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Ghobrial IM, Gormley N, Kumar SK, Mateos MV, Bergsagel PL, Chesi M, Dhodapkar MV, Dispenzieri A, Fonseca R, Getz G, Kastritis E, Kristinsson SY, Martinez-Climent JA, Manier S, Marinac CR, Maura F, Morgan GJ, Davies FE, Nadeem O, Nuvolone M, Paiva B, O'Donnell E, Prosper F, Shah UA, Sklavenitis-Pistofidis R, Sperling AS, Vassiliou GS, Munshi NC, Castle PE, Anderson KC, San Miguel JF. Round Table Discussion on Optimal Clinical Trial Design in Precursor Multiple Myeloma. Blood Cancer Discov 2024; 5:146-152. [PMID: 38441243 PMCID: PMC11061588 DOI: 10.1158/2643-3230.bcd-24-0022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
SUMMARY While the current approach to precursor hematologic conditions is to "watch and wait," this may change with the development of therapies that are safe and extend survival or delay the onset of symptomatic disease. The goal of future therapies in precursor hematologic conditions is to improve survival and prevent or delay the development of symptomatic disease while maximizing safety. Clinical trial considerations in this field include identifying an appropriate at-risk population, safety assessments, dose selection, primary and secondary trial endpoints including surrogate endpoints, control arms, and quality-of-life metrics, all of which may enable more precise benefit-risk assessment.
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Affiliation(s)
| | - Nicole Gormley
- Division of Hematology, Food and Drug Administration, Silver Spring, Maryland
| | - Shaji K. Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maria-Victoria Mateos
- Hospital Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), Centro de Investigación del Cancer (IBMCC-USAL, CSIC), CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | | | - Marta Chesi
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona
| | | | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rafael Fonseca
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Gad Getz
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Jose Angel Martinez-Climent
- Cancer Center Clinica Universidad de Navarra (CCUN), Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Salomon Manier
- Hematology Department, CHU Lille, Lille University, INSERM UMR-S1277, Lille, France
| | | | - Francesco Maura
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Gareth J. Morgan
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, New York
| | - Faith E. Davies
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, New York
| | - Omar Nadeem
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mario Nuvolone
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Bruno Paiva
- Cancer Center Clinica Universidad de Navarra (CCUN), Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | | | - Felipe Prosper
- Hematology Service and Cell Therapy Unit and Program of Hematology-Oncology CIMA, Clinica Universidad de Navarra, Cancer Center Clínica Universidad de Navarra (CCUN) and Instituto de Investigación Sanitaria de Navarra (IdISNA), Pamplona, Spain
- Centro de Investigación Biomedica en Red Cancer (CIBERONC) and RICORS TERAV, Madrid, Spain
| | - Urvi A. Shah
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - George S. Vassiliou
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | | | - Philip E. Castle
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | | | - Jesus F. San Miguel
- Cancer Center Clinica Universidad de Navarra (CCUN), Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
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Lee DJ, El-Khoury H, Tramontano AC, Alberge JB, Perry J, Davis MI, Horowitz E, Redd R, Sakrikar D, Barnidge D, Perkins MC, Harding S, Mucci L, Rebbeck TR, Ghobrial IM, Marinac CR. Mass spectrometry-detected MGUS is associated with obesity and other novel modifiable risk factors in a high-risk population. Blood Adv 2024; 8:1737-1746. [PMID: 38212245 PMCID: PMC10997907 DOI: 10.1182/bloodadvances.2023010843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/31/2023] [Accepted: 11/11/2023] [Indexed: 01/13/2024] Open
Abstract
ABSTRACT Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant condition of multiple myeloma with few known risk factors. The emergence of mass spectrometry (MS) for the detection of MGUS has provided new opportunities to evaluate its risk factors. In total, 2628 individuals at elevated risk for multiple myeloma were enrolled in a screening study and completed an exposure survey (PROMISE trial). Participant samples were screened by MS, and monoclonal proteins (M-proteins) with concentrations of ≥0.2 g/L were categorized as MS-MGUS. Multivariable logistic models evaluated associations between exposures and MS outcomes. Compared with normal weight (body mass index [BMI] of 18.5 to <25 kg/m2), obesity (BMI of ≥30 kg/m2) was associated with MS-MGUS, adjusting for age, sex, Black race, education, and income (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.21-2.47; P = .003). High physical activity (≥73.5 metabolic equivalent of task (MET)-hours per week vs <10.5 MET-hours per week) had a decreased likelihood of MS-MGUS (OR, 0.45, 95% CI, 0.24-0.80; P = .009), whereas heavy smoking and short sleep had increased likelihood of MS-MGUS (>30 pack-years vs never smoker: OR, 2.19; 95% CI, 1.24-3.74; P = .005, and sleep <6 vs ≥6 hours per day: OR, 2.11; 95% CI, 1.26-3.42; P = .003). In the analysis of all MS-detected monoclonal gammopathies, which are inclusive of M-proteins with concentrations of <0.2 g/L, elevated BMI and smoking were associated with all MS-positive cases. Findings suggest MS-detected monoclonal gammopathies are associated with a broader range of modifiable risk factors than what has been previously identified. This trial was registered at www.clinicaltrials.gov as #NCT03689595.
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Affiliation(s)
- David J. Lee
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Habib El-Khoury
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Jean-Baptiste Alberge
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jacqueline Perry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Maya I. Davis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Erica Horowitz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Robert Redd
- Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | - Lorelei Mucci
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Timothy R. Rebbeck
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Irene M. Ghobrial
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA
| | - Catherine R. Marinac
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA
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3
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Lee DJ, O'Donnell EK, Raje N, Panaroni C, Redd R, Ligibel J, Sears DD, Nadeem O, Ghobrial IM, Marinac CR. Design and Rationale of Prolonged Nightly Fasting for Multiple Myeloma Prevention (PROFAST): Protocol for a Randomized Controlled Pilot Trial. JMIR Res Protoc 2024; 13:e51368. [PMID: 38466984 DOI: 10.2196/51368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Obesity is an established, modifiable risk factor of multiple myeloma (MM); yet, no lifestyle interventions are routinely recommended for patients with overweight or obesity with MM precursor conditions. Prolonged nightly fasting is a simple, practical dietary regimen supported by research, suggesting that the synchronization of feeding-fasting timing with sleep-wake cycles favorably affects metabolic pathways implicated in MM. We describe the design and rationale of a randomized controlled pilot trial evaluating the efficacy of a regular, prolonged nighttime fasting schedule among individuals with overweight or obesity at high risk for developing MM or a related lymphoid malignancy. OBJECTIVE We aim to investigate the effects of 4-month prolonged nightly fasting on body composition and tumor biomarkers among individuals with overweight or obesity with monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or smoldering Waldenström macroglobulinemia (SWM). METHODS Individuals with MGUS, SMM, or SWM aged ≥18 years and a BMI of ≥25 kg/m2 are randomized to either a 14-hour nighttime fasting intervention or a healthy lifestyle education control group. Participants' baseline diet and lifestyle patterns are characterized through two 24-hour dietary recalls: questionnaires querying demographic, comorbidity, lifestyle, and quality-of-life information; and wrist actigraphy measurements for 7 days. Fasting intervention participants are supported through one-on-one telephone counseling by a health coach and automated SMS text messaging to support fasting goals. Primary end points of body composition, including visceral and subcutaneous fat (by dual-energy x-ray absorptiometry); bone marrow adiposity (by bone marrow histology); and tumor biomarkers, specifically M-proteins and serum free light-chain concentrations (by gel-based and serum free light-chain assays), are assessed at baseline and after the 4-month study period; changes therein from baseline are evaluated using a repeated measures mixed-effects model that accounts for the correlation between baseline and follow-up measures and is generally robust to missing data. Feasibility is assessed as participant retention (percent dropout in each arm) and percentage of days participants achieved a ≥14-hour fast. RESULTS The PROlonged nightly FASTing (PROFAST) study was funded in June 2022. Participant recruitment commenced in April 2023. As of July 2023, six participants consented to the study. The study is expected to be completed by April 2024, and data analysis and results are expected to be published in the first quarter of 2025. CONCLUSIONS PROFAST serves as an important first step in exploring the premise that prolonged nightly fasting is a strategy to control obesity and obesity-related mechanisms of myelomagenesis. In evaluating the feasibility and impact of prolonged nightly fasting on body composition, bone marrow adipose tissue, and biomarkers of tumor burden, this pilot study may generate hypotheses regarding metabolic mechanisms underlying MM development and ultimately inform clinical and public health strategies for MM prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT05565638; http://clinicaltrials.gov/ct2/show/NCT05565638. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51368.
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Affiliation(s)
- David J Lee
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Elizabeth K O'Donnell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Noopur Raje
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Cristina Panaroni
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Robert Redd
- Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Jennifer Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Dorothy D Sears
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Omar Nadeem
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Catherine R Marinac
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, United States
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4
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Schrag D, Beer TM, McDonnell CH, Nadauld L, Dilaveri CA, Reid R, Marinac CR, Chung KC, Lopatin M, Fung ET, Klein EA. Blood-based tests for multicancer early detection (PATHFINDER): a prospective cohort study. Lancet 2023; 402:1251-1260. [PMID: 37805216 PMCID: PMC11027492 DOI: 10.1016/s0140-6736(23)01700-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/29/2023] [Accepted: 08/11/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Multicancer early detection (MCED) blood tests can detect a cancer signal from circulating cell-free DNA (cfDNA). PATHFINDER was a prospective cohort study investigating the feasibility of MCED testing for cancer screening. METHODS In this prospective cohort study done in oncology and primary care outpatient clinics at seven US health networks, a convenience sample of adults aged 50 years or older without signs or symptoms of cancer consented to MCED testing. We collected blood, analysed cfDNA, and returned results to participants' doctors. If a methylation signature indicative of cancer was detected, predicted cancer signal origin(s) informed diagnostic assessment. The primary outcome was time to, and extent of, diagnostic testing required to confirm the presence or absence of cancer. This trial is registered at ClinicalTrials.gov, NCT04241796, and is completed. FINDINGS Between Dec 12, 2019, and Dec 4, 2020, we recruited 6662 participants. 4204 (63·5%) of 6621 participants with analysable results were women, 2417 (36·5%) were men, and 6071 (91·7%) were White. A cancer signal was detected in 92 (1·4%) of 6621 participants with analysable results. 35 (38%) participants were diagnosed with cancer (true positives) and 57 (62%) had no cancer diagnosis (false positives). Excluding two participants whose diagnostic assessments began before MCED test results were reported, median time to diagnostic resolution was 79 days (IQR 37-219): 57 days (33-143) in true-positive and 162 days (44-248) in false-positive participants. Most participants had both laboratory tests (26 [79%] of 33 with true-positive results and 50 [88%] of 57 with false-positive results) and imaging (30 [91%] of 33 with true-positive results and 53 [93%] of 57 with false-positive results). Fewer procedures were done in participants with false-positive results (17 [30%] of 57) than true-positive results (27 [82%] of 33) and few had surgery (one with a false-positive result and three with a true-positive result). INTERPRETATION This study supports the feasibility of MCED screening for cancer and underscores the need for further research investigating the test's clinical utility. FUNDING GRAIL.
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Affiliation(s)
- Deb Schrag
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | | | | | | | - Robert Reid
- US Oncology Research, VA Cancer Specialists, Fairfax, VA, USA
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5
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Farrell M, Fairfield H, Karam M, D'Amico A, Murphy CS, Falank C, Pistofidi RS, Cao A, Marinac CR, Dragon JA, McGuinness L, Gartner CG, Iorio RD, Jachimowicz E, DeMambro V, Vary C, Reagan MR. Targeting the fatty acid binding proteins disrupts multiple myeloma cell cycle progression and MYC signaling. eLife 2023; 12:e81184. [PMID: 36880649 PMCID: PMC9995119 DOI: 10.7554/elife.81184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
Multiple myeloma is an incurable plasma cell malignancy with only a 53% 5-year survival rate. There is a critical need to find new multiple myeloma vulnerabilities and therapeutic avenues. Herein, we identified and explored a novel multiple myeloma target: the fatty acid binding protein (FABP) family. In our work, myeloma cells were treated with FABP inhibitors (BMS3094013 and SBFI-26) and examined in vivo and in vitro for cell cycle state, proliferation, apoptosis, mitochondrial membrane potential, cellular metabolism (oxygen consumption rates and fatty acid oxidation), and DNA methylation properties. Myeloma cell responses to BMS309403, SBFI-26, or both, were also assessed with RNA sequencing (RNA-Seq) and proteomic analysis, and confirmed with western blotting and qRT-PCR. Myeloma cell dependency on FABPs was assessed using the Cancer Dependency Map (DepMap). Finally, MM patient datasets (CoMMpass and GEO) were mined for FABP expression correlations with clinical outcomes. We found that myeloma cells treated with FABPi or with FABP5 knockout (generated via CRISPR/Cas9 editing) exhibited diminished proliferation, increased apoptosis, and metabolic changes in vitro. FABPi had mixed results in vivo, in two pre-clinical MM mouse models, suggesting optimization of in vivo delivery, dosing, or type of FABP inhibitors will be needed before clinical applicability. FABPi negatively impacted mitochondrial respiration and reduced expression of MYC and other key signaling pathways in MM cells in vitro. Clinical data demonstrated worse overall and progression-free survival in patients with high FABP5 expression in tumor cells. Overall, this study establishes the FABP family as a potentially new target in multiple myeloma. In MM cells, FABPs have a multitude of actions and cellular roles that result in the support of myeloma progression. Further research into the FABP family in MM is warrented, especially into the effective translation of targeting these in vivo.
