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Baracy MG, Kerl A, Hagglund K, Fennell B, Corey L, Aslam MF. Trends in surgical approach to hysterectomy and perioperative outcomes in Michigan hospitals from 2010 through 2020. J Robot Surg 2023; 17:2211-2220. [PMID: 37280406 DOI: 10.1007/s11701-023-01631-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/21/2023] [Indexed: 06/08/2023]
Abstract
The objective of this study was to determine the trends in surgical approach to hysterectomy over the last decade and compare perioperative outcomes and complications. This retrospective cohort study used clinical registry data from the Michigan Hospitals that participated in Michigan Surgical Quality Collaborative (MSQC) from January 1st, 2010 through December 30th, 2020. A multigroup time series analysis was performed to determine how surgical approach to hysterectomy [open/TAH, laparoscopic (TLH/LAVH), and robotic-assisted (RA)] has changed over the last decade. Abnormal uterine bleeding, uterine fibroids, chronic pelvic pain, pelvic organ prolapse, endometriosis, pelvic mass, and endometrial cancer were the most common indications for hysterectomy. The open approach to hysterectomy declined from 32.6 to 16.9%, a 1.9-fold decrease, with an average decline of 1.6% per year (95% CI - 2.3 to - 0.9%). Laparoscopic-assisted hysterectomies decreased from 27.2 to 23.8%, a 1.5-fold decrease, with an average decrease of 0.1% per year (95% CI - 0.7 to 0.6%). Finally, the robotic-assisted approach increased from 38.3 to 49.3%, a 1.25-fold increase, with an average of 1.1% per year (95% CI 0.5 to 1.7%). For malignant cases, open procedures decreased from 71.4 to 26.6%, a 2.7-fold decrease, while RA-hysterectomy increased from 19.0 to 58.7%, a 3.1-fold increase. After controlling for the confounding variables age, race, and gynecologic malignancy, RA hysterectomy was found to have the lowest rate of complications when compared to the vaginal, laparoscopic and open approaches. Finally, after controlling for uterine weight, black patients were twice as likely to undergo an open hysterectomy compared to white patients.
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Affiliation(s)
- Michael G Baracy
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA.
| | - Alexis Kerl
- Department of Family Medicine, Ascension St. John Hospital, Detroit, MI, 48236, USA
| | - Karen Hagglund
- Department of Biomedical Investigations and Research, Ascension St. John Hospital, Detroit, MI, 48236, USA
| | - Brian Fennell
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48202, USA
| | - Logan Corey
- Department of Gynecologic Oncology, Wayne State University, Detroit, MI, 48202, USA
| | - Muhammad Faisal Aslam
- Department of Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Detroit, MI, 48236, USA
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA
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Corey L, Wallbillich JJ, Wu S, Farrell A, Hodges K, Xiu J, Nabhan C, Guastella A, Kheil M, Gogoi R, Winer I, Bandyopadhyay S, Huang M, Jones N, Wilhite A, Karnezis A, Thaker P, Herzog TJ, Oberley M, Korn WM, Vezina A, Morris R, Ali-Fehmi R. The Genomic Landscape of Vulvar Squamous Cell Carcinoma. Int J Gynecol Pathol 2023; 42:515-522. [PMID: 37131274 PMCID: PMC10417246 DOI: 10.1097/pgp.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Vulvar squamous cell cancer (VSC) accounts for 90% of vulvar cancers. Next-generation sequencing studies of VSC imply human papillomavirus (HPV) and p53 status play separate roles in carcinogenesis and prognosis. We sought to describe the genomic landscape and analyze the immunologic profiles of VSC with respect to HPV and p53 status. A total of 443 VSC tumors underwent tumor profiling. Next-generation sequencing was performed on genomic DNA isolated from formalin-fixed paraffin-embedded tumor samples. PD-L1, microsatellite instability were tested by fragment analysis, IHC, and next-generation sequencing. Tumor mutational burden-high was defined as >10 mutations per MB. HPV 16/18 positive (HPV+) status was determined using whole exome sequencing on 105 samples. Three cohorts were identified from 105 samples with known HPV: HPV+, HPV-/p53wt, and HPV-/p53mt. Where HPV and p53 status were examined, TP53 mutations were exclusive of HPV+ tumors. In all, 37% of samples were HPV+. Among the 66 HPV- tumors, 52 (78.8%) were HPV-/p53mt and 14 (21.2%) were HPV-/p53wt. The HPV-/p53wt cohort had a higher rate of mutations in the PI3KCA gene (42.9% HPV-/p53wt vs 26.3% HPV+ vs. 5.8% HPV-/p53mt, q =0.028) and alterations in the PI3K/AkT/mTOR pathway (57.1% HPV-/p53wt vs. 34.2% HPV+ vs. 7.7% HPV-/p53mt, q =0.0386) than the other 2 cohorts. Ninety-eight VSC tumors with HPV16/18 information underwent transcriptomic analysis and immune deconvolution method. No differences were observed in immune profiles. The HPV-/p53wt VSC tumors had significantly higher rates of mutations in the PI3KCA gene and alterations in the PI3K/AkT/mTOR pathway, a potential target that merits further investigation in this subgroup.
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Nurdin N, Corey L, O'Toole S, Sopena-Falco J, Houlihan D, Feeney ER. Sustained Virological Response Rates following Hepatitis C treatment with Direct-Acting Antivirals in patients. Ir Med J 2023; 116:813. [PMID: 37606261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
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Adzibolosu N, Alvero AB, Ali-Fehmi R, Gogoi R, Corey L, Tedja R, Chehade H, Gogoi V, Morris R, Anderson M, Vitko J, Lam C, Craig DB, Draghici S, Rutherford T, Mor G. Immunological modifications following chemotherapy are associated with delayed recurrence of ovarian cancer. Front Immunol 2023; 14:1204148. [PMID: 37435088 PMCID: PMC10331425 DOI: 10.3389/fimmu.2023.1204148] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Ovarian cancer recurs in most High Grade Serous Ovarian Cancer (HGSOC) patients, including initial responders, after standard of care. To improve patient survival, we need to identify and understand the factors contributing to early or late recurrence and therapeutically target these mechanisms. We hypothesized that in HGSOC, the response to chemotherapy is associated with a specific gene expression signature determined by the tumor microenvironment. In this study, we sought to determine the differences in gene expression and the tumor immune microenvironment between patients who show early recurrence (within 6 months) compared to those who show late recurrence following chemotherapy. Methods Paired tumor samples were obtained before and after Carboplatin and Taxol chemotherapy from 24 patients with HGSOC. Bioinformatic transcriptomic analysis was performed on the tumor samples to determine the gene expression signature associated with differences in recurrence pattern. Gene Ontology and Pathway analysis was performed using AdvaitaBio's iPathwayGuide software. Tumor immune cell fractions were imputed using CIBERSORTx. Results were compared between late recurrence and early recurrence patients, and between paired pre-chemotherapy and post-chemotherapy samples. Results There was no statistically significant difference between early recurrence or late recurrence ovarian tumors pre-chemotherapy. However, chemotherapy induced significant immunological changes in tumors from late recurrence patients but had no impact on tumors from early recurrence patients. The key immunological change induced by chemotherapy in late recurrence patients was the reversal of pro-tumor immune signature. Discussion We report for the first time, the association between immunological modifications in response to chemotherapy and the time of recurrence. Our findings provide novel opportunities to ultimately improve ovarian cancer patient survival.
