Brentuximab vedotin plus AVD for Hodgkin lymphoma: incidence and management of peripheral neuropathy in a multisite cohort

Brentuximab vedotin (BV) in combination with doxorubicin, vinblastine, and dacarbazine (AVD) is increasingly used for frontline treatment of stage III/IV classical Hodgkin lymphoma (cHL). Peripheral neuropathy (PN) was the most common and treatment-limiting side effect seen in clinical trials but has not been studied in a nontrial setting, in which clinicians may have different strategies for managing it. We conducted a multisite retrospective study to characterize PN in patients who received BV + AVD for newly diagnosed cHL. One hundred fifty-three patients from 10 US institutions were eligible. Thirty-four patients (22%) had at least 1 ineligibility criteria for ECHELON-1, including stage, performance status, and comorbidities. PN was reported by 80% of patients during treatment; 39% experienced grade (G) 1, 31% G2, and 10% G3. In total, BV was modified in 44% of patients because of PN leading to BV discontinuation in 23%, dose reduction in 17%, and temporary hold in 4%. With a median follow-up of 24 months, PN resolution was documented in 36% and improvement in 33% at the last follow-up. Two-year progression-free survival (PFS) for the advanced-stage patients was 82.7% (95% confidence interval [CI], 0.76-0.90) and overall survival was 97.4% (95% CI, 0.94-1.00). Patients who discontinued BV because of PN did not have inferior PFS. In the nontrial setting, BV + AVD was associated with a high incidence of PN. In our cohort, which includes patients who would not have been eligible for the pivotal ECHELON-1 trial, BV discontinuation rates were higher than previously reported, but 2-year outcomes remain comparable.

High-grade B-cell lymphoma, not otherwise specified: a multi-institutional retrospective study

In this multi-institutional retrospective study, we examined the characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS)-a rare category defined by high-grade morphologic features and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements ("double hit"). Our results show that HGBL-NOS tumors are heterogeneous: 83% of patients had a germinal center B-cell immunophenotype, 37% a dual-expressor immunophenotype (MYC and BCL2 expression), 28% MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage IV disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included dose-adjusted cyclophosphamide, doxorubicin, vincristine, and etoposide, with rituximab and prednisone (DA-EPOCH-R; 43%); rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 33%); or other intensive chemotherapy programs. We found no significant differences in the rates of complete response (CR), progression-free survival (PFS), or overall survival (OS) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% and OS was 68.1%. In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase >3 × upper limit of normal, and a dual-expressor immunophenotype. Age >60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS. Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R vs R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS.

Pemigatinib for the treatment of myeloid/lymphoid neoplasms with FGFR1 rearrangement

INTRODUCTION

Myeloid/lymphoid neoplasms with fibroblast growth factor receptor-1 (FGFR1) rearrangements (MLN^FGFR1) are rare entities with aggressive features and poor prognosis. Presentation is heterogeneous, ranging from myeloproliferative neoplasms (with or without eosinophilia) to T-cell lymphoma and acute leukemia. Historical treatments have been guided by the presenting phenotype with induction chemotherapy frequently used. Pemigatinib is a FGFR1-3 tyrosine kinase inhibitor that has demonstrated high complete hematologic and cytogenetic response rates in MLN^FGFR1.

AREAS COVERED

We discuss the pathogenesis, presentation, and historical treatments for MLN^FGFR1, in addition to clinical data using pemigatinib and other targeted therapies. Discussion of the mechanism of action and adverse events are also included.

EXPERT OPINION

Pemigatinib represents a significant advance in the management of MLN^FGFR1. High rates of complete hematologic and cytogenetic response have been observed. While direct comparative data are unavailable, outcomes appear favorable compared to conventional approaches. Long term efficacy and tolerability are not yet known, and allogeneic hematopoietic stem cell transplant (alloHSCT) has been and continues to be the treatment with the highest chance of long term disease free survival in responding patients. Combinations of pemigatinib and chemotherapy, particularly for more aggressive phenotypes, warrant future investigation as does the use of pemigatinib maintenance following alloHSCT.

A multi-center analysis of the impact of DA-EPOCH-R dose-adjustment on clinical outcomes of patients with double/triple-hit lymphoma

Patients with double- and triple-hit lymphomas (DHL/THL) have inferior outcomes with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), and higher-intensity regimens such as dose-adjusted (DA)-EPOCH-R are standard. Dose-intensification of DA-EPOCH-R is guided by hematologic toxicity, without conclusive benefit for DHL/THL patients. To determine if cumulative doses of DA-EPOCH-R or compliance with dose adjustment impacts survival, we retrospectively evaluated detailed clinical data from 109 adult (age ≥18 years) patients with DHL/THL treated with ≥4 cycles of induction DA-EPOCH-R from 2014 to 2019 at six centers. A comprehensive multivariate analysis was performed. Survival outcomes for the entire cohort were comparable to historical estimates for DHL/THL treated with this regimen (median follow-up 27.9 months). Overall survival (OS) and progression-free survival (PFS) were not significantly associated with cumulative chemotherapy dose, dose escalation, or compliance with dose adjustment. Heterogeneous dosing practices were observed. Prospective investigation is warranted to evaluate the practice of dose adjustment of R-EPOCH for patients with DHL/THL.

Outcomes of Tisagenlecleucel in Lymphoma Patients With Predominant Management in an Ambulatory Setting

INTRODUCTION

Chimeric antigen receptor T-cell therapy (CAR T) is a revolutionary adoptive immunotherapy approach in lymphoma; however, substantial resources are necessary for administration and care of these patients. Our institution has administered tisagenlecleucel primarily in an outpatient setting, and here we report our clinical outcomes.

PATIENTS AND METHODS

We conducted a single institution, retrospective study investigating outcomes of adult lymphoma patients treated with commercial tisagenlecleucel between 10/2017 and 12/2020. We analyzed patient characteristics and outcomes of efficacy and safety including overall response rate, progression-free survival, overall survival and cytokine-release syndrome, neurotoxicity, and hospitalizations.

RESULTS

Seventy-two patients with relapsed or refractory non-Hodgkin lymphoma (NHL) who received commercial tisagenlecleucel were identified; 68 (94.4%) patients received outpatient tisagenlecleucel. The overall response rate was 43% with a complete response observed in 25 patients (34.7%). At a median follow-up of 9.1 months, the median progression-free survival was 3.3 months. Grade 3-4 cytokine release syndrome was not observed in the study group and two patients had grade 3-4 neurotoxicity. Twenty-six patients (36.1%) were admitted within 30 days after infusion with a median length of stay of 5 days. Fourteen patients (19.4%) were admitted within 72 hours of infusion. No patient died of CAR T cell-related toxicity.

CONCLUSION

Our experience affirms treatment with tisagenlecleucel in the outpatient setting is safe and feasible with close supervision and adequate institutional experience. After infusion, adverse events were manageable and the majority of patients did not require hospitalization.

New and emerging therapies for the treatment of relapsed/refractory diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is the most common form of aggressive non-Hodgkin lymphoma. Approximately 40% of patients with DLBCL will experience disease relapse or will be refractory to first line chemoimmunotherapy, necessitating second-line salvage therapy. This has historically consisted of platinum-based chemotherapy regimens followed by autologous hematopoietic stem cell transplantation with curative intent for transplant-eligible patients or palliative chemotherapy for transplant-ineligible patients. In recent years there have been several new therapeutic agents approved for the treatment of relapsed/refractory DLBCL, thereby expanding the therapeutic landscape. These agents include polatuzumab vedotin, tafasitamab, loncastuximab tesirine, selinexor, and anti-CD19 chimeric antigen receptor T-cell therapies such as axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel. This review summarizes the pharmacology, efficacy, safety, dosing, and administration of new agents recently approved for the treatment of relapsed/refractory DLBCL.

Addressing the Challenges of Novel Oncology and Hematology Treatments Across Sites of Care: Specialty Pharmacy Solutions

BACKGROUND

The number of Food and Drug Administration (FDA) approvals for anticancer therapies has significantly increased in recent years, but these novel therapies are costly and present challenges to patients and providers. Many institutions have implemented health systems specialty pharmacies (HSSPs) to help patients and providers navigate financial and logistical barriers to treatment with oral anticancer therapies. Patients on oral anticancer therapy are often treated across multiple sites of care which can complicate the inpatient specialty medication initiation process. Health systems often limit inclusion of oral anticancer therapies for inpatient administration due to costs, however several new therapies necessitate admission for treatment initiation. Health systems are then faced with the challenge of starting costly oral anticancer therapy inpatient and ensuring continued access to therapy upon discharge. We describe the integrated HSSP multidisciplinary approach to this MUP including providers, inpatient and outpatient pharmacists, specialty and inpatient pharmacies, institutional procurement team, and the institutional pharmacy and therapeutics (P&T) committee to streamline this process.The HSSP multidisciplinary processes addresses a growing need for cancer patients to receive timely and affordable treatments across different sites of care. The healthcare team and P&T committee ensure the patient receives the most appropriate therapy while being conscious of health-system costs. The HSSP and procurement team ensure the patient can obtain and afford the medication. The implemented processes allows for direct communication and collaboration between different sites of care and this collaborative approach leads to optimal patient care.

18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Following Chimeric Antigen Receptor T-cell Therapy in Large B-cell Lymphoma

PURPOSE

18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a well-established imaging modality to assess responses in patients with B-cell neoplasms. However, there is limited information about the utility of FDG PET/CT after chimeric antigen receptor T-cell (CART) therapies for large B-cell lymphomas. In this retrospective analysis, we aimed to evaluate how FDG PET/CT performs in patients receiving commercially available anti-CD19 CART therapies for relapsed/refractory (r/r) large B-cell lymphomas. In addition, we examined the time to repeat scan and the rate of pseudoprogression within this population. Lastly, the rates of radiographic response to CART therapy using FDG PET/CT are reported.