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Affiliation(s)
- Mariah Farrell
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
- Graduate School of Biomedical Science and Engineering, University of MaineOronoUnited States
- Tufts University School of MedicineBostonUnited States
| | - Heather Fairfield
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
- Graduate School of Biomedical Science and Engineering, University of MaineOronoUnited States
- Tufts University School of MedicineBostonUnited States
| | - Michelle Karam
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
| | - Anastasia D'Amico
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
| | - Connor S Murphy
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
- Graduate School of Biomedical Science and Engineering, University of MaineOronoUnited States
| | - Carolyne Falank
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
| | | | - Amanda Cao
- Dana-Farber Cancer InstituteBostonUnited States
- Harvard Medical SchoolBostonUnited States
| | - Catherine R Marinac
- Dana-Farber Cancer InstituteBostonUnited States
- Harvard Medical SchoolBostonUnited States
| | | | - Lauren McGuinness
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
- University of New EnglandBiddefordUnited States
| | - Carlos G Gartner
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
- Graduate School of Biomedical Science and Engineering, University of MaineOronoUnited States
- Tufts University School of MedicineBostonUnited States
| | - Reagan Di Iorio
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
- University of New EnglandBiddefordUnited States
| | - Edward Jachimowicz
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
| | - Victoria DeMambro
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
- Graduate School of Biomedical Science and Engineering, University of MaineOronoUnited States
| | - Calvin Vary
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
- Graduate School of Biomedical Science and Engineering, University of MaineOronoUnited States
- Tufts University School of MedicineBostonUnited States
| | - Michaela R Reagan
- Center for Molecular Medicine, Maine Health Institute for ResearchScarboroughUnited States
- Graduate School of Biomedical Science and Engineering, University of MaineOronoUnited States
- Tufts University School of MedicineBostonUnited States
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Cowan A, Ferrari F, Freeman SS, Redd R, El-Khoury H, Perry J, Patel V, Kaur P, Barr H, Lee DJ, Lightbody E, Downey K, Argyelan D, Theodorakakou F, Fotiou D, Liacos CI, Kanellias N, Chavda SJ, Ainley L, Sandecká V, Pospíšilová L, Minarik J, Jungova A, Radocha J, Spicka I, Nadeem O, Yong K, Hájek R, Kastritis E, Marinac CR, Dimopoulos MA, Get G, Trippa L, Ghobrial IM. Personalised progression prediction in patients with monoclonal gammopathy of undetermined significance or smouldering multiple myeloma (PANGEA): a retrospective, multicohort study. Lancet Haematol 2023; 10:e203-e212. [PMID: 36858677 PMCID: PMC9991855 DOI: 10.1016/s2352-3026(22)00386-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Patients with precursors to multiple myeloma are dichotomised as having monoclonal gammopathy of undetermined significance or smouldering multiple myeloma on the basis of monoclonal protein concentrations or bone marrow plasma cell percentage. Current risk stratifications use laboratory measurements at diagnosis and do not incorporate time-varying biomarkers. Our goal was to develop a monoclonal gammopathy of undetermined significance and smouldering multiple myeloma stratification algorithm that utilised accessible, time-varying biomarkers to model risk of progression to multiple myeloma. METHODS In this retrospective, multicohort study, we included patients who were 18 years or older with monoclonal gammopathy of undetermined significance or smouldering multiple myeloma. We evaluated several modelling approaches for predicting disease progression to multiple myeloma using a training cohort (with patients at Dana-Farber Cancer Institute, Boston, MA, USA; annotated from Nov, 13, 2019, to April, 13, 2022). We created the PANGEA models, which used data on biomarkers (monoclonal protein concentration, free light chain ratio, age, creatinine concentration, and bone marrow plasma cell percentage) and haemoglobin trajectories from medical records to predict progression from precursor disease to multiple myeloma. The models were validated in two independent validation cohorts from National and Kapodistrian University of Athens (Athens, Greece; from Jan 26, 2020, to Feb 7, 2022; validation cohort 1), University College London (London, UK; from June 9, 2020, to April 10, 2022; validation cohort 1), and Registry of Monoclonal Gammopathies (Czech Republic, Czech Republic; Jan 5, 2004, to March 10, 2022; validation cohort 2). We compared the PANGEA models (with bone marrow [BM] data and without bone marrow [no BM] data) to current criteria (International Myeloma Working Group [IMWG] monoclonal gammopathy of undetermined significance and 20/2/20 smouldering multiple myeloma risk criteria). FINDINGS We included 6441 patients, 4931 (77%) with monoclonal gammopathy of undetermined significance and 1510 (23%) with smouldering multiple myeloma. 3430 (53%) of 6441 participants were female. The PANGEA model (BM) improved prediction of progression from smouldering multiple myeloma to multiple myeloma compared with the 20/2/20 model, with a C-statistic increase from 0·533 (0·480-0·709) to 0·756 (0·629-0·785) at patient visit 1 to the clinic, 0·613 (0·504-0·704) to 0·720 (0·592-0·775) at visit 2, and 0·637 (0·386-0·841) to 0·756 (0·547-0·830) at visit three in validation cohort 1. The PANGEA model (no BM) improved prediction of smouldering multiple myeloma progression to multiple myeloma compared with the 20/2/20 model with a C-statistic increase from 0·534 (0·501-0·672) to 0·692 (0·614-0·736) at visit 1, 0·573 (0·518-0·647) to 0·693 (0·605-0·734) at visit 2, and 0·560 (0·497-0·645) to 0·692 (0·570-0·708) at visit 3 in validation cohort 1. The PANGEA models improved prediction of monoclonal gammopathy of undetermined significance progression to multiple myeloma compared with the IMWG rolling model at visit 1 in validation cohort 2, with C-statistics increases from 0·640 (0·518-0·718) to 0·729 (0·643-0·941) for the PANGEA model (BM) and 0·670 (0·523-0·729) to 0·879 (0·586-0·938) for the PANGEA model (no BM). INTERPRETATION Use of the PANGEA models in clinical practice will allow patients with precursor disease to receive more accurate measures of their risk of progression to multiple myeloma, thus prompting for more appropriate treatment strategies. FUNDING SU2C Dream Team and Cancer Research UK.
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Affiliation(s)
- Annie Cowan
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Federico Ferrari
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Biostatistics and Research Decision Sciences, Merck & Co, Rahway, NJ, USA
| | - Samuel S Freeman
- Bioinformatics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Robert Redd
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Habib El-Khoury
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Vidhi Patel
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Priya Kaur
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hadley Barr
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David J Lee
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Katelyn Downey
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David Argyelan
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Christine Ivy Liacos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Louise Ainley
- UCL Cancer Institute, University College London, London, UK
| | - Viera Sandecká
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Jiri Minarik
- Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Alexandra Jungova
- Department of Hematology and Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jakub Radocha
- Fourth Department of Internal Medicine Hematology, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University, Czech Republic
| | - Ivan Spicka
- First Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University and General Hospital in Prague, Czech Republic
| | - Omar Nadeem
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kwee Yong
- UCL Cancer Institute, University College London, London, UK
| | - Roman Hájek
- Fourth Department of Internal Medicine-Hematology, University Hospital in Ostrava, Ostrava, Czech Republic
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Gad Get
- Bioinformatics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lorenzo Trippa
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Irene M Ghobrial
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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Shah UA, Whiting K, Devlin S, Ershler R, Kanapuru B, Lee DJ, Tahri S, Gwise T, Rustad EH, Mailankody S, Lesokhin AM, Kazandjian D, Maura F, Auclair D, Birmann BM, Usmani SZ, Gormley N, Marinac CR, Landgren O. Extreme body mass index and survival in newly diagnosed multiple myeloma patients. Blood Cancer J 2023; 13:13. [PMID: 36631444 PMCID: PMC9834289 DOI: 10.1038/s41408-022-00782-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA.
| | - Karissa Whiting
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 1275 York Avenue, New York, NY, 10065, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 1275 York Avenue, New York, NY, 10065, USA
| | - Rachel Ershler
- Division of Hematologic Malignancies II, Center for Drug Evaluation and Research, U.S. Food, and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - Bindu Kanapuru
- Division of Hematologic Malignancies II, Center for Drug Evaluation and Research, U.S. Food, and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - David J Lee
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Sabrin Tahri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Hematology, Erasmus University Medical Center, 3000CA, Rotterdam, The Netherlands
| | - Thomas Gwise
- Division of Biometrics IX, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - Even H Rustad
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital Radiumhospitalet, 0379, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Hospital, 0456, Oslo, Norway
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA
| | - Alexander M Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA
| | - Dickran Kazandjian
- Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, 1475 NW 12th Avenue, Miami, FL, 33136, USA
| | - Francesco Maura
- Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, 1475 NW 12th Avenue, Miami, FL, 33136, USA
| | - Daniel Auclair
- Multiple Myeloma Research Foundation, 383 Main Avenue #5, Norwalk, CT, 06851, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA
| | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA
| | - Nicole Gormley
- Division of Hematologic Malignancies II, Center for Drug Evaluation and Research, U.S. Food, and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - Catherine R Marinac
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Ola Landgren
- Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, 1475 NW 12th Avenue, Miami, FL, 33136, USA
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Lightbody ED, Firer DT, Sklavenitis-Pistofidis R, Agius M, Dutta AK, Aranha M, Alberge JB, Hevenor L, Su NK, Boehner C, Horowitz E, Perry J, Cowan A, Barr H, Justis A, Auclair D, Marinac CR, Getz G, Ghobrial I. Abstract 641: Single-cell RNA sequencing of rare circulating tumor cells in precursor myeloma patients reveals molecular underpinnings of tumor cell circulation. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-641] [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
Background: Multiple Myeloma (MM) is a hematological malignancy characterized by abnormal proliferation of terminally differentiated plasma cells (PCs) in the bone marrow (BM). MM is almost always preceded by the precursor stage smoldering multiple myeloma (SMM). BM biopsies are useful to monitor disease progression, but they are invasive and not routinely collected from patients for disease monitoring during precursor stages. Profiling circulating tumor cells (CTCs) from peripheral blood (PB) could aid early detection, disease monitoring, and biomarker identification to predict patients at high risk of progression that may benefit from early therapeutic intervention.
Methods: Paired PB and BM aspirates were collected from 40 SMM patients enrolled in the PCROWD study (IRB #14-174) at Dana-Farber Cancer Institute. Malignant PCs were enriched by magnetic bead-based methods and underwent 5’ single-cell RNA sequencing (scRNA-seq) and single-cell B-cell receptor sequencing (scBCR-seq) (10x Genomics).
Results: We analyzed 105,246 BM PCs and 33,234 PB PCs from 15 patients. To differentiate malignant from normal PCs, we used clonal V(D)J rearrangements, assessed by concurrent scBCR-seq. A total of 86,986 BM tumor cells and 8,718 CTCs were captured. A median of 5, 26, and 47 CTCs were present per mL of blood from low, intermediate, and high-risk SMM patients as defined by the International Myeloma Working Group (IMWG) “20/2/20” criteria, suggesting sequencing-based CTC enumeration corresponds to prognosis. High levels of driver genes commonly upregulated in patients with specific translocations, including CCND1 and MAF, were detected in both BM tumor and CTC clusters in 3 patients with t(11;14) and t(14;16) confirmed by fluorescence in situ hybridization (FISH) clinical testing, and 2 additional patients with inconclusive FISH results (Wilcoxon, q <10-3), supporting the idea of CTC-based prognostication. Differential expression (DE) analysis revealed 8 genes that were significantly upregulated and 3 genes that were significantly downregulated in CTCs compared to BM tumor cells robustly across 15 paired samples. Gene set enrichment analysis (GSEA) revealed genes DE in CTCs are associated with TNF-α and NF-κB signaling, which are commonly induced by extrinsic factors in the bone marrow milieu, providing insight into the biology of tumor cell circulation.
Conclusions: This study highlights the utility of scRNA-seq for molecular profiling of CTCs, even in asymptomatic low tumor burden disease. Additional analyses are ongoing in the expanded cohort of 40 patients with paired samples to help gain further insight into CTC heterogeneity. Overall, this study will help enable the design of new molecular liquid biopsy-based approaches to diagnosis, disease monitoring, and biological insights to improve treatment strategies for precursor myeloma patients.
Citation Format: Elizabeth D. Lightbody, Danielle T. Firer, Romanos Sklavenitis-Pistofidis, Michael Agius, Ankit K. Dutta, Michelle Aranha, Jean-Baptiste Alberge, Laura Hevenor, Nang Kham Su, Cody Boehner, Erica Horowitz, Jacqueline Perry, Anna Cowan, Hadley Barr, Anna Justis, Daniel Auclair, Catherine R. Marinac, Gad Getz, Irene Ghobrial. Single-cell RNA sequencing of rare circulating tumor cells in precursor myeloma patients reveals molecular underpinnings of tumor cell circulation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 641.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Anna Cowan
- 1Dana-Farber Cancer Insitute, Boston, MA
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Sklavenitis-Pistofidis R, Konishi Y, Aranha M, Rahmat M, Wu T, Timonian M, Varmeh S, Heilpern-Mallory D, Agius MP, Su NK, Lightbody ED, Perry J, Horowitz EM, Justis AV, Auclair D, Marinac CR, Fischer ES, Getz G, Ghobrial IM. Abstract 3582: Single-cell RNA-sequencing for immune profiling of SARS-CoV2 vaccine response in healthy individuals and patients with precursor plasma cell malignancies. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3582] [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
Introduction: Patients with hematological malignancies exhibit inferior response to SARS-CoV2 vaccination, compared to healthy individuals, however little is known about patients with precursor hematological malignancies and the cellular underpinnings of vaccination response. Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Myeloma (SMM) are plasma cell premalignancies that precede Multiple Myeloma (MM) and exhibit signs of immune dysregulation; they affect approximately 5% of the population over 50 years of age, who remain largely undiagnosed, due to lack of screening. In November 2019, we launched the IMPACT study to characterize the immune response to SARS-CoV2 vaccination in patients with plasma cell dyscrasias and healthy individuals.
Methods: We performed single-cell RNA-sequencing on 224 peripheral blood mononuclear cell samples drawn from 118 IMPACT (IRB #20-332) participants with MGUS (n=20), SMM (n=48), or MM (n=24), as well as healthy individuals (n=26). Samples were collected before vaccination and after 2 doses of BNT162b2 (Pfizer-BioNtech) (n=123), mRNA-1273 (Moderna) (n=83) or 1 dose of Ad26.COV2.S (Janssen) (n=14).
Results: Overall, we sequenced 2,025,611 cells from 224 samples of 118 patients with MGUS, SMM, MM and healthy individuals pre- and post-vaccination for SARS-CoV2, and profiled 553,082 T-cells, 95,392 B-cells, 74,394 NK cells, 195,371 Monocytes, and 35,236 Dendritic cells (DC). We identified activated clusters of B-cells, NK cells and DCs expressing genes such as CD83, CD69, CXCR4, and genes related to the NF-kB and AP-1 pathways. We compared cell type abundances pre- and post-vaccination within each participant population and found that activated CD83+ cells significantly increased post-vaccination in healthy individuals and patients with MGUS (paired t-test, q < 0.1), but not in patients with SMM or overt MM. At baseline, patients with SMM and MM had significantly fewer memory B-cells and significantly more cytotoxic T-cells and NK cells, compared to healthy individuals (Wilcoxon, q < 0.1), which could partly explain the differences observed post-vaccination. Patients with MM also had significantly higher levels of tolerogenic IL-10-expressing DCs (DC10) at baseline (Wilcoxon, q < 0.1), which could be dampening antigen-specific T-cell responses.
Conclusion: We identified a significant expansion of activated B-cell, NK cell and DC subpopulations expressing CD83, CD69 and CXCR4, following vaccination in healthy individuals and patients with MGUS, but less so in patients with SMM and overt MM. Our results provide insight into the cellular mechanisms of immune response to SARS-CoV2 vaccination in healthy individuals and patients with precursor plasma cell malignancies and suggest that asymptomatic individuals with SMM may exhibit inferior response to vaccination.
Citation Format: Romanos Sklavenitis-Pistofidis, Yoshinobu Konishi, Michelle Aranha, Mahshid Rahmat, Ting Wu, Michael Timonian, Shohreh Varmeh, Daniel Heilpern-Mallory, Michael P. Agius, Nang K. Su, Elizabeth D. Lightbody, Jacqueline Perry, Erica M. Horowitz, Anna V. Justis, Daniel Auclair, Catherine R. Marinac, Eric S. Fischer, Gad Getz, Irene M. Ghobrial. Single-cell RNA-sequencing for immune profiling of SARS-CoV2 vaccine response in healthy individuals and patients with precursor plasma cell malignancies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3582.
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Affiliation(s)
| | | | | | | | - Ting Wu
- 2Broad Institute of MIT & Harvard, Cambridge, MA
| | | | | | | | | | - Nang K. Su
- 1Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | | | - Gad Getz
- 2Broad Institute of MIT & Harvard, Cambridge, MA
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10
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Lee DJ, El-Khoury H, Alberge JB, Sakrikar D, Barnidge D, Perkins MC, Harding S, Perry J, Davis MI, Amstutz J, Horowitz E, Rebbeck TR, Ghobrial IM, Marinac CR. Abstract 3651: Obesity, metabolic comorbidities, and lifestyle factors and their association with monoclonal gammopathies in a high-risk screened population: Results of the PROMISE study. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3651] [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
Background: Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant condition of multiple myeloma (MM) traditionally identified by serum protein electrophoresis (SPEP) and immunofixation (IFX). Recently, novel, ultra-sensitive mass spectrometry (MS)-based approaches have allowed for monoclonal (M)-protein detection at concentrations below SPEP levels.
MGUS has only few known risk factors implicated in its development and progression. Thus, we analyze MS results of the PROMISE nationwide U.S. screening study to evaluate risk factors for (1) MGUS at traditional SPEP/IFX levels of detection and (2) low-level monoclonal gammopathies, which bear uncertain etiology and clinical significance.
Methods: PROMISE enrolled individuals age ≥40 who are Black and/or have a first-degree relative with a blood cancer or MM precursor condition. Those with ≥2 first-degree relatives were eligible at age ≥18. Participants were screened for monoclonal gammopathy by MALDI-TOF MS and provided a survey querying metabolic comorbidities and lifestyle. M-protein concentrations ≥0.02 g/dL were considered traditionally-defined MGUS, whereas M-proteins <0.02 g/dL are hereafter referred to as monoclonal gammopathy of indeterminate potential (MGIP). Multivariable logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for exposure and MGUS/MGIP associations.
Results: 1,893 screened participants completed the survey. MGUS and MGIP were detected in 13.4% and 22.0% of Blacks and 8.6% and 26.7% of individuals with family history. Adjusting for sex, age at screening, income, and education, obesity or BMI of ≥30 was associated with MGUS (OR, 1.55; 95% CI, 1.08-2.21), compared to BMI <30. Clinician-diagnosed hypertension (yes/no) and diabetes mellitus (yes/no) were associated with MGUS with ORs 1.44 (95% CI, 1.01-2.04) and 1.88 (95% CI, 1.004-3.51). There were no significant associations between MGUS and high cholesterol, high triglycerides, heart disease, myocardial infarction, or stroke. Short sleep of ≤6 hours/day was associated with MGUS (OR, 1.43; 95% CI, 1.01-2.03), compared to >6 hours/day. Physical activity (metabolic equivalents/week), smoking status (current, past, never), alcohol consumption (g/day) had no associations with MGUS. No risk factor associations were found for MGIP.
