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Ralphs AS, Anderson ST, Langlais BT, D'Cunha J, Reck Dos Santos PA. Lung Transplantation for People Living With HIV: Promising Mid-term Outcomes. Transplantation 2024; 108:1015-1020. [PMID: 38049940 DOI: 10.1097/tp.0000000000004861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND With increasing life expectancy, patients with HIV are more commonly acquiring other chronic diseases, such as end-stage lung disease, for which transplant may be the only effective solution. Until recently, HIV infection was considered a contraindication to lung transplant (LTx). As LTx in people living with HIV (PLWH) becomes more common, there remain limited data on outcomes in this population. METHODS Using the Organ Procurement and Transplantation Network Standard Transplant Analysis and Research file, we identified LTx recipients with HIV by either serostatus or nucleic acid testing. A control group of confirmed HIV-negative LTx recipients was propensity score matched on age, body mass index, primary diagnosis, and year of transplant. Patient characteristics, transplant parameters, survival, and postoperative outcomes were compared. RESULTS Fifty-nine LTx recipients with HIV were identified and compared with 236 HIV-negative controls. Among PLWH, cytomegalovirus status was more frequently positive (76.3% versus 58.9%, P = 0.014), and the median Lung Allocation Score at match was higher (44 versus 39, P = 0.004). PLWH were more likely to undergo dialysis postoperatively (18.6% versus 8.9%, P = 0.033), although other complication rates were similar. Fifty-three percent of LTx for PLWH occurred since 2020. One-year survival for PLWH was 91.2% versus 88.6% for controls ( P = 0.620). Three-year survival for a smaller subset was also not statistically significant (HIV versus control: 82.6% versus 77.8%, respectively, P = 0.687). CONCLUSIONS There was no difference in 1-y survival for LTx recipients living with HIV compared with a matched control group, supporting this group of patients as viable candidates for LTx.
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Affiliation(s)
- Asher S Ralphs
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Scott T Anderson
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ
- Mayo Clinic Alix School of Medicine, Phoenix, AZ
| | - Blake T Langlais
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, Phoenix, AZ
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ
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Choi K, Spadaccio C, Ribeiro RV, Langlais BT, Villavicencio MA, Pennington K, Spencer PJ, Daly RC, Mallea J, Keshavjee S, Cypel M, Saddoughi SA. Early national trends of lung allograft use during donation after circulatory death heart procurement in the United States. JTCVS Open 2023; 16:1020-1028. [PMID: 38204714 PMCID: PMC10775073 DOI: 10.1016/j.xjon.2023.08.014] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 01/12/2024]
Abstract
Objective Innovative technology such as normothermic regional perfusion and the Organ Care System has expanded donation after circulatory death heart transplantation. We wanted to investigate the impact of donation after circulatory death heart procurement in concurrent lung donation and implantation at a national level. Methods We reviewed the United Network for Organ Sharing database for heart donation between December 2019 and March 2022. Donation after circulatory death donors were separated from donation after brain death donors and further categorized based on concomitant organ procurement of lung and heart, or heart only. Results A total of 8802 heart procurements consisted of 332 donation after circulatory death donors and 8470 donation after brain death donors. Concomitant lung procurement was lower among donation after circulatory death donors (19.3%) than in donation after brain death donors (38.0%, P < .001). The transplant rate of lungs in the setting of concomitant procurement is 13.6% in donation after circulatory death, whereas it is 38% in donation after brain death (P < .001). Of the 121 lungs from 64 donation after circulatory death donors, 22 lungs were retrieved but discarded (32.2%). Normothermic regional perfusion was performed in 37.3% of donation after circulatory death donors, and there was no difference in lung use between normothermic regional perfusion versus direct procurement and perfusion (20.2% and 18.8%). There was also no difference in 1-year survival between normothermic regional perfusion and direct procurement and perfusion. Conclusions Although national use of donation after circulatory death hearts has increased, donation after circulatory death lungs has remained at a steady state. The implantation of lungs after concurrent procurement with the heart remains low, whereas transplantation of donation after circulatory death hearts is greater than 90%. The use of normothermic regional perfusion lungs has been controversial, and we report comparable 1-year outcomes to standard donation after circulatory death lungs. Further studies are warranted to investigate the underlying mechanisms of normothermic regional perfusion on lung function.