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Affiliation(s)
- Nicholas Adzibolosu
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Ayesha B. Alvero
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Rouba Ali-Fehmi
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Radhika Gogoi
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Logan Corey
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Roslyn Tedja
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Hussein Chehade
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Center of Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Vir Gogoi
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Robert Morris
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Matthew Anderson
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Julie Vitko
- Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Clarissa Lam
- Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Douglas B. Craig
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI, United States
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Sorin Draghici
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI, United States
- Advaita Corporation, Ann Arbor, MI, United States
- Division of Information and Intelligent Systems, Directorate for Computer and Information Science and Engineering, National Science Foundation, Alexandria, VA, United States
| | - Thomas Rutherford
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Gil Mor
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
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Corey L, Seaton R, Ruterbusch JJ, Bretschneider CE, Vezina A, Do T, Hobson D, Winer I. Concurrent Surgery for Locoregional Gynecologic Cancers and Pelvic Floor Disorders in a Population of Patients With Medicare Insurance. Obstet Gynecol 2023; 141:629-641. [PMID: 36897144 DOI: 10.1097/aog.0000000000005085] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/08/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To estimate the rate of concurrent surgery for locoregional gynecologic cancer and pelvic organ prolapse-urinary incontinence (POP-UI) and to assess the rate of surgery for POP-UI within 5 years for those who did not undergo concurrent surgery. METHODS This is a retrospective cohort study. The SEER-Medicare data set was used to identify cases of local or regional endometrial, cervical, and ovarian cancer diagnosed from 2000 to 2017. Patients were followed up for 5 years from diagnosis. We used χ 2 tests to identify categorical variables associated with having a concurrent POP-UI procedure with hysterectomy or within 5 years of hysterectomy. Logistic regression was used to calculate odds ratios and 95% CIs adjusted for variables statistically significant (α=.05) in the univariate analyses. RESULTS Of 30,862 patients with locoregional gynecologic cancer, only 5.5% underwent concurrent POP-UI surgery. Of those with a preexisting diagnosis related to POP-UI, however, 21.1% had concurrent surgery. Of the patients who had a diagnosis of POP-UI at the time of initial surgery for cancer and who did not undergo concurrent surgery, an additional 5.5% had a second surgery for POP-UI within 5 years. The rate of concurrent surgery remained constant over the time period (5.7% in 2000 and 2017) despite an increase in the frequency of POP-UI diagnosis in the same time frame. CONCLUSION The rate of concurrent surgery for patients with an early-stage gynecologic cancer and POP-UI-associated diagnosis in women older than age 65 years was 21.1%. Of women who did not undergo concurrent surgery but had a diagnosis of POP-UI, 1 in 18 underwent surgery for POP-UI within 5 years of their index cancer surgery. Dedicated efforts must be made to identify patients who would most benefit from concurrent cancer and POP-UI surgery in those with locoregional gynecologic cancers and pelvic floor disorders.
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Affiliation(s)
- Logan Corey
- Wayne State University School of Medicine and Comprehensive Woman's Care, Detroit, Michigan; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Corey L, Ruterbusch J, Shore R, Ayoola-Adeola M, Baracy M, Corey A, Winer I. Incidence and survival of multiple primary cancers in United States women (349). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Corey L, Walker C, Jang H, Corey A, Konel J, Khalil A, Mattei L, Rubinsak L, Paridon A, Polan R, Kim S, Gogoi R. Blind leading the blind: Is the current peer review process really that flawed? (519). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wallbillich J, Wu S, Corey L, Kheil M, Gogoi R, Huang M, Jones N, Spetzler D, Thaker P, Herzog T, Korn WM, Morris R, Winer I, Ali-Fehmi R. Transcriptomic immune profiling for cervical squamous cell carcinoma: Does HPV type matter? (170). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baracy Jr MG, Hagglund K, Kulkarni S, Afzal F, Arends K, Morris RT, Solomon LA, Aslam MF, Corey L. Decreased incidence of febrile neutropenia in Michigan following masking and social distancing orders for the COVID-19 pandemic: A population based cohort study. World J Clin Oncol 2022; 13:609-615. [PMID: 36157163 PMCID: PMC9346421 DOI: 10.5306/wjco.v13.i7.609] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It has been theorized that 75%-80% of febrile neutropenia (FN) is caused by endogenous pathogens, while up to 20% of cases are thought to be caused by a viral infection. It is unknown if precautions such as masking and social distancing reduce the risk of FN in susceptible populations.
AIM To determine whether coronavirus disease 2019 (COVID-19) infection mitigation efforts, namely masking and social distancing, were associated with a reduction in the incidence of FN.
METHODS This was a retrospective population based cohort study comparing the incidence of FN in the 13 mo prior to (Year 0) and 13 mo following (Year 1) the public health executive orders (PHEO) in Michigan. Data was queried for all emergency department (ED) visits from April 1, 2019 to March 31, 2021 from the National Syndromic Surveillance Program, a program which collects data that is voluntarily submitted by approximately 89% of Michigan EDs. The primary study outcome was the incidence of FN as a proportion of ED visits in the 13-mo before and 13-mo after COVID-19 mitigations efforts, namely masking and social distancing. We hypothesized that there would be a significant decrease in the incidence of FN in the period following the PHEO aimed at reducing the spread of the severe acute respiratory syndrome coronavirus 2 virus.
RESULTS There was a total of 8979221 total ED visits captured during the study period. In Year 0 there were 5073081 recorded ED visits and 3906140 in Year 1. There was a significant reduction in the proportion of total ED visits with a diagnosis of FN, decreasing 13.3% across periods (0.15% vs 0.13%, P = 0.036). In patients with a hematologic malignancy a more impressive reduction in the incidence of FN was evident following PHEO (22% vs 17%, P = 0.02).
CONCLUSION We found a significant association between social distancing and mask guidelines implemented on a large public scale with decreased rates of FN, particularly in those with a hematologic malignancy. These findings may be useful in the design of future research and recommendations regarding the prevention of FN.