Conclusion: In screening a high-risk population by mass spectrometry, we found associations of both traditionally established (obesity) and novel risk factors (diabetes, hypertension, short sleep) with MGUS. None of these exposures were associated with MGIP despite finding a high prevalence of MGIP in Blacks and individuals with family history, suggesting that these risk factors may not be etiologically involved in MGIP development but possibly its clonal expansion to more advanced stages.
Citation Format: David J. Lee, Habib El-Khoury, Jean-Baptiste Alberge, D.J. Sakrikar, David Barnidge, Mark C. Perkins, Stephen Harding, Jacqueline Perry, Maya I. Davis, Julia Amstutz, Erica Horowitz, Timothy R. Rebbeck, Irene M. Ghobrial, Catherine R. Marinac. Obesity, metabolic comorbidities, and lifestyle factors and their association with monoclonal gammopathies in a high-risk screened population: Results of the PROMISE study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3651.
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Konishi Y, Sklavenitis-Pistofidis R, Yue H, Ferrari F, Russo M, Redd RA, Perry J, Horowitz E, Justis AV, Shayegh NA, Lightbody ED, Varmeh S, Nowak RP, Hamilton M, Auclair D, Marinac CR, Trippa L, Fischer ES, Ghobrial IM. Abstract 5277: Humoral SARS-CoV-2 response in asymptomatic precursor plasma cell dyscrasia patients: IMPACT study results. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5277] [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
Introduction: Patients with hematologic malignancies, including multiple myeloma (MM), experience worse SARS-CoV-2 infection outcomes and sub-optimal vaccine responses. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) precede MM and affect ~5% of individuals age >=50. We previously showed that individuals with MGUS and SMM exhibit immune dysregulation. Here, we investigate the immune response to SARS-CoV-2 vaccination in these asymptomatic but potentially immunocompromised individuals.
Methods: The IMPACT study (IRB #20-332) is a prospective study at Dana-Farber Cancer Institute in collaboration with MMRF, which enrolled individuals nationwide with a diagnosed plasma cell dyscrasia and healthy individuals. As of October 2021, 3,005 individuals completed a questionnaire regarding prior infection or vaccination. We obtained 1,350 blood samples from 628 participants and analyzed anti-SARS-CoV-2 IgG antibody titer by ELISA.
Results: 2,771 (92%) participants were fully vaccinated (2 doses BNT162b2 or mRNA-1273; 1 dose Ad26.COV2.s), 269 (9%) had received a 3rd mRNA vaccine dose, and 234 (8%) were unvaccinated. 1,387 (46%) and 1,093 (36%) participants received mRNA vaccines (BNT162b2 and mRNA-1273), and 139 (5%) participants received an adenovirus vector vaccine (Ad26.COV2.S). 34 (1%) individuals reported SARS-CoV-2 infection after full vaccination.
We measured antibody titers in 201 MGUS, 223 SMM, 40 smoldering Waldenstrom macroglobulinemia (SWM), 64 MM, and 100 healthy controls. Multiple linear regression model estimated the association between various clinical variables and post-vaccination antibody titers. As previously reported, having MM was associated with low antibody titer (p < 0.001). Of note, having SMM, regardless of risk stratification by 2/20/20 criteria, was also associated with low antibody titers, indicating that even low-risk SMM patients have a poor response to vaccination. MGUS and SWM diagnoses were not significantly associated with antibody titers. Additionally, male sex (p < 0.010), elapsed time after vaccination (p < 0.001), and BNT162b2 vaccine (p < 0.001) were associated with low antibody titers. SARS-CoV-2 infection prior to vaccination was associated with high antibody titers.
We identified 25 patients (6 MGUS, 10 SMM, 2 SWM, 7 MM) who submitted blood samples after both the 2nd and 3rd dose. In these patients we observed a significant increase in antibody titer after a 3rd dose (p = 0.002). We also observed that antibody titers of patients after a 3rd dose (13 MGUS, 12 SMM, 2 SWM, 31 MM) were comparable to that of healthy individuals after a 2nd dose (p = 0.833).
Conclusion: Our data indicates that suboptimal response to SARS-CoV-2 does not only occur with MM and cancer patients receiving therapy but also in precursor asymptomatic patients including low-risk SMM.
Citation Format: Yoshinobu Konishi, Romanos Sklavenitis-Pistofidis, Hong Yue, Federico Ferrari, Massimiliano Russo, Robert A. Redd, Jacqueline Perry, Erica Horowitz, Anna V. Justis, Nader A. Shayegh, Elizabeth D. Lightbody, Shohreh Varmeh, Radoslaw P. Nowak, Mark Hamilton, Daniel Auclair, Catherine R. Marinac, Lorenzo Trippa, Eric S. Fischer, Irene M. Ghobrial. Humoral SARS-CoV-2 response in asymptomatic precursor plasma cell dyscrasia patients: IMPACT study results [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5277.
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Affiliation(s)
| | | | - Hong Yue
- 1Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | - Mark Hamilton
- 2Multiple Myeloma Research Foundation (MMRF), Norwalk, CT
| | - Daniel Auclair
- 2Multiple Myeloma Research Foundation (MMRF), Norwalk, CT
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12
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El-Khoury H, Lee DJ, Alberge JB, Redd R, Cea-Curry CJ, Perry J, Barr H, Murphy C, Sakrikar D, Barnidge D, Bustoros M, Leblebjian H, Cowan A, Davis MI, Amstutz J, Boehner CJ, Lightbody ED, Sklavenitis-Pistofidis R, Perkins MC, Harding S, Mo CC, Kapoor P, Mikhael J, Borrello IM, Fonseca R, Weiss ST, Karlson E, Trippa L, Rebbeck TR, Getz G, Marinac CR, Ghobrial IM. Prevalence of monoclonal gammopathies and clinical outcomes in a high-risk US population screened by mass spectrometry: a multicentre cohort study. Lancet Haematol 2022; 9:e340-e349. [PMID: 35344689 PMCID: PMC9067621 DOI: 10.1016/s2352-3026(22)00069-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Prevalence estimates for monoclonal gammopathy of undetermined significance (MGUS) are based on predominantly White study populations screened by serum protein electrophoresis supplemented with immunofixation electrophoresis. A prevalence of 3% is reported for MGUS in the general population of European ancestry aged 50 years or older. MGUS prevalence is two times higher in individuals of African descent or with a family history of conditions related to multiple myeloma. We aimed to evaluate the prevalence and clinical implications of monoclonal gammopathies in a high-risk US population screened by quantitative mass spectrometry. METHODS We used quantitative matrix-assisted laser desorption ionisation-time of flight (MALDI-TOF) mass spectrometry and EXENT-iQ software to screen for and quantify monoclonal gammopathies in serum from 7622 individuals who consented to the PROMISE screening study between Feb 26, 2019, and Nov 4, 2021, and the Mass General Brigham Biobank (MGBB) between July 28, 2010, and July 1, 2021. M-protein concentrations at the monoclonal gammopathy of indeterminate potential (MGIP) level were confirmed by liquid chromatography mass spectrometry testing. 6305 (83%; 2211 from PROMISE, 4094 from MGBB) of 7622 participants in the cohorts were at high risk for developing a monoclonal gammopathy on the basis of Black race or a family history of haematological malignancies and fell within the eligible high-risk age range (30 years or older for PROMISE cohort and 18 years or older for MGBB cohort); those over 18 years were also eligible if they had two or more family members with a blood cancer (PROMISE cohort). Participants with a plasma cell malignancy diagnosed before screening were excluded. Longitudinal clinical data were available for MGBB participants with a median follow-up time from serum sample screening of 4·5 years (IQR 2·4-6·7). The PROMISE study is registered with ClinicalTrials.gov, NCT03689595. FINDINGS The median age at time of screening was 56·0 years (IQR 46·8-64·1). 5013 (66%) of 7622 participants were female, 2570 (34%) male, and 39 (<1%) unknown. 2439 (32%) self-identified as Black, 4986 (65%) as White, 119 (2%) as other, and 78 (1%) unknown. Using serum protein electrophoresis with immunofixation electrophoresis, the MGUS prevalence was 6% (101 of 1714) in high-risk individuals aged 50 years or older. Using mass spectrometry, we observed a total prevalence of monoclonal gammopathies of 43% (1788 of 4207) in this group. We termed monoclonal gammopathies below the clinical immunofixation electrophoresis detection level (<0·2 g/L) MGIPs, to differentiate them from those with higher concentrations, termed mass-spectrometry MGUS, which had a 13% (592 of 4207) prevalence by mass spectrometry in high-risk individuals aged 50 years or older. MGIP was predominantly of immunoglobulin M isotype, and its prevalence increased with age (19% [488 of 2564] for individuals aged <50 years, 29% [1464 of 5058] for those aged ≥50 years, and 37% [347 of 946] for those aged ≥70 years). Mass-spectrometry MGUS prevalence increased with age (5% [127 of 2564] for individuals aged <50 years, 13% [678 of 5058] for those aged ≥50 years, and 18% [173 of 946] for those aged ≥70 years) and was higher in men (314 [12%] of 2570) compared with women (485 [10%] 5013; p=0·0002), whereas MGIP prevalence did not differ significantly by gender. In those aged 50 years or older, the prevalence of mass spectrometry was significantly higher in Black participants (224 [17%] of 1356) compared with the controls (p=0·0012) but not in those with family history (368 [13%] of 2851) compared with the controls (p=0·1008). Screen-detected monoclonal gammopathies correlated with increased all-cause mortality in MGBB participants (hazard ratio 1·55, 95% CI 1·16-2·08; p=0·0035). All monoclonal gammopathies were associated with an increased likelihood of comorbidities, including myocardial infarction (odds ratio 1·60, 95% CI 1·26-2·02; p=0·00016 for MGIP-high and 1·39, 1·07-1·80; p=0·015 for mass-spectrometry MGUS). INTERPRETATION We detected a high prevalence of monoclonal gammopathies, including age-associated MGIP, and made more precise estimates of mass-spectrometry MGUS compared with conventional gel-based methods. The use of mass spectrometry also highlighted the potential hidden clinical significance of MGIP. Our study suggests the association of monoclonal gammopathies with a variety of clinical phenotypes and decreased overall survival. FUNDING Stand Up To Cancer Dream Team, the Multiple Myeloma Research Foundation, and National Institutes of Health.
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Affiliation(s)
- Habib El-Khoury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - David J Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jean-Baptiste Alberge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Robert Redd
- Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christian J Cea-Curry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jacqueline Perry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Hadley Barr
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ciara Murphy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Mark Bustoros
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Houry Leblebjian
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Pharmacy, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna Cowan
- Alix School of Medicine, The Mayo Clinic, Rochester, MN, USA
| | - Maya I Davis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Julia Amstutz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Cody J Boehner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Elizabeth D Lightbody
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Romanos Sklavenitis-Pistofidis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Clifton C Mo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA; International Myeloma Foundation, North Hollywood, CA, USA
| | - Ivan M Borrello
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rafael Fonseca
- Department of Medical Oncology, The Mayo Clinic, Phoenix, AZ, USA
| | - Scott T Weiss
- Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth Karlson
- Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lorenzo Trippa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Timothy R Rebbeck
- The Center for Prevention of Progression of Blood Cancer, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Gad Getz
- Harvard Medical School, Boston, MA, USA; Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Catherine R Marinac
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; The Center for Prevention of Progression of Blood Cancer, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; The Center for Prevention of Progression of Blood Cancer, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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13
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Weeks LD, Marinac CR, Redd R, Abel G, Lin A, Agrawal M, Stone RM, Schrag D, Ebert BL. Age-related diseases of inflammation in myelodysplastic syndrome and chronic myelomonocytic leukemia. Blood 2022; 139:1246-1250. [PMID: 34875037 PMCID: PMC8874362 DOI: 10.1182/blood.2021014418] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/30/2021] [Indexed: 01/07/2023] Open
Affiliation(s)
- Lachelle D Weeks
- Department of Medical Oncology
- Center for Prevention of Progression
| | - Catherine R Marinac
- Center for Prevention of Progression
- Division of Population Sciences, Department of Medical Oncology
- Department of Data Science, and
| | - Robert Redd
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Gregory Abel
- Division of Population Sciences, Department of Medical Oncology
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Amy Lin
- Center for Prevention of Progression
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Richard M Stone
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Deborah Schrag
- Division of Population Sciences, Department of Medical Oncology
| | - Benjamin L Ebert
- Department of Medical Oncology
- Center for Prevention of Progression
- Broad Institute, Massachusetts Institute of Technology and Harvard University, Cambridge, MA; and
- Howard Hughes Medical Institute, Boston, MA
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14
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Parikh R, Tariq SM, Marinac CR, Shah UA. A comprehensive review of the impact of obesity on plasma cell disorders. Leukemia 2022; 36:301-314. [PMID: 34654885 PMCID: PMC8810701 DOI: 10.1038/s41375-021-01443-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/05/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022]
Abstract
Multiple myeloma (MM) remains an incurable plasma cell malignancy. Although little is known about the etiology of MM, several metabolic risk factors such as obesity, diabetes, poor nutrition, many of which are modifiable, have been linked to the pathogenesis of numerous neoplasms including MM. In this article, we provide a detailed summary of what is known about the impact of obesity on the pathogenesis of MM, its influence on outcomes in MM patients, and discuss potential mechanisms through which obesity is postulated to influence MM risk and prognosis. Along with advancements in treatment modalities to improve survival in MM patients, focused efforts are needed to prevent or intercept MM at its earliest stages. The consolidated findings presented in this review highlight the need for clinical trials to assess if lifestyle modifications can reduce the incidence and improve outcomes of MM in high-risk populations. Data generated from such studies can help formulate evidence-based lifestyle recommendations for the prevention and control of MM.
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Affiliation(s)
- Richa Parikh
- University of Arkansas for Medical Sciences, Myeloma Center, Little Rock, AR, USA
| | - Syed Maaz Tariq
- Jinnah Sindh Medical University, Karachi City, Sindh, Pakistan
| | - Catherine R. Marinac
- Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Urvi A. Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York City, NY 10065, USA
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15
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Konishi Y, Sklavenitis-Pistofidis R, Yue H, Ferrari F, Redd RA, Lightbody ED, Russo M, Perry J, Horowitz E, Justis AV, Shayegh NA, Savell A, Prescott J, Varmeh S, Nowak RP, Hamilton M, Auclair D, Marinac CR, Trippa L, Fischer ES, Ghobrial IM. Attenuated response to SARS-CoV-2 vaccine in patients with asymptomatic precursor stages of multiple myeloma and Waldenstrom macroglobulinemia. Cancer Cell 2022; 40:6-8. [PMID: 34895486 PMCID: PMC8654583 DOI: 10.1016/j.ccell.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Yoshinobu Konishi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
| | - Romanos Sklavenitis-Pistofidis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
| | - Hong Yue
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Federico Ferrari
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robert A Redd
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elizabeth D Lightbody
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
| | - Massimiliano Russo
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jacqueline Perry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Erica Horowitz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna V Justis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nader A Shayegh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alexandra Savell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Julia Prescott
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shohreh Varmeh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Radosław P Nowak
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Mark Hamilton
- Multiple Myeloma Research Foundation (MMRF), Norwalk, CT, USA
| | - Daniel Auclair
- Multiple Myeloma Research Foundation (MMRF), Norwalk, CT, USA
| | - Catherine R Marinac
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lorenzo Trippa
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Eric S Fischer
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA.