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Affiliation(s)
- Kukbin Choi
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | | | - Blake T. Langlais
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Ariz
| | | | - Kelly Pennington
- Division of Pulmonary & Critical Care, Department of Medicine, Mayo Clinic, Rochester, Minn
| | | | - Richard C. Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jorge Mallea
- Division of Pulmonary, Allergy and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Fla
| | - Shaf Keshavjee
- Department of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Department of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Sahar A. Saddoughi
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
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Agarwal M, Liu A, Almquist D, Langlais BT, Leventakos K, Yu NY, Manochakian R, Ernani V. Chemoimmunotherapy in patients with extensive-stage small cell lung cancer and a poor performance status. Cancer 2023; 129:3546-3553. [PMID: 37548029 DOI: 10.1002/cncr.34966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/02/2023] [Accepted: 06/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Immune checkpoint inhibitor combined with platinum-etoposide is the standard first-line therapy for patients with extensive-stage small cell lung cancer (ES-SCLC). The phase 3 clinical trials that led to the approval of chemoimmunotherapy in ES-SCLC excluded patients who had an Eastern Cooperative Group (ECOG) performance status (PS) of 2-3. Therefore, data on the efficacy of chemoimmunotherapy in patients with an ECOG PS of 2-3 are limited. METHODS A retrospective analysis was performed on patients diagnosed with ES-SCLC who received chemoimmunotherapy (atezolizumab or durvalumab) within the Mayo Clinic Health System between January 2016 and January 2021. The objective of this study was to compare the overall survival (OS), progression-free survival (PFS), and best clinical response to therapy in patients with an ECOG PS of 0-1 vs. patients with an ECOG PS of 2-3 who received chemoimmunotherapy for newly diagnosed ES-SCLC. RESULTS In total, 82 patients were included in the study. The mean ± standard deviation age was 68.1 ± 8.3 years. Of these, 56 patients were identified with an ECOG PS of 0-1, and 26 patients were identified with an ECOG PS of 2-3. The median PFS was similar regardless of ECOG PS (5.8 months [95% CI, 4.3-6.0 months] in the ECOG PS 0-1 group vs. 4.1 months [95% CI, 3.8-6.9 months] in the ECOG PS 2-3; p = .2994). The median OS was also similar regardless of ECOG PS (10.6 months [95% CI, 8.4-13.4 months] in the ECOG PS 0-1 group vs. 9.3 months [95% CI, 4.9-12.8 months]; p = .2718) in the ECOG PS 2-3 group. CONCLUSIONS The study results demonstrated no significant difference in PFS or OS among the ECOG PS 2-3 and ECOG PS 0-1 groups. Therefore, chemoimmunotherapy should be considered for patients who have ES-SCLC with an ECOG PS of 2-3.
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Affiliation(s)
- Muskan Agarwal
- Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Alex Liu
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
| | - Daniel Almquist
- Division of Hematology-Oncology, Sanford Roger Maris Cancer Center, Fargo, North Dakota, USA
| | - Blake T Langlais
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
| | - Rami Manochakian
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Jacksonville, Florida, USA
| | - Vinicius Ernani
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
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4
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Agarwal M, Liu A, Langlais BT, Leventakos K, Yu NY, Almquist D, Manochakian R, Ernani V. Chemoimmunotherapy as the First-Line Treatment for Patients With Extensive-Stage Small-Cell Lung Cancer and an ECOG Performance Status 2 or 3. Clin Lung Cancer 2023; 24:591-597. [PMID: 37365076 DOI: 10.1016/j.cllc.2023.05.005] [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: 05/29/2022] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Studies demonstrated that chemoimmunotherapy prolongs progression-free survival (PFS) and overall survival (OS) in patients with extensive-stage small-cell lung cancer (ES-SCLC) and an Eastern Cooperative Oncology Group performance status (ECOG PS) 0 or 1. However, there is little data regarding chemoimmunotherapy in patients with ES-SCLC and an ECOG PS 2 or 3. This study aims to evaluate the benefits of chemoimmunotherapy compared to chemotherapy in the first-line treatment of patients with ES-SCLC and ECOG PS 2 or 3. MATERIALS AND METHODS This retrospective study analyzed 46 adults treated at Mayo Clinic between 2017 and 2020 with de novo ES-SCLC and an ECOG PS 2 or 3. Twenty patients received platinum-etoposide and 26 patients received platinum-etoposide and atezolizumab. Progression-free survival (PFS) and Overall survival (OS) were calculated using Kaplan-Meier methods. RESULTS PFS was longer in the chemoimmunotherapy group compared to the chemotherapy group, 4.1 months (95% confidence interval [CI]: 3.8-6.9) vs. 3.2 months (95% CI: 0.6-4.8), respectively; P = 0.0491. However, there was no statistically significant difference in the OS between the chemoimmunotherapy and chemotherapy group, 9.3 months (95% CI: : 4.9-12.8) vs. 7.6 months (95% CI: 0.6-11.9), respectively; P = .21. CONCLUSION Chemoimmunotherapy prolongs PFS compared to chemotherapy in patients with newly diagnosed ES-SCLC and an ECOG PS 2 or 3. No OS difference was observed among the chemoimmunotherapy and chemotherapy groups; nevertheless, this may be attributed due to the small sample size of the study.
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Affiliation(s)
- Muskan Agarwal
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Alex Liu
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Phoenix, AZ
| | - Blake T Langlais
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | | | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic Cancer Center, Phoenix, AZ
| | - Daniel Almquist
- Department of Hematology-Oncology, Sanford Roger Maris Cancer Center, Fargo, ND
| | - Rami Manochakian
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Jacksonville, FL
| | - Vinicius Ernani
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Phoenix, AZ.
