Center, Columbia University, New York, NY, USA
| | - A C Uhlemann
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA; Microbiome and Pathogen Genomics Collaborative Center, Columbia University, New York, NY, USA
| | - S S Jacobs
- Division of Oncology, Children's National Medical Center, Washington, DC, USA
| | - C Mowbray
- Division of Oncology, Children's National Medical Center, Washington, DC, USA
| | - T Jubelirer
- Children's Hospital of Philadelphia, Division of Oncology and Center for Childhood Cancer Research, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Philadelphia, PA, USA
| | - K M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - M Walters
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY, USA
| | - E J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY, USA; Institute of Human Nutrition, Columbia University, New York, NY, USA.
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Bouchard EG, Prince MA, McCarty C, Vincent PC, Patel H, LaValley SA, Collins RL, Sahler OJZ, Krenz T, Kelly KM. Understanding social network support, composition, and structure among cancer caregivers. Psychooncology 2023; 32:408-417. [PMID: 36588195 PMCID: PMC10520919 DOI: 10.1002/pon.6087] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We examined the social network support, composition, and structure of pediatric cancer caregivers. METHODS We used a self-report survey to collect egocentric social network data from 107 caregivers of pediatric cancer patients and calculated descriptive statistics to examine cancer-related support network composition, function, and structure. We then ran logistic regressions to examine the relationships between network characteristics and overall satisfaction with social support. RESULTS Family members were the most common source of emotional support and logistical support, and health care providers were the most common source of informational support. Participants perceived the "most helpful" forms of support as being: (1) emotional support from family and health care providers; (2) informational support from health care providers and other cancer caregivers; and (3) logistical support from family. Overall, caregivers wished that 9.8% of their network ties had provided more support, with family members being the most common alter type to disappoint caregivers and offer less support than needed/expected. Caregivers who reported higher network disappointment (having network members who offered less support than needed/expected) were significantly less satisfied with emotional support than those with lower network disappointment (Odds Ratio = 0.18, p = 0.02), and caregivers with higher network disappointment were significantly less satisfied with logistical support compared to those with lower network disappointment (Odds Ratio = 0.14, p = 0.01). CONCLUSION Our results show differences in the nature of social support provided by different types of network members. These findings have implications for tailoring social network interventions to improve caregiver and family outcomes.
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Affiliation(s)
- Elizabeth G. Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | | | - Paula C. Vincent
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Hital Patel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Susan A. LaValley
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | | | - Till Krenz
- UHealth Information Technology, Sylvester Comprehensive Cancer Center
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center
- Department of Pediatrics, University at Buffalo
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Hoppe BS, McCarten KM, Pei Q, Kessel S, Alazraki A, Mhlanga JC, Lai HA, Eutsler E, Hodgson DC, Roberts KB, Charpentier AM, Keller FG, Voss SD, Wu Y, Cho SY, Kelly KM, Castellino SM. Importance of Central Imaging Review in a Pediatric Hodgkin Lymphoma Trial Using PET Response-Adapted Radiotherapy. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00164-5. [PMID: 36868525 PMCID: PMC10363760 DOI: 10.1016/j.ijrobp.2023.02.020] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE We investigated the impact of central review of the interim fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan response (iPET) assessment on treatment allocation on the risk-based, response-adapted, Children's Oncology Group study AHOD1331 (ClinicalTrials.gov: NCT02166463) for pediatric patients with high-risk Hodgkin lymphoma. METHODS AND MATERIALS Per protocol, after 2 cycles of systemic therapy, patients underwent iPET, with visual response assessment by 5-point Deauville score (DS) at their treating institution and a real-time central review, with the latter considered the reference standard. An area of disease with a DS of 1 to 3 was considered a rapid-responding lesion (RRL), whereas a DS of 4 to 5 was considered a slow-responding lesion (SRL). Patients with 1 or more SRLs were considered iPET positive, whereas patients with only RRLs were considered iPET negative. We conducted a predefined exploratory evaluation of concordance in iPET response assessment between institutional and central reviews of 573 patients. The concordance rate was evaluated by using the Cohen kappa statistic (κ; a κ >0.80 was considered very good agreement; >0.60-0.80, good agreement). RESULTS The concordance rate (514/573 [89.7%]) had a κ of 0.685 (95% CI, 0.610-0.759), consistent with "good" agreement. In terms of the direction of discordance, among the 126 patients who were considered iPET positive by institutional review, 38 (30.2%) were categorized as iPET negative by central review, preventing overtreatment with radiotherapy. Conversely, among the 447 patients who were considered iPET negative by institutional review, 21 patients (4.7%) were categorized as iPET positive by the central review and would have been undertreated without radiotherapy. CONCLUSIONS Central review is integral to PET response-adapted clinical trials for children with Hodgkin lymphoma. Continued support of central imaging review and education on DS is needed.
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Affiliation(s)
- Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
| | - Kathleen M McCarten
- Pediatric Radiology, Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | - Qinglin Pei
- Children's Oncology Group Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Sandy Kessel
- Pediatric Radiology, Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | - Adina Alazraki
- Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta-Egleston Hospital, Decatur, Georgia
| | - Joyce C Mhlanga
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Hollie A Lai
- Department of Radiology, Children's Health of Orange County, Orange, California
| | - Eric Eutsler
- Department of Radiology, Progressive Physician Associates, Bethlehem, Pennsylvania
| | - David C Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth B Roberts
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut
| | - Anne-Marie Charpentier
- Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Frank G Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Stephan D Voss
- Department of Radiology, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | - Yue Wu
- Children's Oncology Group Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Steve Y Cho
- Department of Radiology, Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, Wisconsin
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo, Buffalo, New York
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
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Cole PD, Kim SY, Li Y, Schembri A, Kelly KM, Sulis ML, Vrooman L, Welch JJG, Ramjan S, Silverman LB, Sands SA. Feasibility of serial neurocognitive assessment using Cogstate during and after therapy for childhood leukemia. Support Care Cancer 2023; 31:109. [PMID: 36625831 DOI: 10.1007/s00520-022-07566-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Neurocognitive impairment is frequently observed among survivors of childhood acute lymphoblastic leukemia (ALL) within the domains of attention, working memory, processing speed, executive functioning, and learning and memory. However, few studies have characterized the trajectory of treatment-induced changes in neurocognitive function beginning in the first months of treatment, to test whether early changes predict impairment among survivors. If correct, we hypothesize that those children who are most susceptible to early impairment would be ideal subjects for clinical trials testing interventions designed to protect against treatment-related neurocognitive decline. METHODS In this pilot study, we prospectively assessed neurocognitive functioning (attention, working memory, executive function, visual learning, and processing speed), using the Cogstate computerized battery at six time points during the 2 years of chemotherapy treatment and 1-year post-treatment (Dana-Farber Cancer Institute ALL Consortium protocol 11-001; NCT01574274). RESULTS Forty-three patients with ALL consented to serial neurocognitive testing. Of the 31 participants who remained on study through the final time point, 1 year after completion of chemotherapy, 28 (90%) completed at least five of six planned Cogstate testing time points. Performance and completion checks indicated a high tolerability (≥ 88%) for all subtests. One year after completion of treatment, 10 of 29 patients (34%) exhibited neurocognitive function more than 2 standard deviations below age-matched norms on one or more Cogstate subtests. CONCLUSIONS Serial collection of neurocognitive data (within a month of diagnosis with ALL, during therapy, and 1-year post-treatment) is feasible and can be informative for evaluating treatment-related neurocognitive impairment.
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Affiliation(s)
- Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Soo Young Kim
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA
| | - Yuelin Li
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA
| | | | - Kara M Kelly
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maria-Luisa Sulis
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA
| | - Lynda Vrooman
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jennifer J G Welch
- Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sameera Ramjan
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA
| | - Lewis B Silverman
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Stephen A Sands
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.
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28
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Kahn JM, Stevenson K, Beauchemin M, Koch VB, Cole PD, Welch JJG, Gage-Bouchard E, Karsenty C, Silverman LB, Kelly KM, Bona K. Oral Mercaptopurine Adherence in Pediatric Acute Lymphoblastic Leukemia: A Survey Study From the Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium. J Pediatr Hematol Oncol Nurs 2023; 40:17-23. [PMID: 36221984 PMCID: PMC9982234 DOI: 10.1177/27527530221122685] [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] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Oral chemotherapy nonadherence is a challenge in clinical oncology. During therapy for acute lymphoblastic leukemia (ALL), poor adherence to 6-mercaptopurine (6MP) increases relapse risk. Clinically significant nonadherence is reported in 30% of children treated for ALL on Children's Oncology Group (COG) trials. Whether nonadherence rates vary across regimens with different treatment schedules and modes of administration is unknown. Methods: We conducted an exploratory, cross-sectional survey study on parents of children (1-18 years) receiving continuation therapy on, or as per Dana-Farber Cancer Institute (DFCI) ALL Consortium Protocol 11-001. Treatment required weekly visits to the clinic and 14 days of oral 6MP every 3 weeks. Survey assessed self-reported sociodemographics, medication-taking, chemotherapy comprehension, and 6MP adherence; adherence survey items were developed from published surveys. Patients were grouped as nonadherent if they endorsed missing one 6MP dose during the last cycle, or more than one dose during prior cycles, for nonmedical reasons. Results: Sixty-two families completed the surveys, all of whom had evaluable adherence data. In total, 25% of patients met the study definition of nonadherence. Twenty-three percent reported that it was "not easy" to follow administration guidelines around the dairy intake and 57% requested more teaching and educational resources. Conclusion: Self-reported nonadherence to oral 6MP in the DFCI ALL Consortium is high, with rates similar to those observed in the COG. This suggests that the additional contact during weekly infusions on the DFCI is insufficient to address barriers affecting oral chemotherapy adherence.
