1
|
Pinnix C, Dabaja B, Gunther J, Fang P, Wu S, Nastoupil L, Strati P, Nair R, Ahmed S, Steiner R, Westin J, Neelapu S, Rodriguez M, Lee H, Wang M, Fowler N, Flowers C, Feng L, Chi L, Esmaeli B. Response Adapted Ultra Low Dose Radiation Therapy for the Definitive Management of Orbital Indolent B-Cell Lymphoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
2
|
Bannerji R, Yuen S, Phillips T, Arthur C, Isufi I, Marlton P, Seymour JF, Corradini P, Molinari A, Gritti G, Emmons R, Hirata J, Musick L, Saha S, Croft B, Flowers C. POLATUZUMAB VEDOTIN + OBINUTUZUMAB + VENETOCLAX IN PATIENTS WITH RELAPSED/REFRACTORY (R/R) FOLLICULAR LYMPHOMA (FL): PRIMARY ANALYSIS OF A PHASE 1B/2 TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.23_2880] [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: 11/11/2022]
Affiliation(s)
- R. Bannerji
- Rutgers Cancer Institute of New Jersey Section of Hematologic Malignancies New Brunswick New Jersey USA
| | - S. Yuen
- The Calvary Mater Newcastle Hospital Waratah Australia
| | - T. Phillips
- University of Michigan Medical School, Division of Hematology and Oncology Ann Arbor USA
| | - C. Arthur
- Royal North Shore Hospital Sydney Australia
| | - I. Isufi
- Yale University, Smilow Cancer Hospital Section of Hematology New Haven USA
| | - P. Marlton
- Princess Alexandra Hospital and University of Queensland Department of Haematology Brisbane Australia
| | - J. F. Seymour
- Peter MacCallum Cancer Centre & Royal Melbourne Hospital Department of Haematology Melbourne Australia
| | - P. Corradini
- University of Milan, Istituto Nazionale dei Tumori Medical Oncology and Hematology Department Milan Italy
| | - A. Molinari
- AUSL Romagna Ospedale degli Infirmi Dirigente Medico Ematologia Rimini Italy
| | - G. Gritti
- ASST Papa Giovanni XXIII UOC Ematologia Bergamo Italy
| | - R. Emmons
- James Graham Brown Cancer Center Louisville USA
| | - J. Hirata
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - L. Musick
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - S. Saha
- F. Hoffmann‐La Roche Ltd Product Development Biometrics Welwyn Garden City UK
| | - B. Croft
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - C. Flowers
- M.D. Anderson Cancer Center Department of Lymphoma/Myeloma Houston USA
| |
Collapse
|
3
|
Liu Y, Augustyn A, Gunther J, Fang P, Nastoupil L, Ahmed S, Strati P, Nair R, Steiner R, Westin J, Rodriguez M, Neelapu S, Flowers C, Khoury J, Medeiros L, Dabaja B, Pinnix C. Radiation Therapy for Refractory High-grade B-cell Lymphoma with MYC and BCL2 and/or BCL6 Rearrangements. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
4
|
Sehn L, Flowers C, McMillan A, Morschhauser F, Salles G, Felizzi F, Launonen A, Qayum N, Thuresson P. ESTIMATION OF LONG-TERM SURVIVAL WITH POLATUZUMAB VEDOTIN PLUS BENDAMUSTINE AND RITUXIMAB FOR PATIENTS WITH RELAPSED/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA (R/R DLBCL). Hematol Oncol 2019. [DOI: 10.1002/hon.66_2630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- L.H. Sehn
- Department of Medical Oncology; BC Cancer Agency; Vancouver BC Canada
| | - C. Flowers
- Hematology and Oncology; Winship Cancer Institute of Emory University; Atlanta GA United States
| | - A. McMillan
- Centre for Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham United Kingdom
| | - F. Morschhauser
- Institute of Hematology-Transfusion; University of Lille, CHU Lille; Lille Cedex France
| | - G. Salles
- Clinical Haematology; Hospices Civils de Lyon, Université Lyon-1; Lyon France
| | - F. Felizzi
- Global Access - Center of Excellence; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - A. Launonen
- Global Access - Center of Excellence; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - N. Qayum
- Haematology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - P.O. Thuresson
- Global Access - Center of Excellence; F. Hoffmann-La Roche Ltd; Basel Switzerland
| |
Collapse
|
5
|
Tilly H, Flowers C, Friedberg J, Herbaux C, Morschhauser F, Sehn L, Sharman J, Trněný M, Lee C, Salles G. POLARIX: A PHASE 3 STUDY OF POLATUZUMAB VEDOTIN (POLA) PLUS R-CHP VERSUS R-CHOP IN PATIENTS (PTS) WITH UNTREATED DLBCL. Hematol Oncol 2019. [DOI: 10.1002/hon.36_2629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- H. Tilly
- Centre Henri Becquerel; University of Rouen; Rouen France
| | - C. Flowers
- Hematology and Oncology; Winship Cancer Institute of Emory University; Atlanta GA United States
| | - J.W. Friedberg
- School of Medicine and Dentistry; University of Rochester Medical Center; Rochester NY United States
| | - C. Herbaux
- Institute of Hematology-Transfusion; University of Lille; CHU Lille Lille Cedex France
| | - F. Morschhauser
- Institute of Hematology-Transfusion; University of Lille; CHU Lille Lille Cedex France
| | - L.H. Sehn
- Department of Medical Oncology; BC Cancer Agency; Vancouver BC Canada
| | - J. Sharman
- Hematology Oncology; US Oncology and Willamette Valley Cancer Institute; Springfield OR United States
| | - M. Trněný
- 1st Department of Medicine - Department of Haematology; Charles University; Prague Czech Republic
| | - C. Lee
- Product Development Clinical Oncology; Genentech, Inc.; South San Francisco CA United States
| | - G. Salles
- Clinical Haematology; Hospices Civils de Lyon, Université Lyon-1; Lyon France
| |
Collapse
|
6
|
Bond D, Switchenko J, Maddocks K, Churnetski M, Goyal S, Shanmugasundaram K, Calzada O, Kolla B, Bachanova V, Gerson J, Barta S, Hill B, Salwaha Y, Martin P, Maldonado E, Gordon M, Danilov A, Grover N, Mathews S, Burkart M, Karmali R, Ghosh N, Park S, Epperla N, Badar T, Guo J, Hamadani M, Fenske T, Malecek M, Kahl B, Flowers C, Blum K, Cohen J. OUTCOMES FOR PATIENTS WITH MANTLE CELL LYMPHOMA EXPERIENCING FRONTLINE TREATMENT FAILURE: A MULTICENTER RETROSPECTIVE STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.77_2631] [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: 11/12/2022]
Affiliation(s)
- D.A. Bond
- Division of Hematology; Ohio State University Comprehensive Cancer Center; Columbus United States
| | - J. Switchenko
- Department of Biostatistics and Bioinformatics; Rollins School of Public Health, Emory University; Atlanta United States
| | - K. Maddocks
- Division of Hematology; Ohio State University Comprehensive Cancer Center; Columbus United States
| | - M. Churnetski