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5
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Lee MK, Basch E, Mitchell SA, Minasian LM, Langlais BT, Thanarajasingam G, Ginos BF, Rogak LJ, Mendoza TR, Bennett AV, Schrag D, Mazza GL, Dueck AC. Reliability and validity of PRO-CTCAE® daily reporting with a 24-hour recall period. Qual Life Res 2023; 32:2047-2058. [PMID: 36897529 PMCID: PMC10241696 DOI: 10.1007/s11136-023-03374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE The standard recall period for the patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE®) is the past 7 days, but there are contexts where a 24-hour recall may be desirable. The purpose of this analysis was to investigate the reliability and validity of a subset of PRO-CTCAE items captured using a 24-hour recall. METHODS 27 PRO-CTCAE items representing 14 symptomatic adverse events (AEs) were collected using both a 24-hour recall (24 h) and the standard 7 day recall (7d) in a sample of patients receiving active cancer treatment (n = 113). Using data captured with a PRO-CTCAE-24h on days 6 and 7, and 20 and 21, we computed intra-class correlation coefficients (ICC); an ICC ≥ 0.70 was interpreted as demonstrating high test-retest reliability. Correlations between PRO-CTCAE-24h items on day 7 and conceptually relevant EORTC QLQ-C30 domains were examined. In responsiveness analysis, patients were deemed changed if they had a one-point or greater change in the corresponding PRO-CTCAE-7d item (from week 0 to week 1). RESULTS PRO-CTCAE-24h captured on two consecutive days demonstrated that 21 of 27 items (78%) had ICCs ≥ 0.70 (day 6/7 median ICC 0.76), (day 20/21 median ICC 0.84). Median correlation between attributes within a common AE was 0.75, and the median correlation between conceptually relevant EORTC QLQ-C30 domains and PRO-CTCAE-24 h items captured on day 7 was 0.44. In the analysis of responsiveness to change, the median standardized response mean (SRM) for patients with improvement was - 0.52 and that for patients with worsening was 0.71. CONCLUSION A 24-hour recall period for PRO-CTCAE items has acceptable measurement properties and can inform day-to-day variations in symptomatic AEs when daily PRO-CTCAE administration is implemented in a clinical trial.
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Affiliation(s)
- M K Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - E Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | - B T Langlais
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | | | - B F Ginos
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - L J Rogak
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - A V Bennett
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - D Schrag
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - G L Mazza
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - A C Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
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Kosiorek HE, Scherber RM, Geyer HL, Verstovsek S, Langlais BT, Mazza GL, Gotlib J, Gupta V, Padrnos LJ, Palmer JM, Fleischman A, Mesa RA, Dueck AC. Quality of life independently predicts overall survival in myelofibrosis: Key insights from the COntrolled MyeloFibrosis Study with ORal Janus kinase inhibitor Treatment (COMFORT)-I study. Br J Haematol 2022; 198:1065-1068. [PMID: 35751150 DOI: 10.1111/bjh.18329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Heidi E Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Holly L Geyer
- Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Srdan Verstovsek
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas, USA
| | - Blake T Langlais
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Gina L Mazza
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jason Gotlib
- Stanford University Medical Center, Palo Alto, California, USA
| | - Vikas Gupta
- MPN Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leslie J Padrnos
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Jeanne M Palmer
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Angela Fleischman
- Department of Hematology and Oncology, University of California Irvine, Irvine, California, USA
| | - Ruben A Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, Texas, USA
| | - Amylou C Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
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7
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Mazza GL, Petersen MM, Ginos B, Langlais BT, Heon N, Gounder MM, Mahoney MR, Zoroufy AJ, Schwartz GK, Rogak LJ, Thanarajasingam G, Basch E, Dueck AC. Missing data strategies for the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in Alliance A091105 and COMET-2. Qual Life Res 2022; 31:1069-1080. [PMID: 34420143 PMCID: PMC8859007 DOI: 10.1007/s11136-021-02968-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Missing scores complicate analysis of the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) because patients with and without missing scores may systematically differ. We focus on optimal analysis methods for incomplete PRO-CTCAE items, with application to two randomized, double-blind, placebo-controlled, phase III trials. METHODS In Alliance A091105 and COMET-2, patients completed PRO-CTCAE items before randomization and several times post-randomization (N = 64 and 107, respectively). For each trial, we conducted between-arm comparisons on the PRO-CTCAE via complete-case two-sample t-tests, mixed modeling with contrast, and multiple imputation followed by two-sample t-tests. Because interest lies in whether CTCAE grades can inform missing PRO-CTCAE scores, we performed multiple imputation with and without CTCAE grades as auxiliary variables to assess the added benefit of including them in the imputation model relative to only including PRO-CTCAE scores across all cycles. RESULTS PRO-CTCAE completion rates ranged from 100.0 to 71.4% and 100.0 to 77.1% across time in A091105 and COMET-2, respectively. In both trials, mixed modeling and multiple imputation provided the most similar estimates of the average treatment effects. Including CTCAE grades in the imputation model did not consistently narrow confidence intervals of the average treatment effects because correlations for the same PRO-CTCAE item between different cycles were generally stronger than correlations between each PRO-CTCAE item and its corresponding CTCAE grade at the same cycle. CONCLUSION For between-arm comparisons, mixed modeling and multiple imputation are informative techniques for handling missing PRO-CTCAE scores. CTCAE grades do not provide added benefit for informing missing PRO-CTCAE scores. CLINICALTRIALS gov Identifiers: NCT02066181 (Alliance A091105); NCT01522443 (COMET-2).