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16
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Marinac CR, Lee DH, Colditz GA, Rebbeck TR, Rosner B, Bustoros M, Ghobrial IM, Birmann BM. Regular Aspirin Use and Mortality in Multiple Myeloma Patients. Cancer Epidemiol Biomarkers Prev 2021; 31:479-485. [PMID: 34862208 DOI: 10.1158/1055-9965.epi-21-0946] [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] [Received: 08/05/2021] [Revised: 10/20/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inflammation is important in multiple myeloma (MM) pathogenesis, and regular aspirin use has been shown to confer a reduced risk of MM. The influence of aspirin on survival after MM diagnosis is unknown. METHODS We identified 436 men and women diagnosed with MM between 1980 and 2016 in the Health Professionals Follow-up Study (HPFS) and the Nurses' Health Study (NHS) who reported aspirin intake biennially on follow-up questionnaires. Using multivariable Cox proportional hazards regression models, we estimated hazard ratios (HR) and 95% confidence intervals (CI) associated with aspirin use on MM-specific and overall mortality. RESULTS Compared with nonusers, participants who used aspirin after diagnosis had a multivariable HR for MM-specific mortality of 0·61 (95% confidence interval [CI], 0·46, 0·79) and for overall mortality of 0·63 (95% CI, 0·49, 0·80), after adjustment for age at diagnosis, year of diagnosis, sex, body mass index, pre-diagnosis aspirin use, and number of comorbidities. For post-diagnosis aspirin quantity, we observed a modest trend of reduction in MM-specific and all-cause mortality with increasing number of 325 mg tablets of aspirin per week, although the confidence intervals for 1 to <6 and {greater than or equal to}6 tablets overlapped. Results were not materially different before or after the availability of novel therapies (before vs. after the year 2000). Pre-diagnosis frequency or duration of aspirin use was not significantly associated with MM-specific or overall mortality. CONCLUSIONS Findings support the use of aspirin as a complementary strategy to enhance MM survival. IMPACT Confirmation in samples that have comprehensive clinical information is encouraged.
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Affiliation(s)
- Catherine R Marinac
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine
| | - Timothy R Rebbeck
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital
| | - Mark Bustoros
- Hematology & Medical Oncology, Weill Cornell Medicine, Meyer Cancer Center, Cornell University
| | | | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School
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17
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Nadauld LD, McDonnell CH, Beer TM, Liu MC, Klein EA, Hudnut A, Whittington RA, Taylor B, Oxnard GR, Lipson J, Lopatin M, Shaknovich R, Chung KC, Fung ET, Schrag D, Marinac CR. The PATHFINDER Study: Assessment of the Implementation of an Investigational Multi-Cancer Early Detection Test into Clinical Practice. Cancers (Basel) 2021; 13:3501. [PMID: 34298717 PMCID: PMC8304888 DOI: 10.3390/cancers13143501] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 01/22/2023] Open
Abstract
To examine the extent of the evaluation required to achieve diagnostic resolution and the test performance characteristics of a targeted methylation cell-free DNA (cfDNA)-based multi-cancer early detection (MCED) test, ~6200 participants ≥50 years with (cohort A) or without (cohort B) ≥1 of 3 additional specific cancer risk factors will be enrolled in PATHFINDER (NCT04241796), a prospective, longitudinal, interventional, multi-center study. Plasma cfDNA from blood samples will be analyzed to detect abnormally methylated DNA associated with cancer (i.e., cancer "signal") and a cancer signal origin (i.e., tissue of origin). Participants with a "signal detected" will undergo further diagnostic evaluation per guiding physician discretion; those with a "signal not detected" will be advised to continue guideline-recommended screening. The primary objective will be to assess the number and types of subsequent diagnostic tests needed for diagnostic resolution. Based on microsimulations (using estimates of cancer incidence and dwell times) of the typical risk profiles of anticipated participants, the median (95% CI) number of participants with a "signal detected" result is expected to be 106 (87-128). Subsequent diagnostic evaluation is expected to detect 52 (39-67) cancers. The positive predictive value of the MCED test is expected to be 49% (39-58%). PATHFINDER will evaluate the integration of a cfDNA-based MCED test into existing clinical cancer diagnostic pathways. The study design of PATHFINDER is described here.
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Affiliation(s)
- Lincoln D. Nadauld
- Hematology/Oncology, Intermountain Healthcare, St. George, UT 84790, USA
| | | | - Tomasz M. Beer
- Hematology/Medical Oncology, Oregon Health & Science University Knight Cancer Institute, Portland, OR 97239, USA;
| | - Minetta C. Liu
- Departments of Oncology and Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Eric A. Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Andrew Hudnut
- Sutter Health, Sacramento, CA 95816, USA; (C.H.M.III); (A.H.)
| | - Richard A. Whittington
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, UT 84111, USA; (R.A.W.); (B.T.)
| | - Bruce Taylor
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, UT 84111, USA; (R.A.W.); (B.T.)
| | - Geoffrey R. Oxnard
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (G.R.O.); (D.S.); (C.R.M.)
| | - Jafi Lipson
- Radiology Department, Stanford Hospital and Clinics, Stanford, CA 94305, USA;
| | - Margarita Lopatin
- GRAIL, Inc., Menlo Park, CA 94025, USA; (M.L.); (R.S.); (K.C.C.); (E.T.F.)
| | - Rita Shaknovich
- GRAIL, Inc., Menlo Park, CA 94025, USA; (M.L.); (R.S.); (K.C.C.); (E.T.F.)
| | - Karen C. Chung
- GRAIL, Inc., Menlo Park, CA 94025, USA; (M.L.); (R.S.); (K.C.C.); (E.T.F.)
| | - Eric T. Fung
- GRAIL, Inc., Menlo Park, CA 94025, USA; (M.L.); (R.S.); (K.C.C.); (E.T.F.)
| | - Deborah Schrag
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (G.R.O.); (D.S.); (C.R.M.)
| | - Catherine R. Marinac
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (G.R.O.); (D.S.); (C.R.M.)
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18
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Chan AT, Drew DA, Nguyen LH, Joshi AD, Ma W, Guo CG, Lo CH, Mehta RS, Kwon S, Sikavi DR, Magicheva-Gupta MV, Fatehi ZS, Flynn JJ, Leonardo BM, Albert CM, Andreotti G, Beane-Freeman LE, Balasubramanian BA, Brownstein JS, Bruinsma F, Cowan AN, Deka A, Ernst ME, Figueiredo JC, Franks PW, Gardner CD, Ghobrial IM, Haiman CA, Hall JE, Deming-Halverson SL, Kirpach B, Lacey JV, Marchand LL, Marinac CR, Martinez ME, Milne RL, Murray AM, Nash D, Palmer JR, Patel AV, Rosenberg L, Sandler DP, Sharma SV, Schurman SH, Wilkens LR, Chavarro JE, Eliassen AH, Hart JE, Kang JH, Koenen KC, Kubzansky LD, Mucci LA, Ourselin S, Rich-Edwards JW, Song M, Stampfer MJ, Steves CJ, Willett WC, Wolf J, Spector T. The COronavirus Pandemic Epidemiology (COPE) Consortium: A Call to Action. Cancer Epidemiol Biomarkers Prev 2020; 29:1283-1289. [PMID: 32371551 PMCID: PMC7357669 DOI: 10.1158/1055-9965.epi-20-0606] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/08/2023] Open
Abstract
The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) pandemic presents challenges to the real-time collection of population-scale data to inform near-term public health needs as well as future investigations. We established the COronavirus Pandemic Epidemiology (COPE) consortium to address this unprecedented crisis on behalf of the epidemiology research community. As a central component of this initiative, we have developed a COVID Symptom Study (previously known as the COVID Symptom Tracker) mobile application as a common data collection tool for epidemiologic cohort studies with active study participants. This mobile application collects information on risk factors, daily symptoms, and outcomes through a user-friendly interface that minimizes participant burden. Combined with our efforts within the general population, data collected from nearly 3 million participants in the United States and United Kingdom are being used to address critical needs in the emergency response, including identifying potential hot spots of disease and clinically actionable risk factors. The linkage of symptom data collected in the app with information and biospecimens already collected in epidemiology cohorts will position us to address key questions related to diet, lifestyle, environmental, and socioeconomic factors on susceptibility to COVID-19, clinical outcomes related to infection, and long-term physical, mental health, and financial sequalae. We call upon additional epidemiology cohorts to join this collective effort to strengthen our impact on the current health crisis and generate a new model for a collaborative and nimble research infrastructure that will lead to more rapid translation of our work for the betterment of public health.
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Affiliation(s)
- Andrew T Chan
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David A Drew
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Long H Nguyen
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amit D Joshi
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wenjie Ma
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Chuan-Guo Guo
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Chun-Han Lo
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Raaj S Mehta
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sohee Kwon
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel R Sikavi
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marina V Magicheva-Gupta
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zahra S Fatehi
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jacqueline J Flynn
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brianna M Leonardo
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christine M Albert
- Department of Cardiology, Cedars-Sinai Hospital, Los Angeles, California
| | - Gabriella Andreotti
- Division of Cancer Epidemiology & Genetics, Occupational and Environmental Epidemiology Branch, National Institutes of Health, National Cancer Institute, Bethesda, Maryland
| | - Laura E Beane-Freeman
- Division of Cancer Epidemiology & Genetics, Occupational and Environmental Epidemiology Branch, National Institutes of Health, National Cancer Institute, Bethesda, Maryland
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Science, UTHealth School of Public Health, Houston, Texas
| | - John S Brownstein
- Computational Epidemiology Group, Boston Children's Hospital, Boston, Massachusetts
| | - Fiona Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Annie N Cowan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Hospital, Los Angeles, California
| | - Paul W Franks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Genetic and Molecular Epidemiology, Lund University, Malmo, Sweden
| | - Christopher D Gardner
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center and the Epidemiology and Genetics Division, Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Janet E Hall
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | | | - Brenda Kirpach
- Hennepin Health Care Research Institute, Berman Center for Outcomes and Clinical Research, Minneapolis, Minnesota
| | - James V Lacey
- Division of Health Analytics, Department of Computational and Quantitative Medicine, City of Hope, Duarte, California
| | | | - Catherine R Marinac
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
- Moores Cancer Center, University of California, San Diego, La Jolla California
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Anne M Murray
- Hennepin Health Care Research Institute, Berman Center for Outcomes and Clinical Research, Minneapolis, Minnesota
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York, New York
- Department of Epidemiology and Biostatistics, School of Public Health, City University of New York (CUNY), New York, New York
| | - Julie R Palmer
- Slone Epidemiology Center, School of Medicine, Boston University, Boston, Massachusetts
| | | | - Lynn Rosenberg
- Slone Epidemiology Center, School of Medicine, Boston University, Boston, Massachusetts
| | - Dale P Sandler
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics, and Environmental Science, UTHealth School of Public Health, Houston, Texas
| | - Shepherd H Schurman
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | | | - Jorge E Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jae Hee Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences and Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sebastien Ourselin
- Department of Twin Research & Genetic Epidemiology, Kings College, London, United Kingdom
| | - Janet W Rich-Edwards
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mingyang Song
- Clinical & Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meir J Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Claire J Steves
- Department of Twin Research & Genetic Epidemiology, Kings College, London, United Kingdom
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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19
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Lee DH, Fung TT, Tabung FK, Marinac CR, Devore EE, Rosner BA, Ghobrial IM, Colditz GA, Giovannucci EL, Birmann BM. Prediagnosis dietary pattern and survival in patients with multiple myeloma. Int J Cancer 2020; 147:1823-1830. [PMID: 32067221 DOI: 10.1002/ijc.32928] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Abstract
Inflammation and endogenous growth factors are important in multiple myeloma (MM) pathogenesis. Although diets that modulate these biologic pathways may influence MM patient survival, studies have not examined the association of dietary patterns with MM survival. We conducted pooled prospective survival analyses of 423 MM patients from the Nurses' Health Study (1986-2016) and the Health Professionals Follow-up Study (1988-2016) using Cox regression models. We used data from repeated food frequency questionnaires (FFQ) to compute dietary patterns as of the last prediagnosis FFQ, including the Alternate Healthy Eating Index (AHEI)-2010, alternate Mediterranean Diet, Dietary Approaches to Stop Hypertension, Prudent, Western and empirical dietary inflammatory patterns and empirical dietary indices for insulin resistance and hyperinsulinemia. During follow-up, we documented 295 MM-related deaths among 345 total deaths. MM-specific mortality was 15-24% lower per one standard deviation (SD) increase (e.g., toward healthier habits) in favorable dietary pattern scores. For example, the multivariable-adjusted hazard ratio [HR] and 95% confidence interval [CI] per 1-SD increase in AHEI-2010 score were 0.76, 0.67-0.87 (p < 0.001). In contrast, MM-specific mortality was 16-24% higher per 1-SD increase (e.g., toward less healthy habits) in "unhealthy" diet scores; for example, the multivariable-adjusted HR, 95% CI per 1-SD increase in Western pattern score were 1.24, 1.07-1.44 (p = 0.005). Associations were similar for all-cause mortality. In conclusion, our consistent findings for multiple dietary patterns provide the first evidence that MM patients with healthier prediagnosis dietary habits may have longer survival than those with less healthy diets.
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Affiliation(s)
- Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Teresa T Fung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Nutrition, Simmons University, Boston, MA
| | - Fred K Tabung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Catherine R Marinac
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth E Devore
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Graham A Colditz
- Department of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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20
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Marinac CR, Ghobrial IM, Birmann BM, Soiffer J, Rebbeck TR. Dissecting racial disparities in multiple myeloma. Blood Cancer J 2020; 10:19. [PMID: 32066732 PMCID: PMC7026439 DOI: 10.1038/s41408-020-0284-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/17/2019] [Accepted: 08/01/2019] [Indexed: 01/12/2023] Open
Abstract
Multiple myeloma (MM) is a fatal plasma cell dyscrasia with a median overall survival of 5 to 10 years. MM progresses from the more common but often subclinical precursor states of monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) to overt MM. There are large racial disparities in all stages of the disease. Compared with Whites, Blacks have an increased MGUS and MM risk and higher mortality rate, and have not experienced the same survival gains over time. The roots of this disparity are likely multifactorial in nature. Comparisons of Black and White MGUS and MM patients suggest that differences in risk factors, biology, and clinical characteristics exist by race or ancestry, which may explain some of the observed disparity in MM. However, poor accrual of Black MGUS and MM patients in clinical and epidemiological studies has limited our understanding of this disparity and hindered its elimination. Disparities in MM survival also exist but appear to stem from inferior treatment utilization and access rather than underlying pathogenesis. Innovative and multidisciplinary approaches are urgently needed to enhance our understanding of disparities that exist at each stage of the MM disease continuum and facilitate their elimination.
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Affiliation(s)
- Catherine R Marinac
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.,The Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA.,The Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Jenny Soiffer
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Timothy R Rebbeck
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
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21
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Campbell HF, Marinac CR, Masarwi M, Birmann B, Reagan M. Investigation of the relationship between obesity, weight cycling, and tumor progression in a myeloma xenograft model. Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.09.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Pu M, Messer K, Davies SR, Vickery TL, Pittman E, Parker BA, Ellis MJ, Flatt SW, Marinac CR, Nelson SH, Mardis ER, Pierce JP, Natarajan L. Research-based PAM50 signature and long-term breast cancer survival. Breast Cancer Res Treat 2019; 179:197-206. [PMID: 31542876 PMCID: PMC6985186 DOI: 10.1007/s10549-019-05446-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 12/21/2022]
Abstract
Purpose Multi-gene signatures provide biological insight and risk stratification in breast cancer. Intrinsic molecular subtypes defined by mRNA expression of 50 genes (PAM50) are prognostic in hormone-receptor positive postmenopausal breast cancer. Yet, for 25–40% in the PAM50 intermediate risk group, long-term risk remains uncertain. Our study aimed to (i) test the long-term prognostic value of the PAM50 signature in pre- and post-menopausal breast cancer; (ii) investigate if the PAM50 model could be improved by addition of other mRNAs implicated in oncogenesis. Methods We used archived FFPE samples from 1723 breast cancer survivors; high quality reads were obtained on 1253 samples. Transcript expression was quantified using a custom codeset with probes for > 100 targets. Cox models assessed gene signatures for breast cancer relapse and survival. Results Over 15 + years of follow-up, PAM50 subtypes were (P < 0.01) associated with breast cancer outcomes after accounting for tumor stage, grade and age at diagnosis. Results did not differ by menopausal status at diagnosis. Women with Luminal B (versus Luminal A) subtype had a > 60% higher hazard. Addition of a 13-gene hypoxia signature improved prognostication with > 40% higher hazard in the highest vs lowest hypoxia tertiles. Conclusions PAM50 intrinsic subtypes were independently prognostic for long-term breast cancer survival, irrespective of menopausal status. Addition of hypoxia signatures improved risk prediction. If replicated, incorporating the 13-gene hypoxia signature into the existing PAM50 risk assessment tool, may refine risk stratification and further clarify treatment for breast cancer. Electronic supplementary material The online version of this article (10.1007/s10549-019-05446-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Minya Pu
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
| | - Karen Messer
- Department of Family Medicine and Public Health, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA
| | - Sherri R Davies
- Department of Medicine, Washington University St. Louis, St. Louis, MO, USA
| | - Tammi L Vickery
- Washington University St. Louis, McDonnell Genome Institute, St. Louis, MO, USA
| | - Emily Pittman
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
| | - Barbara A Parker
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Matthew J Ellis
- Baylor College of Medicine, Lester and Sue Smith Breast Center, Houston, TX, USA
| | - Shirley W Flatt
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
| | - Catherine R Marinac
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Elaine R Mardis
- Nationwide Children's Hospital, Institute for Genomic Medicine, Columbus, OH, USA
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA
| | - Loki Natarajan
- Department of Family Medicine and Public Health, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA.