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - S. Goyal
- Department of Biostatistics and Bioinformatics; Rollins School of Public Health, Emory University; Atlanta United States
| | - K. Shanmugasundaram
- Department of Internal Medicine; Emory University School of Medicine; Atlanta United States
| | - O. Calzada
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - B. Kolla
- Department of Hematology; University of Minnesota; Minneapolis United States
| | - V. Bachanova
- Department of Hematology; University of Minnesota; Minneapolis United States
| | - J. Gerson
- Hematology; Abramson Cancer Center, University of Pennsylvania; Pennsylvania United States
| | - S. Barta
- Hematology; Abramson Cancer Center, University of Pennsylvania; Pennsylvania United States
| | - B. Hill
- Hematology and Oncology; Cleveland Clinic Taussig Cancer Institute; Cleveland United States
| | - Y. Salwaha
- Hematology and Oncology; Cleveland Clinic Taussig Cancer Institute; Cleveland United States
| | - P. Martin
- Department of Medicine; Weil Cornell Medicine; New York United States
| | - E. Maldonado
- Hematology and Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland United States
| | - M. Gordon
- Hematology and Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland United States
| | - A. Danilov
- Hematology and Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland United States
| | - N. Grover
- Hematology and Oncology; University of North Carolina Lineberger Comprehensive Cancer Center; Chapel Hill United States
| | - S. Mathews
- Hematology and Oncology; University of North Carolina Lineberger Comprehensive Cancer Center; Chapel Hill United States
| | - M. Burkart
- Hematology and Oncology; Northwestern University, Feinberg School of Medicine; Chicago United States
| | - R. Karmali
- Hematology and Oncology; Northwestern University, Feinberg School of Medicine; Chicago United States
| | - N. Ghosh
- Hematology and Oncology; Atrium Health; Charlotte United States
| | - S. Park
- Hematology and Oncology; Atrium Health; Charlotte United States
| | - N. Epperla
- Division of Hematology; Ohio State University Comprehensive Cancer Center; Columbus United States
| | - T. Badar
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - J. Guo
- Department of Medicine; Weil Cornell Medicine; New York United States
| | - M. Hamadani
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - T. Fenske
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - M. Malecek
- Hematology and Oncology; Siteman Cancer Center, Washington University; St. Louis United States
| | - B. Kahl
- Hematology and Oncology; Siteman Cancer Center, Washington University; St. Louis United States
| | - C. Flowers
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - K. Blum
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - J. Cohen
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| |
Collapse
|
7
|
Çağlayan Ç, Dixon J, Salles G, Wall A, Schmitz N, Cunningham D, Poeschel V, Seymour J, Jaeger U, Habermann T, Merli F, Haioun C, Tilly H, Ghesiquieres H, Ziepert M, Flament J, Shi Q, Flowers C. THE CLINICAL COURSE OF DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) OVER TIME: A MULTISTATE SURVIVAL ANALYSIS USING META-DATA FROM 13 FIRST-LINE RANDOMIZED TRIALS. Hematol Oncol 2019. [DOI: 10.1002/hon.56_2630] [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: 11/07/2022]
Affiliation(s)
- Ç. Çağlayan
- Industrial and Systems Engineering; Georgia Institute of Technology; Atlanta GA United States
| | - J.G. Dixon
- Department of Health Sciences Research; Mayo Clinic; Rochester MN United States
| | - G. Salles
- Hematology; Hospices Civils de Lyon; Lyon France
| | - A. Wall
- Department of Health Sciences Research; Mayo Clinic; Rochester MN United States
| | - N. Schmitz
- Hematology and Oncology; University Hospital Muenster; Muenster Germany
| | - D. Cunningham
- Department of Medicine; The Royal Marsden Hospital; Sutton United Kingdom
| | - V. Poeschel
- Medical School; Saarland University; Homburg Germany
| | - J. Seymour
- Clinical Research; Integrated Haematology, Peter MacCallum Cancer Centre; Melbourne Australia
| | - U. Jaeger
- Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - T. Habermann
- Cancer Center; Hematology, Mayo Clinic; Rochester MN United States
| | - F. Merli
- Hematology; AUSL-IRCCS; Reggio Emilia Italy
| | - C. Haioun
- Unite Hemopathies Lymphoides; Hopital Henri Mondor; Creteil France
| | - H. Tilly
- Hématologie; Centre Henri-Becquerel; Rouen France
| | - H. Ghesiquieres
- Service d'Hématologie; Centre Hospitalier Lyon-Sud, Pierre Bénite CEDEX; France
| | - M. Ziepert
- Institut für Medizinische Informatik; Statistik und Epidemiologie, Universität Leipzig; Leipzig Germany
| | - J. Flament
- Medicine and Biology; Celgene Corporation; Boudry Switzerland
| | - Q. Shi
- Department of Health Sciences Research; Mayo Clinic; Rochester MN United States
| | - C. Flowers
- Winship Cancer Institute; Emory University; Atlanta GA United States
| |
Collapse
|
8
|
Collins G, Noy A, de Vos S, Thieblemont C, Martin P, Flowers C, Morschhauser F, Ma S, Coleman M, Peles S, Smith S, Barrientos J, Smith A, Munneke B, Dimery I, Beaupre D, Chen R. Safety and efficacy of single-agent ibrutinib in patients with relapsed/refractory (R/R) marginal zone lymphoma (MZL): A multicenter, open-label, phase 2 study. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- G.P. Collins
- Department of Haematology; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - A. Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center; New York USA
| | - S. de Vos
- Division of Hematology/Oncology; David Geffen School of Medicine at UCLA; Los Angeles USA
| | - C. Thieblemont
- APHP; Hopital Saint-Louis-Paris Diderot University, Hemato-oncology Department; Paris France
| | - P. Martin
- Division of Hematology/Oncology; Weill Cornell Medical College; New York USA
| | - C. Flowers
- Department of Hematology and Medical Oncology; Winship Cancer Institute of Emory University; Atlanta USA
| | - F. Morschhauser
- Hematologie; Centre Hospitalier Universitaire, Université de Lille, EA GRIIOT; Lille Cedex France
| | - S. Ma
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine; Northwestern University; Chicago USA
| | - M. Coleman
- Division of Hematology and Medical Oncology, Center for Lymphoma and Myeloma; New York-Presbyterian Hospital and Weill Medical College; New York USA
