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Luke JJ, Dadey RE, Augustin RC, Newman S, Singh KB, Doerfler R, Behr S, Lee P, Isett B, Deitrick C, Li A, Joy M, Reeder C, Smith K, Urban J, Sellitto L, Jelinek M, Christner SM, Beumer JH, Villaruz LC, Kulkarni A, Davar D, Poklepovic AS, Najjar Y, Zandberg DP, Soloff AC, Bruno TC, Vujanović L, Skinner HD, Ferris RL, Bao R. Tumor cell p38 inhibition to overcome immunotherapy resistance. Res Sq 2023:rs.3.rs-3183496. [PMID: 37645831 PMCID: PMC10462255 DOI: 10.21203/rs.3.rs-3183496/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Patients with tumors that do not respond to immune-checkpoint inhibition often harbor a non-T cell-inflamed tumor microenvironment, characterized by the absence of IFN-γ-associated CD8+ T cell and dendritic cell activation. Understanding the molecular mechanisms underlying immune exclusion in non-responding patients may enable the development of novel combination therapies. p38 MAPK is a known regulator of dendritic and myeloid cells however a tumor-intrinsic immunomodulatory role has not been previously described. Here we identify tumor cell p38 signaling as a therapeutic target to potentiate anti-tumor immunity and overcome resistance to immune-checkpoint inhibitors (ICI). Molecular analysis of tumor tissues from patients with human papillomavirus-negative head and neck squamous carcinoma reveals a p38-centered network enriched in non-T cell-inflamed tumors. Pan-cancer single-cell RNA analysis suggests that p38 activation may be an immune-exclusion mechanism across multiple tumor types. P38 knockdown in cancer cell lines increases T cell migration, and p38 inhibition plus ICI in preclinical models shows greater efficacy compared to monotherapies. In a clinical trial of patients refractory to PD1/L1 therapy, pexmetinib, a p38 inhibitor, plus nivolumab demonstrated deep and durable clinical responses. Targeting of p38 with anti-PD1 has the potential to induce the T cell-inflamed phenotype and overcome immunotherapy resistance.
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Affiliation(s)
- Jason J. Luke
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebekah E. Dadey
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ryan C. Augustin
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Newman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Krishna B. Singh
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rose Doerfler
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Behr
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
| | | | - Brian Isett
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Cancer Bioinformatics Core, UPMC, Pittsburgh, PA, USA
| | - Christopher Deitrick
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Cancer Bioinformatics Core, UPMC, Pittsburgh, PA, USA
| | - Aofei Li
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marion Joy
- Translational Pathology Imaging Laboratory, UPMC, Pittsburgh, PA, USA
| | - Carly Reeder
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Julie Urban
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
| | | | - Mark Jelinek
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
- Biostatistics Core, UPMC, Pittsburgh, PA, USA
| | - Susan M. Christner
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Jan H. Beumer
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmaceutical Sciences, School of Pharmacy, Pittsburgh, PA, USA
| | - Liza C. Villaruz
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aditi Kulkarni
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diwakar Davar
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew S. Poklepovic
- Departments of Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Departments of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Yana Najjar
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Adam C. Soloff
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tullia C. Bruno
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lazar Vujanović
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heath D. Skinner
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert L. Ferris
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Riyue Bao