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Affiliation(s)
- Gina L. Mazza
- grid.417468.80000 0000 8875 6339Alliance Statistics and Data Center, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259 USA ,grid.417468.80000 0000 8875 6339Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ USA
| | - Molly M. Petersen
- grid.417468.80000 0000 8875 6339Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ USA
| | - Brenda Ginos
- grid.417468.80000 0000 8875 6339Alliance Statistics and Data Center, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259 USA ,grid.417468.80000 0000 8875 6339Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ USA
| | - Blake T. Langlais
- grid.417468.80000 0000 8875 6339Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ USA
| | - Narre Heon
- grid.51462.340000 0001 2171 9952Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Mrinal M. Gounder
- grid.51462.340000 0001 2171 9952Memorial Sloan Kettering Cancer Center, New York, NY USA
| | | | - Alexander J. Zoroufy
- grid.66875.3a0000 0004 0459 167XAlliance Statistics and Data Center, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Gary K. Schwartz
- grid.21729.3f0000000419368729Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY USA
| | - Lauren J. Rogak
- grid.51462.340000 0001 2171 9952Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Gita Thanarajasingam
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Ethan Basch
- grid.51462.340000 0001 2171 9952Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.410711.20000 0001 1034 1720UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC USA
| | - Amylou C. Dueck
- grid.417468.80000 0000 8875 6339Alliance Statistics and Data Center, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259 USA ,grid.417468.80000 0000 8875 6339Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ USA
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Langlais BT, Mazza GL, Kosiorek HE, Palmer J, Mesa R, Dueck AC. Validation of a Modified Version of the Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score. J Hematol 2021; 10:207-211. [PMID: 34804309 PMCID: PMC8577588 DOI: 10.14740/jh914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with myeloproliferative neoplasms (MPNs) suffer from chronic and progressive symptom burden. MPN trials capturing patient-reported symptoms routinely administer the MPN Symptom Assessment Form (SAF). The MPN-10 assesses 10 of the most clinically relevant symptoms, including fatigue and generates a Total Symptom Score (TSS). The original MPN-10 included a fatigue item from the Brief Fatigue Inventory (BFI). The myelofibrosis-specific symptom assessment tool called the MFSAF v4 utilizes a fatigue item developed to be consistent with other items within the SAF. This study sought to validate a modified version of the MPN-10 TSS using the SAF fatigue item for harmonization with MFSAF v4. METHODS Survey data from two cohorts of patients with essential thrombocythemia, polycythemia vera, or myelofibrosis assessing MPN characteristics and symptom burden were used. RESULTS AND CONCLUSION BFI and SAF fatigue items were highly correlated in raw score (Pearson r = 0.88), comparable in their severity categorizations (89% agreement for severe versus non-severe) and respective contributions to the TSS (both Cronbach's alpha = 0.89). Reliability of SAF fatigue was acceptable and independently associated with known disease-related characteristics (splenomegaly, low quality-of-life, and distress). Fatigue in patients with MPNs is measured with high similarity using the SAF fatigue item within the MPN-10 in harmonization with the MFSAF v4.
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Affiliation(s)
- Blake T. Langlais
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Gina L. Mazza
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Heidi E. Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Jeanne Palmer
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Amylou C. Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA,Corresponding Author: Amylou C. Dueck, Department of Quantitative Health Sciences, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA.
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Gowin K, Langlais BT, Kosiorek HE, Dueck A, Millstine D, Huberty J, Eckert R, Mesa RA. The SIMM study: Survey of integrative medicine in myeloproliferative neoplasms. Cancer Med 2020; 9:9445-9453. [PMID: 33140580 PMCID: PMC7774715 DOI: 10.1002/cam4.3566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/14/2020] [Revised: 08/25/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022] Open
Abstract
Myeloproliferative neoplasms (MPNs) are characterized by significant symptom burden. Integrative medicine (IM) offers unique symptom management strategies. This study describes IM interventions utilized by MPN patients and the association with symptom burden, quality of life, depression, and fatigue adjusted for lifestyle confounders. MPN patients were surveyed online for IM utilization, MPN symptom burden (MPN‐Symptom Assessment Form Total Symptom Score), depression (Patient Health Questionnaire), fatigue (Brief Fatigue Inventory), and a single question on overall quality of life. Measures were compared by IM participation and adjusted for alcohol and tobacco use, BMI, diet, and MPN type using multiple linear and logistic regression. A total of 858 participants were included in the analysis. Aerobic activity (p =< 0.001) and strength training (p = 0.01) were associated with lower mean symptom burden while massage (p =< 0.001) and support groups (p =< 0.001) were associated with higher levels of symptom burden. Higher quality of life was reported in massage (p = 0.04) and support groups (p = 0.002) while lower quality of life was noted in aerobic activity (p =< 0.001) and strength training (p = 0.001). A lower depression screening score was noted in those participating in aerobic activity (p = 0.006), yoga (p = 0.03), and strength training (p = 0.02). Lower fatigue was noted in those participating in aerobic activity (p =< 0.001) and strength training (p = 0.03) while higher fatigue was noted in those participating in massage (p =< 0.001) and breathing techniques (p = 0.02). Data available on request from the authors. This international survey of MPN patients on IM usage, has shown that patients who participated in a form of IM had a pattern of decreased levels of symptom burden, fatigue, depression, and higher QoL, as adjusted for health lifestyle practices overall.