| | - S. Peles
- Hematology; Florida Cancer Specialists; Atlantis USA
| | - S. Smith
- Department of Medicine and Clinical Research Division, Division of Medical Oncology; University of Washington and Fred Hutchinson Cancer Research Center; Seattle USA
| | - J. Barrientos
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Hempstead USA
| | - A. Smith
- Clinical Operations, Pharmacylics LLC, an Abbvie Company; Sunnyvale USA
| | - B. Munneke
- Biostatistics; Pharmacylics LLC, an Abbvie Company; Sunnyvale USA
| | - I. Dimery
- Clinical Operations, Pharmacylics LLC, an Abbvie Company; Sunnyvale USA
| | - D. Beaupre
- Clinical Operations, Pharmacylics LLC, an Abbvie Company; Sunnyvale USA
| | - R. Chen
- Hematology/Oncology; City of Hope National Medical Center; Duarte USA
| |
Collapse
|
9
|
Heumann T, Esiashvili N, Parker S, Switchenko J, Lechowicz M, Flowers C, Khan M. Total Skin Electron Irradiation (TSEI) Using Rotational Technique for Cutaneous T-Cell Lymphoma. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
10
|
Link BK, Miller TP, Byrtek M, Cerhan JR, Zelenetz AD, Dillon H, Flowers C, Friedberg JW. Second-line therapy in follicular lymphoma in the United States: Report of NLCS observational study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
11
|
Nooka AK, DeJoubner NJ, Nabhan C, Zhou X, Taylor M, Byrtek M, Miller TP, Friedberg JW, Zelenetz AD, Link BK, Cerhan JR, Dillon H, Levy D, Hirata J, Flowers C. Examination of the Follicular Lymphoma International Prognostic Index (FLIPI) in the National LymphoCare Study (NLCS): A U.S. patient cohort treated predominantly in community practices. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
12
|
Flowers C, Taylor M, Hirata J, Dillon H, Zelenetz AD, Hainsworth JD, Cerhan JR, Rogers ES, Friedberg JW, Link BK. Use of maintenance rituximab (R) in the United States following R-based induction for follicular lymphoma (FL). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
13
|
Flowers C, Sinha R, Kaufman J, Shenoy P, Lewis C, Bumpers K, Rogatko A. Bortezomib plus modified R-CHOP as initial therapy for indolent B-cell lymphomas: Phase I results. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8577 Background: Adding rituximab (R) to chemotherapy improves survival for patients (pts) with follicular lymphoma (FL) and other indolent non-Hodgkin lymphomas (NHL), but not all pts respond. Bortezomib (B) + RCHOP has a high complete response (CR) rate, but higher doses of B with standard vincristine produced severe neuropathy. We developed a phase I/II trial to test if adding B to RCHOP with modified vincristine dosing can be well-tolerated and yield a high CR rate. Methods: Untreated pts with indolent NHL and indications for treatment based on GELF criteria or FLIPI ≥3 received R 375mg/m2, cyclophosphamide 750mg/m2, doxorubicin 50mg/m2, vincristine 1.4mg/m2 (capped at 1.5mg) on day 1, B 1.0- 1.6mg/m2 days 1 and 8, and prednisone 100mg days 1–5 for 6–8 cycles. The maximum tolerated dose (MTD) was defined as the regimen at which <30% grade ≥3 non-hematological or grade ≥4 hematological toxicity (>14 days) occurs. Dose escalation used the Escalation with Overdose Control Bayesian method with upper bound (θ=0.3). This facilitated MTD finding with fewer pts given prior data on B+RCHOP. Functional Assessment of Cancer Therapy (FACT) Neurotoxicity (11-item; 4 point scale), EMG, nerve conduction velocity and epidermal nerve fiber density measures were taken at baseline and after cycle 4. Results: 11 pts with FL (n=6) or other indolent NHL enrolled in phase I. Median age was 59 years (range 29–69). 6 pts (55%) had stage IV disease; 8 (64%) had FLIPI ≥2. Pts received RCHOP + B at 1.0 mg/m2 (n=1), 1.3 mg/m2 (n= 6) or 1.6 mg/m2 (n= 4) and together completed 67 cycles. Treatment was well tolerated. Neuropathy occurred in 4 pts (36%), with 2 grade 1, 1 grade 2 and 1 grade 3 toxicity ( Table ). Grade 4 neutropenia occurred in 4 pts (36%), but none >14 days. Overall response rate was 100% with 5/8 finished pts (63%) achieving CR. 3 continue on treatment. Mean FACT Neurotoxicity after cycle 4 remained < 1 for all items. Conclusions: Adding bortezomib to RCHOP produces limited toxicity when vincristine is capped at 1.5 mg. Phase II will explore the efficacy of this regimen. [Table: see text] [Table: see text]
Collapse
Affiliation(s)
- C. Flowers
- Emory University School of Medicine, Atlanta, GA
| | - R. Sinha
- Emory University School of Medicine, Atlanta, GA
| | - J. Kaufman
- Emory University School of Medicine, Atlanta, GA
| | - P. Shenoy
- Emory University School of Medicine, Atlanta, GA
| | - C. Lewis
- Emory University School of Medicine, Atlanta, GA
| | - K. Bumpers
- Emory University School of Medicine, Atlanta, GA
| | - A. Rogatko
- Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
14
|
Hutcherson D, Surati M, Sanvidge K, Harvey D, Al-Baldawi R, Langston A, Flowers C, Lonial S, Kaufman J, Lechowicz M, Waller E. Pharmacokinetic (PK) Comparison Of Intravenous Versus Oral Busulfan Conditioning Regimens for Acute Myeloid Leukemia (AML) And Myelodysplastic Syndrome (MDS) Patients. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Kaufman JL, Lonial S, Sinha R, Torre C, Langston AA, Lechowicz MJ, Flowers C, McMillan S, Renfroe H, Heffner LT, Waller EK. A364 A Randomized Phase I Study of Melphalan and Bortezomib for Autologous Transplant in Myeloma. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-9190(11)70559-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
16
|
Garwood ER, Kumar AS, Baehner F, Garber JE, Troyan S, Olopade OI, Moore D, Au A, Flowers C, Campbell M, Hylton N, Esserman LJ, Rush-Port E. Fluvastatin has biologic effects on stage 0 and 1 breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-4122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #4122
Introduction: Statins are safe, reduce cardiovascular risk, and impact pathways critical to cancer progression. We and others have shown lipophilic statins cause apoptosis and growth suppression in vitro and in vivo, and though epidemiologic data are mixed, statin effect appears most evident in estrogen receptor (ER) negative or grade 3 disease. To look for a direct biologic effect of lipophilic statins, we conducted a perioperative pilot window trial in women with breast cancer (BC).