- Hillman Cancer Center, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Ferris RL, Moskovitz J, Kunning S, Ruffin AT, Reeder C, Ohr J, Gooding WE, Kim S, Karlovits BJ, Vignali DAA, Duvvuri U, Johnson JT, Petro D, Heron DE, Clump DA, Bruno TC, Bauman JE. Phase I Trial of Cetuximab, Radiotherapy, and Ipilimumab in Locally Advanced Head and Neck Cancer. Clin Cancer Res 2022; 28:1335-1344. [PMID: 35091445 PMCID: PMC9164766 DOI: 10.1158/1078-0432.ccr-21-0426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/21/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Concurrent radiotherapy with cetuximab, an anti-EGFR mAb, is a standard treatment for locally advanced head and neck squamous carcinoma (HNSCC). Cytotoxic T lymphocyte antigen-4-positive (CTLA-4+) regulatory T cells (Treg) dampen cellular immunity and correlate negatively with clinical outcomes. This phase I study added ipilimumab, an anti-CTLA-4 mAb, to cetuximab-radiotherapy. PATIENTS AND METHODS A (3 + 3) design was used to establish the recommended phase II dose (RP2D) of ipilimumab, added at week 5 for four, every-3-week doses to fixed, standard cetuximab-radiotherapy. Eligible subjects had stage III to IVb, high-risk [human papillomavirus-negative (HPV-)] or intermediate-risk HPV-positive (HPV+)] HNSCC. Dose-limiting toxicity (DLT) was defined as any grade 4 adverse event (AE) except in-field radiation dermatitis or immune-related (ir) AE requiring ≥2 weeks of systemic steroids. Baseline tumor and serial blood specimens were collected for immune correlatives. RESULTS From July 2013 to May 2016, 18 patients enrolled. Two of 6 in cohort 1 (ipilimumab 3 mg/kg) experienced grade 3 dermatologic DLTs, triggering deescalation of ipilimumab to 1 mg/kg. Dose level -1 was expanded to N = 12 without DLT. irAE included: grade 1, 2, and 3 dermatitis (2, 1, and 3 cases), grade 4 colitis (1), and grade 1 hyperthyroidism (1). Three-year disease-free survival (DFS) and overall survival were 72% [90% confidence interval (CI), 57-92] and 72% (90% CI, 56-92). High expression of coinhibitory receptors PD1/LAG3/CD39 on baseline tumor-infiltrating Treg was associated with worse DFS (HR = 5.6; 95% CI, 0.83-37.8; P = 0.08). CONCLUSIONS The RP2D for ipilimumab plus standard cetuximab-radiotherapy is 1 mg/kg in weeks 5, 8, 11, and 14. The regimen is tolerable and yields acceptable survival without cytotoxic chemotherapy.
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Affiliation(s)
- Robert L. Ferris
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Radiation Oncology, UPMC Hillman Cancer Center Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica Moskovitz
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sheryl Kunning
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Radiation Oncology, UPMC Hillman Cancer Center Pittsburgh, PA, USA
| | - Ayana T. Ruffin
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Radiation Oncology, UPMC Hillman Cancer Center Pittsburgh, PA, USA
| | | | - James Ohr
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Dario A. A. Vignali
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Radiation Oncology, UPMC Hillman Cancer Center Pittsburgh, PA, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Jonas T. Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Dwight E. Heron
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Bons Secours Mercy Health, Dept of Radiation Oncology, Youngstown, OH
| | - David A. Clump
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Radiation Oncology, UPMC Hillman Cancer Center Pittsburgh, PA, USA
| | - Tullia C. Bruno
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julie E. Bauman
- Division of Hematology and Oncology, University of Arizona Cancer Center, Tucson, AZ, USA
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3
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Kürten CHL, Kulkarni A, Cillo AR, Santos PM, Roble AK, Onkar S, Reeder C, Lang S, Chen X, Duvvuri U, Kim S, Liu A, Tabib T, Lafyatis R, Feng J, Gao SJ, Bruno TC, Vignali DAA, Lu X, Bao R, Vujanovic L, Ferris RL. Investigating immune and non-immune cell interactions in head and neck tumors by single-cell RNA sequencing. Nat Commun 2021; 12:7338. [PMID: 34921143 PMCID: PMC8683505 DOI: 10.1038/s41467-021-27619-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 11/16/2021] [Indexed: 02/08/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is characterized by complex relations between stromal, epithelial, and immune cells within the tumor microenvironment (TME). To enable the development of more efficacious therapies, we aim to study the heterogeneity, signatures of unique cell populations, and cell-cell interactions of non-immune and immune cell populations in 6 human papillomavirus (HPV)+ and 12 HPV- HNSCC patient tumor and matched peripheral blood specimens using single-cell RNA sequencing. Using this dataset of 134,606 cells, we show cell type-specific signatures associated with inflammation and HPV status, describe the negative prognostic value of fibroblasts with elastic differentiation specifically in the HPV+ TME, predict therapeutically targetable checkpoint receptor-ligand interactions, and show that tumor-associated macrophages are dominant contributors of PD-L1 and other immune checkpoint ligands in the TME. We present a comprehensive single-cell view of cell-intrinsic mechanisms and cell-cell communication shaping the HNSCC microenvironment.