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Affiliation(s)
- Krisstina Gowin
- Department of Hematology, University of Arizona, Tucson, AZ, USA
| | - Blake T Langlais
- Department of Biostatistics, Mayo Clinic, Phoenix, Phoenix, AZ, USA
| | - Heidi E Kosiorek
- Department of Biostatistics, Mayo Clinic, Phoenix, Phoenix, AZ, USA
| | - Amylou Dueck
- Department of Biostatistics, Mayo Clinic, Phoenix, Phoenix, AZ, USA
| | - Denise Millstine
- Integrative Medicine Program, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Jennifer Huberty
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Ryan Eckert
- Mays Cancer Center, University of Texas, San Antonio, TX, USA
| | - Ruben A Mesa
- Mays Cancer Center, University of Texas, San Antonio, TX, USA
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Padrnos L, Scherber R, Geyer H, Langlais BT, Dueck AC, Kosiorek HE, Senyak Z, Clark M, Boxer M, Cotter M, Harrison C, Stonnington C, Geda Y, Mesa R. Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition. Cancer Med 2020; 9:8301-8309. [PMID: 32976697 PMCID: PMC7666736 DOI: 10.1002/cam4.3380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/01/2020] [Revised: 07/17/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background Philadelphia chromosome negative myeloproliferative neoplasms (MPNs), including essential thrombocythemia, polycythemia vera, and myelofibrosis, have severe function‐limiting symptom burden that is experienced by the majority of patients. Previous studies have suggested that depression may be present in over a quarter of MPN patients, but to date no studies have evaluated the relationship between depression and other variables such as symptoms. Methods A 70‐item internet based survey regarding fatigue and mood symptoms was developed by a multidisciplinary team of MPN investigators, patients and patient advocates including Patient Health Questionnaire and the Myeloproliferative Neoplasm Symptom Assessment Form was completed by over 1300 patients with MPN diagnosis. Results There were 309 respondents (23%) with PHQ‐2 scores ≥ 3. In this analysis, we found worse systemic symptom burden in individuals reporting depressive symptoms. Conclusion This analysis suggests the importance of depression in contributing to as well as confounding symptomatology in MPN patients, and suggests that this critical variable should also be addressed by clinicians and researchers alike when comprehensively assessing symptom burden etiologies.
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Affiliation(s)
- Leslie Padrnos
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Robyn Scherber
- Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, Portland, Texas, Oregon, USA
| | - Holly Geyer
- Division of Hospital Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Amylou C Dueck
- Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Zhenya Senyak
- MPN Forum, MPN Research Foundation, Chicago, IL, USA
| | - Matthew Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary Cotter
- MPN Forum, MPN Research Foundation, Chicago, IL, USA
| | - Claire Harrison
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,MPN Voice, London, United Kingdom
| | | | - Yonas Geda
- Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, AZ, USA.,Center for Bioelectronics and Biosensors, Arizona State University, Tempe, AZ, USA
| | - Ruben Mesa
- Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, Portland, Texas, Oregon, USA
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11
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DeLeon TT, Almquist DR, Kipp BR, Langlais BT, Mangold A, Winters JL, Kosiorek HE, Joseph RW, Dronca RS, Block MS, McWilliams RR, Kottschade LA, Rumilla KM, Voss JS, Seetharam M, Sekulic A, Markovic SN, Bryce AH. Assessment of clinical outcomes with immune checkpoint inhibitor therapy in melanoma patients with CDKN2A and TP53 pathogenic mutations. PLoS One 2020; 15:e0230306. [PMID: 32196516 PMCID: PMC7083309 DOI: 10.1371/journal.pone.0230306] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/27/2020] [Indexed: 12/27/2022] Open
Abstract
Background CDKN2A and TP53 mutations are recurrent events in melanoma, occurring in 13.3% and 15.1% of cases respectively and are associated with poorer outcomes. It is unclear what effect CDKN2A and TP53 mutations have on the clinical outcomes of patients treated with checkpoint inhibitors. Methods All patients with cutaneous melanoma or melanoma of unknown primary who received checkpoint inhibitor therapy and underwent genomic profiling with the 50-gene Mayo Clinic solid tumor targeted cancer gene panel were included. Patients were stratified according to the presence or absence of mutations in BRAF, NRAS, CDKN2A, and TP53. Patients without mutations in any of these genes were termed quadruple wild type (QuadWT). Clinical outcomes including median time to progression (TTP), median overall survival (OS), 6-month and 12-month OS, 6-month and 12-month without progression, ORR and disease control rate (DCR) were analyzed according to the mutational status of CDKN2A, TP53 and QuadWT. Results A total of 102 patients were included in this study of which 14 had mutations of CDKN2A (CDKN2Amut), 21 had TP53 mutations (TP53mut), and 12 were QuadWT. TP53mut, CDKN2Amut and QuadWT mutational status did not impact clinical outcomes including median TTP, median OS, 6-month and 12-month OS, 6-month and 12-month without progression, ORR and DCR. There was a trend towards improved median TTP and DCR in CDKN2Amut cohort and a trend towards worsened median TTP in the QuadWT cohort. Conclusion Cell cycle regulators such as TP53 and CDKN2A do not appear to significantly alter clinical outcomes when immune checkpoint inhibitors are used.