PROCEDURES

The pre-treatment and post-treatment scans were analyzed from a selected cohort of 43 patients from a single institution. Patients were stratified by diagnosis of either a first occurrence of diffuse large B-cell lymphoma: de novo diffuse large B-cell lymphoma (DLBCL); or a transformed diffuse large B-cell lymphoma arising from indolent non-Hodgkin lymphoma (t-iNHL).

RESULTS

More patients received CART therapy for DLBCL than t-iNHL (65 % vs 35 %). FDG PET/CT had a 99 % sensitivity and 100 % specificity for detecting recurrent disease in this group. The median time to initial response assessment was 86 days (IQR 79-91; full range 24-146) after infusion. There were no biopsy-proven cases of pseudoprogression identified. In this selected group of patients, the overall response rate by Lugano 2014 criteria was 56 %. All patients with a partial response (N = 6) eventually progressed despite additional therapy.

CONCLUSIONS

Due to its excellent test characteristics and ability to detect asymptomatic disease, routine surveillance with PET/CT at 3 months after CART infusion is supported by our data. Earlier PET/CT may be of value in select situations as we did not find any cases of pseudoprogression.

Post-transplant lymphoproliferative disorder in kidney transplant patients: A multicenter report

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Background: Post-Transplant Lymphoproliferative Disorder (PTLD) is a complication of transplantation that often arises due to reactivation of the Epstein-Bar Virus (EBV). Given the rarity of this disease, a full understanding of its presentation and optimal therapies has yet to be determined. Methods: A multicenter retrospective analysis was performed utilizing data from kidney transplant patients (pts) who developed PTLD at the Hospital of the University of Pennsylvania and the Cleveland Clinic. The association between categorical variables and clinical response were assessed via Fisher’s exact testing. Results: 117 pts had diagnoses of PTLD after kidney transplantation. The median age at PTLD diagnosis was 52 yrs (range 17-89 yrs), and the median time from transplantation to diagnosis was 3.6 yrs (range: 7 days-36 yrs). Pt characteristics included: 84% Caucasian, 57% male, and 11% combined kidney and pancreas transplant patients. 68% pts had received unrelated donor transplants; 41% had prior rejection episodes. PTLD histology was 72% monomorphic and 28% polymorphic. Polymorphic PTLD was more likely to be EBV+ than monomorphic PTLD (81% vs. 54%, p = 0.05). At diagnosis, immunosuppression included: steroids (95%), mycophenolate (44%), azathioprine (40%), sirolimus (30%), cyclosporine (46%), and/or tacrolimus (45%). Common PTLD symptoms included fever (34%), pain (38%), weight loss (30%), fatigue (30%), and/or mass (26%). The most common sites of involvement were lymph nodes (64%), kidney allograft (22%), and/or GI tract (17%). At diagnosis, 61% of patients’ tumors were EBV+ and 59% of patients had elevated serum LDH. Overall, the majority of pts responded to first-line PTLD therapy, with 61% CR and 14% PR. Reduction of immunosuppression (RI) alone (36% of pts) led to 48% CR and 12% PR; RI with rituximab (16%) led to 47% CR and 7% PR; and RI with chemotherapy (14%) resulted in 58% CR and 42% PR. Patients treated with RI as well as resection (n = 18) of their limited stage disease had better outcomes (p = 0.05). Overall survival for all patients was 10.7 years (95%CI: 5.2-13 years). PTLD patients < 40 yrs were more likely to achieve CR after first line therapy (p < 0.001), have allograft involvement (p = 0.003), and have a polymorphic histology (p = 0.002). Allograft involvement tended to occur sooner after transplant (p = 0.001) and was more likely to present with allograft failure (p = 0.007). PTLD with allograft involvement had better response to first therapy than regular PTLD (p = 0.007) and often responded well to complete resection and RI. Conclusions: Pts with PTLD may achieve a CR through different initial therapies. Younger patients and those able to undergo complete resection of disease and RI had better prognoses. Allograft involvement by PTLD carries a good prognosis and should be identified and treated differently from other presentations.

Reversion and non-reversion mechanisms of resistance to PARP inhibitor or platinum chemotherapy in BRCA1/2-mutant metastatic breast cancer

BACKGROUND

Little is known about mechanisms of resistance to poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPi) and platinum chemotherapy in patients with metastatic breast cancer and BRCA1/2 mutations. Further investigation of resistance in clinical cohorts may point to strategies to prevent or overcome treatment failure.

PATIENTS AND METHODS

We obtained tumor biopsies from metastatic breast cancer patients with BRCA1/2 deficiency before and after acquired resistance to PARPi or platinum chemotherapy. Whole exome sequencing was carried out on each tumor, germline DNA, and circulating tumor DNA. Tumors underwent RNA sequencing, and immunohistochemical staining for RAD51 foci on tumor sections was carried out for functional assessment of intact homologous recombination (HR).

RESULTS

Pre- and post-resistance tumor samples were sequenced from eight patients (four with BRCA1 and four with BRCA2 mutation; four treated with PARPi and four with platinum). Following disease progression on DNA-damaging therapy, four patients (50%) acquired at least one somatic reversion alteration likely to result in functional BRCA1/2 protein detected by tumor or circulating tumor DNA sequencing. Two patients with germline BRCA1 deficiency acquired genomic alterations anticipated to restore HR through increased DNA end resection: loss of TP53BP1 in one patient and amplification of MRE11A in another. RAD51 foci were acquired post-resistance in all patients with genomic reversion, consistent with reconstitution of HR. All patients whose tumors demonstrated RAD51 foci post-resistance were intrinsically resistant to subsequent lines of DNA-damaging therapy.

CONCLUSIONS

Genomic reversion in BRCA1/2 was the most commonly observed mechanism of resistance, occurring in four of eight patients. Novel sequence alterations leading to increased DNA end resection were seen in two patients, and may be targetable for therapeutic benefit. The presence of RAD51 foci by immunohistochemistry was consistent with BRCA1/2 protein functional status from genomic data and predicted response to later DNA-damaging therapy, supporting RAD51 focus formation as a clinically useful biomarker.

Management and outcomes of sinus histiocytosis with massive lymphadenopathy (Rosai Dorfman Disease)

Sinus histiocytosis with massive lymphadenopathy (Rosai Dorfman Disease [RDD]), is a rare, benign but clinically heterogeneous histiocytic disorder. Our aims were to analyze the clinical characteristics of the disease and explore the outcomes of patients with RDD followed at our institution. Between January 2000 and February 2019, there were 15 patients with a pathologically confirmed diagnosis of RDD. Median age at diagnosis was 48 years old (range 26-78). The majority (87%, n = 13) of the patients had extranodal disease. Frontline approaches included surgical intervention/complete excision (n = 5, 33%), rituximab monotherapy (n = 5, 33%), observation (n = 3, 20%), and radiation (n = 2, 13%). Two of the five patients underwent surgical excision and were subsequently treated with rituximab. Of the 7 patients who were given rituximab, 64% remained progression free 24 months after the initial rituximab administration. Our review parallels previous reports and highlights rituximab as a favorable option for therapy if ineligible for surgery or radiation.

Treatment of Patients With Relapsed/Refractory Non-Hodgkin Lymphoma With Venetoclax: A Single-Center Evaluation of Off-Label Use

INTRODUCTION

Venetoclax is a highly effective agent in chronic lymphocytic leukemia and acute myeloid leukemia. Phase I/II clinical trials have shown it to be safe and effective in non-Hodgkin lymphoma (NHL). Adverse events were consistent with package labeling despite escalation to high doses. To the best of our knowledge, venetoclax use outside the setting of a clinical trial of NHL has not been reported.

PATIENTS AND METHODS

We conducted a single-center, retrospective study of 34 adult patients who had been treated off-label with venetoclax-containing regimens from 2016 to 2018.

RESULTS

Of the 34 patients with NHL treated with venetoclax therapy, 13 had had high-grade B-cell lymphoma/diffuse large B-cell lymphoma, 10 mantle cell lymphoma, 5 transformed follicular lymphoma, 2 Richter transformation, 2 marginal zone lymphoma, 1 follicular lymphoma, and 1 post-transplant lymphoproliferative disorder. The patients had received a median of 4 previous therapies. The overall response rate was 26% (3% with a complete response and 35% with stable disease). The median venetoclax dose achieved was 400 mg. Of those receiving combination therapy, 18% had undergone radiation and 62% had received other systemic antineoplastic therapy. The median progression-free and overall survival for the cohort was 2 and 4.5 months, respectively. Adverse events occurred in 76% of the patients during venetoclax therapy. The adverse events included neutropenia, thrombocytopenia, tumor lysis syndrome, infection, neutropenic fever, diarrhea, and 1 opportunistic infection.

CONCLUSION

Venetoclax therapy in a real-world cohort offered modest benefits in heavily pretreated patients. Adverse events were observed at a greater incidence than in the clinical trials. A wide heterogeneity of venetoclax dose escalation, multiagent combinations, and timing of initiation were identified and require investigation in subsequent clinical trials.