 Methods: 40 subjects with stage 0,1 BC were randomized to high dose (80mg/day) or low dose (20mg/day) fluvastatin for 3-6 weeks prior to surgery. Paired tissue (core biopsy and surgical specimen), peripheral blood and MRI were obtained. Primary endpoint was Ki-67 (proliferation) change. Secondary endpoints included cleaved caspase-3 (CC3, apoptosis), longest diameter (LD) by MRI, and C-reactive protein (CRP) change. Subgroup analyses was planned by grade (3 vs. 1,2), statin dose; and ER status. Immunohistochemistry (IHC) on paraffin tissue used standard streptavidin biotin methods. A single breast pathologist reviewed all slides; a single radiologist read all MRIs, both blinded to timepoint.
 Results: Median serum cholesterol decreased by 16% (-23% and -12% for high and low dose, respectively p=0.012), indicating drug effect and compliance. 29 patients had sufficient tumor for paired IHC, 14 and 15 were grade 3 and 1,2, and 10 and 19 were ER - and +, respectively. In grade 3 (73% of which were ER-) vs. 1,2 tumors, there was a significant decrease in Ki-67, -7.2% (interquartile range (IQR) -13.4%, 0% ) vs. -0.3% (IQR -3%, .8%), respectively, p=0.04. CC3 (apoptosis) increased, 60% vs. 13% for grade 3 vs. 1,2 tumors, respectively, p=0.015. ER- and ER+ cases had a similar reduction in Ki67 with a median drop of 2% (IQR -13.4%, 1%) and 1.2% (IQR -6.6%,0.8%), respectively, p=0.56. While CC3 was increased in ER- vs. + (55% vs. 29%), the difference was not statistically significant. There was no dose dependent effect on Ki-67or CC3.There was no evidence of Ki67 or CC3 change when all grades were analyzed together (median drop 1.2%) and no change in CRP. Of 14 subjects with paired MRIs, 4 grade 3 cases showed a significant decrease in LD, marked ductal dilatation and increased necrosis.with statin exposure.
 Conclusions: A lipophilic statin, fluvastatin, reduced cholesterol and had measurable biologic changes (reduced proliferation, size and increased apoptosis) in stage 0,1 BC after only 3-6 weeks of exposure, specifically in the grade 3 subset. Results support the study of statins for chemoprevention for women at risk for or with stage 0 grade 3 BC, where new agents are needed.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4122.
Collapse
Affiliation(s)
- ER Garwood
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - AS Kumar
- 2 Surgery, UC - East Bay, Oakland, CA
| | - F Baehner
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - JE Garber
- 3 Medicine, Dana-Farber Cancer Inst, Boston, MA
| | - S Troyan
- 4 Surgery, Beth Israel Deaconess Med Ctr, Boston, MA
| | - OI Olopade
- 5 Medicine, Univ of Chicago, Chicago, IL
| | - D Moore
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - A Au
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - C Flowers
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - M Campbell
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - N Hylton
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - LJ Esserman
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | | |
Collapse
|
17
|
Murali S, Winton E, Waller EK, Heffner LT, Lonial S, Flowers C, Kaufman J, Arellano M, Lechowicz MJ, Mann KP, Khoury HJ, Langston AA. Long-term progression-free survival after early autologous transplantation for mantle-cell lymphoma. Bone Marrow Transplant 2008; 42:529-34. [DOI: 10.1038/bmt.2008.201] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
18
|
Shenoy P, Halkar R, Wilson S, Flowers C. Routine scans for lymphoma produce minimal radiation-related cancer mortality risk. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.17508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
19
|
Dejoubner N, Ali Z, Grasier M, Hamilton E, Flowers C, Lonial S, Langston A, Waller EK. The prognostic significance of donor dendritic cells in allogeneic hematopoietic progenitor cell transplant. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
20
|
Waller E, Ninan MJ, Roback J, Arellano M, Flowers C. The occurrence of idiopathic secondary post-transplant thrombocytopenia and the kinetics of platelet recovery predict survival in patients undergoing autologous hematopoietic progenitor cell transplantation. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7109 Background: The frequency and clinical significance of secondary thrombocytopenia following initial engraftment in autologous hematopoietic progenitor cell transplantation (HPCT) is unknown. Methods: An IRB-approved retrospective study of thrombopoiesis in 359 patients transplanted with autologous blood (97%) or marrow (3%) who achieved transfusion-independent platelet engraftment to >50,000/mcL. Idiopathic secondary post-transplant thrombocytopenia (ISPT) was defined as >50% decline in blood platelets to <100,000/mcL in the absence of relapse or sepsis. Results: 62 of 359 study subjects (17%) met the criteria for ISPT within the first 100 days post-transplant. Patients with ISPT had more rapid platelet engraftment (17 + 5 days) versus non-ISPT patients (18 + 18 days; p=0.002) and partial recovery of platelet counts (median 96K/mcL) by day 75 post-transplant. The median survival for the entire population was 6.2 years with shorter survival in AML (1.3 years), breast cancer (6.2 years) and myeloma (5.5 years) than lymphoma patients (median not reached). Co- variates associated with post-transplant death (p<0.1) were entered into a multivariable logistic regression analysis stratified by cancer diagnosis at the time of transplant. Three factors were independently associated with worse survival: the number of prior chemotherapy regimens, failure to achieve a normal platelet counts post-transplant, and the occurrence of ISPT. A prognostic score was developed based upon the occurrence of ISPT and post-transplant platelet counts of <150,000/mcL. Survival of patients with both factors (n=25) was poor (15% alive at 5 years); patients with one factor (n=145) had 49% 5-year survival; patients with 0 factors (n=189) had 72% 5-year survival. Patients who failed to achieve a normal post-transplant platelet count received significantly fewer CD34+ cells/kg (P<0.001), while patients with ISPT received fewer CD34+CD38- cells/kg (P=0.001). Conclusion: ISPT reflects poor engraftment with long-term-repopulating CD34+ CD38- stem cells. The quantity and quality of autologous HPC in the graft are important prognostic variables for long-term survival. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- E. Waller
- Emory University, Atlanta, GA; Atlanta Medical Center, Atlanta, GA
| | - M. J. Ninan
- Emory University, Atlanta, GA; Atlanta Medical Center, Atlanta, GA
| | - J. Roback
- Emory University, Atlanta, GA; Atlanta Medical Center, Atlanta, GA
| | - M. Arellano
- Emory University, Atlanta, GA; Atlanta Medical Center, Atlanta, GA
| | - C. Flowers
- Emory University, Atlanta, GA; Atlanta Medical Center, Atlanta, GA
| |
Collapse
|
21
|