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23
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Hartman SJ, Nelson SH, Marinac CR, Natarajan L, Parker BA, Patterson RE. The effects of weight loss and metformin on cognition among breast cancer survivors: Evidence from the Reach for Health study. Psychooncology 2019; 28:1640-1646. [PMID: 31140202 DOI: 10.1002/pon.5129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Breast cancer survivors experience problems with cognition that interfere with daily life and can last for years. In the general population, obesity and diabetes are risk factors for cognitive decline, and weight loss can improve cognition; however, the impact of intentional weight loss on cancer survivors' cognition has not been tested. We investigated the impact of weight loss and metformin on changes in cognitive function in a sample of breast cancer survivors. METHODS Overweight/obese postmenopausal breast cancer survivors (n = 333) were randomized to a weight loss intervention versus control and metformin versus placebo in a 2 × 2 factorial design. Outcomes were changes in five cognitive domains from baseline to 6 months measured by objective neurocognitive tests. RESULTS There were no statistically significant intervention effects for the metformin or weight loss interventions in five neurocognitive domains. Baseline body mass index (BMI) was a significant effect modifier of the changes in verbal functioning for the weight loss (P = 0.009) and metformin interventions (P = 0.0125). These effect modifications were independent of percent weight loss achieved during the 6-month study period. CONCLUSIONS This randomized controlled trial of weight loss and metformin interventions that examined changes to cognition among breast cancer survivors suggests that these interventions may not improve cognitive functioning among breast cancer survivors in general. However, weight loss may improve verbal functioning among individuals with a higher BMI.
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Affiliation(s)
- Sheri J Hartman
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, California.,UC San Diego Moores Cancer Center, UC San Diego, La Jolla, California
| | - Sandahl H Nelson
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, California.,UC San Diego Moores Cancer Center, UC San Diego, La Jolla, California
| | - Catherine R Marinac
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Loki Natarajan
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, California.,UC San Diego Moores Cancer Center, UC San Diego, La Jolla, California
| | - Barbara A Parker
- UC San Diego Moores Cancer Center, UC San Diego, La Jolla, California.,Department of Medicine, UC San Diego, La Jolla, California
| | - Ruth E Patterson
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, California.,UC San Diego Moores Cancer Center, UC San Diego, La Jolla, California
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24
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Marinac CR, Suppan CA, Giovannucci E, Song M, Kværner AS, Townsend MK, Rosner BA, Rebbeck TR, Colditz GA, Birmann BM. Elucidating Under-Studied Aspects of the Link Between Obesity and Multiple Myeloma: Weight Pattern, Body Shape Trajectory, and Body Fat Distribution. JNCI Cancer Spectr 2019; 3:pkz044. [PMID: 31448358 PMCID: PMC6699596 DOI: 10.1093/jncics/pkz044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/30/2019] [Accepted: 06/19/2019] [Indexed: 11/14/2022] Open
Abstract
Background Although obesity is an established modifiable risk factor for multiple myeloma (MM), several nuanced aspects of its relation to MM remain unelucidated, limiting public health and prevention messages. Methods We analyzed prospective data from the Nurses' Health Study and Health Professionals Follow-Up Study to examine MM risk associated with 20-year weight patterns in adulthood, body shape trajectory from ages 5 to 60 years, and body fat distribution. For each aforementioned risk factor, we report hazard ratios (HRs) and 95% confidence intervals (CIs) for incident MM from multivariable Cox proportional-hazards models. Results We documented 582 incident MM cases during 4 280 712 person-years of follow-up. Persons who exhibited extreme weight cycling, for example, those with net weight gain and one or more episodes of intentional loss of at least 20 pounds or whose cumulative intentional weight loss exceeded net weight loss with at least one episode of intentional loss of 20 pounds or more had an increased MM risk compared with individuals who maintained their weight (HR = 1.71, 95% CI = 1.05 to 2.80); the association was statistically nonsignificant after adjustment for body mass index. We identified four body shape trajectories: lean-stable, lean-increase, medium-stable, and medium-increase. MM risk was higher in the medium-increase group than in the lean-stable group (HR = 1.62, 95% CI = 1.22 to 2.14). Additionally, MM risk increased with increasing hip circumference (HR per 1-inch increase: 1.03, 95% CI = 1.01 to 1.06) but was not associated with other body fat distribution measures. Conclusions Maintaining a lean and stable weight throughout life may provide the strongest benefit in terms of MM prevention.
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Affiliation(s)
| | | | | | - Mingyang Song
- See the Notes section for the full list of authors' affiliations
| | - Ane S Kværner
- See the Notes section for the full list of authors' affiliations
| | - Mary K Townsend
- See the Notes section for the full list of authors' affiliations
| | - Bernard A Rosner
- See the Notes section for the full list of authors' affiliations
| | | | - Graham A Colditz
- See the Notes section for the full list of authors' affiliations
| | - Brenda M Birmann
- See the Notes section for the full list of authors' affiliations
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25
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Natarajan L, Pu M, Davies SR, Vickery TL, Nelson SH, Pittman E, Parker BA, Ellis MJ, Flatt SW, Mardis ER, Marinac CR, Pierce JP, Messer K. miRNAs and Long-term Breast Cancer Survival: Evidence from the WHEL Study. Cancer Epidemiol Biomarkers Prev 2019; 28:1525-1533. [PMID: 31186261 DOI: 10.1158/1055-9965.epi-18-1322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/22/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is substantial variation in breast cancer survival rates, even among patients with similar clinical and genomic profiles. New biomarkers are needed to improve risk stratification and inform treatment options. Our aim was to identify novel miRNAs associated with breast cancer survival and quantify their prognostic value after adjusting for established clinical factors and genomic markers. METHODS Using the Women's Healthy Eating and Living (WHEL) breast cancer cohort with >15 years of follow-up and archived tumor specimens, we assayed PAM50 mRNAs and 25 miRNAs using the Nanostring nCounter platform. RESULTS We obtained high-quality reads on 1,253 samples (75% of available specimens) and used an existing research-use algorithm to ascertain PAM50 subtypes and risk scores (ROR-PT). We identified miRNAs significantly associated with breast cancer outcomes and then tested these in independent TCGA samples. miRNAs that were also prognostic in TCGA samples were further evaluated in multiple regression Cox models. We also used penalized regression for unbiased discovery. CONCLUSIONS Two miRNAs, 210 and 29c, were associated with breast cancer outcomes in the WHEL and TCGA studies and further improved risk stratification within PAM50 risk groups: 10-year survival was 62% in the node-negative high miR-210-high ROR-PT group versus 75% in the low miR-210- high ROR-PT group. Similar results were obtained for miR-29c. We identified three additional miRNAs, 187-3p, 143-3p, and 205-5p, via penalized regression. IMPACT Our findings suggest that miRNAs might be prognostic for long-term breast cancer survival and might improve risk stratification. Further research to incorporate miRNAs into existing clinicogenomic signatures is needed.
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Affiliation(s)
- Loki Natarajan
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California. .,Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Minya Pu
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Sherri R Davies
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Tammi L Vickery
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
| | - Sandahl H Nelson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Emily Pittman
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Barbara A Parker
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,Department of Medicine, University of California, San Diego, La Jolla, California
| | - Matthew J Ellis
- Baylor College of Medicine, Lester and Sue Smith Breast Center, Houston, Texas
| | - Shirley W Flatt
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Elaine R Mardis
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Catherine R Marinac
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.,Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Karen Messer
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.,Moores Cancer Center, University of California, San Diego, La Jolla, California
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26
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Bustoros M, Kastritis E, Sklavenitis‐Pistofidis R, Liu C, Hornburg K, Kanellias N, Kim G, Liu D, Gavriatopoulou M, Marinac CR, Roussou M, Migkou M, Noonan K, Reyes K, Rivotto B, Neuse CJ, Ziogas DC, Laubach J, Terpos E, Anderson KC, Richardson PG, Ghobrial IM, Dimopoulos MA. Bone marrow biopsy in low-risk monoclonal gammopathy of undetermined significance reveals a novel smoldering multiple myeloma risk group. Am J Hematol 2019; 94:E146-E149. [PMID: 30773670 DOI: 10.1002/ajh.25441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Mark Bustoros
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Efstathios Kastritis
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens, School of Medicine Athens Greece
| | - Romanos Sklavenitis‐Pistofidis
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Chia‐Jen Liu
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Kalvis Hornburg
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Nikolaos Kanellias
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens, School of Medicine Athens Greece
| | - Geon Kim
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - David Liu
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Maria Gavriatopoulou
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens, School of Medicine Athens Greece
| | - Catherine R. Marinac
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health Boston Massachusetts
| | - Maria Roussou
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens, School of Medicine Athens Greece
| | - Magdalini Migkou
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens, School of Medicine Athens Greece
| | - Kimberly Noonan
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Kaitlen Reyes
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Bradley Rivotto
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Carl Jannes Neuse
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Dimitrios C. Ziogas
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens, School of Medicine Athens Greece
| | - Jacob Laubach
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Evangelos Terpos
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens, School of Medicine Athens Greece
| | - Kenneth C. Anderson
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Paul G. Richardson
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Irene M. Ghobrial
- Center for Prevention of Progression of Blood CancersDana‐Farber Cancer Institute Boston Massachusetts
- Department of Medical Oncology, Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Meletios A. Dimopoulos
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens, School of Medicine Athens Greece
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27
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Nelson SH, Natarajan L, Patterson RE, Hartman SJ, Thompson CA, Godbole SV, Johnson E, Marinac CR, Kerr J. Physical Activity Change in an RCT: Comparison of Measurement Methods. Am J Health Behav 2019; 43:543-555. [PMID: 31046885 DOI: 10.5993/ajhb.43.3.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives: We aimed to quantify the agreement between self-report, standard cut-point accelerometer, and machine learning accelerometer estimates of physical activity (PA), and exam- ine how agreement changes over time among older adults in an intervention setting. Methods: Data were from a randomized weight loss trial that encouraged increased PA among 333 postmenopausal breast cancer survivors. PA was estimated using accelerometry and a validated questionnaire at baseline and 6-months. Accelerometer data were processed using standard cut-points and a validated machine learning algorithm. Agreement of PA at each time-point and change was assessed using mixed effects regression models and concordance correlation. Results: At baseline, self-report and machine learning provided similar PA estimates (mean dif- ference = 11.5 min/day) unlike self-report and standard cut-points (mean difference = 36.3 min/ day). Cut-point and machine learning methods assessed PA change over time more similarly than other comparisons. Specifically, the mean difference of PA change for the cut-point versus machine learning methods was 5.1 min/day for intervention group and 2.9 in controls, whereas it was ≥ 24.7 min/day for other comparisons. Conclusions: Intervention researchers are facing the issue of self-report measures introducing bias and accelerometer cut-points being insensi- tive. Machine learning approaches may bridge this gap.
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28
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Bustoros M, Sklavenitis-Pistofidis R, Kapoor P, Liu CJ, Kastritis E, Zanwar S, Fell G, Abeykoon JP, Hornburg K, Neuse CJ, Marinac CR, Liu D, Soiffer J, Gavriatopoulou M, Boehner C, Cappuccio JM, Dumke H, Reyes K, Soiffer RJ, Kyle RA, Treon SP, Castillo JJ, Dimopoulos MA, Ansell SM, Trippa L, Ghobrial IM. Progression Risk Stratification of Asymptomatic Waldenström Macroglobulinemia. J Clin Oncol 2019; 37:1403-1411. [PMID: 30990729 DOI: 10.1200/jco.19.00394] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Waldenström macroglobulinemia (WM) is preceded by asymptomatic WM (AWM), for which the risk of progression to overt disease is not well defined. METHODS We studied 439 patients with AWM, who were diagnosed and observed at Dana-Farber Cancer Institute between 1992 and 2014. RESULTS During the 23-year study period, with a median follow-up of 7.8 years, 317 patients progressed to symptomatic WM (72%). Immunoglobulin M 4,500 mg/dL or greater, bone marrow lymphoplasmacytic infiltration 70% or greater, β2-microglobulin 4.0 mg/dL or greater, and albumin 3.5 g/dL or less were all identified as independent predictors of disease progression. To assess progression risk in patients with AWM, we trained and cross-validated a proportional hazards model using bone marrow infiltration, immunoglobulin M, albumin, and beta-2 microglobulin values as continuous measures. The model divided the cohort into three distinct risk groups: a high-risk group with a median time to progression (TTP) of 1.8 years, an intermediate-risk group with a median TTP of 4.8 years, and a low-risk group with a median TTP of 9.3 years. We validated this model in two external cohorts, demonstrating robustness and generalizability. For clinical applicability, we made the model available as a Web page application ( www.awmrisk.com ). By combining two cohorts, we were powered to identify wild type MYD88 as an independent predictor of progression (hazard ratio, 2.7). CONCLUSION This classification system is positioned to inform patient monitoring and care and, for the first time to our knowledge, to identify patients with high-risk AWM who may need closer follow-up or benefit from early intervention.
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Affiliation(s)
- Mark Bustoros
- 1 Dana-Farber Cancer Institute, Boston, MA.,3 Harvard Medical School, Boston, MA
| | | | | | - Chia-Jen Liu
- 1 Dana-Farber Cancer Institute, Boston, MA.,5 Tapei Veterans General Hospital, Taipei, Taiwan.,6 National Yang-Ming University, Taipei, Taiwan
| | | | | | | | | | | | - Carl Jannes Neuse
- 1 Dana-Farber Cancer Institute, Boston, MA.,8 University of Münster Faculty of Medicine, Münster, Germany
| | - Catherine R Marinac
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Harvard T.H. Chan School of Public Health, Boston, MA
| | - David Liu
- 1 Dana-Farber Cancer Institute, Boston, MA.,3 Harvard Medical School, Boston, MA
| | - Jenny Soiffer
- 1 Dana-Farber Cancer Institute, Boston, MA.,9 University of Miami Miller School of Medicine, Miami, FL
| | | | - Cody Boehner
- 1 Dana-Farber Cancer Institute, Boston, MA.,10 University of Massachusetts, Boston, MA
| | | | | | | | - Robert J Soiffer
- 1 Dana-Farber Cancer Institute, Boston, MA.,3 Harvard Medical School, Boston, MA
| | | | - Steven P Treon
- 1 Dana-Farber Cancer Institute, Boston, MA.,3 Harvard Medical School, Boston, MA
| | - Jorge J Castillo
- 1 Dana-Farber Cancer Institute, Boston, MA.,3 Harvard Medical School, Boston, MA
| | | | | | - Lorenzo Trippa
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Harvard T.H. Chan School of Public Health, Boston, MA
| | - Irene M Ghobrial
- 1 Dana-Farber Cancer Institute, Boston, MA.,3 Harvard Medical School, Boston, MA
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Marinac CR, Birmann BM. Rising cancer incidence in younger adults: is obesity to blame? The Lancet Public Health 2019; 4:e119-e120. [DOI: 10.1016/s2468-2667(19)30017-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
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Cespedes Feliciano EM, Quante M, Weng J, Mitchell JA, James P, Marinac CR, Mariani S, Redline S, Kerr J, Godbole S, Manteiga A, Wang D, Hipp JA. Actigraphy-Derived Daily Rest-Activity Patterns and Body Mass Index in Community-Dwelling Adults. Sleep 2018; 40:4344553. [PMID: 29029250 DOI: 10.1093/sleep/zsx168] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Study Objectives To examine associations between 24-hour rest-activity patterns and body mass index (BMI) among community-dwelling US adults. Rest-activity patterns provide a field method to study exposures related to circadian rhythms. Methods Adults (N = 578) wore an actigraph on their nondominant wrist for 7 days. Intradaily variability and interdaily stability (IS), M10 (most active 10-hours), L5 (least active 5-hours), and relative amplitude (RA) were derived using nonparametric rhythm analysis. Mesor, acrophase, and amplitude were calculated from log-transformed count data using the parametric cosinor approach. Results Participants were 80% female and mean (standard deviation) age was 52 (15) years. Participants with higher BMI had lower values for magnitude, RA, IS, total sleep time (TST), and sleep efficiency. In multivariable analyses, less robust 24-hour rest-activity patterns as represented by lower RA were consistently associated with higher BMI: comparing the bottom quintile (least robust) to the top quintile (most robust 24-hour rest-activity pattern) of RA, BMI was 3-kg/m2 higher (p = .02). Associations were similar in magnitude to an hour less of TST (1-kg/m2 higher BMI) or a 10% decrease in sleep efficiency (2-kg/m2 higher BMI), and independent of age, sex, race, education, and the duration of rest and/or activity. Conclusions Lower RA, reflecting both higher night activity and lower daytime activity, was associated with higher BMI. Independent of the duration of rest or activity during the day or night, 24-hour rest, and activity patterns from actigraphy provide aggregated measures of activity that associate with BMI in community-dwelling adults.