Appropriate prescribing of antiemetics with oral oncolytic therapy: a single center experience

Background: Chemotherapy-induced nausea and vomiting (CINV) is a common and significant side-effect of chemotherapy that can impact a patient’s quality-of-life (QoL). As oral oncolytic therapies (OOT) become a common treatment option, they pose unique challenges for providers and patients. Unlike infusion therapies, a single-day administration, OOT may require daily dosing during a treatment cycle and, therefore, require patients to be proactive in terms of supportive care monitoring and prevention. The American Society of Clinical Oncology provides recommendations for appropriate emetic prophylaxis, however, due to limited data for OOT, only offer recommendations for single-day IV chemotherapy.

Aims: The objective of this quality improvement study was to review the appropriate prescribing of antiemetics with OOT, in the specialty and ambulatory setting, and evaluate the opportunity to enhance medication safety and improve vigilance of concurrent prescribing with pharmacist involvement.

Methods: All patients ordered for OOT between January and December 2018 to the Hospital of the University of Pennsylvania specialty pharmacy were reviewed for concurrent antiemetic prescriptions. Patients were excluded if prescriptions were sent to a satellite or outside institution pharmacy. Patients who were identified to have a discordant antiemetic:OOT prescribing ratio were evaluated for adverse events such as CINC-related office visits or hospitalization; as documented in the electronic medical record.

Results: A total of 1,630 OOT prescriptions were written for 354 patients. Two hundred and sixty-eight patients were excluded for the following reasons; 117 (33.0%) were prescribed to a satellite or outside pharmacy and 151 (42%) had concordant antiemetics. Eighty-six patients were included based on initial discordance given that OOT and antiemetics were not ordered within the same office visit. Upon further evaluation, 60 were found to have active antiemetics ordered as part of a previous line of therapy and, therefore, had an adequate supply. Of the n = 26 without antiemetics, n = 4 were deemed to not require antiemetics, while n = 22 were confirmed to lack prescriptions. There were no reports of CINV that required urgent care or hospitalizations.

Conclusions: OOT is becoming increasingly common, with unique risks such as CINV. The authors plan to increase the pharmacist involvement with the prescribing and counseling of new OOT to promote improved supportive care measures, communication between patients and providers, and potential avoidance of patient harm and improved QoL.

Oral Vancomycin Prophylaxis Is Highly Effective in Preventing Clostridium difficile Infection in Allogeneic Hematopoietic Cell Transplant Recipients

BACKGROUND

Clostridium difficile infection (CDI) is a leading cause of infectious complications in allogeneic hematopoietic cell transplant recipients (alloHCT). We sought to evaluate whether prophylactic oral vancomycin reduces the incidence of CDI in alloHCT recipients.

METHODS

We conducted a retrospective cohort study to examine the effectiveness of CDI prophylaxis with oral vancomycin, as compared to no prophylaxis, in 145 consecutive adult alloHCT recipients at the University of Pennsylvania between April 2015 and November 2016. Patients received oral vancomycin 125 mg twice daily, starting on admission and continuing until discharge. The primary outcome of interest was the association between oral vancomycin prophylaxis and CDI diagnosis. Secondary outcomes included graft-versus-host disease (GVHD) and relapse.

RESULTS

There were no cases of CDI in patients that received prophylaxis (0/90, 0%), whereas 11/55 (20%) patients who did not receive prophylaxis developed CDI (P < .001). Oral vancomycin prophylaxis was not associated with a higher risk of acute, grades 2-4 GVHD (subhazard ratio [sHR] 1.59; 95% confidence interval [CI] 0.88-2.89; P = .12), acute, grades 3-4 GVHD (sHR 0.65; 95% CI 0.25-1.66; P = .36), or acute, grades 2-4 gastrointestinal GVHD (sHR 1.95; 95% CI 0.93-4.07; P = .08) at day 180 post-transplant. No associations between oral vancomycin and relapse or survival were observed.

CONCLUSIONS

Prophylaxis with oral vancomycin is highly effective in preventing CDI in alloHCT recipients without increasing the risk of graft-versus-host disease or disease relapse. Further evaluation via a prospective study is warranted.

Abstract PD9-01: Genomic alterations associated with loss of HR expression in metastatic breast cancer

Background: Discordance in hormone receptor (HR) status between primary (p) tumors and metastatic (m) recurrences has been widely described. Loss of estrogen and progesterone receptor expression occurs in ˜12% of asynchronous recurrences, leading to triple-negative (TN) status in the metastasis. Genomic mechanisms driving HR loss and its prognostic and therapeutic implications have not been fully elucidated.

Methods: Targeted NGS (Oncopanel, OP) at Dana-Farber Cancer Institute using multiplexed copy number variation and mutation (mut) detection across the full coding regions of 300 genes and selected intronic regions of 35 genes was prospectively performed on either archival primary or metastatic samples collected in patients (pts) with metastatic breast cancer (MBC). Receptor status at initial diagnosis and recurrence were reviewed using a 1% cutoff to define HR-positivity and excluding HER2+ cases. Fisher´s exact test was used to compare frequency of alterations. Tumor mut burden (TMB) was computed normalizing the sum of reported exon mut in each pt by the exonic-bait-set size of the panel.

Results: Between 8/2013-9/2016, 929 pts with MBC underwent OP testing. Of 517 pts diagnosed with primary HR+/HER2- breast cancer, at time of recurrence 388 remained HR+/HER2- (pHR+/mHR+), 39 switched to HR-/HER2- (pHR+/mTN, of which 23 (59%) had initial HR expression &gt;10%), 10 switched to HER2+ and 80 had unknown metastatic receptor status. Comparison between primary samples in pHR+/mHR+ (n=245) and pHR+/mTN (n=24) showed that pHR+/mTN was significantly more likely to harbor mut in TP53, STK11 and MSH6, amplifications (amp) in CCNE1 and FGFR2, and less likely to have PIK3CA mut or CCND1 amp. Median TMB in primary pHR+/mHR+ was 6.05 mut/Mb (0-37.5) and 5.68 mut/Mb (1.2-10.9) in pHR+/mTN (p=0.45). Metastatic samples in pHR+/mTN (n=15) were enriched in ARID1A, CRTC2 and CDH1 mut compared to metastases (n=40) in pts who remained TN (pTN/mTN). Deletions in CDKN2A/2B and RB1, and mut in TP53, NOTCH2 and ERCC2 were more prevalent in recurrent tumors of pHR+/mTN than pHR+/mHR+. In metastases, TMB was higher in pHR+/mTN than pTN/mTN or pHR+/mHR+ (10.9 vs. 7.0 vs. 7.3 mut/Mb, respectively; p=0.002). Median OS from initial diagnosis was 9.4 yrs in pHR+/mTN, less than pHR+/mHR+ (15.9 yrs; p=0.009) and greater than pTN/mTN (4.3 yrs; p=0.008). Median OS from MBC diagnosis was 1.8 yrs in pHR+/mTN, less than pHR+/mHR+ (6.4 yrs; p=0.001) but not significantly different than pTN/mTN (1.5 yrs, p=0.3).

 pHR+/mHR+ (n=245)pHR+/mTN (n=24)p value NFreq (%)NFreq (%) MutTP536325.72083.3&lt;0.00001PIK3CA9438.4000GATA33514.3000.053STK1152.0312.50.026MSH641.6312.50.017AmpFGFR20028.30.008CCNE10028.30.008CCND14418.0000.018

Conclusion: Targeted NGS shows that alterations in DNA damage and cell-cycle regulation pathways in primary HR+ tumors are associated with HR loss in the metastatic setting. Primary tumors that lose HR appear more similar to basal-like than luminal tumors, despite &gt;10% baseline HR expression in most pts, and once metastatic, survival is comparable to pTN/mTN. Metastases with HR loss have higher TMB than those that remain HR+ or TN throughout the course of the disease. These findings, if confirmed, may influence treatment and pt selection for clinical trials.

Citation Format: Garrido-Castro AC, Hughes ME, Cherniack A, Barroso-Sousa R, Bychkovsky BL, Di Lascio S, Berger A, Mittendorf EA, Files JL, Guo H, Kumari P, Cerami E, Krop IE, Wagle N, Lindeman NI, MacConaill LE, Dillon DA, Winer EP, Lin NU. Genomic alterations associated with loss of HR expression in metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD9-01.

Abstract P4-04-02: Identifying ERBB-2 activating mutations (mts) in HER2 negative tumors for clinical trials – Impact of institute-wide genomic testing and trial matching on trial enrollment in clinical practice

Introduction

Tailored treatment trials with biomarker-driven hypotheses are becoming an important strategy in drug development. Umbrella, basket and enrichment trials with eligibility predicated upon results of tumor sequencing are increasingly common. Several institutional and commercial genomic assays have been developed. However, the value of broad-based testing in recruiting patients (pts) to molecular-based clinical trials designed for small subgroups has not been fully evaluated and has been challenging to assess in a real-world setting. We evaluated the likelihood of trial enrollment based upon an institute-wide genomic test.

Methods

Since 2013, all pts with metastatic breast cancer (MBC) seen at least once at Dana-Farber Cancer Institute have been offered the option of tumor sequencing using multiplexed copy number variation (CNV) and mts detection across the full coding regions of a total of 447 cancer genes and 191 regions across 60 genes for rearrangement detection (Oncopanel; OP). For our primary analysis, we selected the ongoing multi-center phase II trial (NCT01670877) activated at our site on Sep 30, 2013, evaluating neratinib in ERBB-2 mutated pts, as the study provided a clear delineation of eligible mts, and timing of slot availability was retrievable retrospectively over an extended time frame. Our primary aim was to describe the proportion of pts with a qualifying ERBB-2 mt detected by OP who enrolled on the selected trial. Secondary objectives included median time from OP result to trial registration and description of ERBB-2 mts spectrum within each subtype. Associations were calculated by Fisher's test.