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Affiliation(s)
- Justine M. Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell
Transplantation, Columbia University Irving Medical
Center, New York, NY, USA
| | - Kristen Stevenson
- Department of Biostatistics and
Computational Biology, Dana-Farber Cancer Institute, Harvard Medical
School, Boston, MA, USA
| | - Melissa Beauchemin
- Division of Pediatric Hematology, Oncology and Stem Cell
Transplantation, Columbia University Irving Medical
Center, New York, NY, USA
- Columbia University School of Nursing, New York, NY, USA
| | - Victoria B. Koch
- Department of Pediatric Oncology,
Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter D. Cole
- Rutgers Cancer Institute of New
Jersey, New Brunswick, NJ, USA
| | - Jennifer J. G. Welch
- Pediatric Hematology Oncology, Hasbro Children’s Hospital/Brown University, Providence, RI, USA
| | - Elizabeth Gage-Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer
Center, Buffalo, NY, USA
| | - Cecile Karsenty
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,
USA
- Texas Children’s Cancer and Hematology
Centers, Texas Children’s Hospital, Houston, TX, USA
| | - Lewis B. Silverman
- Department of Pediatric Oncology,
Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kara M. Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer
Center, Buffalo, NY, USA
| | - Kira Bona
- Department of Pediatric Oncology,
Dana-Farber Cancer Institute, Boston, MA, USA
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Castellino SM, Pei Q, Parsons SK, Hodgson D, McCarten K, Horton T, Cho S, Wu Y, Punnett A, Dave H, Henderson TO, Hoppe BS, Charpentier AM, Keller FG, Kelly KM. Brentuximab Vedotin with Chemotherapy in Pediatric High-Risk Hodgkin's Lymphoma. N Engl J Med 2022; 387:1649-1660. [PMID: 36322844 PMCID: PMC9945772 DOI: 10.1056/nejmoa2206660] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [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: 11/05/2022]
Abstract
BACKGROUND In adults with advanced-stage Hodgkin's lymphoma, the CD30-directed antibody-drug conjugate brentuximab vedotin combined with multiagent chemotherapy has been shown to have greater efficacy, but also more toxic effects, than chemotherapy alone. The efficacy of this targeted therapy approach in children and adolescents with Hodgkin's lymphoma is unclear. METHODS We conducted an open-label, multicenter, randomized, phase 3 trial involving patients 2 to 21 years of age with previously untreated Hodgkin's lymphoma of stage IIB with bulk tumor or stage IIIB, IVA, or IVB. Patients were assigned to receive five 21-day cycles of brentuximab vedotin with doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide (brentuximab vedotin group) or the standard pediatric regimen of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (standard-care group). Slow-responding lesions, defined by a score of 4 or 5 (on a 5-point scale, with scores of 1 to 3 indicating rapid-responding lesions), were identified on centrally reviewed positron-emission tomography-computed tomography after two cycles. Involved-site radiation therapy was administered after the fifth cycle of therapy to slow-responding lesions and to large mediastinal adenopathy that was present at diagnosis. The primary end point was event-free survival, defined as the time until disease progression occurred, relapse occurred, a second malignant neoplasm developed, or the patient died. Safety and overall survival were assessed. RESULTS Of 600 patients who were enrolled across 153 institutions, 587 were eligible. At a median follow-up of 42.1 months (range, 0.1 to 80.9), the 3-year event-free survival was 92.1% (95% confidence interval [CI], 88.4 to 94.7) in the brentuximab vedotin group, as compared with 82.5% (95% CI, 77.4 to 86.5) in the standard-care group (hazard ratio for event or death, 0.41; 95% CI, 0.25 to 0.67; P<0.001). The percentage of patients who received involved-site radiation therapy did not differ substantially between the brentuximab vedotin group and the standard-care group (53.4% and 56.8%, respectively). Toxic effects were similar in the two groups. Overall survival at 3 years was 99.3% (95% CI, 97.3 to 99.8) in the brentuximab vedotin group and 98.5% (95% CI, 96.0 to 99.4) in the standard-care group. CONCLUSIONS The addition of brentuximab vedotin to standard chemotherapy resulted in superior efficacy, with a 59% lower risk of an event or death, and no increase in the incidence of toxic effects at 3 years. (Funded by the National Institutes of Health and others; AHOD1331 ClinicalTrials.gov number, NCT02166463.).
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Affiliation(s)
- Sharon M Castellino
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Qinglin Pei
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Susan K Parsons
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - David Hodgson
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Kathleen McCarten
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Terzah Horton
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Steve Cho
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Yue Wu
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Angela Punnett
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Hema Dave
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Tara O Henderson
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Bradford S Hoppe
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Anne-Marie Charpentier
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Frank G Keller
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Kara M Kelly
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
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Aziz-Bose R, Zheng DJ, Umaretiya PJ, Ilcisin L, Stevenson K, Koch V, Valenzuela A, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Tran TH, Michon B, Welch JJG, Silverman LB, Wolfe J, Bona K. Feasibility of oncology clinical trial-embedded evaluation of social determinants of health. Pediatr Blood Cancer 2022; 69:e29933. [PMID: 36069432 DOI: 10.1002/pbc.29933] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/06/2022]
Abstract
Social determinants of health (SDoH) are associated with stark disparities in cancer outcomes, but systematic SDoH data collection is virtually absent from oncology clinical trials. Trial-based SDoH data are essential to ensure representation of marginalized populations, contextualize outcome disparities, and identify health-equity intervention opportunities. We report the feasibility of a pediatric oncology multicenter therapeutic trial-embedded SDoH investigation. Among 448 trial participants, 392 (87.5%) opted-in to the embedded SDoH study; 375 (95.7%) completed baseline surveys, with high longitudinal response rates (88.9-93.1%) over 24 months. Trial-embedded SDoH data collection is feasible and acceptable and must be consistently included within future oncology trials.
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Affiliation(s)
- Rahela Aziz-Bose
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Zheng
- Divisions of Hematology and Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristen Stevenson
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Victoria Koch
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ariana Valenzuela
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Peter D Cole
- Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Lisa M Gennarini
- Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Montefiore Medical Center, Bronx, New York, USA
| | - Justine M Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Thai-Hoa Tran
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada
| | - Bruno Michon
- Department of Pediatrics, Centre Hospitalier Universitaire de Quebec, Saint-Foy, QC, Canada
| | - Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children's Hospital/Brown University, Providence, Rhode Island, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Joanne Wolfe
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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31
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Bouchard EG, Collins RL, Vincent PC, Patel H, Sahler OJZ, McCarty C, Prince MA, Kelly KM. An initial investigation of using smartphone-enabled micro-temporal data collection to increase acceptability, feasibility, and validity of research on cancer caregiving. Pediatr Blood Cancer 2022; 69:e29886. [PMID: 35869890 PMCID: PMC10273258 DOI: 10.1002/pbc.29886] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Smartphone-enabled micro-temporal data collection has potential to increase reliability, validity, and feasibility of participant-reported data and is a promising strategy for pediatric oncology supportive care and quality-of-life research. Given the demands of pediatric cancer caregiving, we sought to understand the feasibility and acceptability of smartphone data collection that included short surveys administered daily for 14 days via text message link. METHODS We recruited pediatric cancer caregivers, whose children (ages 0-18 years) were on active treatment, to complete a 14-day daily survey study via smartphone. We implemented our study procedures and examined feasibility through study enrollment rates, reasons for refusal, retention rates, number of reminders and number of completed surveys. We examined acceptability using caregiver ratings of survey length, burden, and ease of completion on a smartphone. RESULTS We recruited (N = 75) caregivers to the study and had an 84% enrollment rate. Reasons for declining participation included passive refusal (n = 13) and too busy (n = 1). The participant retention rate was 100% and compliance with daily survey completion was 99%. Most surveys were completed following two prompts and took participants 5 minutes or less to complete. Caregivers rated the surveys as easy to complete, low burden, and just right in length. CONCLUSION A daily self-report, using a brief (≤5 minutes) survey administered on a smartphone via text message prompt, is a feasible and acceptable method. Future research should extend these findings to understand the generalizability across pediatric cancer caregiving contexts.