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Affiliation(s)
| | - Mirja Quante
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Neonatology, University of Tuebingen, Tuebingen, Baden-Wuerttemberg, Germany
| | - Jia Weng
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jonathan A Mitchell
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA.,Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Sara Mariani
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA.,Moores UC San Diego Cancer Center, La Jolla, CA
| | - Suneeta Godbole
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Alicia Manteiga
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO
| | - Daniel Wang
- Moores UC San Diego Cancer Center, La Jolla, CA
| | - J Aaron Hipp
- Department of Parks, Recreation, and Tourism Management, North Carolina State University, Raleigh, NC.,Center for Geospatial Analytics, North Carolina State University, Raleigh, NC.,Center for Human Health and the Environment, North Carolina State University, Raleigh, NC
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Patterson RE, Marinac CR, Sears DD, Kerr J, Hartman SJ, Cadmus-Bertram L, Villaseñor A, Flatt SW, Godbole S, Li H, Laughlin GA, Oratowski-Coleman J, Parker BA, Natarajan L. The Effects of Metformin and Weight Loss on Biomarkers Associated With Breast Cancer Outcomes. J Natl Cancer Inst 2018; 110:1239-1247. [PMID: 29788487 PMCID: PMC6235688 DOI: 10.1093/jnci/djy040] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/05/2018] [Accepted: 02/16/2018] [Indexed: 12/19/2022] Open
Abstract
Background This study investigated the effects of metformin and weight loss on biomarkers associated with breast cancer prognosis. Methods Overweight/obese postmenopausal breast cancer survivors (n = 333) were randomly assigned to metformin vs placebo and to a weight loss intervention vs control (ie, usual care). The 2 × 2 factorial design allows a single randomized trial to investigate the effect of two factors and interactions between them. Outcomes were changes in fasting insulin, glucose, C-reactive protein (CRP), estradiol, testosterone, and sex-hormone binding globulin (SHBG). The trial was powered for a main effects analysis of metformin vs placebo and weight loss vs control. All tests of statistical significance were two-sided. Results A total of 313 women (94.0%) completed the six-month trial. High prescription adherence (ie, ≥80% of pills taken) ranged from 65.9% of participants in the metformin group to 81.3% of those in the placebo group (P < .002). Mean percent weight loss was statistically significantly higher in the weight loss group (-5.5%, 95% confidence interval [CI] = -6.3% to -4.8%) compared with the control group (-2.7%, 95% CI = -3.5% to -1.9%). Statistically significant group differences (ie, percent change in metformin group minus placebo group) were -7.9% (95% CI = -15.0% to -0.8%) for insulin, -10.0% (95% CI = -18.5% to -1.5%) for estradiol, -9.5% (95% CI = -15.2% to -3.8%) for testosterone, and 7.5% (95% CI = 2.4% to 12.6%) for SHBG. Statistically significant group differences (ie, percent change in weight loss group minus placebo group) were -12.5% (95% CI = -19.6% to -5.3%) for insulin and 5.3% (95% CI = 0.2% to 10.4%) for SHBG. Conclusions As adjuvant therapy, weight loss and metformin were found to be a safe combination strategy that modestly lowered estrogen levels and advantageously affected other biomarkers thought to be on the pathway for reducing breast cancer recurrence and mortality.
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Affiliation(s)
- Ruth E Patterson
- Department of Family Medicine and Public Health, La Jolla, CA
- Moores UC San Diego Cancer Center, La Jolla, CA
| | - Catherine R Marinac
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Dorothy D Sears
- Department of Family Medicine and Public Health, La Jolla, CA
- Department of Medicine, La Jolla, CA
- Moores UC San Diego Cancer Center, La Jolla, CA
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, La Jolla, CA
- Moores UC San Diego Cancer Center, La Jolla, CA
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, La Jolla, CA
- Moores UC San Diego Cancer Center, La Jolla, CA
| | | | - Adriana Villaseñor
- Department of Family Medicine and Public Health, La Jolla, CA
- Moores UC San Diego Cancer Center, La Jolla, CA
| | | | | | | | - Gail A Laughlin
- Department of Family Medicine and Public Health, La Jolla, CA
| | | | - Barbara A Parker
- Department of Medicine, La Jolla, CA
- Moores UC San Diego Cancer Center, La Jolla, CA
| | - Loki Natarajan
- Department of Family Medicine and Public Health, La Jolla, CA
- Moores UC San Diego Cancer Center, La Jolla, CA
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Quante M, Mariani S, Weng J, Marinac CR, Kaplan ER, Rueschman M, Mitchell JA, James P, Hipp JA, Cespedes Feliciano EM, Wang R, Redline S. Zeitgebers and their association with rest-activity patterns. Chronobiol Int 2018; 36:203-213. [PMID: 30365354 DOI: 10.1080/07420528.2018.1527347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/29/2023]
Abstract
Zeitgebers such as light, eating and physical activity provide input to the circadian clock. Chronic circadian misalignment is associated with significant adverse health effects. An improved understanding of the impact of the timing of zeitgebers on the stability of 24-hour rest-activity rhythm in free-living settings may identify behavioural and environmental intervention targets. A total of 133 healthy adults, aged 21-60 years, wore a wrist actigraph for 7 consecutive days. We applied a non-parametric analysis to activity counts to derive rest-activity patterns. We administered a questionnaire through a smartphone app to collect self-reported timing of light exposure, eating episodes and physical activity. To assess the relationship between timing exposures (first and last exposure to outdoor light, first exposure to indoor light, last eating episode, first eating episode, morning physical activity proportion, evening physical activity proportion) and rest-activity or sleep outcomes (bedtimes, total sleep time, inter-daily stability, intra-daily variability, L5 and M10 midpoint), we first calculated Spearman correlations, using the false discovery rate method to control for multiple comparisons. From those significant associations, we then fit regression models adjusting for age, sex, race, household income, education level, study site, body mass index, as well as physical activity. Finally, we tested for interaction between chronotype and each timing-related exposure and stratified the analysis by morning type. All zeitgebers, except for evening physical activity proportion, were correlated with at least four of the seven sleep and rest-activity outcomes. In adjusted analysis, later timing of first (after 6:30 to 7:45 AM versus earlier) and last exposure to indoor light (after 11:00 PM versus earlier) and first (after 7:45-9:45 AM versus earlier) and last eating episode (after 8:00-09:00 PM versus earlier) were associated with a shift of 0.60-1.39 hours to later bedtimes, M10 and L5 midpoints (i.e. timing of peak activities or inactivities). Later timing of first exposure to outdoor light (after 09:30 AM versus earlier) was also associated with 0.51 (95% CI: 0.19 to 0.83) hours longer total sleep time. Higher morning physical activity proportion (> 33%) was associated with 0.95 (95% CI: -1.38 to -0.53) hours earlier in-bed time and 0.69 (95% CI: -1.14 to -0.24) hours earlier out-of-bed time, 0.92 (95% CI: -1.41 to -0.42) hours earlier M10 and 0.96 (95% CI: -1.42 to -0.49) min earlier L5 midpoint. The results did not change substantially with further adjustment for total activity. There was a significant interaction between morning chronotype and first eating episode with rest-activity patterns (p < 0.05), with first eating episode associating with timing of activities only in non-morning type adults. Timing of zeitgebers was associated with sleep and rest-activity patterns, including bedtimes, L5 and M10 midpoint. Future research should evaluate the impact of manipulating zeitgebers on both circadian rhythms and health outcomes.
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Affiliation(s)
- Mirja Quante
- a Department of Neonatology , University of Tuebingen , Tuebingen, Germany.,b Division of Sleep and Circadian Disorders, Department of Medicine , Brigham & Women's Hospital & Harvard Medical School , Boston MA
| | - Sara Mariani
- b Division of Sleep and Circadian Disorders, Department of Medicine , Brigham & Women's Hospital & Harvard Medical School , Boston MA
| | - Jia Weng
- b Division of Sleep and Circadian Disorders, Department of Medicine , Brigham & Women's Hospital & Harvard Medical School , Boston MA
| | - Catherine R Marinac
- c Division of Population Sciences, Department of Medical Oncology , Dana-Farber Cancer Institute , Boston , MA
| | - Emily R Kaplan
- b Division of Sleep and Circadian Disorders, Department of Medicine , Brigham & Women's Hospital & Harvard Medical School , Boston MA
| | - Michael Rueschman
- b Division of Sleep and Circadian Disorders, Department of Medicine , Brigham & Women's Hospital & Harvard Medical School , Boston MA
| | - Jonathan A Mitchell
- d Division of Gastroenterology , Hepatology and Nutrition, Children's Hospital of Philadelphia , Philadelphia , PA.,e Department of Pediatrics , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA
| | - Peter James
- f Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA
| | - J Aaron Hipp
- g Department of Parks , Recreation, and Tourism Management; Center for Geospatial Analytics; and Center for Human Health and the Environment, NC State University , Raleigh , NC
| | | | - Rui Wang
- b Division of Sleep and Circadian Disorders, Department of Medicine , Brigham & Women's Hospital & Harvard Medical School , Boston MA.,f Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA
| | - Susan Redline
- b Division of Sleep and Circadian Disorders, Department of Medicine , Brigham & Women's Hospital & Harvard Medical School , Boston MA.,i Beth Israel Deaconess Medical Center , Boston , MA
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Marinac CR, Nelson SH, Cadmus-Bertram L, Kerr J, Natarajan L, Godbole S, Hartman SJ. Dimensions of sedentary behavior and objective cognitive functioning in breast cancer survivors. Support Care Cancer 2018; 27:1435-1441. [PMID: 30225570 DOI: 10.1007/s00520-018-4459-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/30/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE To examine associations between dimensions of sedentary behavior and cognitive function in breast cancer survivors. METHODS Sedentary behavior variables were measured using thigh-worn activPALs, and included total daily sitting time, time in long sitting bouts, sit-to-stand transitions, and standing time. Cognitive function was assessed using the NIH Toolbox Cognitive Domain. Separate multivariable linear regression models were used to examine associations between sedentary behavior variables with the cognitive domain scores of attention, executive functioning, episodic memory, working memory, and information processing speed. RESULTS Thirty breast cancer survivors with a mean age of 62.2 (SD = 7.8) years who were 2.6 (SD = 1.1) years since diagnosis completed study assessments. In multivariable linear regression models, more time spent standing was associated with faster information processing (b: 5.78; p = 0.03), and more time spent in long sitting bouts was associated with worse executive function (b: -2.82; p = 0.02), after adjustment for covariates. No other sedentary behavior variables were statistically significantly associated with the cognitive domains examined in this study. CONCLUSIONS Two important sedentary constructs that are amenable to intervention, including time in prolonged sitting bouts and standing time, may be associated with cognitive function in breast cancer survivors. More research is needed to determine whether modifying these dimensions of sedentary behavior will improve cognitive function in women with a history of breast cancer, or prevent it from declining in breast cancer patients.
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Affiliation(s)
- Catherine R Marinac
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Dana-1167, 450 Brookline Ave, Boston, MA, 02215, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Sandahl H Nelson
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA.,Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | | | - Jacqueline Kerr
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA.,Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Loki Natarajan
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA.,Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Suneeta Godbole
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA.,Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
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Kerr J, Marinac CR, Ellis K, Godbole S, Hipp A, Glanz K, Mitchell J, Laden F, James P, Berrigan D. Comparison of Accelerometry Methods for Estimating Physical Activity. Med Sci Sports Exerc 2017; 49:617-624. [PMID: 27755355 DOI: 10.1249/mss.0000000000001124] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE This study aimed to compare physical activity estimates across different accelerometer wear locations, wear time protocols, and data processing techniques. METHODS A convenience sample of middle-age to older women wore a GT3X+ accelerometer at the wrist and hip for 7 d. Physical activity estimates were calculated using three data processing techniques: single-axis cut points, raw vector magnitude thresholds, and machine learning algorithms applied to the raw data from the three axes. Daily estimates were compared for the 321 women using generalized estimating equations. RESULTS A total of 1420 d were analyzed. Compliance rates for the hip versus wrist location only varied by 2.7%. All differences between techniques, wear locations, and wear time protocols were statistically different (P < 0.05). Mean minutes per day in physical activity varied from 22 to 67 depending on location and method. On the hip, the 1952-count cut point found at least 150 min·wk of physical activity in 22% of participants, raw vector magnitude found 32%, and the machine-learned algorithm found 74% of participants with 150 min of walking/running per week. The wrist algorithms found 59% and 60% of participants with 150 min of physical activity per week using the raw vector magnitude and machine-learned techniques, respectively. When the wrist device was worn overnight, up to 4% more participants met guidelines. CONCLUSION Estimates varied by 52% across techniques and by as much as 41% across wear locations. Findings suggest that researchers should be cautious when comparing physical activity estimates from different studies. Efforts to standardize accelerometry-based estimates of physical activity are needed. A first step might be to report on multiple procedures until a consensus is achieved.
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Affiliation(s)
- Jacqueline Kerr
- 1Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA; 2Graduate School of Public Health, San Diego State University, San Diego, CA; 3Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA; 4Department of Parks, Recreation, and Tourism Management, North Carolina State University Center for Geospatial Analytics, Center for Human Health and the Environment, North Carolina State University, Raleigh, NC; 5Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, PA; 6Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA; 7Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; 8Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; 9Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and 10National Cancer Institute, National Institutes of Health, Bethesda, MD
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Marinac CR, Dunsiger SI, Marcus BH, Rosen RK, Gans KM, Hartman SJ. Mediators of a physical activity intervention among women with a family history of breast cancer. Women Health 2017; 58:699-713. [PMID: 28532339 DOI: 10.1080/03630242.2017.1333075] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The current study examined mediators of an efficacious physical activity intervention. Women with a mean age of 42.6 (range 23-61) years and a family history of breast cancer were randomized to either an Internet-based physical activity intervention (n = 28) or an active control condition (n = 27) for three months. Data were collected between November 2010 and August 2011. Hypothesized mediators were examined using a product of coefficients model with bootstrapped standard errors. Significant mediation was observed for both self-efficacy and behavioral processes. Specifically, the regression coefficients of the indirect effects ("ab path": unstandardized effect of the intervention on physical activity that occurred through the mediator) were ab = 38.58 (95% confidence interval [CI]: 8.66-92.76) for self-efficacy, and ab = 42.02 (95% CI: 6.76-104.84) for behavioral processes. Other factors examined in this study, including cognitive processes, decisional balance, and perceived risk of breast cancer, were not statistically significant mediators. Findings suggest that self-efficacy and behavioral processes may be key constructs to use in targeting future physical activity interventions among women with a family history of breast cancer.