Results

We identified a total of 1,046 pts with HER-2 negative MBC and who had OP results between Sep 1, 2013 and Jun 1, 2017. A total of 43 pts (4.1%) were found to have ERBB-2 mts. Of these, 20 (1.9%) had activating eligible mts. The proportion of these pts who enrolled in the trial was 30% (6/20). Of the remaining 14 pts, 5 screen-failed and 2 were enrolled with known ERBB-2 mt through other testing modalities. Seven of 20 (35%) molecularly eligible pts were not approached (3 pts lost to follow-up, 3 enrolled in other clinical trials and 1 pt chose standard treatment). The median time from OP result to trial enrollment was 85 days (34-554). A significantly higher frequency of ERBB2 activating mts was found in ER+ compared to ER- primary tumors (2.5% vs. 0.3%, p =0.036), and in lobular tumors compared with ductal (5.5% vs. 1.25%, p=0.003). Frequency of eligible mts in primary tumors were similar to metastatic site (1.9% and 1.8%, respectively p=1.0)

Discussion

In this cohort, activating ERBB-2 mts were present in 20 of 1046 (1.9%) pts tested. Although over half of pts with eligible mts on OP testing were approached for NCT01670877, only 0.5% of the total tested population were enrolled (6/1046). Our data illustrate the substantial challenges in screening and enrolling to trials of rare subsets, even within a large academic institution, and point to the need for creative and novel approaches to leverage pts and community- and academic-based providers to more effectively support the success of such studies.

Citation Format: Exman P, Garrido-Castro A, Hughes ME, Freedman RA, Ma C, Bose R, Cerami E, Wagle N, Barroso-Sousa R, Fitz CD, Lindeman NI, MacConaill L, Bychkovsky BL, Lloyd MR, Mackichan CR, Kumari P, Tolaney SM, Krop IE, Winer EP, Dillon DA, Lin NU. Identifying ERBB-2 activating mutations (mts) in HER2 negative tumors for clinical trials – Impact of institute-wide genomic testing and trial matching on trial enrollment in clinical practice [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-04-02.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2016

Leaves of wheat infected with the leaf rust fungus Puccinia triticina were obtained from farm fields and breeding plots at experimental stations in the Great Plains, Ohio River Valley, and southeastern states in 2016 in order to identify virulence phenotypes prevalent in the United States in different wheat-growing regions. In total, 496 single uredinial isolates derived from the leaf rust collections were tested for virulence to 20 lines of Thatcher wheat that differ for single leaf rust resistance genes. In total, 71 virulence phenotypes were described in the United States in 2016. The three most common virulence phenotypes across the United States were MBTNB, MBDSD, and TNBJJ. Phenotype MBTNB is virulent to Lr11, and was most common in the soft red winter wheat region of the southeastern states and Ohio Valley. Phenotype MBDSD is virulent to Lr17 and Lr39, and was most common in the hard red winter wheat area of the southern Great Plains. Phenotype TNBJJ is virulent to Lr24 and Lr39, which are present in the hard red winter wheat cultivars. The P. triticina population in the United States was characterized by two major regional groups of virulence phenotypes in the Great Plains region where hard red winter and spring wheat cultivars are grown, and in the southeastern states and Ohio Valley region where soft red winter wheat cultivars are grown. Isolates from New York State differed the most for virulence compared with the other two major regions.

Tidal and diel orchestration of behaviour and gene expression in an intertidal mollusc

Intertidal inhabitants are exposed to the 24-hour solar day, and the 12.4 hour rising and falling of the tides. One or both of these cycles govern intertidal organisms' behaviour and physiology, yet little is known about the molecular clockworks of tidal rhythmicity. Here, we show that the limpet Cellana rota exhibits robust tidally rhythmic behaviour and gene expression. We assembled a de-novo transcriptome, identifying novel tidal, along with known circadian clock genes. Surprisingly, most of the putative circadian clock genes, lack a typical rhythmicity. We identified numerous tidally rhythmic genes and pathways commonly associated with the circadian clock. We show that not only is the behaviour of an intertidal organism in tune with the tides, but so too are many of its genes and pathways. These findings highlight the plasticity of biological timekeeping in nature, strengthening the growing notion that the role of 'canonical' circadian clock genes may be more fluid than previously thought, as exhibited in an organism which has evolved in an environment where tidal oscillations are the dominant driving force.

Abstract P4-10-04: EMBRACE (Ending metastatic breast cancer for everyone): A comprehensive approach to improve the care of patients with metastatic breast cancer

Background: In contrast to early stage breast cancer, the quality of care for patients with metastatic breast cancer (MBC) has been relatively understudied, as have interventions to improve care in the real-world setting. Patients with MBC face a variety of unique needs related to their disease, treatment options, and supportive care. Little attention has been focused on leveraging the strengths of academic and community-based settings to provide optimal care for these patients. To address these critical issues, we have designed and implemented a comprehensive program that combines clinical care, clinical research, physician engagement and patient education to optimize the care of MBC patients.

Methods: We developed a consistent and comprehensive intake process and follow-up approach for MBC patients who were seen at least once in the Breast Oncology Clinic (BOC) at Dana-Farber Cancer Institute (DFCI). A key component of our approach is the EMBRACE coordinator who meets with each MBC patient at the first clinic visit to review the clinical program, available educational and supportive resources, and consents to research studies. Each coordinator supports the DFCI-based oncologist and follows a discrete patient panel longitudinally, for whom they are responsible for facilitating referrals to supportive care resources, identifying potential candidates for trial prescreening, tracking availability of results from molecular testing for clinical trial matching, facilitating communication between DFCI-based providers and referring providers and organizing re-consultation visits when clinically appropriate. The coordinator contacts patients every 3 months to inquire about the patient's overall health and needs and provides updates on upcoming educational and supportive care activities at our institution. Educational offerings have been expanded to include a bi-annual newsletter, quarterly email updates, webcasts and an annual educational patient forum. Results: The program was fully implemented in the BOC across 27 oncologists in August 2016, after the start of a pilot in July 2015. On average, the program enrolls 30 to 40 new MBC patients per month at their initial visit. The EMBRACE coordinators currently support the DFCI-based oncologists in the care of approximately 1500 new and existing MBC patients and facilitate collaborations with 350 referring providers.

Conclusions: The EMBRACE program has made a tangible improvement in the quality of care for patients with MBC in our clinic. We have successfully established the infrastructure of the coordinator role and a robust tracking system to support the patient, DFCI-based provider, and referring provider. While the program has been solely based at DFCI, we believe that our approach has the potential for impact beyond our institution and ultimately serve as a model for enhanced academic-community-patient partnership.

Citation Format: Hughes ME, Frank ES, Merrill MS, Santiago RA, Kuhnly N, Crowley LM, Gupta G, Winer EP, Lin NU. EMBRACE (Ending metastatic breast cancer for everyone): A comprehensive approach to improve the care of patients with metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-04.

Abstract GS3-07: Genome-wide copy number analysis of chemotherapy-resistant metastatic triple-negative breast cancer from cell-free DNA

Introduction:

Triple-negative breast cancer (TNBC) is a poor prognosis breast cancer subset characterized by relatively few mutations but extensive copy number alterations (CNAs). Cell-free DNA (cfDNA) offers the potential to overcome infrequent tumor biopsies in metastatic TNBC (mTNBC) and interrogate the genomics of chemotherapy resistance.

Methods:

506 archival or fresh plasma samples were identified from 164 patients with mTNBC who had previously received chemotherapy. We performed low coverage whole genome sequencing to determine genome-wide copy number and estimate 'tumor fraction' of cfDNA (TFx) using our recently-developed approach, ichorCNA. In patient samples with TFx &gt;10%, we identified regions that were significantly gained or lost using GISTIC2.0. We compared CNAs of 20 paired primary-metastatic samples and also mTNBCs from cfDNA versus primary TNBCs from TCGA and METABRIC.

Results:

We successfully obtained high quality, low coverage whole genome sequencing data for 478 (94.5%) plasma samples from 158 patients, with 1 to 14 samples per patient. TFx and copy number profiles were highly concordant with paired metastatic biopsy (n=10, range 0-7 days from biopsy to blood draw) with sensitivity of 0.86 and specificity of 0.90 and reproducible in independently-processed blood draws (TFx intraclass correlation coefficient 0.984). Median overall survival from time of first blood draw was 8 months, and TFx was highly correlated independent of primary stage, primary receptor status, age at primary diagnosis, BRCA status, and metastatic line of therapy: adjusted hazard ratio between 4th and 1st quartiles = 2.14 (95% CI 1.40-3.28; p=0.00049). 101/158 patients (63.9%) had at least one sample with TFx &gt;10%, our threshold for high confidence CNA calls. Copy number profiles and percent genome altered were remarkably similar between mTNBCs and primary TNBCs in TCGA and METABRIC (n=433), suggesting that large-scale chromosomal events are infrequent in TNBC metastatic progression. We identified chromosomal gains that demonstrated significant enrichment in mTNBCs relative to paired primary TNBCs (n=20) and also TCGA/METABRIC, including driver genes (NOTCH2, AKT2, AKT3) and putative antibody-drug conjugate targets. Finally, we identify a novel association of gains of 18q11 and/or 19p13 with poor metastatic prognosis, independent of clinicopathologic factors and TFx.

Conclusions:

Here, we present the first large-scale genomic characterization of metastatic TNBC to our knowledge, derived exclusively from cfDNA. 'Tumor fraction' of cfDNA is an independent prognostic marker in mTNBC. Primary and metastatic TNBC have remarkably similar copy number profiles yet we identify alterations enriched and prognostic in mTNBC. Collectively, these data have potential implications in the understanding of metastasis, therapeutic resistance, and novel therapeutic targets.