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Affiliation(s)
- Cornelius H L Kürten
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aditi Kulkarni
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony R Cillo
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patricia M Santos
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anna K Roble
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sayali Onkar
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Graduate Program of Microbiology and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Carly Reeder
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Xueer Chen
- Deparment of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Angen Liu
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tracy Tabib
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Lafyatis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jian Feng
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA, USA
- Cancer Virology Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Shou-Jiang Gao
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA, USA
- Cancer Virology Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Tullia C Bruno
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dario A A Vignali
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xinghua Lu
- Deparment of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Riyue Bao
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lazar Vujanovic
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert L Ferris
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA.
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Nieuwoudt C, Reeder C, Van Nes J, Schoutko W, Fortner K. Immunization uptake for pertussis and influenza vaccines in pregnancy across different clinical settings at a single institution. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.090] [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: 10/27/2022]
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Fortner K, Spires B, Reeder C, Chernicky L, Zite N, Towers C. Rates of intrapartum fever and number of digital vaginal exams by quarter of the academic year in a university hospital. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reeder C, Towers C, Clark C, Chernicky L, Zite N, Fortner K. Rate of histologic chorioamnionitis among parturients with intrapartum fever. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2017.08.058] [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: 10/18/2022]
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Reeder C, Huddy V, Cella M, Taylor R, Greenwood K, Landau S, Wykes T. A new generation computerised metacognitive cognitive remediation programme for schizophrenia (CIRCuiTS): a randomised controlled trial. Psychol Med 2017; 47:2720-2730. [PMID: 28866988 PMCID: PMC5647677 DOI: 10.1017/s0033291717001234] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cognitive remediation (CR) is a psychological therapy, which improves cognitive and social functioning in people with schizophrenia. It is now being implemented within routine clinical services and mechanisms of change are being explored. We designed a new generation computerised CR programme, CIRCuiTS (Computerised Interactive Remediation of Cognition - a Training for Schizophrenia), to enhance strategic and metacognitive processing, with an integrated focus on the transfer of cognitive skills to daily living. This large trial tested its feasibility to be delivered in therapist-led and independent sessions, and its efficacy for improved cognitive and social functioning. METHODS A two arm single blind randomised superiority trial comparing CIRCuiTS plus treatment-as-usual (TAU) with TAU alone in 93 people with a diagnosis of schizophrenia. Cognitive, social functioning and symptom outcomes were assessed at pre- and post-therapy and 3 months later. RESULTS 85% adhered to CIRCuiTS, completing a median of 28 sessions. There were significant improvements in visual memory at post-treatment (p = 0.009) and follow-up (p = 0.001), and a trend for improvements in executive function at post-treatment (p = 0.056) in favour of the CIRCuiTS group. Community function was also differentially and significantly improved in the CIRCuiTS group at post-treatment (p = 0.003) but not follow-up, and was specifically predicted by improved executive functions. CONCLUSIONS CIRCuiTS was beneficial for improving memory and social functioning. Improved executive functioning emerges as a consistent predictor of functional gains and should be considered an important CR target to achieve functional change. A larger-scale effectiveness trial of CIRCuiTS is now indicated.
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Affiliation(s)
- C. Reeder
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
| | | | - M. Cella
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
| | - R. Taylor
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
| | - K. Greenwood
- Sussex Partnership NHS Foundation
Trust, Sussex, UK
- School of Psychology, University of
Sussex, Falmer, UK
| | - S. Landau
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
| | - T. Wykes
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
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Gowin K, Kosiorek H, Dueck A, Mascarenhas J, Hoffman R, Reeder C, Camoriano J, Tibes R, Gano K, Palmer J, Mesa R. Multicenter phase 2 study of combination therapy with ruxolitinib and danazol in patients with myelofibrosis. Leuk Res 2017. [PMID: 28646676 DOI: 10.1016/j.leukres.2017.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 01/10/2023]
Abstract
Myelofibrosis is a myeloproliferative neoplasm that is characterized by splenomegaly, profound symptom burden, and cytopenias. JAK inhibitor therapy offers improvements in splenomegaly, symptom burden, and potentially survival; however, cytopenias remain a significant challenge. Danazol has previously demonstrated improvements in myelofibrosis-associated anemia. We conducted a phase II clinical trial evaluating the efficacy and tolerability of combination therapy with ruxolitinib, an oral JAK inhibitor, and danazol. Fourteen intermediate or high-risk MF patients were enrolled at 2 institutions. Responses per IWG-MRT criteria were stable disease in 9 patients (64.2%) clinical improvement in 3 (21.4%) all of which were spleen responses, partial response in 1 (7.1%) and progressive disease in 1 (7.1%). Despite limited IWG-MRT response, stabilization of anemia and thrombocytopenia was demonstrated. In JAK inhibitor naïve patients, 4/5 (80%) had stable or increasing hemoglobin. Of the 9 patients on prior JAK inhibitor, 5 patients (55.5%) and 8 patients (88.9%) had stable or increasing hemoglobin or platelet levels, respectively. Adverse events possibly related included grade 3 or greater hematologic toxicity in ten patients (71.4%) and non-hematologic toxicity in two patients (14.3%). Although combination therapy did not lead to increased hematologic response per IWG-MRT criteria, hematologic stabilization was observed and may be clinically useful.