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Affiliation(s)
- Elizabeth G. Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | - Paula C. Vincent
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Hital Patel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | | | | | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Parekh A, Keller FG, McCarten KM, Kessel S, Cho S, Pei Q, Wu Y, Castellino SM, Constine LS, Schwartz CL, Hodgson D, Kelly KM, Hoppe BS. Targeted radiotherapy for early-stage, low-risk pediatric Hodgkin lymphoma slow early responders: a COG AHOD0431 analysis. Blood 2022; 140:1086-1093. [PMID: 35763667 PMCID: PMC9461469 DOI: 10.1182/blood.2022016098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/01/2022] [Accepted: 06/12/2022] [Indexed: 11/20/2022] Open
Abstract
Children's Oncology Group (COG) trial AHOD0431 reduced systemic therapy and used response-adapted involved-field radiotherapy (IFRT) in early-stage pediatric classic Hodgkin lymphoma. We investigated the impact of positron emission tomographic response after 1 cycle (PET1) and on IFRT outcomes and pattern of relapse. Patients in AHOD0431 underwent PET1 response assessment after AVPC (doxorubicin, vincristine, prednisone, and cyclophosphamide). "Rapid early responders" (RERs) had a negative PET1 (PET1-); "slow early responders" (SERs) had a positive PET1 (PET1+). Patients with a partial response by computed tomographic and functional imaging after 3 chemotherapy cycles received 21-Gy IFRT, whereas complete responders had no IFRT. Progression-free survival (PFS) was evaluated for RERs and SERs treated with or without IFRT. Recurrence sites were initial, new, or both. Relapses involving initial sites were characterized as "within the PET1+ site" or "initially involved but outside the PET1+ site." Median follow-up was 118 months. The 10-year PFS rate among RERs was 96.6% with IFRT and 84.1% without IFRT (P = .10), whereas SERs were 80.9% with IFRT and 64.0% without IFRT (P = .03). Among 90 RERs who did not receive IFRT, all 14 relapses included an initial site. Among 45 SERs receiving no IFRT, 14 of 16 relapses were in the initial site (9 PET1+ site only). Among 58 patients receiving IFRT, 5 of 10 relapses were in the PET1+ site. After 3 cycles of AVPC alone, RERs showed favorable results. Conversely, SERs had unfavorable outcomes with AVPC alone, although they improved with 21-Gy IFRT. RT remains an important component of treatment for SERs. This trial was registered at www.clinicaltrials.gov as #NCT00302003.
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Affiliation(s)
- Akash Parekh
- Department of Radiation Oncology, University of Florida, Gainesville, FL
| | - Frank G Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | | | - Sandy Kessel
- Imaging and Radiation Oncology Core, Lincoln, RI
| | - Steve Cho
- Nuclear Medicine Section, Department of Radiobiology, University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI
| | - Qinglin Pei
- Department of Biostatistics, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL
| | - Yue Wu
- Department of Biostatistics, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Cindy L Schwartz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; and
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Bouchard EG, Epstein LH, Patel H, Vincent PC, LaValley SA, Devonish JA, Wadium J, Wen X, Kelly KM. Behavioral parenting skills as a novel target for improving medication adherence in young children: Feasibility and acceptability of the CareMeds intervention. Pediatr Hematol Oncol 2022; 39:529-539. [PMID: 35139726 PMCID: PMC9363525 DOI: 10.1080/08880018.2022.2025964] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
In pediatric cancer care, medication non-adherence is a significant driver of avoidable suffering and death. There is a lack of interventions designed for families of young children, where patient medication refusal/avoidance is a common barrier to adherence. We developed the CareMeds intervention which focuses on caregiver skills training to help young children take medicine calmly and without use of restraint techniques. The goal of this preliminary study was to assess the acceptability and feasibility of the CareMeds intervention. Caregivers of pediatric cancer patients (ages 2-10) whose children were on a home-based oral medication regimen were recruited to participate. Feasibility was examined through study enrollment and retention rates as well as reasons for refusal and drop out. Acceptability was evaluated through usability of and engagement with intervention components and an acceptability questionnaire. Feasibility: We recruited N = 9 caregivers to participate in this intervention pilot study and had a 75% enrollment rate. Reasons for declining included scheduling concerns (n = 2) and lack of interest (n = 1). The participant retention rate was 100% with 100% adherence to intervention sessions. Acceptability: Parents rated the sessions and resource materials as acceptable and reported frequent use of skills taught in the intervention. The CareMeds intervention is an acceptable and feasible strategy for caregivers of pediatric cancer patients and warrants future research to examine the efficacy of behavioral parenting skills interventions to improve medication adherence in young children.
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Affiliation(s)
- Elizabeth G. Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | - Hital Patel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Paula C. Vincent
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Susan A. LaValley
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Julia A. Devonish
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
- Department of Medicine, Division of General Internal Medicine, University at Buffalo
| | | | - Xiaozhong Wen
- Division of Behavioral Medicine, University at Buffalo
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center
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Athale UH, Flamand Y, Blonquist T, Stevenson KE, Spira M, Asselin BL, Clavell LA, Cole PD, Kelly KM, Laverdiere C, Leclerc JM, Michon B, Schorin MA, Welch JJG, Harris MH, Neuberg DS, Sallan SE, Silverman LB. Predictors of thrombosis in children receiving therapy for acute lymphoblastic leukemia: Results from Dana-Farber Cancer Institute ALL Consortium trial 05-001. Pediatr Blood Cancer 2022; 69:e29581. [PMID: 35316569 DOI: 10.1002/pbc.29581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Although thromboembolism (TE) is a serious complication in patients with acute lymphoblastic leukemia (ALL), thromboprophylaxis is not commonly used due to the inherent bleeding risk in this population. Identifying prothrombotic risk factors will help target thromboprophylaxis to those at highest thrombotic risk. We aimed to define predictors and the impact of TE on ALL outcome in children (1-18 years) treated on the Dana-Farber Cancer Institute ALL 05-001 trial. METHODS Clinical and laboratory data including TE events were prospectively collected. PCR-based allelic discrimination assay identified single-nucleotide polymorphisms (SNP) for prothrombin G20210A (rs1799963) and Factor V G1691A (rs6025). Univariate and multivariable competing risk regression models evaluated the effect of diagnostic clinical (age, sex, body mass index, ALL-immunophenotype, risk group) and laboratory variables (presenting leukocyte count, blood group, SNPs) on the cumulative incidence of TE. Cox regression modeling explored the impact of TE on survival. RESULTS Of 794 patients [median age 4.97 (range, 1.04-17.96) years; males 441], 100 developed TE; 25-month cumulative incidence 13.0% (95% CI, 10.7%-15.5%). Univariate analyses identified older age (≥10 years), presenting leucocyte count, T-ALL, high-risk ALL, and non-O blood group as risk factors. Age and non-O blood group were independent predictors of TE on multivariable regression; the blood group impact being most evident in patients 1-5 years of age (P = 0.011). TE did not impact survival. Induction TE was independently associated with induction failure (OR 6.45; 95% CI, 1.64-25.47; P = 0.008). CONCLUSION We recommend further evaluation of these risk factors and consideration of thromboprophylaxis for patients ≥10 years (especially those ≥15 years) when receiving asparaginase.