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Affiliation(s)
- Michael Gerard Baracy Jr
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Detroit, MI 48236, United States
| | - Karen Hagglund
- Medical Research, Ascension St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Sanjana Kulkarni
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Detroit, MI 48236, United States
| | - Fareeza Afzal
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Detroit, MI 48236, United States
| | - Katherine Arends
- Surveillance and Infectious Disease Epidemiology Section, Michigan Department of Health and Human Services, Lansing, MI 48933, United States
| | - Robert T Morris
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, MI 48201, United States
| | - Leigh Ann Solomon
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Detroit, MI 48236, United States
| | - Muhammad Faisal Aslam
- Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Detroit, MI 48236, United States
| | - Logan Corey
- Department of Gynecologic Oncology, Wayne State University, Detroit, MI 48202, United States
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Corey L, Wu S, Brodskiy P, Hodges K, Oberley MJ, Musallam R, Kheil M, Bandyopadhyay S, Wallbillich J, Winer IS, Morris R, Ali-Fehmi R. Molecular classification of endometrial carcinoma applied to endometrial atypical hyperplasia biopsy specimens. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17622 Background: 50% of endometrial atypical hyperplasia (AH) cases on endometrial sampling have concurrent endometrial cancer (EC) on hysterectomy. Little data exists regarding molecular signatures that can predict the presence of concurrent endometrial cancer in patients with AH on biopsy. Therefore, we set to characterize molecular landscapes of endometrial samples diagnosed with AH with EC on the final hysterectomy specimen, using matched controls. Methods: Karmanos Cancer Institute pathology database was searched for patients with AH on endometrial curettage or biopsy who had a hysterectomy within 6 months. Only samples with adequate tissue for next generation sequencing were included. In total, 59 tissue samples from 34 patients were included: there were 15 AH endometrial biopsy samples, 18 AH final hysterectomy samples (13 matched pairs), 13 EC endometrial biopsies and 13 samples that were EC on final hysterectomy samples (12 matched pairs) that were analyzed using next-generation sequencing (WES) and/or whole transcriptome sequencing (WTS) (NovaSeq). TMB was measured by counting all somatic mutations found per tumor (TMB-high: >10 mutations per MB). Immune cell infiltrates were calculated by Quantiseq. Significance was determined using Fisher exact, Chi-square and Mann-Whitney U test and adjusted for multiple comparisons: p < 0.05 but q > 0.05 was considered a trend. Results: Clinical analysis demonstrated 15/34 patients with endometrial AH on initial sampling and EC on the final hysterectomy. 2 out of 15 patients were > stage II at time of surgery. Molecularly, fewer PTEN mutations were found between AH (2/8) and EC (14/17) on final hysterectomy (25% vs 82.4%, p = 0.01). Samples of EC origin were MSI-H by NGS-MSI (3/18) and had no mutations in PPP2R1A (0/16). Comparing hysterectomy samples, EC trended toward increased CTLA4 (FC: 6.97-fold) expression and immune cell infiltration of Macrophage M1 (+1.19%), NK cells (+2.13%), CD8+ T Cells (+1.27%), regulatory T cells (+2.17%) and Dendritic cells (+2.87%) compared to AH samples (all p < 0.05). Similarly, when comparing endometrial biopsies, EC samples trended toward increased expression of CTLA4 (12.6-fold), HAVCR2/TIM3 (FC: 2.59-fold) and IFNG (FC: 17.8-fold) immune checkpoint genes, as well as increased immune cell infiltration of Neutrophils (+11.7%), CD8+ T cells (+2.39%) and regulatory T cells (+2.43%) compared to AH samples (all p < 0.05). Conclusions: There are molecular and tumor microenvironment differences seen between AH endometrial biopsies that have concurrent EC compared to those that do not on the final hysterectomy specimens. These differences may lead to advances in identifying appropriate patients for fertility sparing treatments, versus those that can be managed surgically by a benign gynecologist or a gynecologic oncologist. Analyses with larger sample sizes are needed and are ongoing.
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Affiliation(s)
- Logan Corey
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | | | | | | | - Rami Musallam
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | - Mira Kheil
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | | | | | | | - Rouba Ali-Fehmi
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
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Corey L, Ruterbusch J, Shore R, Ayoola-Adeola M, Baracy M, Vezina A, Winer I. Incidence and Survival of Multiple Primary Cancers in US Women With a Gynecologic Cancer. Front Oncol 2022; 12:842441. [PMID: 35402231 PMCID: PMC8983878 DOI: 10.3389/fonc.2022.842441] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate risk of a second cancer and associated survival times in United States women with diagnosis of cancer. Methods The Surveillance Epidemiology and End Results (SEER) database was queried for 2 cohorts of women aged 18 - 89 with either an index gynecologic or non-gynecologic cancer diagnosed between 1992 - 2017. Index cases were followed to determine if a second primary cancer was subsequently diagnosed; defined according to SEER multiple primary and histology coding rules. Standard Incident Ratios (SIR) and latency intervals between index diagnosis and second primary diagnosis were evaluated. Among those who developed a second primary cancer, median survival times from diagnosis of second primary cancer were also calculated. Results Between 1992 - 2017, 227,313 US women were diagnosed with an index gynecological cancer and 1,483,016 were diagnosed with an index non-gynecologic cancer. Among patients with index gynecologic cancer, 7.78% developed a non-gynecologic subsequent primary cancer. The risk of developing any non-gynecologic cancer following an index gynecologic cancer was higher than the risk in the general population (SIR 1.05, 95% CI 1.04 - 1.07). Organs especially at risk were Thyroid (SIR 1.45), Colon and Rectum (SIR 1.23), and Urinary System (SIR 1.33). Among women diagnosed with an index non-gynecologic cancer, 0.99% were diagnosed with a subsequent gynecologic cancer. The risk of developing a gynecologic cancer following a non-gynecologic cancer was also elevated compared to the average risk of the general population (SIR 1.05, 1.03 - 1.07), with uterine cancer having the highest SIR of 1.13. Conclusion The risk of a developing a second primary cancer and the corresponding survival time is based on the order and site of the index and subsequent cancer. Surveillance guidelines should be examined further to optimize survivorship programs.