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Affiliation(s)
- Catherine R Marinac
- a Department of Medical Oncology , Dana-Farber Cancer Institute , Boston , Massachusetts , USA.,b Department of Family Medicine and Public Health , University of California, San Diego , La Jolla , California , USA.,c Moores UC San Diego Cancer Center , University of California , San Diego, La Jolla , California , USA
| | - Shira I Dunsiger
- d Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Department of Behavioral and Social Sciences , Brown School of Public Health , Providence , Rhode Island , USA
| | - Bess H Marcus
- b Department of Family Medicine and Public Health , University of California, San Diego , La Jolla , California , USA
| | - Rochelle K Rosen
- d Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Department of Behavioral and Social Sciences , Brown School of Public Health , Providence , Rhode Island , USA
| | - Kim M Gans
- e Department of Human Development and Family Studies and the Center for Health, Interventions and Prevention , University of Connecticut , Storrs , Connecticut , USA.,f Department of Behavioral and Social Sciences and the Institute for Community Health Promotion , Brown School of Public Health , Providence , Rhode Island , USA
| | - Sheri J Hartman
- b Department of Family Medicine and Public Health , University of California, San Diego , La Jolla , California , USA.,c Moores UC San Diego Cancer Center , University of California , San Diego, La Jolla , California , USA.,d Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Department of Behavioral and Social Sciences , Brown School of Public Health , Providence , Rhode Island , USA
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Mitchell JA, Quante M, Godbole S, James P, Hipp JA, Marinac CR, Mariani S, Cespedes Feliciano EM, Glanz K, Laden F, Wang R, Weng J, Redline S, Kerr J. Variation in actigraphy-estimated rest-activity patterns by demographic factors. Chronobiol Int 2017. [PMID: 28650674 DOI: 10.1080/07420528.2017.1337032] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [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: 12/25/2022]
Abstract
Rest-activity patterns provide an indication of circadian rhythmicity in the free-living setting. We aimed to describe the distributions of rest-activity patterns in a sample of adults and children across demographic variables. A sample of adults (N = 590) and children (N = 58) wore an actigraph on their nondominant wrist for 7 days and nights. We generated rest-activity patterns from cosinor analysis (MESOR, acrophase and magnitude) and nonparametric circadian rhythm analysis (IS: interdaily stability; IV: intradaily variability; L5: least active 5-hour period; M10: most active 10-hour period; and RA: relative amplitude). Demographic variables included age, sex, race, education, marital status, and income. Linear mixed-effects models were used to test for demographic differences in rest-activity patterns. Adolescents, compared to younger children, had (1) later M10 midpoints (β = 1.12 hours [95% CI: 0.43, 1.18] and lower M10 activity levels; (2) later L5 midpoints (β = 1.6 hours [95% CI: 0.9, 2.3]) and lower L5 activity levels; (3) less regular rest-activity patterns (lower IS and higher IV); and 4) lower magnitudes (β = -0.95 [95% CI: -1.28, -0.63]) and relative amplitudes (β = -0.1 [95% CI: -0.14, -0.06]). Mid-to-older adults, compared to younger adults (aged 18-29 years), had (1) earlier M10 midpoints (β = -1.0 hours [95% CI: -1.6, -0.4]; (2) earlier L5 midpoints (β = -0.7 hours [95% CI: -1.2, -0.2]); and (3) more regular rest-activity patterns (higher IS and lower IV). The magnitudes and relative amplitudes were similar across the adult age categories. Sex, race and education level rest-activity differences were also observed. Rest-activity patterns vary across the lifespan, and differ by race, sex and education. Understanding population variation in these patterns provides a foundation for further elucidating the health implications of rest-activity patterns across the lifespan.
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Affiliation(s)
- Jonathan A Mitchell
- a Division of Gastroenterology, Hepatology and Nutrition , Children's Hospital of Philadelphia , Philadelphia , PA , USA.,b Department of Pediatrics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Mirja Quante
- c Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology , Brigham & Women's Hospital & Harvard Medical School , Boston , MA , USA.,d Department of Neonatology , University of Tuebingen , Tuebingen , Germany
| | - Suneeta Godbole
- e Department of Family Medicine & Public Health , University of California, San Diego , San Diego , CA , USA
| | - Peter James
- f Channing Division of Network Medicine , Brigham and Women's Hospital & Harvard Medical School , Boston , MA , USA.,g Departments of Environmental Health and Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - J Aaron Hipp
- h Department of Parks, Recreation, and Tourism Management, Center for Geospatial Analytics, and Center for Human Health and the Environment , NC State University , Raleigh , NC , USA
| | | | - Sara Mariani
- c Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology , Brigham & Women's Hospital & Harvard Medical School , Boston , MA , USA
| | | | - Karen Glanz
- k Perelman School of Medicine and School of Nursing, University of Pennsylvania , Philadelphia , PA , USA
| | - Francine Laden
- f Channing Division of Network Medicine , Brigham and Women's Hospital & Harvard Medical School , Boston , MA , USA.,g Departments of Environmental Health and Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Rui Wang
- c Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology , Brigham & Women's Hospital & Harvard Medical School , Boston , MA , USA
| | - Jia Weng
- c Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology , Brigham & Women's Hospital & Harvard Medical School , Boston , MA , USA
| | - Susan Redline
- c Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology , Brigham & Women's Hospital & Harvard Medical School , Boston , MA , USA.,l Beth Israel Deaconess Medical Center , Boston , MA , USA
| | - Jacqueline Kerr
- e Department of Family Medicine & Public Health , University of California, San Diego , San Diego , CA , USA
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Quante M, Mitchell JA, Godbole S, James P, Hipp A, Marinac CR, Mariani S, Cespedes Feliciano EM, Glanz K, Laden F, Wang R, Weng J, Redline S, Kerr J. 0693 VARIATION IN ACTIGRAPHY-ESTIMATED REST-ACTIVITY PATTERNS BY DEMOGRAPHIC FACTORS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.692] [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: 11/13/2022] Open
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Marinac CR, Nelson SH, Breen CI, Hartman SJ, Natarajan L, Pierce JP, Flatt SW, Sears DD, Patterson RE. Prolonged Nightly Fasting and Breast Cancer Prognosis. JAMA Oncol 2017; 2:1049-55. [PMID: 27032109 DOI: 10.1001/jamaoncol.2016.0164] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Rodent studies demonstrate that prolonged fasting during the sleep phase positively influences carcinogenesis and metabolic processes that are putatively associated with risk and prognosis of breast cancer. To our knowledge, no studies in humans have examined nightly fasting duration and cancer outcomes. OBJECTIVE To investigate whether duration of nightly fasting predicted recurrence and mortality among women with early-stage breast cancer and, if so, whether it was associated with risk factors for poor outcomes, including glucoregulation (hemoglobin A1c), chronic inflammation (C-reactive protein), obesity, and sleep. DESIGN, SETTING, AND PARTICIPANTS Data were collected from 2413 women with breast cancer but without diabetes mellitus who were aged 27 to 70 years at diagnosis and participated in the prospective Women's Healthy Eating and Living study between March 1, 1995, and May 3, 2007. Data analysis was conducted from May 18 to October 5, 2015. EXPOSURES Nightly fasting duration was estimated from 24-hour dietary recalls collected at baseline, year 1, and year 4. MAIN OUTCOMES AND MEASURES Clinical outcomes were invasive breast cancer recurrence and new primary breast tumors during a mean of 7.3 years of study follow-up as well as death from breast cancer or any cause during a mean of 11.4 years of surveillance. Baseline sleep duration was self-reported, and archived blood samples were used to assess concentrations of hemoglobin A1c and C-reactive protein. RESULTS The cohort of 2413 women (mean [SD] age, 52.4 [8.9] years) reported a mean (SD) fasting duration of 12.5 (1.7) hours per night. In repeated-measures Cox proportional hazards regression models, fasting less than 13 hours per night (lower 2 tertiles of nightly fasting distribution) was associated with an increase in the risk of breast cancer recurrence compared with fasting 13 or more hours per night (hazard ratio, 1.36; 95% CI, 1.05-1.76). Nightly fasting less than 13 hours was not associated with a statistically significant higher risk of breast cancer mortality (hazard ratio, 1.21; 95% CI, 0.91-1.60) or a statistically significant higher risk of all-cause mortality (hazard ratio, 1.22; 95% CI, 0.95-1.56). In multivariable linear regression models, each 2-hour increase in the nightly fasting duration was associated with significantly lower hemoglobin A1c levels (β = -0.37; 95% CI, -0.72 to -0.01) and a longer duration of nighttime sleep (β = 0.20; 95% CI, 0.14-0.26). CONCLUSIONS AND RELEVANCE Prolonging the length of the nightly fasting interval may be a simple, nonpharmacologic strategy for reducing the risk of breast cancer recurrence. Improvements in glucoregulation and sleep may be mechanisms linking nightly fasting with breast cancer prognosis.
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Affiliation(s)
- Catherine R Marinac
- University of California, San Diego Moores Cancer Center, La Jolla2Graduate School of Public Health, San Diego State University, San Diego, California3Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Sandahl H Nelson
- University of California, San Diego Moores Cancer Center, La Jolla2Graduate School of Public Health, San Diego State University, San Diego, California
| | - Caitlin I Breen
- University of California, San Diego Moores Cancer Center, La Jolla
| | - Sheri J Hartman
- University of California, San Diego Moores Cancer Center, La Jolla3Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Loki Natarajan
- University of California, San Diego Moores Cancer Center, La Jolla3Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - John P Pierce
- University of California, San Diego Moores Cancer Center, La Jolla3Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Shirley W Flatt
- University of California, San Diego Moores Cancer Center, La Jolla
| | - Dorothy D Sears
- University of California, San Diego Moores Cancer Center, La Jolla3Department of Family Medicine and Public Health, University of California, San Diego, La Jolla4Division of Endocrinology and Metabolism, Department of Medicine, University of California, S
| | - Ruth E Patterson
- University of California, San Diego Moores Cancer Center, La Jolla3Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
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Brychta RJ, Arnardottir NY, Johannsson E, Wright EC, Eiriksdottir G, Gudnason V, Marinac CR, Davis M, Koster A, Caserotti P, Sveinsson T, Harris T, Chen KY. Influence of Day Length and Physical Activity on Sleep Patterns in Older Icelandic Men and Women. J Clin Sleep Med 2017; 12:203-13. [PMID: 26414978 DOI: 10.5664/jcsm.5486] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/12/2015] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES To identify cross-sectional and seasonal patterns of sleep and physical activity (PA) in community-dwelling, older Icelandic adults using accelerometers. METHODS A seven-day free-living protocol of 244 (110 female) adults aged 79.7 ± 4.9 years was conducted as part of a larger population-based longitudinal observational-cohort study in the greater Reykjavik area of Iceland. A subpopulation (n = 72) repeated the 7-day measurement during seasonal periods with greater (13.4 ± 1.4 h) and lesser (7.7 ± 1.8 h) daylight. RESULTS Cross-sectional analyses using multiple linear regression models revealed that day length was a significant independent predictor of sleep duration, mid-sleep, and rise time (all p < 0.05). However, the actual within-individual differences in sleep patterns of the repeaters were rather subtle between periods of longer and shorter day-lengths. Compared to women, men had a shorter sleep duration (462 ± 80 vs. 487 ± 68 minutes, p = 0.008), earlier rise time, and a greater number of awakenings per night (46.5 ± 18.3 vs. 40.2 ± 15.7, p = 0.007), but sleep efficiency and onset latency were similar between the two sexes. Daily PA was also similar between men and women and between periods of longer and shorter day-lengths. BMI, age, gender, and overall PA all contributed to the variations in sleep parameters using multiple regression analysis. CONCLUSIONS The sleep and PA characteristics of this unique population revealed some gender differences, but there was limited variation in response to significant daylight changes which may be due to long-term adaptation.
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Affiliation(s)
- Robert J Brychta
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Nanna Yr Arnardottir
- Research Center of Movement Science, University of Iceland, Reykjavík, Iceland.,Icelandic Heart Association, Kópavogur, Iceland
| | - Erlingur Johannsson
- Center of Sport and health Sciences, School of Education, University of Iceland, Laugarvatn, Iceland
| | - Elizabeth C Wright
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kópavogur, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Catherine R Marinac
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Megan Davis
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Thorarinn Sveinsson
- Research Center of Movement Science, University of Iceland, Reykjavík, Iceland
| | | | - Kong Y Chen
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Hartman SJ, Dunsiger SI, Marinac CR, Marcus BH, Rosen RK, Gans KM. Internet-based physical activity intervention for women with a family history of breast cancer. Health Psychol 2016; 34S:1296-304. [PMID: 26651471 DOI: 10.1037/hea0000307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Physical inactivity is a modifiable risk factor for breast cancer. Physical activity interventions that can be delivered through the Internet have the potential to increase participant reach. The efficacy of an Internet-based physical activity intervention was tested in a sample of women at an elevated risk for breast cancer. METHOD A total of 55 women with at least 1 first-degree relative with breast cancer (but no personal history of breast cancer) were randomized to a 3-month theoretically grounded Internet-based physical activity intervention or an active control arm. Minutes of moderate to vigorous physical activity, psychosocial mediators of physical activity adoption and maintenance, as well as worry and perceived risk of developing breast cancer were assessed at baseline, 3-month, and 5-month follow up. RESULTS Participants were on average 46.2 (SD = 11.4) years old with a body mass index of 27.3 (SD = 4.8) kg/m2. The intervention arm significantly increased minutes of moderate to vigorous physical activity compared to the active control arm at 3 months (213 vs. 129 min/week) and 5 months (208 vs. 119 min/week; both ps < .001). Regression models indicated that participants in the intervention had significantly higher self-efficacy for physical activity at 3 months (p < .01) and borderline significantly higher self-efficacy at 5 months (p = .05). Baseline breast cancer worry and perceived risk were not associated with physical activity. CONCLUSION Findings from this study suggest that an Internet-based physical activity intervention may substantially increase physical activity in women with a family history of breast cancer.
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Affiliation(s)
- Sheri J Hartman
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Miriam Hospital, Brown University
| | | | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, Miriam Hospital, Brown University
| | - Kim M Gans
- Department of Human Development and Family Studies, University of Connecticut
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Nelson SH, Marinac CR, Patterson RE, Nachuta SJ, Caan BJ, Chen WY, Shu XO, Pierce JP. Abstract PD4-08: Post-diagnosis physical activity and comorbidities, not BMI, explain mortality risk in the after breast cancer pooling project. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd4-08] [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
Background: In its 2014 position statement, ASCO concluded that obesity is associated with worse prognosis after cancer diagnosis. However in the same year, a comprehensive review by the World Cancer Research Fund concluded that there was limited evidence that greater body fatness increases risk of overall or breast cancer mortality, indicating that further investigation into lifestyle factors are needed. The After Breast Cancer (ABC) Pooling Project has reported, separately, significant mortality effects of pre-diagnosis BMI and of post-diagnosis physical activity (PA). We investigate whether the effect of BMI can be limited to subgroups characterized by comorbidities and physical activity.
Methods: Data are from the three US cohorts that were harmonized in the ABCPP (n=9513) including: the Women's Healthy Eating and Living (WHEL), Life After Cancer Epidemiology (LACE), and Nurses' Health (NHS) studies. Stepwise delayed entry Cox proportional hazards models examined each lifestyle predictor (BMI, PA, and comorbidities assessed after diagnosis) sequentially and together in multivariate models for breast cancer and all-cause mortality.
Results: In multivariate models without the other two target variables, PA was significantly associated with a 17% decrease in the risk of breast cancer mortality among women in the highest quartile of PA (MET hr/wk > 21.4), compared to the lowest quartile (MET hr/wk < 2.7) (HR=0.81,95% CI= 0.67,0.97). In the model with major comorbidities, there was a significant 40% increase in the risk of breast cancer mortality among women diagnosed with both diabetes and hypertension (HR=1.40, 95% CI= 1.01,1.93). In the model with BMI, there was no significant association with risk of breast cancer mortality. These results were essentially unchanged with all variables in a single model.
For all-cause mortality, the PA-only model showed a significant PA effect with the hazard decreasing from 20% to 40% across quartiles (Q2 HR=0.80, 95% CI=0.71,0.90, Q4 HR=0.62, 95% CI=0.54,0.71). In the comorbidity-only model, both diabetes and hypertension significantly increased hazard of all-cause mortality 80% and 33%, respectively. Having both diagnoses was associated with a significant, 2.3 fold increase in all-cause mortality (HR=2.34, 95% CI= 1.95,2.81).
In the BMI-only model, being underweight was associated with a significant 2.4 fold increase in risk of all-cause mortality, and there was a 20 and 37% increase in risk associated with being categorized as obese I or II (Obese I HR=1.23, 95% CI=1.07,1.40, Obese II HR=1.37, 95% CI=1.16,1.61).
With all three variables in the model, the risk associated with being obese decreased and became non-significant (Obese I HR=1.06, Obese II HR=1.05), while the significance, strength, and direction of the association of comorbidities and PA with all-cause mortality remained constant.
Conclusion: These data suggest that post-diagnosis comorbidities and lack of physical activity, rather than high BMI , are the important risk factors for all-cause and breast cancer specific mortality. While needing further validation, these suggest that physical activity interventions and monitoring treatment for comorbidities should become standard of care for breast cancer survivors.
Citation Format: Nelson SH, Marinac CR, Patterson RE, Nachuta SJ, Caan BJ, Chen WY, Shu X-O, Pierce JP. Post-diagnosis physical activity and comorbidities, not BMI, explain mortality risk in the after breast cancer pooling project. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-08.