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Affiliation(s)
- Uma H Athale
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Yael Flamand
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Traci Blonquist
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kristen E Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Menachem Spira
- Department of Pediatrics, New York-Presbyterian Hospital, New York, New York
| | - Barbara L Asselin
- Department of Pediatrics, University of Rochester Medical Center and School of Medicine, Rochester, New York
| | | | - Peter D Cole
- Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kara M Kelly
- Roswell Park Comprehensive Cancer Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Caroline Laverdiere
- Hematology-Oncology Division, Charles Bruneau Cancer Center, Sainte-Justine University Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Jean-Marie Leclerc
- Hematology-Oncology Division, Charles Bruneau Cancer Center, Sainte-Justine University Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Sainte-Foy, Quebec, Canada
| | | | - Jennifer J G Welch
- Pediatric Hematology Oncology, Hasbro Children's Hospital/Brown University, Providence, Rhode Island
| | - Marian H Harris
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Donna S Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephen E Sallan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts
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Lo AC, Major A, Super L, Appel B, Shankar A, Constine LS, Marks LJ, Kelly KM, Metzger ML, Buhtoiarov IN, Mauz-Körholz C, Costa ARS, Binkley MS, Flerlage J. Practice patterns for the management of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL): an international survey by the Global NLPHL One Working Group (GLOW). Leuk Lymphoma 2022; 63:1997-2000. [PMID: 35357263 DOI: 10.1080/10428194.2022.2053533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Andrea C Lo
- Radiation Oncology, BC Cancer, Vancouver, Canada
- Surgery, University of British Columbia, Vancouver, Canada
| | - Ajay Major
- The University of Chicago Medical Center, Chicago, IL, USA
| | - Leanne Super
- Children's Cancer Centre, Monash Children's Hospital, Melbourne, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
- Pediatrics, Monash University, Melbourne, Australia
| | - Burton Appel
- Pediatric Hematology-Oncology, Joseph M. Sanzari Children's Hospital, Hackensack, NJ, USA
| | - Ananth Shankar
- Child and Young People's Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Louis S Constine
- Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
- Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Lianna J Marks
- Pediatric Hematology, Oncology, and Stem Cell Transplantation, Stanford University School of Medicine, Stanford, CA, USA
| | - Kara M Kelly
- Pediatric Hematology/Oncology, Roswell Park Comprehensive Cancer Center, University at Buffalo, Buffalo, NY, USA
| | - Monika L Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ilia N Buhtoiarov
- Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Christine Mauz-Körholz
- Pediatric Hematology and Oncology, Justus-Liebig-University of Giessen, Gießen, Germany
- Medical Faculty of the Martin-Luther University of Halle-Wittenberg, Halle, Germany
| | - Ana Rosa S Costa
- HematoOnco Pediatra, Hospital de Câncer Infantojuvenil de Barretos, Barretos, Brazil
| | - Michael S Binkley
- Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jamie Flerlage
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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36
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Buhtoiarov IN, Mba NI, Santos CD, McCarten KM, Metzger ML, Pei Q, Rizvan Bush R, Kayla Baker K, Kelly KM, Cole PD. Durable remission for four pediatric patients with high-risk relapsed classical Hodgkin lymphoma treated with brentuximab vedotin plus gemcitabine but without autologous stem cell transplantation: A report from the Children's Oncology Group. Pediatr Blood Cancer 2022; 69:e29649. [PMID: 35338689 PMCID: PMC9465975 DOI: 10.1002/pbc.29649] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 11/07/2022]
Abstract
Patients with therapy-refractory or high-risk relapsed classical Hodgkin lymphoma are typically treated with the high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) to consolidate the response to salvage therapy. The combination of brentuximab vedotin with gemcitabine has recently been shown to be an effective and safe salvage regimen. While the majority of patients with complete responses to this regimen ultimately underwent HDC/ASCT consolidation, four subjects, reported herein, achieved durable complete remissions lasting more than 4 years after the study treatment but without ASCT consolidation. Further investigation of treatment strategies incorporating targeted agents may allow omission of HDC/ASCT for select patients.
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Affiliation(s)
- Ilia N. Buhtoiarov
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children’s, Cleveland, OH
| | - Nkechi I. Mba
- Department of Pediatric Hematology and Oncology, Driscoll Children’s Hospital, Corpus Christi, TX
| | - Crystal D.L. Santos
- Department of Pediatric Hematology and Oncology, Driscoll Children’s Hospital, Corpus Christi, TX
| | | | - Monika L. Metzger
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Qinglin Pei
- Children’s Oncology Group, Department of Biostatistics; University of Florida, Gainesville, FL
| | | | - K Kayla Baker
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Peter D. Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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37
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Parikh RR, Kelly KM, Hodgson DC, Hoppe BS, McCarten KM, Karolczuk K, Pei Q, Wu Y, Cho SY, Schwartz C, Cole PD, Roberts K. Patterns of Initial Relapse from a Phase 3 Study of Response-Based Therapy for High-Risk Hodgkin Lymphoma (AHOD0831): A Report from the Children's Oncology Group. Int J Radiat Oncol Biol Phys 2022; 112:890-900. [PMID: 34767937 PMCID: PMC9038118 DOI: 10.1016/j.ijrobp.2021.10.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE The Children's Oncology Group protocol AHOD0831, for pediatric patients with high-risk classical Hodgkin lymphoma (cHL), used response-adapted radiation fields, rather than larger involved-field radiation therapy (IFRT) that were historically used. This retrospective analysis of patterns of relapse among patients enrolled in the study was conducted to study the potential effect of a reduction in RT exposure. METHODS AND MATERIALS From December 2009 to January 2012, 164 eligible patients under 22 years old with stage IIIB (43%) and stage IVB (57%) enrolled on AHOD0831. All patients received 4 cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC). Those patients with a slow early response (SER) after the first 2 ABVE-PC courses were nonrandomly assigned to 2 intensification cycles with ifosfamide/vinorelbine before the final 2 ABVE-PC cycles. Response-adapted RT (21 Gy) was prescribed to initial areas of bulky disease and SER sites. Rapid early response (RER) sites without bulk were not targeted. Imaging studies at the time of progression or relapse were reviewed centrally for this retrospective analysis. Relapses were characterized with respect to site (initial, new, or both; and initial bulk or initial nonbulk), initial chemotherapy response, and radiation field (in-field, out-of-field, or both). RESULTS Of the entire cohort, 140 patients were evaluable for the patterns of failure analyses. To investigate the pattern of failure, this analysis focuses on 23 patients who followed protocol treatment and suffered relapses at a median 1.05 years with 7.97-year median follow-up time. These 23 patients (11 RER and 12 SER) experienced a relapse in 105 total sites (median, 4; range, 1-11). Of the 105 relapsed sites, 67 sites (64%) occurred within an initial site of involvement, with 12 of these 67 sites (18%) at an initial site of bulky disease and 63 of these 67 relapses (94%) occurring in sites that were not fluorodeoxyglucose (FDG)-avid after 2 cycles of ABVE-PC (PET2-negative). Of the 105 relapsed sites, 34 sites (32%) occurred in a new site of disease (that would not have been covered by RT); and, overall, only 4 of 140 patients (2.8%) (occurring in 3 RER and 1 SER) experienced isolated out-of-field relapses that would have been covered by historical IFRT. CONCLUSIONS For a cohort of high-risk patients with cHL patients, most failures occurred in nonbulky, initially involved sites, largely due to response-based consolidation RT delivered to patients with bulky disease. In this analysis, we discovered low rates of failures outside of these modern risk-adapted radiation treatment volumes. Also, FDG uptake on PET2 did not identify most relapse sites.
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Affiliation(s)
- Rahul R Parikh
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, New Jersey.
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - David C Hodgson
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Kathleen M McCarten
- Imaging and Radiation Oncology Core Group Rhode Island (IROC-RI). Lincoln, Rhode Island
| | - Katie Karolczuk
- Imaging and Radiation Oncology Core Group Rhode Island (IROC-RI). Lincoln, Rhode Island
| | - Qinglin Pei
- Department of Biostatistics, University of Florida, Children's Oncology Group, Statistics and Data Center, Gainesville, Florida
| | - Yue Wu
- Department of Biostatistics, University of Florida, Children's Oncology Group, Statistics and Data Center, Gainesville, Florida
| | - Steve Y Cho
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Cindy Schwartz
- Division of Pediatric Hematology, Oncology and BMT, Medical College of Wisconsin Milwaukee, Wisconsin
| | - Peter D Cole
- Division of Pediatric Hematology/Oncology, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Kenneth Roberts
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut
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38
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Johnston RL, Mottok A, Chan FC, Jiang A, Diepstra A, Visser L, Telenius A, Gascoyne RD, Friedman DL, Schwartz CL, Kelly KM, Scott DW, Horton TM, Steidl C. A gene expression-based model predicts outcome in children with intermediate-risk classical Hodgkin lymphoma. Blood 2022; 139:889-893. [PMID: 34662378 PMCID: PMC8832480 DOI: 10.1182/blood.2021011941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/31/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
Abstract
Classical Hodgkin lymphoma (cHL) is a common malignancy in children and adolescents. Although cHL is highly curable, treatment with chemotherapy and radiation often come at the cost of long-term toxicity and morbidity. Effective risk-stratification tools are needed to tailor therapy. Here, we used gene expression profiling (GEP) to investigate tumor microenvironment (TME) biology, to determine molecular correlates of treatment failure, and to develop an outcome model prognostic for pediatric cHL. A total of 246 formalin-fixed, paraffin-embedded tissue biopsies from patients enrolled in the Children's Oncology Group trial AHOD0031 were used for GEP and compared with adult cHL data. Eosinophil, B-cell, and mast cell signatures were enriched in children, whereas macrophage and stromal signatures were more prominent in adults. Concordantly, a previously published model for overall survival prediction in adult cHL did not validate in pediatric cHL. Therefore, we developed a 9-cellular component model reflecting TME composition to predict event-free survival (EFS). In an independent validation cohort, we observed a significant difference in weighted 5-year EFS between high-risk and low-risk groups (75.2% vs 90.3%; log-rank P = .0138) independent of interim response, stage, fever, and albumin. We demonstrate unique disease biology in children and adolescents that can be harnessed for risk-stratification at diagnosis. This trial was registered at www.clinicaltrials.gov as #NCT00025259.