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Affiliation(s)
- K Gowin
- Mayo Clinic Arizona, Department of Hematology, Phoenix, AZ, USA
| | - H Kosiorek
- Mayo Clinic Arizona, Department of Health Sciences Research, Section of Biostatistics, Phoenix, AZ, USA
| | - A Dueck
- Mayo Clinic Arizona, Department of Health Sciences Research, Section of Biostatistics, Phoenix, AZ, USA
| | - J Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, USA
| | - R Hoffman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, USA
| | - C Reeder
- Mayo Clinic Arizona, Department of Hematology, Phoenix, AZ, USA
| | - J Camoriano
- Mayo Clinic Arizona, Department of Hematology, Phoenix, AZ, USA
| | - R Tibes
- Mayo Clinic Arizona, Department of Hematology, Phoenix, AZ, USA
| | - K Gano
- Mayo Clinic Arizona, Department of Hematology, Phoenix, AZ, USA
| | - J Palmer
- Mayo Clinic Arizona, Department of Hematology, Phoenix, AZ, USA
| | - R Mesa
- Mayo Clinic Arizona, Department of Hematology, Phoenix, AZ, USA.
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Srivastava RM, Trivedi S, Concha-Benavente F, Gibson SP, Reeder C, Ferrone S, Ferris RL. CD137 Stimulation Enhances Cetuximab-Induced Natural Killer: Dendritic Cell Priming of Antitumor T-Cell Immunity in Patients with Head and Neck Cancer. Clin Cancer Res 2016; 23:707-716. [PMID: 27496866 DOI: 10.1158/1078-0432.ccr-16-0879] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/22/2016] [Accepted: 07/19/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE Cetuximab, an EGFR-specific antibody (mAb), modestly improves clinical outcome in patients with head and neck cancer (HNC). Cetuximab mediates natural killer (NK) cell:dendritic cell (DC) cross-talk by cross-linking FcγRIIIa, which is important for inducing antitumor cellular immunity. Cetuximab-activated NK cells upregulate the costimulatory receptor CD137 (4-1BB), which, when triggered by agonistic mAb urelumab, might enhance NK-cell functions, to promote T-cell-based immunity. EXPERIMENTAL DESIGN CD137 expression on tumor-infiltrating lymphocytes was evaluated in a prospective cetuximab neoadjuvant trial, and CD137 stimulation was evaluated in a phase Ib trial, in combining agonistic urelumab with cetuximab. Flow cytometry and cytokine release assays using NK cells and DC were used in vitro, testing the addition of urelumab to cetuximab-activated NK, DC, and cross presentation to T cells. RESULTS CD137 agonist mAb urelumab enhanced cetuximab-activated NK-cell survival, DC maturation, and tumor antigen cross-presentation. Urelumab boosted DC maturation markers, CD86 and HLA DR, and antigen-processing machinery (APM) components TAP1/2, leading to increased tumor antigen cross-presentation. In neoadjuvant cetuximab-treated patients with HNC, upregulation of CD137 by intratumoral, cetuximab-activated NK cells correlated with FcγRIIIa V/F polymorphism and predicted clinical response. Moreover, immune biomarker modulation was observed in an open label, phase Ib clinical trial, of patients with HNC treated with cetuximab plus urelumab. CONCLUSIONS These results suggest a beneficial effect of combination immunotherapy using cetuximab and CD137 agonist in HNC. Clin Cancer Res; 23(3); 707-16. ©2016 AACR.