Citation Format: Stover DG, Parsons HA, Ha G, Freeman S, Barry B, Guo H, Choudhury A, Gydush G, Reed S, Rhoades J, Rotem D, Hughes ME, Dillon DA, Partridge AH, Wagle N, Krop IE, Getz G, Golub TA, Love JC, Winer EP, Tolaney SM, Lin NU, Adalsteinsson VA. Genome-wide copy number analysis of chemotherapy-resistant metastatic triple-negative breast cancer from cell-free DNA [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS3-07.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2015

Leaves of wheat infected with the leaf rust fungus, Puccinia triticina, were obtained from farm fields and breeding plots at experimental stations in the Great Plains, Ohio River Valley, and southeastern states in 2015 in order to identify virulence phenotypes prevalent in the United States in different wheat growing regions. A total of 526 single uredinial isolates derived from the leaf rust collections were tested for virulence to 20 lines of Thatcher wheat that differ for single leaf rust resistance genes. A total of 60 virulence phenotypes were described in the United States in 2015. The three most common virulence phenotypes across the United States were MBDSD, MBTNB, and TBBGS. Phenotype MBDSD is virulent to Lr17, Lr37, and Lr39, and was most common in the hard red winter wheat area of the southern Great Plains. Phenotype MBTNB is virulent to Lr11, and was most common in the soft red winter wheat region of the southeastern states and Ohio Valley. Phenotype TBBGS is virulent to Lr39, which is present in the hard red winter wheat cultivars, and Lr21, which is present in the hard red spring wheat cultivars. The P. triticina population in the United States was characterized by two major regional groups of virulence phenotypes in the Great Plains region where hard red winter and spring wheat cultivars are grown, and in the southeastern states and Ohio Valley region where soft red winter wheat cultivars are grown.

Persistence of ibrutinib-associated hypertension in CLL pts treated in a real-world experience

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Background: Cardiovascular (CV) complications associated with ibrutinib (Ibr) include hypertension (HTN) and atrial fibrillation (AFIB) (incidence 26% and 9%, OBrien, ASH 2016). Unlike clinical trials, Ibr toxicities are the most common reasons for its discontinuation in clinical practice. The incidence of HTN in pts treated with Ibr outside of clinical trial setting and its impact on outcomes is unknown. Methods: Retrospective, cohort study of Ibr-treated CLL pts to estimate HTN incidence. Baseline CLL characteristics and co-morbidities were recorded. Blood pressure (BP) measurements were recorded prior to Ibr and sequentially following exposure at specific time points. CV meds were reviewed during a 12 mo follow-up period. The association between Ibr exposure and BP was tested. Results: 153 consecutive CLL pts treated with Ibr at a dose of 420 mg/day were identified. Med age was 57 yr (range: 34-87), relapsed CLL (69%), follow-up 14.5 mo. CV pre-Ibr characteristics included: smoking hx (49%), HTN (42%), hyperlipidemia (39%), diabetes (17%), CAD (12%), AFIB (6.8%). Proportion of pts on ≥1 anti-HTN med increased from 44% pre-Ibr (20% ≥ 2) to 57% during Ibr (30% ≥ 2). Med pre-Ibr BP was 127/70 mmHg (range 90-182/48-95mmHg). At 1, 3, 6, 9, 12 mo, med BPs were 137/73, 141/75, 143/76, 140/75, 142/77 (7 mo to peak BP). There was a significant association between Ibr exposure and increased BP (p<.01). New HTN was observed in 40% of pts and 36% HTN pts had BP increased above baseline (med baseline 135/70 vs peak 161/80). Incidence of new AFIB was 8.1%. In UV analyses, predictive clinical factors for HTN were not identified. Pre-Ibr HTN (OR 3.0, p .05), CAD (OR 4.3, p .03), prior AFIB event (OR 10.8, p.001), hyperlipidemia (OR 3.4, p.05) were associated with post-Ibr AFIB. Conclusions: In the largest real-world series focused on BP in Ibr treated pts, we demonstrate a clear association between Ibr and HTN. Nearly 40% of pts developed HTN within 12 mo of Ibr exposure (vs. 26% in clinical trials over 5 yr). Despite aggressive management (multiple agents), Ibr associated HTN was persistent. These data underscore the critical need for monitoring and management strategies for HTN and follow-up data on future CV events.

Clinical outcomes of DLBCL, follicular lymphoma (FL) and Richter transformation (RT) patients treated with ibrutinib: A real-world experience of off-label ibrutinib use

e19043

Background: Ibrutinib (IBR), a BTK inhibitor, is FDA approved for CLL, Waldenstrom macroglobulinemia, marginal zone lymphoma and mantle cell lymphoma. Despite limited data, IBR is being utilized as a therapy for patients (pts) with relapsed/refractory (RR) DLBCL and FL. In an effort to further characterize the efficacy of IBR in these settings, we conducted a retrospective cohort study of IBR-treated pts with DLBCL, RT or FL. Methods: A retrospective cohort study of DLBCL, RT and FL pts treated with IBR was completed. Data collected included demographics, stage, IPI, prior treatments, IBR dose/duration, reasons for discontinuation, and response. PFS and OS were estimated using the Kaplan Meier method. Results: 44 pts were identified (DLBCL: n = 24, 55%; FL: n = 12, 27%; RT: n = 8, 18%). Baseline characteristics: age (range 19 – 80), 61% male, 95% ECOG 0 - 1, 71% stage IV, 62% elevated LDH, 48% R-IPI ≥ 4. DLBCL subtypes (Hans criteria) were 46% non-GC (n = 11), 29% GC (n = 7), 25% unclassifiable (n = 6). In FL, 8% were grade 1, 59% grade 2, and 33% grade 3a. Med number of prior therapies was 5 (range 1-11). Most common reasons for IBR discontinuation were progression (35%), toxicity (20%), bridge to CAR-T (10%). PFS and OS data are shown in the table below. In DLBCL, cell of origin (Hans) did not impact outcomes (p = .97, LR test). PFS was superior in RT as compared to DLBCL (p = .03, LR test). Conclusions: In the largest single-center, real-world experience of IBR use in DLBCL, RT and FL, we validate findings reported in clinical trials. In FL, responses appear to be durable (median PFS > 10 months). Outcomes are poor in DLBCL and use of IBR as monotherapy is not recommended. Perhaps IBR is best used as a short-term bridge to more definitive therapies. Cell of origin (Hans) may not predict PFS and should not be used to select pts for IBR. Pts with RT appear to have more durable responses (vs. DLBCL) suggesting differing dependence on BTK signaling. [Table: see text]

Abstract P1-12-08: The incidence and outcomes of brain metastases in HER2-positive metastatic breast cancer with the advent of modern anti-HER2 therapies

Background: Human epidermal growth factor receptor 2 (HER2) is over-expressed in approximately 20 - 30% of breast cancers. HER2-positive breast cancers frequently metastasize to the brain. In recent years, many new drugs have been approved for HER2-positive metastatic breast cancer (MBC). In the metastatic setting, trastuzumab was approved in 2000, lapatinib 2007, and pertuzumab and ado-trastuzumab emtansine in 2012. We sought to describe the incidence, time course, and prognostic factors of BM in patients (pts) with HER2+ MBC during the time when dramatic changes in systemic therapy occurred.

Patients/methods: The study included pts with HER2-positive MBC treated at two academic hospitals: Dana Farber Cancer Institute (DFCI) (2000-2007 [DFCI-T1], 2008-2011 [DFCI-T2]) and University of North Carolina (UNC) (2012-2014). We examined the incidence of BM (at diagnosis [dx] and within 1-2 years of MBC dx). We combined the two cohorts to examine outcomes – time to BM, survival following MBC, and survival following BM – using the Kaplan Meier method and Cox regression modeling.

Results: We identified 185 (DFCI n=128, 97 diagnosed 2000-2007 and 31 diagnosed 2008-2011; UNC n=57, all diagnosed 2012-2014) pts with HER2-positive MBC. Through a median of 4 years follow-up after the MBC dx (min 2, max 11), 118 had died and 67 were censored. The median age at MBC dx was 52 (min 25, max 88), 149 (82%) were Caucasian, 88 (48%) had hormone receptor (HR) positive BC, and 67 (37%) had de-novo (i.e., non-recurrent) MBC. BM was present at the MBC dx for 8% of pts in DFCI-T1, 16 % of pts in DFCI-T2, and 16% of pts at UNC. Within 1 year of the MBC dx, BM was present in 21% of DFCI-T1, 29% in DFCI-T2, 23% of UNC pts. Within 2 years of the MBC dx, 67 (36%) pts had developed BM, of which one third (22) were diagnosed at initial MBC presentation. In unadjusted analyses, there were no differences in time to BM dx by age (p=0.2), race (p=0.1) or HR status (p=0.1). The median survival following the development of BM for all pts was 1.5 years. A multivariable model predicting survival after the MBC dx, found factors associated with shorter survival included having (vs. not having) BM at the initial MBC dx, having received (vs. not having received) adjuvant HER2-directed therapy prior to the MBC dx, and having recurrent (vs. de novo) MBC (P≤0.02 for all). Age, HR status, race and time period of MBC dx were not significant in the multivariable model.