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Affiliation(s)
- Rebecca L Johnston
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
- Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Anja Mottok
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Institute of Pathology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Fong Chun Chan
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Aixiang Jiang
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Arjan Diepstra
- Department of Pathology & Medical Biology, University of Groningen, Groningen, The Netherlands
| | - Lydia Visser
- Department of Pathology & Medical Biology, University of Groningen, Groningen, The Netherlands
| | - Adèle Telenius
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Randy D Gascoyne
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Debra L Friedman
- Department of Pediatrics, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Cindy L Schwartz
- Pediatric Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY; and
| | - David W Scott
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Terzah M Horton
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX
| | - Christian Steidl
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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39
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Kahn JM, Pei Q, Friedman DL, Kaplan J, Keller FG, Hodgson D, Wu Y, Appel BE, Bhatia S, Henderson TO, Schwartz CL, Kelly KM, Castellino SM. Survival by age in paediatric and adolescent patients with Hodgkin lymphoma: a retrospective pooled analysis of children's oncology group trials. Lancet Haematol 2022; 9:e49-e57. [PMID: 34971582 PMCID: PMC8815096 DOI: 10.1016/s2352-3026(21)00349-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 09/20/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adolescents with Hodgkin lymphoma have worse disease outcomes than children. Whether these differences persist within clinical trials is unknown. We examined survival, by age, in patients receiving response-adapted therapy for Hodgkin lymphoma on Children's Oncology Group (COG) trials. METHODS Patients (aged 1-21 years) diagnosed with classical Hodgkin lymphoma and enrolled between Sept 23, 2002, and Jan 19, 2012, on one of three phase 3 COG trials in the USA and Canada were eligible for inclusion. The three COG trials were defined by risk group according to Ann Arbor stage, B-symptoms, and bulk (AHOD0431 [low risk; NCT00302003], AHOD0031 [intermediate risk; NCT00025259], or AHOD0831 [high risk; NCT01026220]). The outcomes of this study were event-free survival (death, relapse, or subsequent neoplasm) and overall survival. Cox proportional hazards models estimated survival, adjusting for disease and treatment factors both overall and in patients with mixed cellularity or non-mixed cellularity (nodular sclerosing and not-otherwise-specified) disease. FINDINGS Of 2155 patients enrolled on the three trials, 1907 (88·4%; 968 [50·8%] male and 939 [49·2%] female; 1227 [64·3%] non-Hispanic White) were included in this analysis. After a median follow-up of 7·4 years (IQR 4·3-10·2), older patients (aged ≥15 years) had worse unadjusted 5-year event-free survival (80% [95% CI 78-83]) than did younger patients (aged <15 years; 86% [83-88]; HR 1·38 [1·11-1·71]; p=0·0038). Older patients also had worse unadjusted 5-year overall survival than did younger patients (96% [95% CI 95-97] vs 99% [98-99]; HR 2·50 [1·41-4·45]; p=0·0012). In patients with non-mixed cellularity histology, older patients had a significantly increased risk of having an event than did younger patients with the same histology (HR 1·32 [1·03-1·68]; p=0·027). Older patients with mixed cellularity had significantly worse 5-year event-free survival than did younger patients in unadjusted (77% [95% CI 65-86] for older patients vs 94% [88-97] for younger patients; HR 2·93 [1·37-6·29]; p=0·0039) and multivariable models (HR 3·72 [1·56-8·91]; p=0·0032). Overall, older patients were more likely to die than younger patients (HR 3·08 [1·49-6·39]; p=0·0025). INTERPRETATION Adolescents (≥15 years) treated on COG Hodgkin lymphoma trials had worse event-free survival and increased risk of death compared with children (<15 years). Our findings highlight the need for prospective studies to examine tumour and host biology, and to test novel therapies across the age spectrum. FUNDING National Institutes of Health, St Baldrick's Foundation, and Lymphoma Research Foundation.
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Affiliation(s)
- Justine M Kahn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
| | - Qinglin Pei
- Department of Biostatistics, Children's Oncology Group Statistics & Data Center, Gainesville, FL, USA
| | - Debra L Friedman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics: Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Joel Kaplan
- Levine Children's Cancer & Blood Disorders, Carolinas Medical Center, Charlotte, NC, USA
| | - Frank G Keller
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - David Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Yue Wu
- Department of Biostatistics, Children's Oncology Group Statistics & Data Center, Gainesville, FL, USA
| | - Burton E Appel
- Children's Cancer Institute, Joseph M Sanzari Children's Hospital, Hackensack, NJ, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara O Henderson
- University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Cindy L Schwartz
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
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40
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Milgrom SA, Kim J, Chirindel A, Kim J, Pei Q, Chen L, Buxton A, Kessel S, Leal J, McCarten KM, Hoppe BS, Wolden SL, Schwartz CL, Friedman DL, Kelly KM, Cho SY. Prognostic value of baseline metabolic tumor volume in children and adolescents with intermediate-risk Hodgkin lymphoma treated with chemo-radiation therapy: FDG-PET parameter analysis in a subgroup from COG AHOD0031. Pediatr Blood Cancer 2021; 68:e29212. [PMID: 34245210 PMCID: PMC8809108 DOI: 10.1002/pbc.29212] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Positron emission tomography (PET)-based measures of baseline total-body tumor burden may improve risk stratification in intermediate-risk Hodgkin lymphoma (HL). MATERIALS AND METHODS Evaluable patients were identified from a cohort treated homogeneously with the same combined modality regimen on the Children's Oncology Group AHOD0031 study. Eligible patients had high-quality baseline PET scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were each measured based on 15 thresholds for every patient. Univariate and multivariable Cox regression and Kaplan-Meier survival analyses assessed for an association of MTV and TLG with event-free survival (EFS). RESULTS From the AHOD0031 cohort (n = 1712), 86 patients were identified who (i) were treated with four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide (ABVE-PC) chemotherapy followed by involved field radiotherapy, and (ii) had a baseline PET scan that was amenable to quantitative analysis. Based on univariate Cox regression analysis, six PET-derived parameters were significantly associated with EFS. For each of these, Kaplan-Meier analyses and the log-rank test were used to compare patients with highest tumor burden (i.e., highest 15%) to the remainder of the cohort. EFS was significantly associated with all six PET parameters (all p < .029). In a multivariable model controlling for important covariates including disease bulk and response to chemotherapy, MTV2BP was significantly associated with EFS (p = .012). CONCLUSION Multiple baseline PET-derived volumetric parameters were associated with EFS. MTV2BP was highly associated with EFS when controlling for disease bulk and response to chemotherapy. Incorporation of baseline MTV into risk-based treatment algorithms may improve outcomes in intermediate-risk HL.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado, USA
| | - Jihyun Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Alin Chirindel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jongho Kim
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qinglin Pei
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Lu Chen
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Allen Buxton
- Children's Oncology Group, Statistics and Data Center, Monrovia, California, USA
| | - Sandy Kessel
- Imaging and Radiation Oncology Core Group, Lincoln, Rhode Island, USA
| | - Jeffrey Leal
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cindy L Schwartz
- Division of Pediatric Hematology, Oncology, and BMT, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Debra L Friedman
- Division of Pediatric Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Steve Y Cho
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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41
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Vrooman LM, Blonquist TM, Stevenson KE, Supko JG, Hunt SK, Cronholm SM, Koch V, Kay-Green S, Athale UH, Clavell LA, Cole PD, Harris MH, Kelly KM, Laverdiere C, Leclerc JM, Michon B, Place AE, Schorin MA, Welch JJG, Neuberg DS, Sallan SE, Silverman LB. Efficacy and Toxicity of Pegaspargase and Calaspargase Pegol in Childhood Acute Lymphoblastic Leukemia: Results of DFCI 11-001. J Clin Oncol 2021; 39:3496-3505. [PMID: 34228505 DOI: 10.1200/jco.20.03692] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia (ALL) Consortium Protocol 11-001 assessed efficacy and toxicity of calaspargase pegol (calaspargase), a novel pegylated asparaginase formulation with longer half-life, compared with the standard formulation pegaspargase. METHODS Patients age 1 to ≤ 21 years with newly diagnosed ALL or lymphoblastic lymphoma were randomly assigned to intravenous pegaspargase or calaspargase, 2,500 IU/m2/dose. Patients received one induction dose. Beginning week 7, pegaspargase was administered every 2 week for 15 doses and calaspargase every 3 week for 10 doses (30 weeks). Serum asparaginase activity (SAA) (≥ 0.1 IU/mL considered therapeutic) was assessed 4, 11, 18, and 25 days after the induction dose and before each postinduction dose. RESULTS Between 2012 and 2015, 239 eligible patients enrolled (230 ALL, nine lymphoblastic lymphoma); 120 were assigned to pegaspargase and 119 to calaspargase. After the induction dose, SAA was ≥ 0.1 IU/mL in ≥ 95% of patients on both arms 18 days after dosing. At day 25, more patients had SAA ≥ 0.1 IU/mL with calaspargase (88% v 17%; P ˂ .001). Postinduction, median nadir SAAs were similar (≥ 1.0 IU/mL) for both arms. Of 230 evaluable patients, 99% of pegaspargase and 95% of calaspargase patients achieved complete remission (P = .12), with no difference in frequency of high end-induction minimal residual disease among evaluable patients with B acute lymphoblastic leukemia (B-ALL). There were no differences in frequencies of asparaginase allergy, pancreatitis, thrombosis, or hyperbilirubinemia. With 5.3 years median follow-up, 5-year event-free survival for pegaspargase was 84.9% (SE ± 3.4%) and 88.1% (± SE 3.0%) for calaspargase (P = .65). CONCLUSION Every 3-week calaspargase had similar nadir SAA, toxicity, and survival outcomes compared with every 2-week pegaspargase. The high nadir SAA observed for both preparations suggest dosing strategies can be further optimized.