Kaufman JL, Waller EK, Torre C, McMillan S, Langston A, Flowers C, Lechowicz M, Tighiouart M, Lonial S. A randomized phase I trial of melphalan + bortezomib as conditioning for autologous transplant for myeloma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17550 High dose chemotherapy and autologous transplant (HDT) clearly benefits most patients with myeloma, but the addition of chemotherapy or TBI to melphalan (M) does not improve outcomes. Bortezomib (B) is a proteasome inhibitor which synergizes with chemotherapy due to its effects on DNA repair enzymes. Recent data has shown that B upregulates the anti-apoptotic protein MCL-1, which would suggest that B followed by M is inferior to M followed by B. We designed a randomized phase I trial combining B and Melphalan 200 mg/m2 (Mel200) in order to determine the toxicity, optimal dose and sequence of administration. Patients were randomized to receive either B 24 hours before Mel 200 or B 24 hours after Mel 200. Standard transplant criteria were used with the addition of requiring measurable numbers of plasma cells at the time of transplant. Enrolled patients underwent BM aspirate on day -4 (before B) and day 0 (before PBSC infusion). Bone marrows were tested for apoptosis, and myeloma cells were sorted for protein analysis. Age range was 48–74 years. Prior therapy has included Velcade (n = 2, both responsive) thalidomide (n = 2) and prior melphalan in 2 (1 HDT). Time to WBC and Plt engraftment were not different from historical cohorts receiving MEL 200 alone. Four patients have been randomized to date with 3 in the B “before“ arm, and 1 in the B “after” arm. Of the 3 patients who received B before M, day 0 bone marrow revealed minimal changes in marrow myeloma cell apoptosis in two patients, and in one patient a >20 fold increase in myeloma cell apoptosis on the day 0 marrow sample when compared to the day - 4 marrow. In the patient enrolled in the B after M arm, there was a 10 fold increase in the day 0 marrow myeloma cell apoptosis. Western blot analysis for DNA repair enzymes and MCL-1 on sorted tumor cells are planned, as is ELISA for secreted cytokines before and after therapy. Toxicity and response data with an update of the molecular correlates will be presented. The combination of B and M as conditioning for HDT is feasible. The optimal dose and sequence of administration remains unknown. Accrual continues. [Table: see text]
Collapse
|
22
|
van den Broek NR, White SA, Flowers C, Cook JD, Letsky EA, Tanumihardjo SA, Mhango C, Molyneux M, Neilson JP. Randomised trial of vitamin A supplementation in pregnant women in rural Malawi found to be anaemic on screening by HemoCue. BJOG 2006; 113:569-76. [PMID: 16579803 DOI: 10.1111/j.1471-0528.2006.00891.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effects of vitamin A supplementation in women with anaemia during pregnancy. DESIGN Single-centre randomised controlled trial. SETTING Rural community in southern Malawi, central Africa. POPULATION Seven hundred women with singleton pregnancies at 12-24 weeks measured by ultrasound scan and with haemoglobin <11.0 g/dl by HemoCue screening method. Analysis was by intention to treat. All received iron and folate, and sulphadoxine/pyrimethamine for antimalarial prophylaxis. METHODS Women were randomised to receive oral supplementation with daily 5000 or 10,000 iu vitamin A, or placebo. MAIN OUTCOME MEASURES Anaemia, as assessed by Coulter counter, severe anaemia, iron status and indices of infection. RESULTS Vitamin A deficiency was, in this rural population, less common than predicted. Vitamin A supplementation had no significant impact on anaemia, severe anaemia, iron status and indices of infection. Vitamin A stores were less likely to be depleted at the end of pregnancy in supplemented groups. CONCLUSIONS Vitamin A supplementation programmes to reduce anaemia should not be implemented in similar antenatal populations in rural sub-Saharan Africa unless evidence emerges of positive benefit on substantive clinical outcomes. Introducing public health interventions of unknown benefit and with unclear biological mechanisms can divert scarce resources from clinical and social interventions more likely to impact maternal mortality.
Collapse
|
23
|
Arellano M, Flowers C, Waller E, Lonial S, Kaufman J, Winton E, Khoury H, Langston A. Reduced-intensity conditioning permits a significant graft vs leukemia (GvL) effect for acute leukemia. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
24
|
Kahn S, Koshy M, Flowers C, Lechowicz M, Hollenbach K, Johnstone P. Value of PET Restaging After Chemotherapy for Non-Hodgkins Lymphoma: Implications for Consolidation Radiotherapy. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Arellano ML, Lonial S, Langston A, Flowers C, Heffner T, Hutcherson D, Winton E, Waller E. Results of a clinical phase I dose-escalation study of cytarabine in combination with fixed dose vinorelbine, paclitaxel, etoposide, and cisplatin (VTEPA) for the treatment of relapsed/refractory lymphoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6691] [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: 11/20/2022] Open
|
26
|
Flowers C. Coagulopathies from drugs. Br Dent J 2004; 196:311; author reply 311. [PMID: 15044969 DOI: 10.1038/sj.bdj.4811088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
27
|
Shapiro RA, Mullane KM, Camras L, Flowers C, Sutton S. Clinical and magnetic resonance imaging regression of progressive multifocal leukoencephalopathy in an AIDS patient after intensive antiretroviral therapy. J Neuroimaging 2001; 11:336-9. [PMID: 11462308 DOI: 10.1111/j.1552-6569.2001.tb00060.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 11/27/2022] Open
Abstract
A 36-year-old homosexual man with 6 months of visual symptoms and headaches had right homonymous hemianopia, mild new learning impairment, and alexia with agraphia. The initial brain magnetic resonance imaging (MRI) scan was reported consistent with left occipital infarction. Subsequent MRI demonstrated abnormal demyelination in subcortical white matter and deep parieto-occipital white matter bilaterally, but primarily left. Human immunodeficiency virus testing and cerebrospinal fluid polymerase chain reaction for JC virus DNA were both positive, consistent with progressive multifocal leukoencephalopathy (PML) with AIDS. His clinical status steadily deteriorated, and MRI white matter abnormalities worsened despite high-dose antiretroviral therapy. After the antiretroviral regimen was intensified by the addition of a protease inhibitor, rapid clinical and radiographic improvement occurred with subsequent MRI studies revealing only residual left parieto-occipital encephalomalacia. PML in AIDS patients has been associated with a nearly uniformly poor prognosis until recent reports of improved outcomes after highly active antiretroviral therapy. This patient with PML and AIDS similarly showed a robust clinical and MRI response to intensive antiretroviral combination therapy, which has been maintained for more than 3 years.