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Affiliation(s)
| | - Sumita Trivedi
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Sandra P Gibson
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carly Reeder
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Soldano Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania. .,Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Cancer Immunology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
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Drake RJ, Day CJ, Picucci R, Warburton J, Larkin W, Husain N, Reeder C, Wykes T, Marshall M. A naturalistic, randomized, controlled trial combining cognitive remediation with cognitive-behavioural therapy after first-episode non-affective psychosis. Psychol Med 2014; 44:1889-1899. [PMID: 24172842 DOI: 10.1017/s0033291713002559] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive remediation (CR) preceding cognitive-behavioural therapy for psychosis (CBTp) was trialled within routine clinical services, with the hypothesis that following first-episode non-affective psychosis CR would enhance CBTp efficacy by improving neuropsychological performance. METHOD A total of 61 patients with DSM-IV non-affective psychoses waiting for routine CBTp were randomized to computerized CR over 12 weeks, supported by a trained support worker, or time-matched social contact (SC). Primary outcome was the blind-rated Psychotic Symptoms Rating Scale (PSYRATS). Secondary outcomes included measures of CBTp progress, cognition, symptoms, insight and self-esteem: all at baseline, after CR (12 weeks) and after CBTp (42 weeks). PSYRATS and global neuropsychological efficacy were tested using mixed-effects models with a group × time interaction term. Measures of CBTp progress and some neuropsychological measures were modelled by regression. RESULTS There was no significant difference between the CR and SC groups in PSYRATS (group × time coefficient 0.3, 95% confidence interval -0.4 to 1.1, p = 0.39). However, after CR CBTp was shorter [median 7 sessions, interquartile range (IQR) 2-12 after CR; median 13, IQR 4-18 after SC; model p = 0.011] and linked to better insight (p = 0.02). Global cognition did not improve significantly more after CR (p = 0.20) but executive function did (Wisconsin Card Sort, p = 0.012). CONCLUSIONS CBTp courses preceded by CR were far shorter but achieved the same outcome as CBTp preceded by an active control, consistent with neuropsychological improvement enhancing CBTp. CR was delivered by staff with minimal training, offering the potential to reduce the costs of CBTp considerably.
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Affiliation(s)
- R J Drake
- University of Manchester,Manchester Academic Health Science Centre, Manchester,UK
| | - C J Day
- Lancashire Care NHS Foundation Trust, Preston,UK
| | - R Picucci
- Lancashire Care NHS Foundation Trust, Preston,UK
| | - J Warburton
- Lancashire Care NHS Foundation Trust, Preston,UK
| | - W Larkin
- Lancashire Care NHS Foundation Trust, Preston,UK
| | - N Husain
- University of Manchester,Manchester Academic Health Science Centre, Manchester,UK
| | - C Reeder
- Institute of Psychiatry,King's College London, London,UK
| | - T Wykes
- Institute of Psychiatry,King's College London, London,UK
| | - M Marshall
- University of Manchester,Manchester Academic Health Science Centre, Manchester,UK
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Cella M, Swan S, Medin E, Reeder C, Wykes T. Metacognitive awareness of cognitive problems in schizophrenia: exploring the role of symptoms and self-esteem. Psychol Med 2014; 44:469-476. [PMID: 23734941 PMCID: PMC3880064 DOI: 10.1017/s0033291713001189] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND People with a diagnosis of schizophrenia have limited metacognitive awareness of their symptoms. This is also evident for cognitive difficulties when neuropsychological assessments and self-reports are compared. Unlike for delusions and hallucinations, little attention has been given to factors that may influence the mismatch between objective and subjectively reported cognitive problems. Symptom severity, and also self-esteem and social functioning, can have an impact on cognitive problem perception and help to explain the gap between objective and subjective cognitive assessments in psychosis. METHOD One-hundred participants with a diagnosis of schizophrenia were recruited and assessed with a comprehensive neuropsychological battery, a measure of awareness of cognitive problems and measures of psychotic symptoms, social and behavioural functioning and self-esteem. Regression was used to investigate the influence of symptoms, social functioning and self-esteem, and patients with different levels of cognitive problem awareness were contrasted. RESULTS Simple correlation analysis replicated the lack of association between objective cognitive measures and metacognitive awareness of cognitive problems. However, the results of the regression analyses highlight that self-esteem and negative symptoms predict metacognitive awareness. When significant predictors were controlled, individuals with better awareness had more impaired working memory but higher IQ. CONCLUSIONS Poor self-esteem and high negative symptoms are negatively associated with metacognitive awareness in people with schizophrenia. Interventions that aim to improve cognition should consider that cognitive problem reporting in people with schizophrenia correlates poorly with objective measures and is biased not only by symptoms but also by self-esteem. Future studies should explore the causal pathways using longitudinal designs.