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Affiliation(s)
- Thomas T. DeLeon
- Department of Hematology & Oncology, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
| | - Daniel R. Almquist
- Department of Hematology & Oncology, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
| | - Benjamin R. Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Blake T. Langlais
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
| | - Aaron Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
| | - Jennifer L. Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Heidi E. Kosiorek
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
| | - Richard W. Joseph
- Department of Hematology & Oncology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Roxana S. Dronca
- Department of Hematology & Oncology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Matthew S. Block
- Department of Hematology & Oncology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Robert R. McWilliams
- Department of Hematology & Oncology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Lisa A. Kottschade
- Department of Hematology & Oncology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Kandelaria M. Rumilla
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Jesse S. Voss
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Mahesh Seetharam
- Department of Hematology & Oncology, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
| | - Aleksandar Sekulic
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
- Mayo Clinic Cancer Center, Phoenix, Arizona, United States of America
| | - Svetomir N. Markovic
- Department of Hematology & Oncology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Alan H. Bryce
- Department of Hematology & Oncology, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
- * E-mail:
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12
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Shah I, Baffy NJ, Horsley-Silva JL, Langlais BT, Ruff KC. Peppermint Oil to Improve Visualization in Screening Colonoscopy: A Randomized Controlled Clinical Trial. Gastroenterology Res 2019; 12:141-147. [PMID: 31236155 PMCID: PMC6575129 DOI: 10.14740/gr1180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/05/2019] [Accepted: 04/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background Screening colonoscopy has been associated with reduced mortality from colorectal cancer by means of early detection and timely treatment. However, visualization during colonoscopy is often impaired since the colon is naturally prone to peristalsis and spasm. There is evidence to suggest benefit of topical peppermint oil in causing smooth muscle relaxation, thereby decreasing peristalsis. The aim of our study was to determine if peppermint oil helps reduce colonic spasticity so as to allow for better visualization during screening colonoscopy. Methods We performed a randomized controlled, double-blinded, clinical trial where patients undergoing screening colonoscopy were assigned to receive either peppermint oil or placebo. Once cecum was reached, 50 mL of either solution was directly injected via the working channel of the colonoscope. Colonic peristalsis, spasticity and bowel visibility were documented. Bowel preparation quality, withdrawal time and adenoma detection rate (ADR) were also assessed. Continuous variables were analyzed using t-test or Wilcoxon rank-sum test while categorical variables were compared using the two-way Chi-square test. Results Forty-eight patients were included, of whom 24 patients received peppermint oil and 24 received placebo. Mean Boston bowel preparation score (BBPS) was excellent for both groups (8 points vs. 7.9 points; P = 0.98). Both mean total colonoscopy time (17.8 min vs. 21.9 min; P = 0.07) and mean cecal intubation time (7.2 min vs. 10.3 min; P = 0.04) were shorter with peppermint oil as compared to placebo. Complete absence of bowel spasticity was observed among 58.3% patients in the peppermint oil group as compared to 45.8% patients in the placebo group (P = 0.05). More than 75% of bowel was visualized in 83% of patients in both groups (P = 0.56). Mean ADR was higher in the peppermint group as compared to the placebo group (45.8% vs. 37.5%; P = 0.56). Conclusion Our study suggests that topical peppermint oil reduces bowel wall spasticity, which could lead to better visualization of the bowel during screening colonoscopy. Although use of peppermint oil was associated with better ADRs, these results did not achieve statistical significance. Larger sample size and use of alternative methods of peppermint oil administration allowing for more absorption time may establish stronger results.
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Affiliation(s)
- Ishani Shah
- Department of Internal Medicine, Creighton University St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Noemi J Baffy
- Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Kevin C Ruff
- Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA
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13
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Mazza GL, Kunze KL, Langlais BT, Kosiorek HE, DeWees TA, Geyer HL, Scherber RM, Mesa RA, Dueck AC. Item nonresponse on the Myeloproliferative Neoplasms Symptom Assessment Form (MPN-SAF): a comparison of missing data strategies. Leuk Lymphoma 2019; 60:1789-1795. [PMID: 30652523 DOI: 10.1080/10428194.2018.1548705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Administering questionnaires to patients is an efficient and effective method for assessing patients' symptoms. However, item nonresponse (skipped questions) potentially compromises the utility of these questionnaires. Using an international sample of 2,067 patients with myeloproliferative neoplasms, we evaluated the impact of item nonresponse on scoring of the Myeloproliferative Neoplasms Symptom Assessment Form Total Symptom Score (MPN-SAF TSS or MPN-10). We characterized item nonresponse on the MPN-10 and compared strategies for addressing item nonresponse (available-case analysis, proration, and multiple imputation) on the MPN-10 (multi-symptom assessment) and Brief Fatigue Inventory (BFI; single-symptom assessment). Characteristics of multi-symptom assessments would be expected to adversely affect proration, yet proration and multiple imputation provided very similar results for both the MPN-10 and BFI. This is likely because the MPN-10 item missing data rates were low, consistent with prior clinic- and internet-based studies. These results support the published scoring method for the MPN-10 (proration).