Collapse
Affiliation(s)
- R A Shapiro
- Edward Hines Jr. VA Hospital, PO Box 5000, Hines, IL 60141, USA.
| | | | | | | | | |
Collapse
|
28
|
Feinstein L, Sandmaier B, Maloney D, McSweeney PA, Maris M, Flowers C, Radich J, Little MT, Nash RA, Chauncey T, Woolfrey A, Georges G, Kiem HP, Zaucha JM, Blume KG, Shizuru J, Niederwieser D, Storb R. Nonmyeloablative hematopoietic cell transplantation. Replacing high-dose cytotoxic therapy by the graft-versus-tumor effect. Ann N Y Acad Sci 2001; 938:328-37; discussion 337-9. [PMID: 11458521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Conventional allografting produces considerable regimen-related toxicities that generally limit this treatment to patients younger than 55 years and in otherwise good medical condition. T cell-mediated graft-versus-tumor (GVT) effects are known to play an important role in the elimination of malignant disease after allotransplants. A minimally myelosuppressive regimen that relies on immunosuppression for allogeneic engraftment was developed to reduce toxicities while optimizing GVT effects. Pre-transplant total-body irradiation (200 cGy) followed by post-transplant immunosuppression with cyclosporine (CSP) and mycophenolate mofetil (MMF) permitted human leukocyte antigen (HLA)-matched sibling donor hematopoietic cell engraftment in 82% of patients (n = 55) without prior high-dose therapy. The addition of fludarabine (90 mg/m2) facilitated engraftment in all 28 subsequent patients. Overall, fatal progression of underlying disease occurred in 20% of patients after transplant. Non-relapse mortality occurred in 11% of patients. Toxicities were low. Grade 2-4 acute graft-versus-host disease (GVHD) associated with primary engraftment developed in 47% of patients, and was readily controlled in all but two patients. Donor lymphocyte infusions (DLI) were not very effective at converting a low degree of mixed donor/host chimerism to full donor chimerism; however, the addition of fludarabine reduced the need for DLI. With a median follow-up of 244 days, 68% of patients were alive, with 42% of patients in complete remission, including molecular remissions. Remissions occurred gradually over periods of weeks to a year. If long-term efficacy is demonstrated, such a strategy would expand treatment options for patients who would otherwise be excluded from conventional allografting.
Collapse
Affiliation(s)
- L Feinstein
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., D1-100, P.O. Box 19024, Seattle, Washington 98109-1024, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
The Marital Disaffection Scale was administered, along with measures of positive feelings towards spouse, problem-drinking behavior of spouse, workaholic behavior of spouse, and marital status, to 323 female members of the American Counseling Association. Scores on the Marital Disaffection Scale showed significant inverse correlations (r = -.94) with positive feelings towards spouse and (rpb = -.63) with marital status. Scores on the Marital Disaffection Scale showed significant positive relationships (r = .36) with spouse's problem drinking behavior and (r = .48) with workaholic behavior of spouse. The results support the use of the Marital Disaffection Scale as a measure of emotional estrangement in marriage.
Collapse
Affiliation(s)
- C Flowers
- Department of Educational Administration, Research and Technology, University of North Carolina at Charlotte 28223-0001, USA
| | | | | |
Collapse
|
30
|
Abstract
A prospective hospital-based study was conducted to evaluate the efficacy of serum transferrin receptors in the detection of iron deficiency in pregnant women. The iron status of 100 pregnant women with single uncomplicated term pregnancies in the first stage of labor was established using standard laboratory measures. These included complete hemogram, red cell indices, serum iron, percent transferrin saturation, and serum ferritin. In addition, serum transferrin receptor (STFR) was estimated. The results of 81 women with complete laboratory profiles were analyzed. Thirty-five (43.2%) women were anemic (hemoglobin <11 g/dl). Hemoglobin (Hb) showed a significant correlation with MCH, MCHC, serum iron, and percent transferrin saturation, suggesting that the anemia was likely to be due to iron deficiency. The mean STFR level was 18.05+/-9.9 mg/l in the anemic women and was significantly raised (p<0.001) compared with that of the nonanemic women. STFR correlated significantly with Hb (p<0.001), MCH (p<0.05), MCHC (p<0.01), serum iron (p<0.01), and percent transferrin saturation (p<0.01) and also showed a highly significant correlation with the degree of anemia. Serum ferritin in these women did not correlate with Hb, and only 54.4% of the women had levels <12 ng/ml, which does not reflect the true prevalence of iron deficiency. Serum transferrin receptor estimation is thus a useful measure for detecting iron deficiency in pregnancy.
Collapse
Affiliation(s)
- U Rusia
- Department of Pathology, University College of Medical Sciences and G.T.B. Hospital, Shahdara, Delhi-110095, India.
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
Reduced monoamine oxidase activity has been proposed as a marker for vulnerability to schizophrenia. Reduced monamine oxidase activity has also been shown to occur in cigarette smokers. This study compared monamine oxidase activity level in a matched group of patients with schizophrenia who smoked with a group who did not. Lower levels of monoamine oxidase activity were found in the smokers and this is the likely explanation for the low levels hypothesized as a marker for schizophrenia.
Collapse
Affiliation(s)
- G M Simpson
- Department of Psychiatry, USC School of Medicine, Los Angeles, USA
| | | | | | | | | | | |
Collapse
|
32
|
Rusia U, Flowers C, Madan N, Agarwal N, Sood SK, Sikka M. Serum transferrin receptor levels in the evaluation of iron deficiency in the neonate. Acta Paediatr Jpn 1996; 38:455-9. [PMID: 8942003 DOI: 10.1111/j.1442-200x.1996.tb03526.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Iron deficiency anemia (IDA) is a major global problem. Early onset of iron deficiency in developing countries makes it imperative to identify iron deficiency in neonates. Most conventional laboratory parameters of iron status fail to distinguish neonates with iron deficient erythropoiesis. Serum transferrin receptor (STFR) levels are a recent sensitive measure of iron deficiency and the present study was carried out to evaluate the usefulness of cord serum transferrin receptors in identifying iron deficient erythropoiesis in neonates. A complete hemogram, red cell indices, iron profile: serum iron (SI), percent transferrin saturation (TS%) and serum ferritin (SF) was carried out in 100 full-term neonates and their mothers at parturition. Cord and maternal STFR levels were estimated using a sensitive enzyme-linked immunosorbent assay (ELISA) technique. Anemic women had a significantly lower SI, their TS% and high STFR levels suggesting that iron deficiency was responsible for the anemia. In the neonates of iron deficient mothers, cord SI, TS% and cord ferritin were not significantly different from those of neonates born to non-anemic mothers. Cord STFR level correlated well with hemoglobin (Hb) and laboratory parameters of iron status, and its level was significantly higher in neonates born to anemic mothers than in those born to non-anemic mothers. It was the only laboratory parameter to differentiate between neonates born to anemic and non-anemic mothers. Therefore, STFR is a sensitive index of iron status in neonates and identifies neonates with iron deficient erythropoiesis.