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Affiliation(s)
- Lynda M Vrooman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School Boston, MA
| | - Traci M Blonquist
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | | | - Jeffrey G Supko
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Sarah K Hunt
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sarah M Cronholm
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Victoria Koch
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Samantha Kay-Green
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Uma H Athale
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, ON, Canada
| | - Luis A Clavell
- Division of Pediatric Oncology, San Jorge Children's Hospital, San Juan, Puerto Rico
| | - Peter D Cole
- Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Marian H Harris
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Cancer Institute and Oishei Children's Hospital, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Caroline Laverdiere
- Division of Hematology and Oncology, Hospital Sainte-Justine, University of Montreal, Montreal, Canada
| | - Jean-Marie Leclerc
- Division of Hematology and Oncology, Hospital Sainte-Justine, University of Montreal, Montreal, Canada
| | - Bruno Michon
- Division of Hematology-Oncology, Centre Hospitalier Universite de Quebec, Quebec City, Canada
| | - Andrew E Place
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School Boston, MA
| | | | - Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children's Hospital, Brown University Medical School, Providence, RI
| | - Donna S Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Stephen E Sallan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School Boston, MA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School Boston, MA
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Cannioto RA, Hutson A, Dighe S, McCann W, McCann SE, Zirpoli GR, Barlow W, Kelly KM, DeNysschen CA, Hershman DL, Unger JM, Moore HCF, Stewart JA, Isaacs C, Hobday TJ, Salim M, Hortobagyi GN, Gralow JR, Albain KS, Budd GT, Ambrosone CB. Physical Activity Before, During, and After Chemotherapy for High-Risk Breast Cancer: Relationships With Survival. J Natl Cancer Inst 2021; 113:54-63. [PMID: 32239145 DOI: 10.1093/jnci/djaa046] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/09/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although physical activity has been consistently associated with reduced breast cancer mortality, evidence is largely based on data collected at one occasion. We examined how pre- and postdiagnosis physical activity was associated with survival outcomes in high-risk breast cancer patients. METHODS Included were 1340 patients enrolled in the Diet, Exercise, Lifestyle and Cancer Prognosis (DELCaP) Study, a prospective study of lifestyle and prognosis ancillary to a SWOG clinical trial (S0221). Activity before diagnosis, during treatment, and at 1- and 2-year intervals after enrollment was collected. Patients were categorized according to the Physical Activity Guidelines for Americans as meeting the minimum guidelines (yes/no) and incrementally as inactive, low active, moderately active (meeting the guidelines), or high active. RESULTS In joint-exposure analyses, patients meeting the guidelines before and 1 year after diagnosis experienced statistically significant reductions in hazards of recurrence (hazard ratio [HR] = 0.59, 95% confidence interval [CI] = 0.42 to 0.82) and mortality (HR = 0.51, 95% CI = 0.34-0.77); associations were stronger at 2-year follow-up for recurrence (HR = 0.45, 95% CI = 0.31 to 0.65) and mortality (HR = 0.32, 95% CI = 0.19 to 0.52). In time-dependent analyses, factoring in activity from all time points, we observed striking associations with mortality for low- (HR = 0.41, 95% CI = 0.24 to 0.68), moderate- (HR = 0.42, 95% CI = 0.23 to 0.76), and high-active patients (HR = 0.31, 95% CI = 0.18 to 0.53). CONCLUSIONS Meeting the minimum guidelines for physical activity both before diagnosis and after treatment appears to be associated with statistically significantly reduced hazards of recurrence and mortality among breast cancer patients. When considering activity from all time points, including during treatment, lower volumes of regular activity were associated with similar overall survival advantages as meeting and exceeding the guidelines.
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Affiliation(s)
- Rikki A Cannioto
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Alan Hutson
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Shruti Dighe
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - William McCann
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Susan E McCann
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gary R Zirpoli
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - William Barlow
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Carol A DeNysschen
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Health, Nutrition, and Dietetics, State University of New York at Buffalo, Buffalo, NY, USA
| | - Dawn L Hershman
- Department of Medicine, Columbia University, New York, NY, USA
| | - Joseph M Unger
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Halle C F Moore
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James A Stewart
- Department of Hematology and Oncology, Baystate Medical Center, Springfield, MA, USA
| | - Claudine Isaacs
- Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Timothy J Hobday
- Department of Medical Oncology, Cancer Center, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Salim
- Medical Oncology, Allan Blair Cancer Centre, Regina, SK, Canada
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, Division of Cancer Medicine - Clinical, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Julie R Gralow
- Breast Medical Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Kathy S Albain
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA
| | - G Thomas Budd
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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43
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Langbroek GB, Wolkerstorfer A, Horbach SER, Spuls PI, Kelly KM, Robertson SJ, van Raath MI, Al-Niaimi F, Kono T, Boixeda P, Laubach HJ, Badawi AM, Troilius Rubin A, Haedersdal M, Manuskiatti W, van der Horst CMAM, Ubbink DT. Development of a core outcome domain set for clinical research on capillary malformations (the COSCAM project). J Eur Acad Dermatol Venereol 2021; 35:1888-1895. [PMID: 34014582 PMCID: PMC8453952 DOI: 10.1111/jdv.17376] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 01/19/2023]
Abstract
Background Due to a large variety in treatment outcomes reported in therapeutic trials and lacking patient‐relevant outcomes, it is hard to adequately compare and improve current therapies for patients with capillary malformations (CMs). The Core Outcome Set for Capillary Malformations (COSCAM) project aims to develop a core outcome set (COS) for use in future CM trials, in which we will first develop a core outcome (sub)domain set (CDS). Here, we describe the methods for the development of a CDS and present the results of the first development stage. Methods The COSCAM project is carried out according to the recommendations of the Cochrane Skin Core OUtcomes Set INitiative (CS‐COUSIN) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative. During the first stage, we identified all potentially relevant outcome subdomains based on a systematic review, two focus group sessions and input from patient representatives of Dutch patient organizations and the COSCAM‐founding group. In stage two, we will present the subdomains in a three‐round e‐Delphi study and online consensus meeting, in which CM patients, parents/caregivers and CM experts worldwide rate the importance of the proposed subdomains, hereby finalizing the core outcome (sub)domains of the CDS. Results A total of 67 potential outcome subdomains were included; sixteen were previously used in the literature, 20 were proposed by Dutch patients and their parents/caregivers (n = 13) in focus group sessions and 38 were suggested by the experts of the COSCAM‐founding group. Seven were excluded because of overlap. Conclusion The final CDS may serve as a minimum standard in future CM trials, thereby facilitating adequate comparison of treatment outcomes. After this CDS development, we will select appropriate outcome measurement instruments to measure the core outcome subdomains.