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Affiliation(s)
- Gina L Mazza
- a Mayo Clinic , Health Sciences Research , Scottsdale , AZ , USA
| | - Katie L Kunze
- a Mayo Clinic , Health Sciences Research , Scottsdale , AZ , USA
| | - Blake T Langlais
- a Mayo Clinic , Health Sciences Research , Scottsdale , AZ , USA
| | - Heidi E Kosiorek
- a Mayo Clinic , Health Sciences Research , Scottsdale , AZ , USA
| | - Todd A DeWees
- a Mayo Clinic , Health Sciences Research , Scottsdale , AZ , USA
| | - Holly L Geyer
- b Mayo Clinic , Internal Medicine , Phoenix , AZ , USA
| | - Robyn M Scherber
- c Mays Cancer Center , University of Texas Health San Antonio , San Antonio , TX , USA
| | - Ruben A Mesa
- c Mays Cancer Center , University of Texas Health San Antonio , San Antonio , TX , USA
| | - Amylou C Dueck
- a Mayo Clinic , Health Sciences Research , Scottsdale , AZ , USA
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14
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Caselli RJ, Locke DEC, Woodruff BK, Langlais BT, Dueck AC. Reply to Comment on "Personality Changes During the Transition from Cognitive Health to Mild Cognitive Impairment". J Am Geriatr Soc 2018; 67:192-193. [PMID: 30289960 DOI: 10.1111/jgs.15622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Dona E C Locke
- Division of Psychology, Mayo Clinic Arizona, Scottsdale, AZ
| | | | - Blake T Langlais
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, AZ
| | - Amylou C Dueck
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, AZ
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15
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Abstract
INTRODUCTION Roughly 4% to 23% of the population embody stress prone personality and other traits characterizing a subclinical "broad autism phenotype" (BAP). Subjective cognitive impairment (SCI) among healthy elderly is associated with psychological distress leading us to predict BAP would be associated with SCI. METHODS The Autism Spectrum Quotient, a self-administered 50 item questionnaire, was completed by 419 consecutive members of the Arizona APOE Cohort who underwent neuropsychological testing every 2 years. SCI was assessed with self and informant versions of the Multidimensional Assessment of Neurodegenerative Symptoms (MANS) Questionnaire. RESULTS A total of 45 individuals scored in the BAP range, designated BAP+, and the rest were BAP-. At entry, both Multidimensional Assessment of Neurodegenerative Symptoms Questionnaire Self and Informant scores were higher in the BAP+ group (P<0.0001). After age 60, the BAP+ group had greater annual increases in Multidimensional Assessment of Neurodegenerative Symptoms Questionnaire Self scores (0.05 vs. 0.02; difference=0.03; 95% confidence interval, 0.004-0.05; P=0.02) yet there was no difference between groups in memory decline. Over ~10 years 33 individuals developed mild cognitive impairment: 4 in the BAP+ group (8.9%) and 29 in the BAP- group (7.8%), P=0.77. DISCUSSION Individuals who meet criteria for the BAP have escalating SCI with age, but no greater rate of memory decline or clinical progression to mild cognitive impairment.
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Affiliation(s)
- Richard J. Caselli
- Departments of Neurology, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, Arizona 85259
| | - Blake T. Langlais
- Departments of Biostatistics, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, Arizona 85259
| | - Amylou C. Dueck
- Departments of Biostatistics, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, Arizona 85259
| | - Dona E.C. Locke
- Departments of Psychology, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, Arizona 85259
| | - Bryan K. Woodruff
- Departments of Neurology, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, Arizona 85259
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16
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Langlais BT, Geyer H, Scherber R, Mesa RA, Dueck AC. Quality of life and symptom burden among myeloproliferative neoplasm patients: do symptoms impact quality of life? Leuk Lymphoma 2018; 60:402-408. [PMID: 30033837 DOI: 10.1080/10428194.2018.1480768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients with myeloproliferative neoplasms (MPNs) are faced with high disease-related symptom burden and quality of life (QoL) decrements. This analysis assesses the extent to which individual symptoms or summary measures across symptoms impact QoL overall and within MPN subgroups. Four sets of summary measures were constructed assessing symptom prevalence and severity within group-standardized and patient-individualized approaches. Among 1416 international patients with MPNs, mean symptom severity and prevalence were highly correlated (p < .001). Individual symptoms most impacting QoL were inactivity (R2=0.29), fatigue (R2=0.23), and depression (R2=0.23). Multiple symptom severity scores are needed to best predict QoL. Symptom severity at the patient-level is more predictive of QoL than severity at the group-level where a fewer number of symptoms are considered. Having at least one severe symptom and having multiple symptoms of moderate intensity are meaningfully predictive of QoL decrements. Results were highly consistent across disease subgroups.