Conclusions: Among pts diagnosed in the modern era, after new therapies became available, BM remains a common problem for pts with HER2-positive MBC. While no obvious trends in the incidence of HER2-positive MBC are suggested, conclusions regarding incidence trends should be considered hypothesis-generating until larger, population-based data become available. Nevertheless, a dx of BM early in the course of MBC treatment and prior receipt of adjuvant trastuzumab appeared to confer a more aggressive disease course. Coordinated, prospective collection of the incidence and outcomes of BM among pts with HER2-positive MBC, studies of pts who develop BM &gt;2 years after their MBC dx, and clinical trials of treatment strategies for pts with trastuzumab-resistant BM are needed.

Citation Format: Strulov Shachar S, Deal AM, Vaz-Luis I, Dees EC, Carey LA, Hassett MJ, Garrett AL, Benbow JM, Hughes ME, Mounsey L, Lin N, Anders CK. The incidence and outcomes of brain metastases in HER2-positive metastatic breast cancer with the advent of modern anti-HER2 therapies [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-12-08.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2014

Collections of Puccinia triticina obtained from wheat fields and breeding plots in the Great Plains, Ohio River Valley, and southeastern states, were tested for virulence in 2014 in order to determine the virulence of the wheat leaf rust pathogen population in the United States. Single uredinial isolates (380 total) were derived from the collections and tested for virulence phenotype on 20 lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes. In 2014, 55 virulence phenotypes were described in the United States. Virulence phenotypes MBTNB, TBBGS, and TCRKG were the three most common phenotypes. Phenotypes MBTNB and TCRKG are both virulent to Lr11, and TCRKG is also virulent to Lr18 and Lr26. MBTNB and TCRKG were most common in the soft red winter wheat region of the southeastern states and the Ohio Valley. Phenotype TBBGS is virulent to Lr39, which is present in the hard red winter wheat cultivars, and Lr21, which is present in the hard red spring wheat cultivars. Isolates with virulence to Lr11, Lr18, and Lr26 were most common in the southeastern states and Ohio Valley region. Isolates with virulence to Lr21 and Lr39 were most common in the hard red wheat region of the southern and northern Great Plains.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2013

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from wheat fields and breeding plots by USDA-ARS personnel and cooperators in the Great Plains, Ohio River Valley, and southeastern states in order to determine the virulence of the wheat leaf rust population in 2013. Single uredinial isolates (490 total) were derived from the collections and tested for virulence phenotype on 20 lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes. In 2013, 79 virulence phenotypes were described in the United States. Virulence phenotypes MBTNB, TNBGJ, and MCTNB were the three most common phenotypes. Phenotypes MBTNB and MCTNB are both virulent to Lr11, and MCTNB is virulent to Lr26. MBTNB and MCTNB were most common in the soft red winter wheat region of the southeastern states and Ohio Valley. Phenotype TNBGJ is virulent to Lr39/41 and was widely distributed throughout the hard red winter wheat region of the Great Plains. Isolates with virulence to Lr11, Lr18, and Lr26 were common in the southeastern states and Ohio Valley region. Isolates with virulence to Lr21, Lr24, and Lr39/41 were frequent in the hard red wheat region of the southern and northern Great Plains.

Lack of a significant pharmacokinetic interaction between maraviroc and tacrolimus in allogeneic HSCT recipients

OBJECTIVES

Emerging data suggest that the combination of tacrolimus and the CCR5 antagonist maraviroc, both cytochrome P450-3A4 substrates, may be effective in preventing graft-versus-host disease in patients undergoing allogeneic HSCT. This study evaluated whether a pharmacokinetic interaction exists between these agents.

METHODS

The study included 36 allogeneic HSCT recipients who received maraviroc + tacrolimus and 43 recipients of tacrolimus alone. We used a difference-in-differences analysis to examine the change in the concentration/dose ratios of tacrolimus after the discontinuation of maraviroc. In addition, we analysed the concentrations and dose requirements of tacrolimus in the two groups.

RESULTS

There was no significant difference in tacrolimus concentration/dose ratios in patients receiving maraviroc + tacrolimus compared with tacrolimus alone. Upon discontinuation of maraviroc, the change in concentration/dose ratio was small and not significant relative to the control group, and the effect estimate was further attenuated after adjustment for confounders [-0.35 (ng/mL)/(mg/day); P = 0.46]. In addition, the change in mean tacrolimus dose after discontinuation of maraviroc was similar between the groups (0.12 mg/day; P = 0.56), as was the change in mean tacrolimus concentration (0.02 ng/mL; P = 0.97).

CONCLUSIONS

Our findings do not support a significant inhibitory effect of maraviroc on the metabolism of tacrolimus. These data demonstrate that this drug combination is safe and imply that the protective effect of maraviroc against graft-versus-host disease was not mediated through an increase in tacrolimus concentrations. These findings are important for the design of clinical trials that evaluate maraviroc in combination with cytochrome P450-3A4 substrates.

Carbodiimide induced cross-linking, ligand addition, and degradation in gelatin

The water-soluble carbodiimide, 1-ethyl-3-(3-(dimethylaminopropyl)-carbodiimide (EDC) is widely used in protein chemistry. We used EDC-induced gelatin cross-linking as a model for amide bond formation to resolve reaction ambiguities with common variables of buffers, gelatin concentration, and pH. Percentage changes in SEC high molecular weight peak areas were used to follow the reactions. Differences in reaction rate and extent were observed with four commonly used buffers, while differences in extent were observed for commonly used concentrations and pH. We also investigated an anhydride mechanism for aqueous EDC-induced amide bond formation that has received little attention since its proposal in 1995. Gelatin carboxyl groups had a synergistic role during the addition of hydrazine to corroborate the anhydride formation between carboxyl groups. EDC-induced degradation of gelatin was investigated using percentage changes in SEC low molecular weight peak areas. The degradation occurred in excess EDC at neutral to alkaline pH and was enhanced substantially when reacting amino groups were not available. A mechanism of EDC-induced gelatin degradation is proposed and designated the extended Khorana mechanism. This EDC side reaction has the potential to occur in peptides and proteins under similar conditions.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2012

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from wheat fields and breeding plots by United States Department of Agriculture-Agricultural Research Service personnel and cooperators in the Great Plains, Ohio River Valley, southeastern states, and Washington State and Idaho in order to determine the virulence of the wheat leaf rust population in 2012. Single uredinial isolates (501 in total) were derived from the collections and tested for virulence phenotype on 20 lines of 'Thatcher' wheat that are near-isogenic for leaf rust resistance genes. In 2012, 74 virulence phenotypes were described in the United States. Virulence phenotypes TNBGJ, TCRKG, and MBTNB were the three most common phenotypes. Phenotype TNBGJ is virulent to Lr39/41 and was widely distributed throughout the hard red winter wheat region of the Great Plains. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and was found mostly in the soft red winter wheat region in the eastern United States. Phenotype MBTNB is virulent to Lr11 and was also found mostly in the soft red winter wheat region. The frequency of isolates with virulence to Lr39/41, which is present in many hard red winter wheat cultivars in the Great Plains region, continued to increase. Isolates with virulence to Lr21, which is present in many hard red spring wheat cultivars, also continued to increase in frequency in the northern Great Plains region.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2011

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from wheat fields and breeding plots by USDA-ARS personnel and cooperators in the Great Plains, Ohio River Valley, southeastern states, Oregon, and Washington State in order to determine the virulence of the wheat leaf rust population in 2011. Single uredinial isolates (440 total) were derived from the collections and tested for virulence phenotype on 18 lines of Thatcher wheat and a winter wheat line that are near-isogenic for 19 leaf rust resistance genes. In 2011, 87 virulence phenotypes were described in the United States. Virulence phenotypes TBBGJ, MLDSD, and TCRKG were the three most common phenotypes. Phenotype TBBGJ is virulent to Lr39/41 and was widely distributed throughout the hard red winter wheat region of the Great Plains. Phenotype MLDSD is virulent to Lr17 and Lr39/41 and was widely distributed throughout the United States. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and was found mostly in the soft red winter wheat region in the eastern United States. Isolates with virulence to Lr39/41 and avirulence to Lr9 were prevalent in the Great Plains region for the first time. Virulence to Lr21 was present in five virulence phenotypes mostly from the spring wheat region of the northern Great Plains.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2010

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from wheat fields and breeding plots by United States Department of Agriculture-Agricultural Research Service personnel and cooperators in the Great Plains, Ohio River Valley, southeastern states, Oregon, and Washington State in order to determine the virulence of the wheat leaf rust population in 2010. Single uredinial isolates (537 total) were derived from the collections and tested for virulence phenotype on 19 lines of 'Thatcher' wheat and a winter wheat line that are near-isogenic for 20 leaf rust resistance genes. In 2010, 38 virulence phenotypes were described in the United States. Virulence phenotypes MLDSD, TDBJG, and TCRKG were the three most common phenotypes. Phenotype MLDSD is virulent to Lr17 and Lr39/Lr41 and was widely distributed throughout the United States. Phenotype TDBJG is virulent to Lr24 and was found in both the soft red winter wheat and hard red winter wheat regions. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and was found mostly in the soft red winter wheat region in the eastern United States. Virulence to Lr21 was found for the first time in North America in isolates collected from spring wheat cultivars in North Dakota and Minnesota.

P1-11-02: Racial/Ethnic Differences in Adjuvant Trastuzumab Receipt for Women with Breast Cancer within the National Comprehensive Cancer Network

Background Racial/ethnic disparities in breast cancer care are well documented. Although adjuvant trastuzumab has been shown to improve disease outcomes for women with Human Epidermal Growth Factor Receptor 2 (HER2)-positive cancers, the ‘real world’ utilization and toxicity of adjuvant trastuzumab are unknown. Because therapy involves one year of treatment and the costs of treatment are high, a risk for treatment disparity exists. We examined differences in receipt and completion of adjuvant trastuzumab by race/ethnicity, education, employment, and insurance for women diagnosed with HER2−positive breast cancer.