Collapse
Affiliation(s)
- U Rusia
- Department of Pathology, University College of Medical Sciences, Shahdara, Delhi, India
| | | | | | | | | | | |
Collapse
|
33
|
Abstract
To assess the usefulness of the Caco-2 cell culture system as a model to study the availability of dietary iron, preliminary experiments were performed to determine the optimal conditions for iron uptake and transport. Iron uptake of radioactive ferrous sulfate was optimal at pH 5.5 using a 2:1 molar ratio of ascorbic acid to iron and a 1-h incubation time. Under these experimental conditions, we studied the effect on iron uptake of adding supernatants from homogenates of different meat sources, soybean protein isolates, egg albumen and bovine serum albumin. Iron uptake was 6.3 +/- 1.7% from meat, which was significantly greater (P < 0.001) than the values of 1.2 +/- 0.3% from soybean protein, 1.3 +/- 0.3% from egg albumen and 0.8 +/- 0.1% from bovine serum albumin. Iron uptake was also significantly higher from digested meat samples than from undigested meat when the protein concentration was equalized. Measurements of iron uptake and protein concentration from fractions obtained after preparative isoelectric focusing of meat and soybean protein extracts showed two peaks of higher protein concentration and iron uptake in meat, apparently not found in soybean protein, that contained the factor(s) responsible for the higher iron uptake by the cells. In view of these observed similarities with iron absorption studies in humans, we conclude that the Caco-2 cell culture system is a useful in vitro model to study food iron availability.
Collapse
Affiliation(s)
- M N Garcia
- University of Kansas Medical Center, Department of Medicine, Kansas City 66160, USA
| | | | | |
Collapse
|
34
|
King RJ, Flowers C. Neurochemical predictors and correlates of vulnerability to cocaine use. NIDA Res Monogr 1996; 159:228-63; discussion 264-8. [PMID: 8784861 DOI: 10.1037/e495692006-020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R J King
- Department of Psychiatry, Stanford University Medical School, CA 94305, USA
| | | |
Collapse
|
35
|
Abstract
Three cases of portal venous system wall calcifications demonstrated by computed tomography are presented. The clinical features, possible pathogenesis, differential diagnosis, and therapeutic significance of this condition are reviewed.
Collapse
Affiliation(s)
- O Egiebor
- Department of Radiology, Cook County Hospital, Chicago, IL 60612, USA
| | | | | | | |
Collapse
|
36
|
Lenert LA, Michelson D, Flowers C, Bergen MR. IMPACT: an object-oriented graphical environment for construction of multimedia patient interviewing software. Proc Annu Symp Comput Appl Med Care 1995:319-23. [PMID: 8563293 PMCID: PMC2579107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This paper describes our software for rapid construction of multimedia computer interviews. The program, which we call IMPACT, was designed to measure preferences for health outcomes using the standard gamble and other decision analytic techniques. IMPACT is also a multimedia shell program that allows researchers to interactively construct patient interviewing instruments without programming or scripting. It supports the integration of text, graphics, synthesized speech, digital sound and QuickTime movies into interviewing instruments through a point-and-click interface. IMPACT also supports branching logic and randomizing the presentation order of materials within an instrument. This allows customization of the presentation based on patient responses and facilitates experimental designs. Validation studies show that preference assessments performed using IMPACT have high test-retest reliability (r = 0.83, n = 96). Post-test surveys (n = 52) show that most subjects understand valuation methods (86%) and believe that the explanations provided were clear (96%) and that methods were reasonable (80%). The majority of subjects thought the preference assessment methods were not difficult to use (53%) and would have been comfortable using such methods for medical decisions (53%).
Collapse
Affiliation(s)
- L A Lenert
- Department of Medicine, Stanford Univ. School of Medicine, CA 94305, USA
| | | | | | | |
Collapse
|
37
|
Abstract
Eleven consecutive SCID-diagnosed generalized social phobias without major depression, other prominent anxiety disorders, substance abuse, alcoholism or organic mental disorder, were treated, open label, with sertraline up to 200 mg daily for 12 weeks. There were seven completers. Of these, five showed substantial improvement, after being on sertraline 100 mg daily for two weeks (following no response to sertraline 50 mg daily for four weeks). There were few side effects among the completers. The four dropouts complained of side effects and loss of interest in continuing treatment. Final average dose for completers who responded was 170 mg daily.
Collapse
|
38
|
Flowers C. Dentists and the NHS. BMJ 1993; 306:462. [PMID: 8461759 PMCID: PMC1676505 DOI: 10.1136/bmj.306.6875.462-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
39
|
Abstract
Using stereological techniques we have estimated the volume density of melanin and counted the number of pigmented and non-pigmented neuronal cell bodies in the pars compacta of the substantia nigra of 12 autopsied patients with acquired immune deficiency syndrome (AIDS) who did not have inflammation or necrosis of the midbrain or clinical parkinsonism. The total number of neuronal cell bodies was 25% lower in AIDS (P less than 0.01) than in 12 age-matched controls, although the volume density of neuronal melanin did not differ from that of controls because the percentage of pigmented cell bodies was higher (P less than 0.01) and the cell bodies were more fully packed with melanin in AIDS. Also, the expected increase with age of the volume density of neuronal melanin (P less than 0.02) and the percentage of pigmented neurons (P less than 0.01) occurred in the controls but not in AIDS patients. Importantly, our histopathological examination showed unequivocal nigral degeneration with neuronal loss, small neuronal cell bodies packed with melanin, reactive astrocytosis and extra-cellular melanin in the AIDS patients but not in controls. Our study shows that a subclinical nigral degeneration is common in AIDS and could possibly explain the heightened susceptibility of some patients to drug-induced parkinsonism.