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Affiliation(s)
- Blake T Langlais
- a Section of Biostatistics , Mayo Clinic , Scottsdale , AZ , USA
| | - Holly Geyer
- b Department of Internal Medicine , Mayo Clinic , Phoenix , AZ , USA
| | - Robyn Scherber
- c Division of Hematology and Medical Oncology, Oregon Health and Science University , Portland , OR , USA.,d Division of Hematology and Oncology, University of Texas Health San Antonio MD Anderson Mays Cancer Center , San Antonio , TX , USA
| | - Ruben A Mesa
- d Division of Hematology and Oncology, University of Texas Health San Antonio MD Anderson Mays Cancer Center , San Antonio , TX , USA
| | - Amylou C Dueck
- a Section of Biostatistics , Mayo Clinic , Scottsdale , AZ , USA
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17
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Caselli RJ, Woodruff BK, Langlais BT, Dueck AC, Locke DE. P4‐080: SUBJECTIVE COGNITIVE IMPAIRMENT AND THE BROAD AUTISM PHENOTYPE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Caselli RJ, Langlais BT, Dueck AC, Henslin BR, Johnson TA, Woodruff BK, Hoffman-Snyder C, Locke DEC. Personality Changes During the Transition from Cognitive Health to Mild Cognitive Impairment. J Am Geriatr Soc 2018; 66:671-678. [PMID: 29341070 DOI: 10.1111/jgs.15182] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Behavioral problems in individuals with Alzheimer's disease (AD) impose major management challenges. Current prevention strategies are anchored to cognitive outcomes, but behavioral outcomes may provide another, clinically relevant opportunity for preemptive therapy. We sought to determine whether personality changes that predispose to behavioral disorders arise during the transition from preclinical AD to mild cognitive impairment (MCI). DESIGN Longitudinal observational cohort study. SETTING Academic medical center. PARTICIPANTS Members of an apolipoprotein E (APOE) ɛ4 genetically enriched cohort of Maricopa County residents who were neuropsychiatrically healthy at entry (N = 277). Over a mean interval of 7 years, 25 who developed MCI and had the Neuroticism, Extraversion, and Openness Personality Inventory-Revised (NEO-PI-R) before and during the MCI transition epoch were compared with 252 nontransitioners also with serial NEO-PI-R administrations. INTERVENTION Longitudinal administration of the NEO-PI-R and neuropsychological test battery. MEASUREMENTS Change in NEO-PI-R factor scores (neuroticism, extraversion, openness, agreeableness, conscientiousness) from entry to the epoch of MCI diagnosis or an equivalent follow-up duration in nontransitioners. RESULTS NEO-PI-R neuroticism T-scores increased significantly more in MCI transitioners than in nontransitioners (mean 2.9, 95% confidence interval (CI) = 0.9-4.9 vs 0, 95% CI = -0.7-0.7, P = .02), and openness decreased more in MCI transitioners than in nontransitioners (-4.8, 95% CI = -7.3 to -2.4 vs -1.0, 95% CI = -1.6 to -0.4, P < .001). Concurrent subclinical but statistically significant changes in behavioral scores worsened more in MCI transitioners than nontransitioners for measures of depression, somatization, irritability, anxiety, and aggressive attitude. CONCLUSION Personality and subclinical behavioral changes begin during the transition from preclinical AD to incident MCI and qualitatively resemble the clinically manifest behavioral disorders that subsequently arise in individuals with frank dementia.
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Affiliation(s)
| | - Blake T Langlais
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Amylou C Dueck
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Bruce R Henslin
- Department of Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Travis A Johnson
- Department of Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Bryan K Woodruff
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Dona E C Locke
- Division of Psychology, Mayo Clinic Arizona, Scottsdale, Arizona
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19
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Desai AJ, Dong M, Langlais BT, Dueck AC, Miller LJ. Cholecystokinin responsiveness varies across the population dependent on metabolic phenotype. Am J Clin Nutr 2017; 106:447-456. [PMID: 28592602 PMCID: PMC5525122 DOI: 10.3945/ajcn.117.156943] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/05/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Cholecystokinin (CCK) is an important satiety factor, acting at type 1 receptors (CCK1Rs) on vagal afferent neurons; however, CCK agonists have failed clinical trials for obesity. We postulated that CCK1R function might be defective in such patients due to abnormal membrane composition, such as that observed in cholesterol gallstone disease.Objective: Due to the challenges in directly studying CCK1Rs relevant to appetite control, our goal was to develop and apply a method to determine the impact of a patient's own cellular environment on CCK stimulus-activity coupling and to determine whether CCK sensitivity correlated with the metabolic phenotype of a high-risk population.Design: Wild-type CCK1Rs were expressed on leukocytes from 112 Hispanic patients by using adenoviral transduction and 24-h culture, with quantitation of cholesterol composition and intracellular calcium responses to CCK. Results were correlated with clinical, biochemical, and morphometric characteristics.Results: Broad ranges of cellular cholesterol and CCK responsiveness were observed, with elevated cholesterol correlated with reduced CCK sensitivity. This was prominent with increasing degrees of obesity and the presence of diabetes, particularly when poorly controlled. No single standard clinical metric correlated directly with CCK responsiveness. Reduced CCK sensitivity best correlated with elevated serum triglycerides in normal-weight participants and with low HDL concentrations and elevated glycated hemoglobin in obese and diabetic patients.Conclusions: CCK responsiveness varies widely across the population, with reduced signaling in patients with obesity and diabetes. This could explain the failure of CCK agonists in previous clinical trials and supports the rationale to develop corrective modulators to reverse this defective servomechanism for appetite control. This trial was registered at www.clinicaltrials.gov as NCT03121755.
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Affiliation(s)
- Aditya J Desai
- Department of Molecular Pharmacology and Experimental Therapeutics and
| | - Maoqing Dong
- Department of Molecular Pharmacology and Experimental Therapeutics and
| | | | | | - Laurence J Miller
- Department of Molecular Pharmacology and Experimental Therapeutics and
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