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Affiliation(s)
- Logan Corey
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States.,Department of OB/GYN, Detroit Medical Center Graduate Medical Education, Detroit, MI, United States
| | - Julie Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States.,Department of Gynecologic Oncology, Karmanos Cancer Institute, Detroit, MI, United States
| | - Ron Shore
- Department of Gynecologic Oncology, Karmanos Cancer Institute, Detroit, MI, United States
| | - Martins Ayoola-Adeola
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Michael Baracy
- Department of OB/GYN, Ascension St. John Hospital, Detroit, MI, United States
| | - Alex Vezina
- Department of OB/GYN, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Ira Winer
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States.,Department of Gynecologic Oncology, Karmanos Cancer Institute, Detroit, MI, United States
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Corey L, Cote ML, Ruterbusch JJ, Vezina A, Winer I. Disparities in adjuvant treatment of high-grade endometrial cancer in the Medicare population. Am J Obstet Gynecol 2022; 226:541.e1-541.e13. [PMID: 34736911 DOI: 10.1016/j.ajog.2021.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Black women experience worse survival effects with high-grade endometrial cancer. Differences in adjuvant treatment have been proposed to be major contributors to this disparity. However, little is known about the differences in type or timing of adjuvant treatment as it relates to race and ethnicity in the Medicare population. OBJECTIVE This study aimed to examine patterns of adjuvant therapy and survival for non-Hispanic Black women vs non-Hispanic White women and Hispanic women who have undergone surgery for high-grade endometrial cancer in the Medicare population. STUDY DESIGN We used the Medicare-linked Surveillance, Epidemiology, and End Results database to identify women who underwent surgery as a primary treatment for uterine grade 3 endometrioid adenocarcinoma, carcinosarcoma, clear-cell carcinoma, or serous carcinoma between the years 2000 and 2015. Women who did not identify as White or Black race or Hispanic ethnicity were excluded. Multinomial logistic regression was used to estimate odds ratios and 95% confidence intervals for receiving a treatment delay or not receiving adjuvant treatment (compared with those who received adjuvant treatment within 12 weeks) adjusted for clinical and demographic characteristics. Overall survival was stratified by race and ethnicity, route of surgery, operative complications, and type and timing of adjuvant therapy, which were analyzed using the Kaplan-Meier method. Cox proportional-hazards regression was used to estimate the hazard ratio of death by race and ethnicity adjusted for known predictors and surgical outcomes and adjuvant therapy patterns. RESULTS A total of 12,201 women met the study inclusion criteria. Non-Hispanic Black patients had a significantly worse 5-year overall survival than Hispanic and non-Hispanic White patients (30.9 months vs 51.0 months vs 53.6 months, respectively). Approximately 632 of 7282 patients (8.6%) who received adjuvant treatment experienced a treatment delay. Delay in treatment of ≥12 weeks was significantly different by race and ethnicity (P=.034), with 12% of Hispanic, 9% of non-Hispanic Black, and 8% of non-Hispanic White women experiencing a delay. After adjustment for the number of complications, age, histology (endometrioid vs nonendometroid), International Federation of Gynecology and Obstetrics stage, marital status, comorbidity count, surgical approach, lymph node dissection, and urban-rural code, Hispanic women had a 71% increased risk of treatment delay (odds ratio, 1.71; 95% confidence interval, 1.23-2.38) for all stages of disease. In the same model, non-Hispanic Black race was independently predictive of decreased use of adjuvant treatment for the International Federation of Gynecology and Obstetrics stage II and higher (odds ratio, 1.32; 95% confidence interval, 1.04-1.68). Non-Hispanic Black race, number of perioperative complications, and nonendometrioid histology were predictive of worse survival in univariate models. Treatment delay was not independently predictive of worse 1- or 5-year survival at any stage. CONCLUSION Non-Hispanic Black race was predictive of worse 5-year survival across all stages and was associated with omission of adjuvant treatment in International Federation of Gynecology and Obstetrics stage II or higher high-grade endometrial cancer. In unadjusted analyses, patients who experience treatment omission or delay experienced poorer overall survival, but these factors were not independently associated in multivariate analyses. This study suggests that race and ethnicity are independently associated with the type and timing of adjuvant treatment in patients with high-grade endometrial cancer. Further efforts to identify specific causes of barriers to care and timely treatment are imperative.
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Corey L, Walker C, Corey A, Konel J, Khalil A, Jang H, Kim S, Gogoi R. Does Origin of Article Impact Citation Metrics in Gynecologic Oncology? Gynecol Oncol Rep 2022; 40:100958. [PMID: 35313463 PMCID: PMC8933665 DOI: 10.1016/j.gore.2022.100958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 10/25/2022] Open
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Abstract
Personalized medicine in gynecologic oncology is an evolving field. In recent years, tumor profiling and large databases such as TCGA and NCI-Match have provided us with enormous amounts of molecular data. Several therapies that capitalize on novel genetic and immune discoveries including VEGF inhibitors, PARP inhibitors, and cancer vaccinations are discussed in this article. Additionally, we have seen direct to consumer marketing play an important role in cancer care and prevention as patients have increased ability to access genetic testing. This presents a unique challenge to gynecologic oncology providers as we learn to navigate the world of personalized medicine.
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Affiliation(s)
- Logan Corey
- Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, 2700 Napoleon Avenue, New Orleans, LA 70115, USA.
| | - Ana Valente
- Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, 2700 Napoleon Avenue, New Orleans, LA 70115, USA
| | - Katrina Wade
- Department of Gynecologic Oncology, Ochsner Clinic Foundation, 2700 Napoleon Avenue, New Orleans, LA 70115, USA
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Corey L, Fucinari J, Elshaikh M, Schultz D, Mussallam R, Zaiem F, Daaboul F, Fehmi O, Dyson G, Ruterbusch J, Morris R, Cote ML, Ali-Fehmi R, Bandyopadhyay S. Impact of positive cytology in uterine serous carcinoma: A reassessment. Gynecol Oncol Rep 2021; 37:100830. [PMID: 34345643 PMCID: PMC8319448 DOI: 10.1016/j.gore.2021.100830] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/07/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
Prognostic implications of peritoneal cytology in uterine serous cancer are unclear. Positive cytology is not associated with FIGO stage or LVSI. Peritoneal cytology is an independent prognosticator in uterine serous cancer. Positive cytology is independently associated with worse overall survival and ECSS.
Objectives The aim of this study was to evaluate the prognostic value of peritoneal cytology status among other clinicopathological parameters in uterine serous carcinoma (USC). Methods A retrospective study of 148 patients diagnosed with uterine serous carcinoma from 1997 to 2016 at two academic medical centers in the Detroit metropolitan area was done. A central gynecologic pathologist reviewed all available slides and confirmed the histologic diagnosis of each case of USC. We assessed the prognostic impact of various clinicopathological parameters on overall survival (OS) and endometrial cancer-specific survival (ECSS). Those parameters included race, body mass index (BMI), stage at diagnosis, tumor size, lymphovascular invasion (LVSI), peritoneal cytology status, receipt of adjuvant treatment, and comorbidity count using the Charlson Comorbidity Index (CCI). We used Cox proportional hazards models and 95% confidence intervals for statistical analysis. Results Positive peritoneal cytology had a statistically significant effect on OS (HR: 2.09, 95% CI: [1.19, 3.68]) and on ECSS (HR: 2.02, 95% CI: [1.06 – 3.82]). LVSI had a statistically significant effect on both OS (HR: 2.27, 95% CI: [1.14, 4.53]) and ECSS (HR: 3.45, 95% CI: [1.49, 7.99]). Black or African American (AA) race was also found to have a significant effect on both OS (HR: 1.92, 95% CI: [1.07, 3.47]) and ECSS (HR: 2.01, 95% CI: [1.02, 3.98]). Other factors including BMI and tumor size > 1 cm did not show a statistically significant impact on OS or ECSS. Conclusions Peritoneal washings with positive cytology and LVSI are important prognostic tools that may have a significant impact on overall survival in USC and can be used as independent negative prognosticators to help guide adjuvant treatment.