Collapse
Affiliation(s)
- M G Reyes
- Division of Pathology (Neuropathology), Hektoen Institute for Medical Research, Cook County Hospital, Chicago, IL 60612
| | | | | | | | | |
Collapse
|
40
|
Arthur JE, Ellis IO, Flowers C, Roebuck E, Elston CW, Blamey RW. The relationship of "high risk" mammographic patterns to histological risk factors for development of cancer in the human breast. Br J Radiol 1990; 63:845-9. [PMID: 2252976 DOI: 10.1259/0007-1285-63-755-845] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [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: 12/31/2022] Open
Abstract
In the UK Trial for the Early Detection of Breast Cancer in Nottingham, 119 women were identified as having fibrocystic change with epithelial hyperplasia or in situ carcinoma. Their mammograms were classified according to Wolfe's criteria and the corresponding histology for each patient was classified for degrees of epithelial hyperplasia, atypia and in situ neoplasia using Page's criteria. A control population of patients presenting for breast screening was used to represent the general population. No correlation was found between the four mammographic Wolfe patterns, N1, P1, P2 and DY and histological evidence of epithelial hyperplasia, atypia or in situ carcinoma. A further study was carried out to determine histological features of Wolfe pattern, using radiological examination of resected breast tissue. The variation in Wolfe pattern was related to the distribution of fibrous and adipose tissue in the breast interlobular stroma and appeared to have no relationship to epithelial parenchymal content. This information does not support the hypothesis that radiographic densities of P2 and DY patterns correspond to high risk epithelial proliferation.
Collapse
Affiliation(s)
- J E Arthur
- Department of Histopathology, City Hospital, Nottingham
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
We previously described new bone formation in fluoride-treated osteoporotic patients. Since then, several investigators have contended that fluoride-induced "hot spots," as seen on bone scintigrams, represent stress fractures. To further evaluate this issue we analyzed scintigrams, radiographs, and quantitative computer tomography (CT) scans of the spine and femoral condyles from 129 patients, obtained before and during therapy. Hot spots, new or of increased intensity, were more than twice as common in the weight-bearing peripheral skeleton than in nonweight-bearing sites (p less than 0.001). The hot spots were usually diffuse, multiple, bilateral, and mostly seen early in therapy, a pattern quite different from that expected of stress fractures. Previously, we postulated that mechanical stress and fluoride act synergistically to stimulate new bone formation. If this hypothesis were correct, we would expect to see a greater increase in femoral condyle bone density in patients with hot spots. Consistent with this hypothesis, patients who developed hot spots in the knees had a greater increase in condylar density (22 +/- 2.5 vs. 9 +/- 3.3 mg/cc) than those without hot spots and stress fractures were not seen in either group. Additionally, patients with more than 5 hot spots in the peripheral skeleton had greater increases in spinal and condylar density than those with fewer than 5 hot spots. Finally, stress fractures were found in less than 2% of our patients. While we do not exclude the possibility that some additional patients may have had stress fractures, our data support the hypothesis that the great majority of hot spots seen on the scintigrams are the sites of new bone formation.
Collapse
Affiliation(s)
- E E Schulz
- Department of Radiation Sciences, School of Medicine, Loma Linda University, CA
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
This study was undertaken to assess the relationship between iron absorption and the concentration of duodenal iron proteins in normal subjects and patients with idiopathic hemochromatosis (IH). Biopsies were obtained endoscopically from the duodenum in 17 normal subjects, 3 of whom were mildly iron deficient, and 7 patients with untreated IH. The absorption of both heme and nonheme iron was increased in IH despite a 20-fold elevation in serum ferritin. Immunoassays using MAb were used to measure transferrin, H-rich ferritin, and L-rich ferritin in mucosal samples. Mucosal transferrin concentrations in normal subjects did not correlate with either iron status or iron absorption, indicating that mucosal transferrin plays no physiological role in iron absorption. Mucosal transferrin was significantly lower in IH, presumably because of a decrease in mucosal transferrin receptors. Mucosal H and L ferritin concentrations were directly related to body iron stores and inversely related to iron absorption in normal subjects. In IH, mucosal H and L ferritin failed to increase in parallel with the serum ferritin, but were appropriate for the level of iron absorption. The relationship of mucosal H/L ferritin in IH did not differ from that observed in normal subjects. Our findings indicate that the major abnormality in duodenal iron proteins in IH is a parallel decrease in the concentration of H- and L-rich ferritin. It is not evident whether this is the result or the cause of the absorptive abnormality.
Collapse
Affiliation(s)
- P Whittaker
- Department of Medicine, Kansas University Medical Center, Kansas City 66103
| | | | | | | | | | | | | |
Collapse
|
43
|
Seligmann J, Flowers C, Gosnell M, Harrison J, Nelson M. Taking life one night at a time. "Sex addicts" seek help. Newsweek 1987; 110:48-9. [PMID: 10318618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
44
|
Abstract
Symptoms of DaCosta's syndrome include effort fatigue and breathlessness, chest pain, palpitation, and dizziness. Considered purely functional and anxiety-related by DaCosta, the syndrome has since been related to the mitral valve prolapse (MVP) syndrome and autonomic hyperreactivity. We studied these specific symptoms in similar cohorts of 68 patients with and without documented MVP from a single practice of internal medicine and found only 6% of patients having MVP without symptoms compared to 25% of control subjects (P less than .01). Palpitation was present in 71% of patients with MVP and 33% of controls (P less than .001); dyspnea was noted by 50% of those with MVP and 28% of controls (P less than .02), and chest pain by 44% of patients with MVP and 25% of controls (P less than .01). Our results confirm reports that the symptoms of DaCosta's syndrome are more common in patients with MVP and may call the physician's attention to the proper diagnosis.
Collapse
|
45
|
Flowers C. Changes in the ratio of consultants to junior staff in accident departments. West J Med 1982. [DOI: 10.1136/bmj.284.6316.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
46
|
Goldfarb JL, Mumford DM, Schum DA, Smith PB, Flowers C, Schum C. An attempt to detect “pregnancy susceptibility” in indigent adolescent girls. J Youth Adolesc 1977; 6:127-44. [PMID: 12260057 DOI: 10.1007/bf02139080] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
47
|
Boreham P, Davis R, Miller J, Jackson A, Gear MWL, Briers PJ, Kilby JO, Hardingham M, Calvert D, Dew AB, Wright AE, Nicol A, Hart CT, Urquhart GED, Wright MP, Fox GC, Howell-Hughes T, Hills M, Jarrett RF, Thomson DS, Coates RH, Stevens DL, Cash I, Davies RAC, Creery RDG, Honneyman FD, Fairgrieve J, Owen KL, Haynes S, Flowers C, Joyce M. Consultant Contract. West J Med 1974. [DOI: 10.1136/bmj.3.5924.176-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
48
|
|
49
|
Flowers C. Accident and Emergency Services. West J Med 1971. [DOI: 10.1136/bmj.3.5767.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
50
|
Flowers C. Accident and Emergency Services. West J Med 1971. [DOI: 10.1136/bmj.1.5746.462-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|