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Affiliation(s)
- M. Cella
- Institute of Psychiatry, King's College London, UK
| | - S. Swan
- Institute of Psychiatry, King's College London, UK
| | - E. Medin
- Institute of Psychiatry, King's College London, UK
| | - C. Reeder
- Institute of Psychiatry, King's College London, UK
| | - T. Wykes
- Institute of Psychiatry, King's College London, UK
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McCartan N, Colclough JM, Crewe JP, Munn CJ, Berry SA, Reeder C, Loster N. STREET DOCTORS ARE WE MAKING AN IMPACT? Arch Emerg Med 2013. [DOI: 10.1136/emermed-2013-203113.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kumar S, Mikhael J, Lacy M, LaPlant B, Buadi F, Dingli D, Gertz M, Miceli T, Bergsagel L, Hayman S, Reeder C, Stewart K, Dispenzieri A, Gastineau D, Winters J. Phase II Trial of Intravenously Administered AMD3100 (Plerixafor) for Stem Cell Mobilization in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplantation Following a Lenalidomide Based Initial Therapy. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.129] [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: 11/16/2022]
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Czuczman MS, Vose J, Zinzani P, Reeder C, Buckstein R, Haioun C, Bouabdallah R, Polikoff J, Ervin-Haynes A, Witzig T. Efficacy and safety of lenalidomide oral monotherapy in patients with relapsed or refractory diffuse large B-cell lymphoma: Results from an international study (NHL-003). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e19504] [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
e19504 Background: Patients with diffuse large-B-cell lymphoma (DLBCL) who are not cured with R-CHOP or high-dose chemotherapy with autologous stem cell rescue have a dismal prognosis. A recent phase II trial (NHL-002) of lenalidomide in patients with relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL) demonstrated a 19% overall response rate (ORR) with a 7-month median duration of response (DR) in the subset of patients with DLBCL. A supporting international phase II trial (NHL-003) of single-agent lenalidomide was initiated for patients with relapsed or refractory aggressive NHL that had received at least one prior treatment and had measurable disease. Herein, we report the data from the DLBCL patients enrolled in this trial. Methods: Patients received 25 mg oral lenalidomide once daily on days 1–21 of every 28-day cycle and continued therapy until disease progression or toxicity. The 1999 IWLRC methodology was used to assess response and progression. Results: One hundred-three DLBCL patients were enrolled and were evaluable for response assessment. The median age was 66 years (21–87) and 70 patients (68%) were male. Median time from diagnosis was 2 years (0.4–18.6), patients had received a median of 3 prior treatment regimens (1–10) and 46 of the patients (45%) had received a prior stem cell transplant (DLBCL-stem cell). Response rates are shown in the Table . Grade 3 or 4 adverse events occurring in more than 5% of patients were neutropenia (34%), thrombocytopenia (18%), asthenia (9%), anemia (8%), leucopenia (7%), back pain (6%) and dyspnea (6%). Conclusions: This international study demonstrates that lenalidomide is active in heavily pre-treated patients with relapsed or refractory DLBCL and has manageable side effects. [Table: see text] [Table: see text]
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Affiliation(s)
- M. S. Czuczman
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
| | - J. Vose
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
| | - P. Zinzani
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
| | - C. Reeder
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
| | - R. Buckstein
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
| | - C. Haioun
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
| | - R. Bouabdallah
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
| | - J. Polikoff
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
| | - A. Ervin-Haynes
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
| | - T. Witzig
- Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska, Omaha, NE; Institute of Hematology and Medical Oncology, Bologna, Italy; Mayo Clinic, Scottsdale, AZ; Toronto Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Hôpital Henri Mondor, Créteil, France; Institute Paoli-Calmettes Haematology, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Mayo Clinic, Rochester, MN
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Hayes M, Reeder C, Beer TM. Acupuncture for hot flashes for prostate cancer patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16125] [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