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Affiliation(s)
- Logan Corey
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan.,Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, Michigan
| | - Juliana Fucinari
- Karmanos Cancer Institute, Population Sciences and Disparities Research, Detroit, Michigan
| | | | | | - Rami Mussallam
- Wayne State University, School of Medicine, Department of Pathology, Detroit, Michigan
| | - Feras Zaiem
- Wayne State University, School of Medicine, Department of Pathology, Detroit, Michigan
| | - Fayez Daaboul
- Wayne State University, School of Medicine, Department of Pathology, Detroit, Michigan
| | - Omar Fehmi
- University of Michigan, Ann Arbor, Michigan
| | - Greg Dyson
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan
| | - Julie Ruterbusch
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan
| | - Robert Morris
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan.,Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, Michigan
| | - Michelle L Cote
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan.,Karmanos Cancer Institute, Population Sciences and Disparities Research, Detroit, Michigan
| | - Rouba Ali-Fehmi
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan
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Corey L, Cote ML, Ruterbusch JJ, Winer IS. Disparities in adjuvant treatment of high-grade endometrial cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e17572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17572 Background: To examine surgical outcomes, patterns of adjuvant therapy, and survival for non-Hispanic Black (NHB) women compared to non-Hispanic White (NHW) and Hispanic (HS) women who have undergone surgery for high grade endometrial cancer in the Medicare population. Methods: We utilized the SEER-Medicare linked database to identify women who underwent surgery as a primary treatment for uterine grade 3 endometrioid adenocarcinoma, carcinosarcoma, clear cell carcinoma, or serous carcinoma between the years 2000 and 2015. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for receiving a treatment delay or not receiving adjuvant treatment (compared to those who received adjuvant treatment within 12 weeks) adjusted for clinical and demographic characteristics. Overall survival (OS) stratified by race/ethnicity, route of surgery, operative complications, and type and timing of adjuvant therapy were analyzed using the Kaplan-Meier method. Cox Proportional hazards regression was used to estimate hazard of death by race/ethnicity adjusted for known predictors, as well as surgical outcomes and adjuvant therapy patterns. Results: 12, 201 women met study inclusion criteria. NHB patients had a significantly worse five-year overall survival (OS) than HS and NHW patients (30.9 months vs 51.0 months vs 53.6 months, respectively). Approximately 8.6% of patients who received adjuvant treatment experienced a treatment delay (632/7, 282). Delay in treatment of greater than or equal to 12 weeks was significantly different by race/ethnicity (p=0.034), with 12% of HS, 9% of NHB, and 8% of NHW women experiencing a delay. After adjustment for number of complications, age, histology (endometrioid v. non-endometroid), FIGO stage, marital status, comorbidity count, surgical approach, lymph node dissection, and urban-rural code, HS had a 71% increased risk of treatment delay (OR 1.71, CI 1.23-2.38) for all stages of disease. In the same model, NHB race was independently predictive of decreased use of adjuvant treatment for FIGO stage II and higher (OR 1.32, CI 1.04-1.68). NHB race, number of perioperative complications, and non-endometrioid histology were predictive of worse OS in univariate models. Treatment delay was not independently predictive of worse 1- or 5-year survival at any stage. Conclusions: NHB race is predictive of worse 5-year survival across all stages and is also associated with omission of adjuvant treatment in ≥FIGO Stage II high grade endometrial cancers. HS ethnicity was associated with treatment delay across all stages. In unadjusted analyses, patients who experience treatment omission or delay experienced poorer OS, but these factors were not independently associated in multivariate analyses.
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Eichholz K, Haeseleer F, Corey L. Development of anti-PD-1 chimeric antigen receptor T cells to target a PD-1+ CD4 T cell population enriched in HIV provirus. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30228-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Personalized medicine in gynecologic oncology is an evolving field. In recent years, tumor profiling and large databases such as TCGA and NCI-Match have provided us with enormous amounts of molecular data. Several therapies that capitalize on novel genetic and immune discoveries including VEGF inhibitors, PARP inhibitors, and cancer vaccinations are discussed in this article. Additionally, we have seen direct to consumer marketing play an important role in cancer care and prevention as patients have increased ability to access genetic testing. This presents a unique challenge to gynecologic oncology providers as we learn to navigate the world of personalized medicine.
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Affiliation(s)
- Logan Corey
- Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, 2700 Napoleon Avenue, New Orleans, LA 70115, USA.
| | - Ana Valente
- Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, 2700 Napoleon Avenue, New Orleans, LA 70115, USA
| | - Katrina Wade
- Department of Gynecologic Oncology, Ochsner Clinic Foundation, 2700 Napoleon Avenue, New Orleans, LA 70115, USA
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Eichholz K, Peterson C, Wagner T, Rawlings D, Zhu J, Corey L. In situ multiplex RNA fluorescence imaging of SHIV1157ipd3N4 and anti-HIV CAR T cells to study CAR T cell trafficking to sites of viral reservoir in macaque lymphoid tissues. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Phipps W, Orem J, Kafeero J, Bakenga A, Holoya G, Huang M, McIntosh M, Fitzgibbon M, Wald A, Corey L, Casper C. Interrogation of HHV-8 transcriptome in KS tumors and association with KS presentation and outcomes in Uganda. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Liao L(H, Trama A, Williams W, Moody M, Vandergrift N, Tomaras G, Marshall D, Gurley T, Whitesides J, Eudailey J, Foulger A, Parks R, Stolarchuk C, Lloyd K, Soderberg K, Mascola J, Koup R, Corey L, Nabel G, Gilber P, Morgan C, Maenza J, Keefer M, Hammer S, Churchyard G, Montefior D, Graham B, Baden L, Kepler T, Haynes B. Role of Intestinal Microbiota in Shaping the B Cell Repertoire in HIV Infection and Env Vaccination. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5023a.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Larry (Huaxin) Liao
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - A.M. Trama
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - W.B. Williams
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - M.A. Moody
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - Nathan Vandergrift
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - G.D. Tomaras
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - D.J. Marshall
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - T. Gurley
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - J. Whitesides
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - J. Eudailey
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - A. Foulger
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - R. Parks
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - C. Stolarchuk
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - K.E. Lloyd
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - K. Soderberg
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - J.R. Mascola
- National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Bethesda, MD, United States
| | - R. Koup
- National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Bethesda, MD, United States
| | - L. Corey
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - G.B. Nabel
- National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Bethesda, MD, United States
| | - P. Gilber
- University of Washington, SCHARP, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - C. Morgan
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - J. Maenza
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - M. Keefer
- University of Rochester Medical Center, Division of Infectious Disease, Rochester, NY, United States
| | - S. Hammer
- Columbia University Medical Center, New York, NY, United States
| | | | - D.C. Montefior
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
| | - B.S Graham
- National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Bethesda, MD, United States
| | - L.R. Baden
- Brigham and Women's Hospital, Boston, MA, United States
| | - T.B. Kepler
- Boston University, Boston, MA, United States
| | - B.F. Haynes
- Duke University Medical Center, Human Vaccine Institute, Durham, NC, United States
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Stekler JD, Wellman R, Holte S, Maenza J, Stevens CE, Corey L, Collier AC. Are there benefits to starting antiretroviral therapy during primary HIV infection? Conclusions from the Seattle Primary Infection Cohort vary by control group. Int J STD AIDS 2012; 23:201-6. [PMID: 22581875 DOI: 10.1258/ijsa.2011.011178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is controversial whether starting combination antiretroviral therapy (cART) during primary HIV infection (PHI) is beneficial. Subjects in this observational cohort began cART <30 days (group 1: acute treatment, n = 40), 31-180 days (group 2: early treatment, n = 82) or >180 days (group 3: delayed treatment, n = 35) after HIV infection, and were compared with 27 historical and 60 contemporary controls. Time to HIV-related diagnoses did not differ for group 1 (adjusted hazard ratio [aHR] 1.44, P = 0.3) or group 2 (aHR 1.17, P = 0.5) compared with contemporary controls, but it was delayed for both treated groups (aHR 0.38 for group 1, P = 0.01; and aHR 0.28 for group 2, P < 0.0001) compared with historical controls. Although rates of HIV-related diagnoses were similar in acutely treated subjects and contemporary controls, results were confounded by associations between higher CD4 counts, lower HIV RNA levels and delayed disease progression as reasons for deferring treatment. Randomized trials are needed to address benefits of cART during PHI.