Methods Using the National Comprehensive Cancer Network (NCCN) Breast Cancer Outcomes Database, we identified 1,146 women with stage I-III HER-2 positive breast cancer who presented to participating NCCN institutions during 2005–2008. In multivariable logistic analyses, we assessed the effect of race/ethnicity on the likelihood of trastuzumab therapy, and among women who initiated trastuzumab, the likelihood of completing ≥ 270 days of therapy, adjusting for center, diagnosis year, age, insurance, comorbidity, education, employment, and tumor characteristics. We also examined reasons for discontinuation of therapy among those who stopped treatment prematurely.

Results Among patients eligible for this analysis, 75% women were Caucasian, 9% were African-American, and 9% were Hispanic. Most women had managed care insurance (71%) and were employed/student (52%). About one-third (36%) had a college degree and 39% had a high school education or less. Overall, most women (82%) received neo/adjuvant trastuzumab and there were no racial/ethnic differences in receipt of therapy (adjusted odds ratio [OR] 1.11, 95% confidence interval [CI] .72-1.71 for African-American and OR 1.39, 95% CI .76-2.54 for Hispanic, versus Caucasian women). Among the 769 women who initiated neo/adjuvant trastuzumab and had ≥ 365 days of follow-up, 84% completed ≥ 270 days of trastuzumab. Rates of completion were lower for African-American (72%) and Hispanic (82%) women than Caucasian women (85%). In adjusted analyses, African-American women but not Hispanic women had lower odds of completing therapy compared with Caucasian women (OR .45, 95% CI .29-.70, p=0.0003). Indemnity insurance (versus managed care) was associated with lower odds of trastuzumab completion, as was having a high school education or less (versus college education). Among the 123 women who did not complete trastuzumab, 26% stopped early for toxicity, and this occurred more frequently for African-American women than Caucasian women (50% vs. 21%), but small sample precluded a meaningful test for statistical significance.

Conclusion: Compared with Caucasian women, African-American women had similar rates of initiation of adjuvant trastuzumab but much lower rates of completion that were not explained by differences in education, employment, or insurance. Because of the significant benefits conferred by adjuvant trastuzumab therapy for HER2−positive breast cancer, interventions to assure completion of therapy could lead to improved outcomes. Further exploration of racial differences in toxicity and tolerance of therapy are also warranted.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-02.

P1-08-05: Age and Survival in Women with Early Stage Breast Cancer: An Analysis Controlling for Tumor Subtype

Background: Previous research has suggested that young age at diagnosis is an independent risk factor for breast cancer recurrence and death in women with early stage breast cancer. However, young women are more likely to have aggressive subtypes of breast cancer. No prior studies have adequately controlled for tumor phenotype, including HER-2/neu (HER2) status, in particular. Recent evidence has suggested that the prognostic effect of young age varies by tumor subtype.

Methods: We examined data from women with newly diagnosed Stage 1–3 breast cancer presenting to one of 8 NCCN centers between January 2000 and December 2007. Multivariate Cox proportional hazards models were used to assess the relationship between age and breast cancer specific survival, controlling for known prognostic factors and treatment. In addition, we conducted stratified analyses by estrogen receptor (ER) and HER2 status.

Results: 19,633 women with Stage 1–3 breast cancer eligible for analysis including 2,177 (11%) who were age 40 years or younger at diagnosis. Younger women were more likely to be non-white or Hispanic, more educated, employed, and to have higher stage, high grade, ER-negative, progesterone receptor (PR) negative, and HER2−positive disease, and treated with chemotherapy and trastuzumab (all variables P&lt; 0.0001 by Chi-Square test). 5-year survival among younger women was 94.1 (95% Confidence Interval [CI] 92.9−95.3) and 96.3 (95% CI 95.9−96.6) for older women. In a multivariate Cox proportional hazards model controlling for sociodemographic, disease, and treatment characteristics, women age &lt; 40 or younger at diagnosis had increased mortality compared to older women (Hazard Ratio [HR] 1.26, 95% CI 1.02−1.56). In stratified analyses, age 40 or less was associated with increased mortality among women with ER-positive disease (HR 1.44, 95% CI 1.01−2.05), but was not among those with ER-negative disease (HR 1.15, 95% CI 0.85−1.55). Younger age was associated with a statistically significant increase in mortality among women with HER2−negative disease (HR 1.29, 95% CI 1.00−1.68), but this difference did not reach statistical significance among those with HER2−positive disease (HR 1.30, 95% CI 0.82−2.09). Conclusions: The effect of age on short-term survival of women with early breast cancer appears to vary by breast cancer subtype, particularly ER status. Further research to elucidate differences in breast cancer biology and efficacy of therapy within tumor types by age is warranted.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-05.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2009

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from surveys of wheat (Triticum aestivum) fields and wheat breeding plots by United States Department of Agriculture-Agricultural Research Service personnel in the Great Plains, Ohio River Valley, southeast, California, and Washington State in order to determine the virulence of the wheat leaf rust population in 2009. Single uredinial isolates (591 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, and Lr28 and a winter wheat line with Lr39/41. Forty-one virulence phenotypes were described. Virulence phenotypes MLDSD, TCRKG, and TDBGG were the three most common phenotypes. Phenotype MLDSD is virulent to Lr17 and Lr39/Lr41 and was widely distributed throughout the United States. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and is found mostly in the soft red winter wheat region in the eastern United States. TDBGG is virulent to Lr24 and was found in both the soft red winter wheat and hard red winter wheat regions. Virulence to Lr21 was not found in any of the tested isolates. Virulence to Lr11, Lr18, and Lr26 increased in 2009 in the soft red winter wheat regions. Virulence to Lr17 and Lr39/Lr41 increased in the Great Plains region. Two separate epidemiological zones of P. triticina in the soft red winter wheat region of the southern and eastern states and in the hard red wheat region of the Great Plains were described.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2008

Collections of Puccinia triticina were obtained from rust-infected wheat (Triticum aestivum) leaves provided by cooperators throughout the United States and from surveys of wheat fields and wheat breeding plots by USDA-ARS personnel in the Great Plains, Ohio River Valley, Southeast, and Washington State in order to determine the virulence of the wheat leaf rust population in 2008. Single uredinial isolates (730 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, Lr28, and a winter wheat line with Lr41. Forty-eight virulence phenotypes were described. Virulence phenotypes TDBGG, TCRKG, and MLDSD were the three most common phenotypes. TDBGG is virulent to Lr24 and was found in both the soft red winter wheat and hard red winter wheat regions. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and is found mostly in the soft red winter wheat region in the eastern United States. Phenotype MLDSD is virulent to Lr17 and Lr41 and was widely distributed in the Great Plains. Virulence to Lr21 was not found in any of the tested isolates. Virulence to Lr11 and Lr18 increased in 2008 in the soft red winter wheat regions. Two separate epidemiological zones of P. triticina in the soft red winter wheat region of the southern and eastern states and in the hard red wheat region of the Great Plains were described.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2007

In 2007, leaf rust of wheat was severe throughout the Great Plains region of North America. Yield losses in wheat due to leaf rust were estimated to be 14% in Kansas. Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio River Valley, southeast, California, and Washington State in order to determine the virulence of the wheat leaf rust population in 2007. Single uredinial isolates (868 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, and Lr28, and on winter wheat lines with genes Lr41 and Lr42. Fifty-two virulence phenotypes were found. Virulence phenotypes TDBJG, MFPSC, and TDBJH were among the four most common phenotypes and were all virulent to resistance gene Lr24. These phenotypes were found throughout the Great Plains region. Phenotype MLDSD, with virulence to Lr9, Lr17, and Lr41, was also widely distributed in the Great Plains. In the soft red winter wheat region of the southeastern states, phenotypes TCRKG, with virulence to genes Lr11, Lr26, and Lr18, and MFGJH, with virulence to Lr24, Lr26, and Lr11, were among the common phenotypes. Virulence phenotypes with virulence to Lr16 were most frequent in the spring wheat region of the northern Great Plains. Virulence phenotypes with virulence to Lr11, Lr18, and Lr26 were most common in the soft red winter areas of the southeastern states and Ohio Valley. Virulence to Lr21 was not found in any of the tested isolates.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2006

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio River Valley, southeast, California, and Washington State in order to determine the virulence of the wheat leaf rust population in 2006. Single uredinial isolates (718 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr2, and Lr28 and winter wheat lines with genes Lr41 and Lr42. In the United States in 2006, 56 virulence phenotypes were found. Virulence phenotypes TDBJG, TDBGG, and TDBJH were among the four most common phenotypes and were all virulent to resistance gene Lr24. These phenotypes were found throughout the Great Plains region. Phenotype MLDSD with virulence to Lr9, Lr17, and Lr41 was also widely distributed in the Great Plains. In the soft red winter wheat region of the southeastern states, phenotypes TCRKG and MBRKG with virulence to genes Lr11, Lr26, and Lr18 were among the common phenotypes. Virulence phenotypes with virulence to Lr16 were most frequent in the spring wheat region of the northern Great Plains. Virulence to Lr21 was not found in any of the tested isolates.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2005