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Affiliation(s)
- G B Langbroek
- Department of Surgery, Amsterdam University Medical Center (UMC) Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Center UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - S E R Horbach
- Department of Plastic-, Reconstructive- and Hand Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Center UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - K M Kelly
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - S J Robertson
- Department of Dermatology and Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - M I van Raath
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - F Al-Niaimi
- Private Dermatological Practice, London, UK.,Department of Dermatology, University of Aalborg, Aalborg, Denmark
| | - T Kono
- Department of Plastic Surgery, Tokai University School of Medicine, Shimokasuya Isehara Kanagawa, Kanagawa, Japan
| | - P Boixeda
- Department of Dermatology, Hospital Ramon y Cajal, Madrid, Spain
| | - H J Laubach
- Department of Dermatology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - A M Badawi
- Department of Dermatology, Szeged University, Szeged, Hungary.,Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - A Troilius Rubin
- Department of Dermatology, Skåne University Hospital, Malmö, Sweden
| | - M Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - W Manuskiatti
- Department of Dermatology, Siriraj Skin Laser Center Department of Dermatology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - C M A M van der Horst
- Department of Plastic-, Reconstructive- and Hand Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - D T Ubbink
- Department of Surgery, Amsterdam University Medical Center (UMC) Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Umaretiya PJ, Koch VB, Stevenson KE, Cole PD, Gennarini LM, Kahn J, Kelly KM, Tran TH, Michon B, Welch JJG, Wolfe J, Silverman LB, Bona KO. Household material hardship and parental distress in a multicenter clinical trial for pediatric acute lymphoblastic leukemia. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10025] [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
10025 Background: Poverty is associated with inferior psychosocial function among parents of children with cancer. Severe parental distress during treatment predicts future poor mental health for both parents and children. It is also associated with impaired parental cognitive bandwidth and executive function, which may have implications for treatment adherence. Efforts to identify poverty-exposures amenable to intervention are essential to improving survivorship quality of life for the > 90% of children with acute lymphoblastic leukemia (ALL) who will be long-term survivors. Household material hardship (HMH) is a targetable poverty exposure defined as at least 1 of 3 unmet basic needs including food, housing, or utilities. Dana-Farber Cancer Institute (DFCI) ALL Consortium trial 16-001 is the first pediatric oncology clinical trial to systematically evaluate HMH. We investigated the hypothesis that HMH exposure independently predicts severe parent psychological distress during ALL therapy. Methods: Patients with newly diagnosed ALL ages 1-17 years were enrolled on the DFCI 16-001 embedded HMH cohort study at 8 U.S. and Canadian centers. Secondary interim analyses used baseline (within 32-days of trial enrollment) and 6-mos parent-reported sociodemographic data, the Kessler-6 (K6) Psychological Distress scale, and trial-collected child and disease data. Severe psychological distress was defined as a K6 > = 13. Multivariable cox regression evaluated baseline HMH-exposure and parent distress at baseline and 6-mos adjusting for child’s initial ALL risk group (Very High Risk (VHR) vs other) and marital status (single vs dual parent). Results: Among 258 families with evaluable data, 34% reported baseline HMH. Families were predominantly English-speaking (54%) dual parent households (71%). Children were a median of 5.7 years (IQR 1.0-17.99) at diagnosis and predominantly non-Hispanic white (66%) with expected disease distribution by immunophenotype (84% B-cell). HMH (odds ratio (OR) 2.18, 95% confidence interval (CI) 1.0-4.31, p = 0.025) and VHR initial risk group (OR 2.32; 95% CI 1.06-5.06, p = 0.035) were independently associated with baseline severe psychological distress. Only HMH was independently associated with 6-mos severe psychological distress (OR 4.93, 95% CI 1.80-13.48, p = 0.002). Future analyses will investigate race and ethnicity associations with parental distress pending trial accrual for statistical power. Conclusions: HMH, a modifiable poverty exposure, is significantly associated with severe parent psychological distress at diagnosis that persists 6-months into pediatric ALL therapy. These findings identify a cohort at high risk of inferior mental health outcomes, and affirm the need for HMH-targeted interventions to support children and parents during cancer treatment to reduce poverty-associated outcome disparities in survivorship.
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Affiliation(s)
- Puja J. Umaretiya
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | | | - Kristen E. Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Justine Kahn
- Columbia University Medical Center, New York, NY
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Cancer Institute and Oishei Children's Hospital, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Thai-Hoa Tran
- CHU Ste-Justine, University of Montreal, Montreal, QC, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Saint-Foy, QC, Canada
| | - Jennifer JG Welch
- Division of Pediatric Hematology-Oncology, Hasbro Children’s Hospital Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | - Kira O'Neil Bona
- Dana-Farber Cancer Institute/Children's Hospital Boston, Boston, MA
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Martone GM, Nanjireddy PM, Craig RA, Prout AJ, Higman MA, Kelly KM, Ambrusko SJ. Acute hepatic encephalopathy and multiorgan failure in sickle cell disease and COVID-19. Pediatr Blood Cancer 2021; 68:e28874. [PMID: 33484077 PMCID: PMC7995186 DOI: 10.1002/pbc.28874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Giulia M. Martone
- Department of PediatricsJohn R. Oishei Children's HospitalUniversity at Buffalo Jacobs School of Medicine & Biomedical SciencesBuffaloNew York
| | - Priyanka M. Nanjireddy
- Division of Hematology/OncologyDepartment of Pediatrics, John R. Oishei Children's HospitalRoswell Park Comprehensive Cancer CenterUniversity at Buffalo Jacobs School of Medicine & Biomedical SciencesBuffaloNew York
| | - Robin A. Craig
- Division of Critical CareDepartment of Pediatrics, John R. Oishei Children's HospitalUniversity at Buffalo Jacobs School of Medicine & Biomedical SciencesBuffaloNew York
| | - Andrew J. Prout
- Division of Critical CareDepartment of Pediatrics, Children's Hospital of MichiganCentral Michigan University College of MedicineDetroitMichigan
| | - Meghan A. Higman
- Division of Hematology/OncologyDepartment of Pediatrics, John R. Oishei Children's HospitalRoswell Park Comprehensive Cancer CenterUniversity at Buffalo Jacobs School of Medicine & Biomedical SciencesBuffaloNew York
| | - Kara M. Kelly
- Division of Hematology/OncologyDepartment of Pediatrics, John R. Oishei Children's HospitalRoswell Park Comprehensive Cancer CenterUniversity at Buffalo Jacobs School of Medicine & Biomedical SciencesBuffaloNew York
| | - Steven J. Ambrusko
- Division of Hematology/OncologyDepartment of Pediatrics, John R. Oishei Children's HospitalRoswell Park Comprehensive Cancer CenterUniversity at Buffalo Jacobs School of Medicine & Biomedical SciencesBuffaloNew York
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46
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Walters M, Mowbray C, Jubelirer T, Jacobs S, Kelly KM, Smith K, Yao Y, Jin Z, Ladas EJ. A bilingual dietary intervention early in treatment is feasible and prevents weight gain in childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2021; 68:e28910. [PMID: 33590674 DOI: 10.1002/pbc.28910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Childhood acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. The onset of obesity during childhood ALL has been well established and is associated with inferior survival rates and increased treatment-related toxicities. This pilot study sought to determine if a dietary intervention is feasible and minimizes weight gain during the initial phases of treatment for ALL. METHODS Participants were recruited from four institutions, fluent in English or Spanish, between 5 and 21 years old, and enrolled within 3 days of starting induction therapy. Participants were counseled for 6 months to follow a low glycemic diet. Dietary and anthropometric data were collected at diagnosis, end of induction, and end of month 6 (NCT03157323). RESULTS Twenty-three of 28 participants (82.1%) were evaluable and included in the analysis. Dietary changes targeted by the nutrition intervention were successful; sugar intake declined (P = .003), whereas vegetable intake increased (P = .033). The majority of participants were able to adhere to the dietary principles prescribed: ≥70.0% reduced glycemic load and ≥60.0% increased fiber intake and decreased sugar intake. Importantly, we did not observe an increase in body mass index z-score during induction or over the 6-month intervention period. Most families found the nutrition intervention easy to follow (60%) and affordable (95%) despite simultaneous initiation of treatment for ALL. CONCLUSIONS A 6-month nutrition intervention initiated during the initial phase of treatment for childhood ALL is feasible and may prevent weight gain. Our preliminary findings need to be confirmed in a larger clinical trial.
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Affiliation(s)
- Michelle Walters
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York
| | - Catriona Mowbray
- Division of Oncology, Children's National Hospital, District of Columbia, Washington
| | - Tracey Jubelirer
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Shana Jacobs
- Division of Oncology, Children's National Hospital, District of Columbia, Washington
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Karen Smith
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yujing Yao
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York.,Institute of Human Nutrition, Columbia University, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
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47
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Lo AC, Dieckmann K, Pelz T, Gallop-Evans E, Engenhart-Cabillic R, Vordermark D, Kelly KM, Schwartz CL, Constine LS, Roberts K, Hodgson D. Pediatric classical Hodgkin lymphoma. Pediatr Blood Cancer 2021; 68 Suppl 2:e28562. [PMID: 33818890 DOI: 10.1002/pbc.28562] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 11/08/2022]
Abstract
Over the past century, classical Hodgkin lymphoma (HL) has been transformed from a uniformly fatal disease to one of the most curable cancers. Given the high cure rate, a major focus of classical HL management is reducing the use of radiation therapy (RT) and chemotherapy agents such as procarbazine and doxorubicin to minimize long-term toxicities. In both North America and Europe, an important philosophy in the management of classical HL is to guide the intensity of treatment according to the risk category of the disease. The main factors used for risk classification are tumor stage, bulk of disease, and the presence of B symptoms. Response to chemotherapy is an important factor guiding the utilization of RT in ongoing Children's Oncology Group (COG) and European Network Pediatric Hodgkin Lymphoma (EuroNet-PHL) trials. Both trial groups have transitioned to reduced RT volumes that target the highest risk sites using highly conformal techniques, along with standard or intensified chemotherapy regimens to improve outcomes in higher risk patients. However, given the potential acute toxicities of intensified chemotherapy, immunoregulatory drugs are being investigated in upcoming trials. The purpose of this review is to summarize current approaches to treating pediatric classical HL according to the COG and EuroNet-PHL.