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Affiliation(s)
- J D Stekler
- Department of Medicine, University of Washington, Seattle, WA, USA.
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Williams WB, Jones K, Krambrink A, Grove D, Liu P, Yates NL, Moody MA, Ferrari G, Pollara J, Moodie Z, Morgan CA, Liao H, Montefiori DC, Ochsenbauer C, Kappes J, Hammer S, Mascola J, Koup R, Corey L, Nabel G, Gilbert P, Churchyard G, Keefer M, Graham BS, Haynes BF, Tomaras GD. Multiple antibody specificities (gp41, V1V2, and V3) elicited in the phase II multiclade (A, B, C) HIV-1 DNA prime, rAd5 boost vaccine trial. Retrovirology 2012. [PMCID: PMC3441791 DOI: 10.1186/1742-4690-9-s2-o55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Keller MJ, Malone AM, Carpenter CA, Lo Y, Huang M, Corey L, Willis R, Nguyen C, Kennedy S, Gunawardana M, Guerrero D, Moss JA, Baum MM, Smith TJ, Herold BC. Safety and pharmacokinetics of aciclovir in women following release from a silicone elastomer vaginal ring. J Antimicrob Chemother 2012; 67:2005-12. [PMID: 22556381 DOI: 10.1093/jac/dks151] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Systemic aciclovir and its prodrug valaciclovir are effective in treating and reducing recurrences of genital herpes simplex virus (HSV) and reducing transmission. Local aciclovir delivery, if it can achieve and maintain comparable intracellular genital tract levels, may be equally effective in the treatment and suppression of genital HSV. Intravaginal ring (IVR) delivery of aciclovir may provide pre-exposure prophylaxis against HSV acquisition. METHODS Tolerability and pharmacokinetics were evaluated in six HIV-negative women with recurrent genital HSV who switched their daily oral valaciclovir suppression to an aciclovir IVR for 7 days (n = 3) or 14 days (n = 3). Blood and cervicovaginal lavage (CVL) were collected after oral and IVR dosing to measure aciclovir concentrations and genital swabs were obtained to quantify HSV shedding by PCR. RESULTS The rings were well tolerated. Median plasma aciclovir concentrations were 110.2 ng/mL (IQR, 85.9-233.5) 12-18 h after oral valaciclovir. Little or no drug was detected in plasma following IVR dosing. Median (IQR) CVL aciclovir levels were 127.3 ng/mL (21-660.8) 2 h after oral valaciclovir, 154.4 ng/mL (60.7-327.5) 12-18 h after oral valaciclovir and 438 ng/mL (178.5-618.5) after 7 days and 393 ng/mL (31.6-1615) after 14 days of aciclovir ring use. Median CVL aciclovir levels 2 h after oral dosing were similar to levels observed 7 (P = 0.99) and 14 (P = 0.75) days after ring use. HSV DNA was not detected in genital swabs and there was no significant change in inflammatory mediators. CONCLUSIONS This first-in-human study demonstrated that an IVR could safely deliver mucosal levels of aciclovir similar to oral valaciclovir without systemic absorption. More intensive site-specific pharmacokinetic studies are needed to determine whether higher local concentrations are needed to achieve optimal drug distribution within the genital tract.
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Affiliation(s)
- M J Keller
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
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Perti T, Baeten J, Johnston C, Diem K, Ochbamichael N, Huang ML, Selke S, Magaret A, Corey L, Wald A. O3-S5.03 High-dose valacyclovir decreases plasma HIV-1 levels more than standard dose acyclovir in HIV-1, HSV-2 positive persons: a randomised, crossover trial. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050109.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Johnston C, Saracino M, Kuntz S, Magaret A, Schiffer JT, Selke S, Huang ML, Corey L, Wald A. O3-S5.02 Frequent breakthrough genital HSV-2 shedding on standard and high dose valacyclovir. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050109.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Schiffer J, Swan D, Magaret A, Johnston C, Selke S, Wald A, Corey L. O4-S1.04 Rapid spread of herpes simplex virus-2 in the human genital tract. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050109.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Wald A, Stoelben S, Tyring S, Warren T, Johnston C, Huang ML, Timmler B, Ruebsamen-Schaeff H, Corey L, Birkmann A. O3-S5.01 Impact of AIC316, a novel antiviral helicase-primase inhibitor, on genital HSV shedding: randomised, double-blind, placebo-controlled trial. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050109.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Mujugira A, Margaret A, Celum C, Lingappa J, Baeten J, Fife K, De Bruyn G, Bukusi E, Corey L, Wald A. P1-S5.25 Acyclovir and transmission of HSV-2 from HSV-2/HIV-1 dually infected persons. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050108.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Hires L, Van Der Pol B, Williams J, Corey L, Hook EW, Nye M, Taylor S, Martens M, Mena L, Warren T. P3-S2.04 Clinical evaluation of the BD HSV2 Qx assay for the direct qualitative testing of HSV2 as compared to viral culture and a laboratory-based PCR assay using male and female external anogenital lesions. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lu Y, Hendrix C, Celum C, Baeten J, Cowan F, Delany-Moretlwe S, Reid S, Hughes J, Wald A, Corey L. LBO-1.1 Acyclovir achieves lower concentration in African HIV-, HSV-2+ women compared to non-African populations, possibly explaining lower herpes suppression. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050119.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pantone A, Van Der Pol B, Williams J, Corey L, Hook E, Body B, Taylor S, Fine P, Ginde S, Lebed J. P3-S2.03 Clinical evaluation of the BD HSV1 Qx assay for the direct qualitative testing of HSV1 as compared to viral culture and a laboratory-based PCR assay using male and female external anogenital lesions. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pollack M, Leisenring W, Pergam S, Corey L, Boeckh M. Evaluation of a Novel Viral Load Based Surveillance Strategy for Prevention of Cytomegalovirus (CMV) Disease in Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Renaud C, Pergam SA, Polyak C, Jain R, Kuypers J, Englund JA, Corey L, Boeckh MJ. Early emergence of an H275Y mutation in a hematopoietic cell transplant recipient treated with intravenous peramivir. Transpl Infect Dis 2010; 12:513-7. [PMID: 21062390 PMCID: PMC3024056 DOI: 10.1111/j.1399-3062.2010.00582.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [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: 12/16/2022]
Abstract
Oseltamivir resistance in pandemic 2009 influenza A/H1N1 is caused by the neuraminidase mutation H275Y. This mutation has also been associated with in vitro resistance to peramivir, but few clinical cases have been described to date. Using allele-specific real-time reverse transcriptase polymerase chain reaction assay for the H275Y mutation, we were able to identify resistant H1N1 in a hematopoietic cell transplant recipient receiving intravenous peramivir therapy, and through serial testing we determined the molecular evolution of resistance. This case demonstrates that an H275Y mutant population can emerge early and replicate in vivo under peramivir antiviral pressure to become the major viral population.