e16125 Background: Hot flashes are a common adverse effect of androgen suppression therapy (AST) for prostate cancer. We sought to determine the effect of acupuncture on hot flash frequency and intensity, quality of life, sleep quality, and biomarkers. Methods: Men on AST who had a hot flash score (HFS) (J Clin Oncol. 2001;19:4280–4290) > 4 were treated with acupuncture with electro-stimulation twice weekly for 4 weeks and once per week for an additional 6 weeks. The treatment plan included the following points: bilateral gallbladder 34, bladder 15, 23, and 32 and unilateral governing vessel 20, heart 7, pericardium 6, liver 2, and spleen 6. Continuous low intensity electro-stimulation at 2 Hz was used to connect bladder 23 inferiorly to bladder 32. Needles were retained for 30 minutes with manual stimulation at 10-minute intervals. The primary endpoint was a 50% reduction in the HFS after 4 weeks of therapy. Hot Flash Related Daily Interference Scale (HFRDIS) (J Pain Symptom Manage. 2001;22:979–989), Pittsburgh Sleep Quality Index (PSQI) (Psychiatry Res. 1989;28:193–213), Short Form Health Survey-36 (SF-36) (Med Care. 1992;30:473–483), blood serotonin, plasma CGRP, and urinary 5-HIAA were also examined. Results: 22 men were enrolled between September 2003 and April 2007 and were eligible and evaluable. After 4 weeks of therapy, 9 of 22 patients (41%, 95%CI 21 to 64%) had > 50% reduction in hot flashes. 12 of 22 patients (55%, 95%CI 32 to 76%) met this response definition after 7 weeks of treatment. No patients had a significant increase in the HFS on therapy. Hot flash related quality of life, measured by HFDIS, improved in all patients and sleep quality, measured by PSQI, improved in hot flash responders. Hot flash related biomarkers including serotonin, 5-HIAA, and CGRP were examined before and after treatment. Conclusions: Multiple placebo-controlled trials have demonstrated that 25% of patients respond to placebo treatment for hot flashes. 41% of patients responded by week 4 and 55% by week 7 in this pilot study providing evidence of a potentially meaningful benefit with acupuncture therapy. Hot flash-related quality of life was also significantly improved with acupuncture treatment. Further studies of acupuncture for hot flashes in men undergoing hormonal treatment for prostate cancer are warranted. No significant financial relationships to disclose.
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Affiliation(s)
- M. Hayes
- Oregon Health & Science University, Portland, OR
| | - C. Reeder
- Oregon Health & Science University, Portland, OR
| | - T. M. Beer
- Oregon Health & Science University, Portland, OR
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Witzig TE, Wiernik PH, Moore T, Reeder C, Cole C, Justice G, Kaplan H, Voralia M, Pietronigro D, Vose JM. Efficacy of lenalidomide oral monotherapy in relapsed or refractory indolent non-Hodgkin's lymphoma: Final results of NHL-001. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8560] [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
8560 Background: Lenalidomide has shown activity in a wide range of hematological malignancies. We conducted a phase II trial of single-agent lenalidomide in indolent non-Hodgkin's lymphoma (NHL). Methods: Patients with relapsed or refractory indolent NHL were eligible, with no limit on the number of previous therapies. Oral lenalidomide 25 mg was self-administered once-daily on days 1–21 of every 28-day cycle for up to 52 weeks as tolerated, or until disease progression. The primary endpoint was overall response rate (ORR), with secondary endpoints of response duration, progression-free survival (PFS), and safety. Results: Forty-three patients were enrolled and were evaluable for response and safety. Patients had received a median of 3 prior systemic therapies (1–17) and half of all patients were refractory to their last therapy. The ORR was 23% (10/43), including a complete response (CR) or unconfirmed CR (CRu) rate of 7%. The median time to first response was 3.6 months (1.7–4.2) and the median time to CR or CRu was 4.2 months (1.9–11.1). Twenty-seven percent (6/22) of patients with follicular lymphoma grade 1 or 2, and 22% (4/18) of patients with small lymphocytic lymphoma responded to therapy. The median duration of response has not reached, but is longer than 16.5 months with 7 of 10 responses ongoing at 15–28 months. Median PFS was 4.4 months (2.5–10.4). Adverse events were consistent with the known safety profile of lenalidomide and manageable; the most common grade 3 or 4 adverse events were neutropenia (30% and 16%, respectively) and thrombocytopenia (14% and 5%, respectively). Conclusions: Oral lenalidomide monotherapy produces durable responses with manageable side effects in relapsed or refractory indolent NHL and warrants further investigation in the treatment of indolent NHL. [Table: see text]
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Affiliation(s)
- T. E. Witzig
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - P. H. Wiernik
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - T. Moore
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - C. Reeder
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - C. Cole
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - G. Justice
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - H. Kaplan
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - M. Voralia
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - D. Pietronigro