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Affiliation(s)
- Andrea C Lo
- Radiation Oncology, British Columbia Cancer and University of British Columbia, Vancouver, Canada
| | - Karin Dieckmann
- Radiation Oncology, Department of Radiotherapy Medical University Vienna, Vienna, Austria
| | - Tanja Pelz
- Department of Radiotherapy, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | | | - Dirk Vordermark
- Department of Radiotherapy, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, and University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Cindy L Schwartz
- Pediatric Hematology and Oncology, Department of Pediatrics, Medical College of Wisconsin, Wisconsin, Milwaukee
| | - Louis S Constine
- Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, New York
| | | | - David Hodgson
- Radiation Oncology, Princess Margaret Cancer Center and University of Toronto, Toronto, Canada
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48
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Giulino-Roth L, Pei Q, Buxton A, Bush R, Wu Y, Wolden SL, Constine LS, Kelly KM, Schwartz CL, Friedman DL. Subsequent malignant neoplasms among children with Hodgkin lymphoma: a report from the Children's Oncology Group. Blood 2021; 137:1449-1456. [PMID: 33512412 PMCID: PMC7976513 DOI: 10.1182/blood.2020007225] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/01/2020] [Indexed: 11/20/2022] Open
Abstract
Survivors of Hodgkin lymphoma (HL) have an increased risk of subsequent malignant neoplasms (SMNs). Response-adapted treatment may decrease this risk by reducing exposure to therapy associated with SMN risk. The Children's Oncology Group study AHOD0031 evaluated response-adapted therapy for children and adolescents with intermediate-risk HL. We report the SMNs among 1711 patients enrolled in AHOD0031. Patients were treated with 4 cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide with or without involved-field radiation therapy (RT). Patients with a slow early response to initial chemotherapy were randomized to 2 additional cycles of dexamethasone, etoposide, cisplatin and cytarabine or no additional chemotherapy, and all received RT. At a median follow-up of 7.3 years, an analysis of SMNs was performed. The 10-year cumulative incidence of SMN was 1.3% (95% confidence interval [CI], 0.6-2.0). SMNs included 3 patients with acute myeloid leukemia (AML), 11 with solid tumors, and 3 with non-Hodgkin lymphoma. Sixteen of 17 patients with an SMN had received combined modality therapy. The standardized incidence ratio for SMN was 9.5 (95% CI, 4.5-15.2) with an excess absolute risk of 1.2 per 1000 person-years. The cumulative incidence of SMNs was higher among patients who received RT (P = .037). In multivariate analysis, RT, B symptoms, and race were associated with SMN risk. Given the latency from exposure, we have likely captured all cases of secondary leukemia and myelodysplastic syndrome (MDS). Longer follow-up is needed to determine the risk of solid tumors. Avoidance of RT without sacrificing disease control should remain a goal for future therapeutic approaches. This trial was registered at www.clinicaltrials.gov as #NCT00025259.
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Affiliation(s)
- Lisa Giulino-Roth
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Qinglin Pei
- Department of Biostatistics, University of Florida, Gainesville, FL
- Children's Oncology Group Statistics and Data Center, Gainesville, FL
| | - Allen Buxton
- Children's Oncology Group Statistics and Data Center, Monrovia, CA
| | - Rizvan Bush
- Children's Oncology Group Statistics and Data Center, Monrovia, CA
| | - Yue Wu
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Louis S Constine
- Department of Radiation Oncology and
- Department of Pediatrics, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - Kara M Kelly
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Cindy L Schwartz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Debra L Friedman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; and
- Vanderbilt-Ingram Cancer Center, Nashville, TN
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49
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Burns MA, Place AE, Stevenson KE, Gutiérrez A, Forrest S, Pikman Y, Vrooman LM, Harris MH, Weinberg OK, Hunt SK, O'Brien JE, Asselin BL, Athale UH, Clavell LA, Cole PD, Gennarini LM, Kahn J, Kelly KM, Laverdiere C, Leclerc JM, Michon B, Schorin MA, Sulis ML, Welch JJG, Neuberg DS, Sallan SE, Silverman LB. Corrigendum. Pediatr Blood Cancer 2021; 68:e28885. [PMID: 33506554 DOI: 10.1002/pbc.28885] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Burns MA, Place AE, Stevenson KE, Gutiérrez A, Forrest S, Pikman Y, Vrooman LM, Harris MH, Weinberg OK, Hunt SK, O’Brien JE, Asselin BL, Athale UH, Clavell LA, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Laverdiere C, Leclerc JM, Michon B, Schorin MA, Sulis ML, Welch JJ, Neuberg DS, Sallan SE, Silverman LB. Identification of prognostic factors in childhood T-cell acute lymphoblastic leukemia: Results from DFCI ALL Consortium Protocols 05-001 and 11-001. Pediatr Blood Cancer 2021; 68:e28719. [PMID: 33026184 PMCID: PMC8369809 DOI: 10.1002/pbc.28719] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES While outcomes for pediatric T-cell acute lymphoblastic leukemia (T-ALL) are favorable, there are few widely accepted prognostic factors, limiting the ability to risk stratify therapy. DESIGN/METHODS Dana-Farber Cancer Institute (DFCI) Protocols 05-001 and 11-001 enrolled pediatric patients with newly diagnosed B- or T-ALL from 2005 to 2011 and from 2012 to 2015, respectively. Protocol therapy was nearly identical for patients with T-ALL (N = 123), who were all initially assigned to the high-risk arm. End-induction minimal residual disease (MRD) was assessed by reverse transcription polymerase chain reaction (RT-PCR) or next-generation sequencing (NGS), but was not used to modify postinduction therapy. Early T-cell precursor (ETP) status was determined by flow cytometry. Cases with sufficient diagnostic DNA were retrospectively evaluated by targeted NGS of known genetic drivers of T-ALL, including Notch, PI3K, and Ras pathway genes. RESULTS The 5-year event-free survival (EFS) and overall survival (OS) for patients with T-ALL was 81% (95% CI, 73-87%) and 90% (95% CI, 83-94%), respectively. ETP phenotype was associated with failure to achieve complete remission, but not with inferior OS. Low end-induction MRD (<10-4 ) was associated with superior disease-free survival (DFS). Pathogenic mutations of the PI3K pathway were mutually exclusive of ETP phenotype and were associated with inferior 5-year DFS and OS. CONCLUSIONS Together, our findings demonstrate that ETP phenotype, end-induction MRD, and PI3K pathway mutation status are prognostically relevant in pediatric T-ALL and should be considered for risk classification in future trials. DFCI Protocols 05-001 and 11-001 are registered at www.clinicaltrials.gov as NCT00165087 and NCT01574274, respectively.
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Affiliation(s)
- Melissa A. Burns
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - Andrew E. Place
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - Kristen E. Stevenson
- Department of Biostatistics and Computational Biology,
Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Alejandro Gutiérrez
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - Suzanne Forrest
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - Yana Pikman
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - Lynda M. Vrooman
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - Marian H. Harris
- Department of Pathology, Boston Children’s Hospital,
Harvard Medical School, Boston, MA
| | | | - Sarah K. Hunt
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
| | - Jane E. O’Brien
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
| | - Barbara L. Asselin
- Department of Pediatrics, Golisano Children’s
Hospital, University of Rochester Medical Center, Rochester, NY
| | - Uma H. Athale
- Division of Pediatric Hematology/Oncology, McMaster
University, Hamilton, ON, Canada
| | - Luis A. Clavell
- Division of Pediatric Oncology, San Jorge Children’s
Hospital, San Juan, Puerto Rico
| | - Peter D. Cole
- Division of Pediatric Hematology/Oncology, Rutgers Cancer
Institute of New Jersey, Rutgers ;Robert Wood Johnson School of Medicine, New
Brunswick, NJ
| | - Lisa M. Gennarini
- Division of Pediatric Hematology/Oncology,
Children’s Hospital at Montefiore, Bronx, NY
| | - Justine M. Kahn
- Division of Pediatric Hematology, Oncology, and Stem Cell
Transplantation, Columbia University, New York, NY
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park
Comprehensive Cancer Center, University at Buffalo, Buffalo, NY
| | - Caroline Laverdiere
- Division of Hematology and Oncology, Hospital
Sainte-Justine, University of Montreal, Montreal, Canada
| | - Jean-Marie Leclerc
- Division of Hematology and Oncology, Hospital
Sainte-Justine, University of Montreal, Montreal, Canada
| | - Bruno Michon
- Division of Hematology-Oncology, Centre Hospitalier
Universite de Quebec, Quebec City, Canada
| | | | - Maria Luisa Sulis
- Pediatric Hematologic Malignancies Service, Department of
Pediatric Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer J.G. Welch
- Division of Pediatric Hematology-Oncology, Hasbro
Children’s Hospital, Warren Alpert Medical School of Brown University,
Providence, RI
| | - Donna S. Neuberg
- Department of Biostatistics and Computational Biology,
Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Stephen E. Sallan
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - Lewis B. Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer
Institute, Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
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