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Affiliation(s)
- C Renaud
- Département de Microbiologie et Immunologie, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
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Celum C, Wald A, Lingappa JR, Magaret AS, Wang RS, Mugo N, Mujugira A, Baeten JM, Mullins JI, Hughes JP, Bukusi EA, Cohen CR, Katabira E, Ronald A, Kiarie J, Farquhar C, Stewart GJ, Makhema J, Essex M, Were E, Fife KH, de Bruyn G, Gray GE, McIntyre JA, Manongi R, Kapiga S, Coetzee D, Allen S, Inambao M, Kayitenkore K, Karita E, Kanweka W, Delany S, Rees H, Vwalika B, Stevens W, Campbell MS, Thomas KK, Coombs RW, Morrow R, Whittington WLH, McElrath MJ, Barnes L, Ridzon R, Corey L. Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2. N Engl J Med 2010; 362:427-39. [PMID: 20089951 PMCID: PMC2838503 DOI: 10.1056/nejmoa0904849] [Citation(s) in RCA: 390] [Impact Index Per Article: 27.9] [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: 11/19/2022]
Abstract
BACKGROUND Most persons who are infected with human immunodeficiency virus type 1 (HIV-1) are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated and is associated with increased plasma and genital levels of HIV-1. Therapy to suppress HSV-2 reduces the frequency of reactivation of HSV-2 as well as HIV-1 levels, suggesting that suppression of HSV-2 may reduce the risk of transmission of HIV-1. METHODS We conducted a randomized, placebo-controlled trial of suppressive therapy for HSV-2 (acyclovir at a dose of 400 mg orally twice daily) in couples in which only one of the partners was seropositive for HIV-1 (CD4 count, > or = 250 cells per cubic millimeter) and that partner was also infected with HSV-2 and was not taking antiretroviral therapy at the time of enrollment. The primary end point was transmission of HIV-1 to the partner who was not initially infected with HIV-1; linkage of transmissions was assessed by means of genetic sequencing of viruses. RESULTS A total of 3408 couples were enrolled at 14 sites in Africa. Of the partners who were infected with HIV-1, 68% were women, and the baseline median CD4 count was 462 cells per cubic millimeter. Of 132 HIV-1 seroconversions that occurred after randomization (an incidence of 2.7 per 100 person-years), 84 were linked within couples by viral sequencing: 41 in the acyclovir group and 43 in the placebo group (hazard ratio with acyclovir, 0.92, 95% confidence interval [CI], 0.60 to 1.41; P=0.69). Suppression with acyclovir reduced the mean plasma concentration of HIV-1 by 0.25 log(10) copies per milliliter (95% CI, 0.22 to 0.29; P<0.001) and the occurrence of HSV-2-positive genital ulcers by 73% (risk ratio, 0.27; 95% CI, 0.20 to 0.36; P<0.001). A total of 92% of the partners infected with HIV-1 and 84% of the partners not infected with HIV-1 remained in the study for 24 months. The level of adherence to the dispensed study drug was 96%. No serious adverse events related to acyclovir were observed. CONCLUSIONS Daily acyclovir therapy did not reduce the risk of transmission of HIV-1, despite a reduction in plasma HIV-1 RNA of 0.25 log(10) copies per milliliter and a 73% reduction in the occurrence of genital ulcers due to HSV-2. (ClinicalTrials.gov number, NCT00194519.)
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Affiliation(s)
- C Celum
- Department of Global Health, University of Washington, Harborview Medical Center, 325 Ninth Ave., Box 359927, Seattle, WA 98104, USA
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Rolland M, Tovanabutra S, Gilbert PB, Sanders-Buell E, Heath L, deCamp AC, Magaret CC, Bose M, Bradfield A, O'Sullivan A, Crossler J, Deng W, Zhao H, Wong K, Raugi DN, Hural J, Dubey S, Frahm N, Michael NL, Shiver J, Corey L, Li F, Self SG, Kim J, Buchbinder S, Casimiro DR, Robertson MN, McElrath MJ, McCutchan FE, Mullins JI. OA06-06 LB. Evidence of vaccine-induced changes in breakthrough HIV-1 strains from the Step trial. Retrovirology 2009. [PMCID: PMC2767565 DOI: 10.1186/1742-4690-6-s3-o42] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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38
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Self S, Li F, Corey L, McElrath J. P17-25. A model for coverage of T-cell HIV vaccines: where are we and where do we need to be? Retrovirology 2009. [PMCID: PMC2767812 DOI: 10.1186/1742-4690-6-s3-p307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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de Bruyn G, Mlisana K, Metch B, Churchyard G, Nchabeleng M, Bekker L, Roux S, Naicker N, Latka M, Corey L, Kublin J, Gray G. P14-07. Offering new prevention modalities in HIV vaccine trials: experience with male circumcision in the Phambili trial. Retrovirology 2009. [PMCID: PMC2767687 DOI: 10.1186/1742-4690-6-s3-p195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Curlin M, Celum C, Sanchez J, Selke S, Baeten J, Huang M, Zuckerman R, Lu X, Erdman D, Corey L. P11-17. Intermittent rectal shedding of multiple human adenovirus serotypes among HIV-positive MSM. Retrovirology 2009. [PMCID: PMC2767651 DOI: 10.1186/1742-4690-6-s3-p162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lingappa JR, Hughes JP, Donnel D, Baeten JM, Mullins JI, Campbell MS, Gray GE, Essex M, Farquhar C, Rees H, Wald A, Corey L, Celum C. OA01-06 LB. HIV-1 plasma RNA and risk of HIV-1 transmission. Retrovirology 2009. [PMCID: PMC2767532 DOI: 10.1186/1742-4690-6-s3-o12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Malhotra U, Nolin J, Horton H, Li F, Corey L, Mullins JI, McElrath MJ. Functional properties and epitope characteristics of T-cells recognizing natural HIV-1 variants. Vaccine 2009; 27:6678-87. [PMID: 19747576 DOI: 10.1016/j.vaccine.2009.08.093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 08/17/2009] [Accepted: 08/26/2009] [Indexed: 11/18/2022]
Abstract
To understand how broad recognition of HIV-1 variants may be achieved we examined T-cell reactivity in newly infected persons as well as vaccine recipients to a broad spectrum of potential T-cell epitope (PTE) variants containing conservative, semi-conservative and non-conservative amino acid substitutions. Among early infected persons T-cells recognized epitope variants with one substitution at a significantly higher frequency versus those with two (P=0.0098) and three (P=0.0125) substitutions. Furthermore T-cells recognized variants containing conservative substitutions at a higher frequency versus those containing semi-conservative (P=0.0029) and non-conservative (P<0.0001) substitutions. Similar effects were observed on recognition of variants by vaccine-induced T-cells. Moreover even when variants were recognized, the IFN-gamma and granzyme B responses as well as T-cell proliferation were of lower magnitude. Finally, we show that epitope distribution is strongly influenced by both processing preferences and amino acid entropy. We conclude that induction of broad immunity is likely to require immunogen sequences that encompass multiple variants. However, cost-effective design of peptide and sequence based vaccine immunogens that provide maximal coverage of circulating sequences may be achieved through emphasis on virus domains likely to be T-cell targets.