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - J. M. Vose
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
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Paripati H, Stewart AK, Cabou S, Dueck A, Zepeda VJ, Pirooz N, Ehlenbeck C, Reeder C, Slack J, Leis JF, Boesiger J, Torloni AS, Fonseca R, Bergsagel PL. Compromised stem cell mobilization following induction therapy with lenalidomide in myeloma. Leukemia 2008; 22:1282-4. [PMID: 18216870 DOI: 10.1038/sj.leu.2405100] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Weller CB, Reeder C. Traumatic pseudoaneurysm of the superficial temporal artery: two cases. J Am Osteopath Assoc 2001; 101:284-7. [PMID: 11381564] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Pseudoaneurysms of the superficial temporal artery are a rare and potentially critical cause of facial masses. Most pseudoaneurysms form as a result of blunt trauma and present as painless, pulsatile tumors that may be associated with neuropathic findings and enlarged size. Without careful evaluation in the primary care setting, pseudoaneurysms can be easily misdiagnosed and improperly managed. They can, however, be accurately diagnosed through physical examination alone and subsequently treated with surgical ligation. The authors present two cases of traumatic pseudoaneurysms of the superficial temporal artery caused by blunt injury and discuss pertinent diagnosis and treatment options, as well as provide a brief review of the anatomy and histopathology of pseudoaneurysms.
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Affiliation(s)
- C B Weller
- Bellbrook Medical Center, 4336 State Route 725, Bellbrook, OH 45305, USA
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Abstract
The current study investigates whether an executive processing measure, response inhibition, is stable over time and across new samples of patients with schizophrenia. Two groups of patients (with and without diagnoses of schizophrenia) were followed up 6 years after baseline data collection. Another separate group of patients with less institutionalized care also completed the same measures to determine whether the response inhibition difficulties had the same prevalence in this new sample.The response inhibition measure was stable over time only in the group of patients with a diagnosis of schizophrenia. The relationship between symptoms and response inhibition difficulties changed over time but was explicable in terms of the interaction between environmental demands and information processing difficulties. The level of response inhibition difficulties (about one-third) was identical in the new sample of patients, which suggests that response inhibition is not dependent on clinical history.
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Affiliation(s)
- T Wykes
- Department of Psychology, Institute of Psychiatry, De Crespigny Park, SE5 8AF, London, UK.
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Abstract
Approaches to cognitive remediation have differed across studies. Most of the larger studies have concentrated on group treatments designed without the benefit of recent laboratory-based studies. The current study describes a randomized trial of an intensive cognitive remediation program involving individual daily sessions of 1 hour for up to 3 months. It targets executive functioning deficits (cognitive flexibility, working memory, and planning) that are known to be problematic in people with schizophrenia. Procedural learning, as well as the principles of errorless learning, targeted reinforcement, and massed practice, was the basis of the intervention. The program was compared with an alternative therapy (intensive occupational therapy) to control for some of the effects of therapeutic contact. Some improvements in cognition followed both therapies. A differential effect in favor of cognitive remediation therapy was found for tests in the cognitive flexibility and the memory subgroups. There was a trend for those receiving atypical antipsychotic medication to benefit more from cognitive remediation for tests of cognitive flexibility. Although there were no consistent changes in symptoms or social functioning between groups, if improvement in cognitive flexibility tasks reached a threshold then there is some evidence that social functioning improved, even over the short duration of the trial. In addition, cognitive remediation differentially improved self-esteem. This study supports the view that cognitive remediation can reduce cognitive deficits and that this reduction may affect social outcome, at least in the short term.
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Affiliation(s)
- T Wykes
- Department of Psychology, Institute of Psychiatry, London, UK
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Daughaday WH, Reeder C. Synchronous activation of DNA synthesis in hypophysectomized rat cartilage by growth hormone. J Lab Clin Med 1966; 68:357-68. [PMID: 5922747] [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: 01/17/2023]
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