Collections of Puccinia triticina were obtained from rust-infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio River Valley, southeast, California, and Washington State, in order to determine the virulence of the wheat leaf rust population in 2005. Single uredinial isolates (797 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, Lr28, and winter wheat lines with genes Lr41 and Lr42. In the United States in 2005, 72 virulence phenotypes of P. triticina were found. Virulence phenotype TDBGH, selected by virulence to resistance gene Lr24, was the most common phenotype in the United States, and was found throughout the Great Plains region. Virulence phenotype MCDSB with virulence to Lr17a and Lr26 was the second most common phenotype and was found widely in the wheat growing regions of the United States. Virulence phenotype MFPSC, which has virulence to Lr17a, Lr24, and Lr26, was the third most common phenotype, and was found in the Ohio Valley region, the Great Plains, and California. The highly diverse population of P. triticina in the United States will continue to present a challenge for the development of wheat cultivars with effective durable resistance to leaf rust.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2004

Collections of Puccinia triticina were obtained from rust-infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, southeast, California, and Pacific Northwest, in order to determine the virulence of the wheat leaf rust population in 2004. Single uredinial isolates (757 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, and Lr28, and winter wheat lines with genes Lr41 and Lr42. In the United States in 2004, 52 virulence phenotypes of P. triticina were found. Virulence phenotype MCDSB, selected by virulence to resistance genes Lr17a and Lr26, was the most common phenotype in the United States and was found in all wheat growing areas. Virulence phenotype TBBGG, with virulence to Lr2a, was the second most common phenotype and was found primarily in the spring wheat region of the north-central states. Virulence phenotype MBDSB, which has virulence to Lr17a, was the third most common phenotype and was found in all wheat growing areas except California. Phenotype TNRJJ, with virulence to genes Lr9, Lr24, and Lr41, was the fourth most common phenotype and occurred in the southeastern states and throughout the Great Plains region. Virulence phenotypes avirulent to a second gene in the Thatcher differential line with Lr1 increased in frequency in the United States in 2004. The highly diverse population of P. triticina in the United States will continue to present a challenge for the development of wheat cultivars with effective durable resistance.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2003

Collections of Puccinia triticina were obtained from rust infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, Southeast, California, and the Pacific Northwest, in order to determine the virulence of the wheat leaf rust fungus in 2003. Single uredinial isolates (580 in total) were derived from the wheat leaf rust collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17, Lr30, LrB, Lr10, Lr14a, and Lr18. In the United States in 2003, 52 virulence phenotypes of P. triticina were found. Virulence phenotype MBDS, which has been selected by virulence to resistance gene Lr17, was the most common phenotype in the United States. MBDS was found in the Southeast, Great Plains, the Ohio Valley, and California. Virulence phenotype THBJ, which has been selected by virulence to genes Lr16 and Lr26, was the second most common phenotype, and was found in the southern and northern central Great Plains region. Phenotype MCDS, which has been selected by virulence to genes Lr17 and Lr26, was the third most common phenotype and occurred in the same regions as MBDS. The use of wheat cultivars with leaf rust seedling resistance genes has selected leaf rust phenotypes with virulence to genes Lr9, Lr16, Lr17, Lr24, and Lr26. The population of P. triticina in the United States is highly diverse for virulence phenotypes, which will continue to present a challenge for the development of wheat cultivars with effective durable resistance.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2002

Collections of Puccinia triticina were obtained from rust-infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, Southeast, California, and the Pacific Northwest, in order to determine the virulence of the wheat leaf rust fungus in 2002. Single uredinial isolates (785 in total) were derived from the wheat leaf rust collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17, Lr30, LrB, Lr10, Lr14a, and Lr18. In the United States in 2002, 52 virulence phenotypes of P. triticina were found. Virulence phenotype MBDS, which is virulent to resistance gene Lr17, was the most common phenotype in the United States. MBDS was found in the Southeast, Great Plains, and the Ohio Valley regions, and also in California. Phenotype MCDS, virulent to Lr17 and Lr26, was the second most common phenotype and occurred in the same regions as MBDS. Virulence phenotype THBJ, which is virulent to Lr16 and Lr26, was the third most common phenotype, and was found in the southern and northern central Great Plains region. Phenotype TLGJ, with virulence to Lr2a, Lr9, and Lr11, was the fourth most common phenotype and was found primarily in the Southeast and Ohio Valley regions. The Southeast and Ohio Valley regions differed from the Great Plains regions for predominant virulence phenotypes, which indicate that populations of P. triticina in those areas are not closely connected. The northern and southern areas of the Great Plains were similar for frequencies of predominant phenotypes, indicating a strong south to north migration of urediniospores.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2001

Collections of Puccinia triticina were obtained from rust-infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, Gulf Coast, California, Pacific Northwest, and Atlantic Coast States in order to determine the virulence of the wheat leaf rust fungus in 2001. Single uredinial isolates (477 in total) were derived from the wheat leaf rust collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17, Lr30, LrB, Lr10, Lr14a, and Lr18. The isolates also were tested for virulence on adult plants with leaf rust resistance genes Lr12, Lr13, Lr22a, Lr22b, Lr34, Lr35, and Lr37. In the United States in 2001, 44 virulence phenotypes of P. triticina were found. Virulence phenotype MBDS, which is virulent to resistance gene Lr17, was the most common phenotype in the United States. MBDS was found in the Southeast, Great Plains, and Ohio Valley regions. Virulence phenotype THBJ, which is virulent to Lr16 and Lr26, was the second most common phenotype, and occurred almost exclusively in the north-central Great Plains region. Phenotype MCDS, which is virulent to Lr17 and Lr26, was the third most common phenotype and was found primarily in the Southeast, Ohio Valley, and Great Plains regions. The Southeast and Ohio Valley regions differed from the Great Plains region for predominant virulence phenotypes, which indicate that populations of P. triticina in those areas are not closely connected. The northern and southern areas of the Great Plains region differed for phenotypes with virulence to Lr16; however, the two areas had other phenotypes in common. Virulence to the adult plant resistance genes Lr35 and Lr37 was detected for the first time in North America in the MBDS, MCJS, and MCDS phenotypes.

Profile and activity of the bacterial biota of ground beef held from freshness to spoilage at 5-7 degrees C

Four samples of fresh ground beef were stored aerobically and held at 5-7 degrees C for up to 28 days. Although one sample initially yielded 21 different genera of bacteria while two others yielded only seven, all four spoiled essentially in the same way as assessed by aerobic, psychrotrophic, and Gram-negative counts, and by extract-release volume (ERV) and pH values. Pseudomonas spp. was dominant in the spoilage of all samples. As to why this group is so consistently associated with the low-temperature aerobic spoilage of fresh meats, it is hypothesized that they possess the capacity to form a biofilm and that quorum sensing is involved in the overall biofilm forming and functioning processes.

Effect of chronic intermittent immobilization stress on Fos-like immunoreactivity in rat brain and adrenal medulla

The present study examined the influence of short- and long-term chronic intermittent immobilization stress throughout the brain and on the adrenal medulla of intact rats using Fos-like immunoreactivity (Fos-LI) as a marker of cellular activation. The effect of adreno-medullectomy on the central nervous system (CNS) response to chronic immobilization stress was also examined. It was found that control unoperated, unstressed rats had no Fos-LI cells in the brain or in the adrenal medulla. In intact rats, neither short term (1 week) nor long term (4 weeks) chronic intermittent immobilization stress produced significant increases in Fos-LI in the CNS compared with control animals. However, marked increase in the number of Fos-LI cells was observed in the adrenal medulla of animals stressed for 4 weeks compared with control, unstressed animals or those stressed for 1 or 2 weeks. In adreno-medullectomised rats, 4 weeks, but not 1 week, chronic immobilization stress produced significant increases in numbers of Fos-LI neurons in the paraventricular hypothalamic and supraoptic nuclei and the medial amygdala compared with intact animals stressed for a similar period of time. It is concluded that long term stress produces chronic Fos-LI in the adrenal medulla and that adreno-medullectomy increases the Fos response of the PVN, supraoptic nucleus and medial amygdala to long term stress.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2000

Collections of Puccinia triticina were obtained from rust infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, Gulf Coast, and Atlantic Coast States in order to determine the virulence of the wheat leaf rust fungus in 2000. Single uredinial isolates (1,120 in total) were derived from the wheat leaf rust collections and tested for virulence phenotype on 16 lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes. In the United States in 2000, 54 virulence phenotypes of P. triticina were found. Virulence phenotypes MBDS and MCDS, which are virulent to resistance gene Lr17, were the first and third most common phenotypes in the United States and were found in the Great Plains and the Ohio Valley regions. MCRK, which is virulent to Lr26, was the second most common phenotype and was found primarily in the Southeast, Ohio Valley, and Northeast regions. In the northern area of the Great Plains, phenotypes with virulence to Lr16 increased in frequency from 1998 and 1999. The Southeast and Great Plains regions had different predominant virulence phenotypes, which indicates that populations of P. triticina in those areas are not closely connected. The northern and southern areas of the Great Plains region had the same predominant virulence phenotypes, indicating movement of virulence phenotypes of P. triticina within this region.

Virulence of Puccinia triticina on Wheat in the United States in 1999

Isolates of Puccinia triticina were obtained from wheat leaf collections made by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, and Gulf Coast states in 1999. Pathogenic races were determined from virulence/avirulence phenotypes on 14 host lines that are near-isogenic for leaf rust resistance. We found 58 races among 1,180 isolates in 1999. As in previous surveys, regional race distribution patterns showed that the central United States is a single epidemiological unit distinct from the eastern United States. The distinctive racial composition of collections from the Southeast, Northeast, and Ohio Valley indicates that populations of P. triticina in those areas are not closely connected, suggesting epidemics originate from localized overwintering sources.