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Affiliation(s)
- U Malhotra
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Nguyen HQ, Okuku F, Ssewankambo F, Magaret AS, Johnston C, Wald A, Kambugu A, Corey L, Orem J, Casper C. AIDS-associated Kaposi sarcoma in Uganda: response to treatment with highly active antiretroviral therapy and chemotherapy. Infect Agent Cancer 2009. [PMCID: PMC4261744 DOI: 10.1186/1750-9378-4-s2-o5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kuypers J, Campbell AP, Cent A, Corey L, Boeckh M. Comparison of conventional and molecular detection of respiratory viruses in hematopoietic cell transplant recipients. Transpl Infect Dis 2009; 11:298-303. [PMID: 19453994 DOI: 10.1111/j.1399-3062.2009.00400.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Sensitive detection of respiratory viruses is important for early diagnosis of infection in patients following hematopoietic cell transplantation (HCT). To evaluate the relative sensitivity of respiratory virus detection in specimens from HCT recipients, we compared the results of conventional and quantitative molecular methods. METHODS We tested 688 nasal wash samples collected prospectively from 131 patients during the first 100 days after HCT by viral culture, fluorescent antibody staining (FA), and real-time quantitative reverse transcription-polymerase chain reaction (PCR) assay for detection of respiratory syncytial virus (RSV), influenza virus types A (FluA) and B (FluB), and parainfluenza virus types 1 (PIV1) and 3 (PIV3). Testing for human metapneumovirus (MPV) was performed only by PCR. Data regarding 10 respiratory symptoms were collected with each sample. RESULTS By any method 37 specimens were positive for a respiratory virus; 34 were positive by PCR, 15 by culture, and 6 by FA. Four specimens were positive by all 3 methods (3 RSV, 1 FluA). One specimen was positive for PIV1, and 2 were positive for rhinovirus by culture alone. Specimens positive by PCR alone included 2 RSV, 2 PIV1, 8 PIV3, and 8 MPV. In 10 specimens positive for RSV, PIV, or influenza virus collected from patients reporting no respiratory symptoms, 9, 4, and 1 specimen were positive by PCR, culture, and FA, respectively. Overall, specimens positive only by PCR had significantly fewer viral copies/mL (mean log(10)=4.32) than specimens positive by both PCR and culture (mean log(10)=5.75; P=0.002) or PCR and FA (mean log(10)=6.83; P<0.001). CONCLUSIONS FA testing alone did not detect a significant proportion of respiratory virus-positive samples in HCT recipients, especially in patients with no respiratory symptoms and patients with PIV detection. PCR increased the yield of positive specimens 2 times relative to culture and more than 4 times relative to FA. Detection of respiratory viruses by PCR alone was associated with lower virus quantities and with fewer reported respiratory symptoms compared with concomitant detection by both PCR and conventional methods, indicating that PCR may be important to detect asymptomatic or mildly symptomatic stages of respiratory viral infections.
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Affiliation(s)
- J Kuypers
- University of Washington, Seattle, Washington, USA.
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Gurunathan S, Habib RE, Baglyos L, Meric C, Plotkin S, Dodet B, Corey L, Tartaglia J. Use of predictive markers of HIV disease progression in vaccine trials. Vaccine 2009; 27:1997-2015. [DOI: 10.1016/j.vaccine.2009.01.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 12/19/2008] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
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Milano F, Campbell A, Kuypers J, Englund J, Callais C, Corey L, Boeckh M. Human Coronavirus (HCOV) and Rhinovirus (HRHV) Infection among Hematopoietic Stem Cell Transplantation (HCT) Recipients. Biol Blood Marrow Transplant 2009. [PMCID: PMC7129590 DOI: 10.1016/j.bbmt.2008.12.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Boeckh M, Nichols G, Chemaly R, Papanicolaou G, Wingard J, Kirby K, Dahlgren C, Corey L, Leisenring W. 75: Prevention of Late CMV Disease After HCT: A Randomized Double-Blind Multicenter Trial of Valganciclovir (VGCV) Prophylaxis Versus PCR-guided GCV/VGCV Preemptive Therapy. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sandhu R, Smith J, Kirby K, Heimfeld S, Corey L, Boeckh M. 80: Primary CMV Infection in CMV Seronegative Recipients of a Stem Cell Product from a Seropositive Donor (D+/R-): Frequency of and Risk Factors for Transmission. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hakki M, Limaye AP, Kim HW, Kirby KA, Corey L, Boeckh M. Invasive Pseudomonas aeruginosa infections: high rate of recurrence and mortality after hematopoietic cell transplantation. Bone Marrow Transplant 2007; 39:687-93. [PMID: 17401395 DOI: 10.1038/sj.bmt.1705653] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Limited data exist regarding the incidence and factors associated with outcome of invasive Pseudomonal infections in hematopoietic cell transplant (HCT). A retrospective analysis of cases of invasive Pseudomonas aeruginosa infection and factors associated with outcome was performed. P. aeruginosa invasive infection occurred in 95 of 5772 patients (1.65%) a median of 63 days after HCT (range 5-1435). Only 28% of infections occurred during periods of neutropenia (absolute neutrophil count<500 cells/mm(3)). Infection-attributable mortality during the initial episode of infection was 35.8%. Factors associated with initial mortality included the presence of a copathogen and high-dose steroid use. Ten (16.4%) of those who survived the initial infection experienced a recurrence of P. aeruginosa infection at a median of 9 days (range 3-17) after stopping antibiotics and 60% of those died as a result of recurrent infection a median of 1 day (range 1-7) after onset of recurrence. Grade 3-4 graft-versus-host disease was associated with a higher risk of recurrent infection. The risk of recurrence was not influenced by the presence of copathogens. Thus, invasive P. aeruginosa infections are associated with high recurrence rates and mortality in this immunocompromised population. Aggressive attempts to reduce immunosuppression and to treat copathogens may help during the initial infection.
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Affiliation(s)
- M Hakki
- Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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Vu D, Peck A, Nichols G, Varley C, Englund J, Corey L, Boeckh M. OSELTAMIVIR PROPHYLAXIIS IN HEMATOPOIETIC STEM CELL TRANSPLANTATION RECIPIENTS: A CASE-CONTROL STUDY. J Investig Med 2007. [DOI: 10.1097/00042871-200701010-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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