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Affiliation(s)
- SH Nelson
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA; Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN; Division of Research, Kaiser Permanente, Oakland, CA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - CR Marinac
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA; Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN; Division of Research, Kaiser Permanente, Oakland, CA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - RE Patterson
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA; Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN; Division of Research, Kaiser Permanente, Oakland, CA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - SJ Nachuta
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA; Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN; Division of Research, Kaiser Permanente, Oakland, CA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - BJ Caan
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA; Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN; Division of Research, Kaiser Permanente, Oakland, CA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - WY Chen
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA; Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN; Division of Research, Kaiser Permanente, Oakland, CA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - X-O Shu
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA; Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN; Division of Research, Kaiser Permanente, Oakland, CA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - JP Pierce
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA; Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN; Division of Research, Kaiser Permanente, Oakland, CA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
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Marinac CR, Neslon SH, Natarajan L, Sears DD, Breen CI, Pierce JP, Patterson RE. Abstract P3-09-01: Intermittent fasting in breast cancer risk and survivorship: Insight from the women's healthy eating and living study. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-09-01] [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
Intermittent fasting (IF) regimens have gained widespread attention in recent years for their possible role in human health and disease risk. In mice, IF schedules that are aligned with sleep-wake cycles appear to positively influence metabolic processes related to cancer risk and may have direct effects on carcinogenesis; however the impact of these regimens on cancer risk in humans remain unclear. We examined associations between nighttime fasting duration (a form of IF aligned with sleep-wake cycles) and (1) biomarkers demonstrated to be associated with breast cancer prognosis; and (2) long-term clinical outcomes in a sample of breast cancer survivors from the Women's Healthy Eating and Living (WHEL) Study.
Dietary data were available for 3,061 non-diabetic women enrolled in the WHEL Study. Nighttime fasting duration was calculated using time-stamped 24-hour dietary recalls collected at the baseline, Year 1, and Year 4 study assessment periods. Approximately 3-4 dietary records were collected per subject at each assessment period, and these records were averaged to yield a single estimate of nighttime fasting duration per time point. Glycosylated hemoglobin (HbA1c) and C-reactive protein (CRP) levels were ascertained from blood specimen collected at baseline. Clinical outcomes recorded during the study follow-up include breast cancer events (recurrence or new primary) and mortality. Linear regression models examined the associations of nighttime fasting with baseline concentrations of HbA1c and CRP. Delayed-entry Cox proportional hazard models were used to assess the association between nighttime fasting duration, recorded at the baseline, Year 1, and Year 4 assessments, with clinical outcomes. These models used a counting process method to account for repeated measures. All models controlled for basic demographic factors, participant characteristics (BMI, comorbidity status, sleep duration), breast cancer characteristics (stage, grade, anti-estrogen use), and dietary variables (total calories, evening calories, eating frequency).
Women fasted an average of 12.5 hours per night (SD=1.6 hours). There were 520 new breast cancer events, and 569 deaths during study follow up. HbA1c level was significantly and inversely related to nighttime fasting duration. Each 2-hour increase in the nighttime fasting duration was associated with a 0.2-unit decrease in HbA1c (β=-0.21; p=0.03 with HbA1c expressed as mmol/mol), and there was no evidence of mediation or effect modification by participant characteristics, e.g., BMI. No associations were observed between nighttime fasting duration and CRP. In longitudinal models, women who fasted less than 13.1 hours per night (bottom two tertiles of nightly fasting distribution) had roughly a 50% higher hazard for experiencing a breast cancer event, compared to women who fasted at least 13.1 hours per night (HR: 1.46; 95%CI: 1.11-1.93; p<0.01). Nighttime fasting duration was not associated with mortality.
Findings suggest that increasing the length of the nighttime fasting interval could be a simple, feasible, and novel strategy to improve glucose control and reduce breast cancer risk. Randomized trials confirming the link between nighttime fasting duration and breast cancer risk are warranted.
Citation Format: Marinac CR, Neslon SH, Natarajan L, Sears DD, Breen CI, Pierce JP, Patterson RE. Intermittent fasting in breast cancer risk and survivorship: Insight from the women's healthy eating and living study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-09-01.
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Affiliation(s)
- CR Marinac
- University of California, San Diego, La Jolla, CA; San Diego State University, San Diego, CA
| | - SH Neslon
- University of California, San Diego, La Jolla, CA; San Diego State University, San Diego, CA
| | - L Natarajan
- University of California, San Diego, La Jolla, CA; San Diego State University, San Diego, CA
| | - DD Sears
- University of California, San Diego, La Jolla, CA; San Diego State University, San Diego, CA
| | - CI Breen
- University of California, San Diego, La Jolla, CA; San Diego State University, San Diego, CA
| | - JP Pierce
- University of California, San Diego, La Jolla, CA; San Diego State University, San Diego, CA
| | - RE Patterson
- University of California, San Diego, La Jolla, CA; San Diego State University, San Diego, CA
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Nelson SH, Marinac CR, Patterson RE, Nechuta SJ, Flatt SW, Caan BJ, Kwan ML, Poole EM, Chen WY, Shu XO, Pierce JP. Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors. Breast Cancer Res Treat 2016; 155:551-7. [PMID: 26861056 DOI: 10.1007/s10549-016-3694-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 10/08/2015] [Accepted: 01/29/2016] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to examine post-diagnosis BMI, very low physical activity, and comorbidities, as predictors of breast cancer-specific and all-cause mortality. Data from three female US breast cancer survivor cohorts were harmonized in the After Breast Cancer Pooling Project (n = 9513). Delayed entry Cox proportional hazards models were used to examine the impact of three post-diagnosis lifestyle factors: body mass index (BMI), select comorbidities (diabetes only, hypertension only, or both), and very low physical activity (defined as physical activity <1.5 MET h/week) in individual models and together in multivariate models for breast cancer and all-cause mortality. For breast cancer mortality, the individual lifestyle models demonstrated a significant association with very low physical activity but not with the selected comorbidities or BMI. In the model that included all three lifestyle variables, very low physical activity was associated with a 22 % increased risk of breast cancer mortality (HR 1.22, 95 % CI 1.05, 1.42). For all-cause mortality, the three individual models demonstrated significant associations for all three lifestyle predictors. In the combined model, the strength and significance of the association of comorbidities (both hypertension and diabetes versus neither: HR 2.16, 95 % CI 1.79, 2.60) and very low physical activity (HR 1.35, 95 % CI 1.22, 1.51) remained unchanged, but the association with obesity was completely attenuated. These data indicate that after active treatment, very low physical activity, consistent with a sedentary lifestyle (and comorbidities for all-cause mortality), may account for the increased risk of mortality, with higher BMI, that is seen in other studies.
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Affiliation(s)
- Sandahl H Nelson
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Catherine R Marinac
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Ruth E Patterson
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Sarah J Nechuta
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shirley W Flatt
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA
| | - Bette J Caan
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Elizabeth M Poole
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xiao-ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John P Pierce
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA.
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
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Patterson RE, Marinac CR, Natarajan L, Hartman SJ, Cadmus-Bertram L, Flatt SW, Li H, Parker B, Oratowski-Coleman J, Villaseñor A, Godbole S, Kerr J. Recruitment strategies, design, and participant characteristics in a trial of weight-loss and metformin in breast cancer survivors. Contemp Clin Trials 2015; 47:64-71. [PMID: 26706665 DOI: 10.1016/j.cct.2015.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 01/03/2023]
Abstract
Weight loss and metformin are hypothesized to improve breast cancer outcomes; however the joint impacts of these treatments have not been investigated. Reach for Health is a randomized trial using a 2 × 2 factorial design to investigate the effects of weight loss and metformin on biomarkers associated with breast cancer prognosis among overweight/obese postmenopausal breast cancer survivors. This paper describes the trial recruitment strategies, design, and baseline sample characteristics. Participants were randomized in equal numbers to (1) placebo, (2) metformin, (3) weight loss intervention and placebo, or (4) weight-loss intervention and metformin. The lifestyle intervention was a personalized, telephone-based program targeting a 7% weight-loss in the intervention arm. The metformin dose was 1500 mg/day. The duration of the intervention was 6 months. Main outcomes were biomarkers representing 3 metabolic systems putatively related to breast cancer mortality: glucoregulation, inflammation, and sex hormones. Between August 2011 and May 2015, we randomized 333 breast cancer survivors. Mass mailings from the California Cancer Registry were the most successful recruitment strategy with over 25,000 letters sent at a cost of $191 per randomized participant. At baseline, higher levels of obesity were significantly associated with worse sleep disturbance and impairment scores, lower levels of physical activity and higher levels of sedentary behavior, hypertension, hypercholesterolemia, and lower quality of life (p<0.05 for all). These results illustrate the health burden of obesity. Results of this trial will provide mechanistic data on biological pathways and circulating biomarkers associated with lifestyle and pharmacologic interventions to improve breast cancer prognosis.
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Affiliation(s)
- Ruth E Patterson
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA.
| | - Catherine R Marinac
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Loki Natarajan
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | | | - Shirley W Flatt
- Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Hongying Li
- Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Barbara Parker
- Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | | | - Adriana Villaseñor
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Suneeta Godbole
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
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Marinac CR, Natarajan L, Sears DD, Gallo LC, Hartman SJ, Arredondo E, Patterson RE. Abstract 1874: Prolonged nightly fasting and breast cancer risk: findings from NHANES (2009-2010). Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1874] [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
A novel line of research has emerged suggesting that daily feeding-fasting schedules have metabolic implications that are highly relevant to breast cancer. In rodents, a habitual daily fasting schedule that is aligned with sleep-wake cycles appears to have favorable effects on a variety of cancer risk factors and may reduce cell proliferation. While data from rodent models are compelling, no human studies have explored the potential impact of this type of fasting schedule on cancer risk factors such as hyperglycemia (a possible facilitator of neoplastic proliferation). We examined cross-sectional associations of nighttime fasting duration with glycemic control biomarkers associated with increased breast cancer risk in a population-based sample of women in the 2009-2010 U.S. National Health and Nutrition Examination Survey.
Dietary, anthropometric and glycosylated hemoglobin (HbA1c) data were available for 2,212 women, and 2-hour postprandial glucose concentrations were available for 1,066 women. Nighttime fasting duration was calculated using time-stamped 24-hour food records. Separate linear regression models examined associations of nighttime fasting with HbA1c and 2-hour glucose concentrations. Logistic regression modeled associations of nighttime fasting duration with elevated HbA1c (HbA1c ≥ 39 mmol/mol or 5.7%) and elevated 2-hour glucose (glucose ≥ 140 mg/dL). All models adjusted for age, education, race/ethnicity, BMI, total kcal intake, evening kcal intake, and the number of eating episodes per day. All analyses used sample weights to account for differential probabilities of selection into the sample, nonresponse, and noncoverage. Standard errors were estimated using Taylor Series Linearization.
Women in this sample were an average of 46.8 years of age (SE = 0.66) and fasted approximately 12.4 (SE = 0.08) hours per night. Each 3-hour increase in nighttime fasting (roughly one standard deviation) was associated with a 4% lower 2-hour postprandial glucose measurement (β 0.96, 95% CI 0.93 - 1.00; p<0.05), and a non-statistically significant 0.4 unit decrease in HbA1c (β -0.39, 95% CI -0.84 - -0.05; p = 0.08). Logistic regression models indicate that each 3-hour increase in nighttime fasting duration was associated with roughly a 20% reduced odds of elevated HbA1c (OR 0.81, 95% CI 0.68, 0.97; p<0.05) and non-significantly reduced odds of elevated 2-hour glucose (OR 0.78, 95%CI 0.53-1.54).
Randomized trials are needed to confirm whether a prolonged nighttime fasting schedule could improve biomarkers of glycemic control, thereby reducing breast cancer risk among women.
Citation Format: Catherine R. Marinac, Loki Natarajan, Dorothy D. Sears, Linda C. Gallo, Sheri J. Hartman, Elva Arredondo, Ruth E. Patterson. Prolonged nightly fasting and breast cancer risk: findings from NHANES (2009-2010). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1874. doi:10.1158/1538-7445.AM2015-1874
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Marinac CR, Natarajan L, Sears DD, Gallo LC, Hartman SJ, Arredondo E, Patterson RE. Prolonged Nightly Fasting and Breast Cancer Risk: Findings from NHANES (2009-2010). Cancer Epidemiol Biomarkers Prev 2015; 24:783-9. [PMID: 25896523 PMCID: PMC4417458 DOI: 10.1158/1055-9965.epi-14-1292] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [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: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A novel line of research has emerged, suggesting that daily feeding-fasting schedules that are synchronized with sleep-wake cycles have metabolic implications that are highly relevant to breast cancer. We examined associations of nighttime fasting duration with biomarkers of breast cancer risk among women in the 2009-2010 U.S. National Health and Nutrition Examination Survey. METHODS Dietary, anthropometric, and HbA1c data were available for 2,212 women, and 2-hour postprandial glucose concentrations were available for 1,066 women. Nighttime fasting duration was calculated using 24-hour food records. Separate linear regression models examined associations of nighttime fasting with HbA1c and 2-hour glucose concentrations. Logistic regression modeled associations of nighttime fasting with elevated HbA1c (HbA1c ≥ 39 mmol/mol or 5.7%) and elevated 2-hour glucose (glucose ≥ 140 mg/dL). All models adjusted for age, education, race/ethnicity, body mass index, total kcal intake, evening kcal intake, and the number of eating episodes per day. RESULTS Each 3-hour increase in nighttime fasting (roughly 1 SD) was associated with a 4% lower 2-hour glucose measurement [β, 0.96; 95% confidence interval (CI), 0.93-1.00; P < 0.05], and a nonstatistically significant decrease in HbA1c. Logistic regression models indicate that each 3-hour increase in nighttime fasting duration was associated with roughly a 20% reduced odds of elevated HbA1c (OR, 0.81; 95% CI, 0.68-0.97; P < 0.05) and nonsignificantly reduced odds of elevated 2-hour glucose. CONCLUSIONS A longer nighttime duration was significantly associated with improved glycemic regulation. IMPACT Randomized trials are needed to confirm whether prolonged nighttime fasting could improve biomarkers of glucose control, thereby reducing breast cancer risk.
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Affiliation(s)
- Catherine R Marinac
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Graduate School of Public Health, San Diego State University, San Diego, California
| | - Loki Natarajan
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California
| | - Dorothy D Sears
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego, La Jolla, California
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California
| | - Sheri J Hartman
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California
| | - Elva Arredondo
- Graduate School of Public Health, San Diego State University, San Diego, California
| | - Ruth E Patterson
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California.
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Marinac CR, Godbole S, Kerr J, Natarajan L, Patterson RE, Hartman SJ. Objectively measured physical activity and cognitive functioning in breast cancer survivors. J Cancer Surviv 2014; 9:230-8. [PMID: 25304986 DOI: 10.1007/s11764-014-0404-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/19/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to explore the relationship between objectively measured physical activity and cognitive functioning in breast cancer survivors. METHODS Participants were 136 postmenopausal breast cancer survivors. Cognitive functioning was assessed using a comprehensive computerized neuropsychological test. Seven-day physical activity was assessed using hip-worn accelerometers. Linear regression models examined associations of minutes per day of physical activity at various intensities on individual cognitive functioning domains. The partially adjusted model controlled for primary confounders (model 1), and subsequent adjustments were made for chemotherapy history (model 2) and body mass index (BMI) (model 3). Interaction and stratified models examined BMI as an effect modifier. RESULTS Moderate-to-vigorous physical activity (MVPA) was associated with information processing speed. Specifically, 10 min of MVPA was associated with a 1.35-point higher score (out of 100) on the information processing speed domain in the partially adjusted model and a 1.29-point higher score when chemotherapy was added to the model (both p < 0.05). There was a significant BMI × MVPA interaction (p = 0.051). In models stratified by BMI (<25 vs. ≥25 kg/m(2)), the favorable association between MVPA and information processing speed was stronger in the subsample of overweight and obese women (p < 0.05) but not statistically significant in the leaner subsample. Light-intensity physical activity was not significantly associated with any of the measured domains of cognitive function. CONCLUSIONS MVPA may have favorable effects on information processing speed in breast cancer survivors, particularly among overweight or obese women. IMPLICATIONS FOR CANCER SURVIVORS Interventions targeting increased physical activity may enhance aspects of cognitive function among breast cancer survivors.
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Affiliation(s)
- Catherine R Marinac
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, USA
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Hartman SJ, Marinac CR, Natarajan L, Patterson RE. Lifestyle factors associated with cognitive functioning in breast cancer survivors. Psychooncology 2014; 24:669-75. [PMID: 25073541 DOI: 10.1002/pon.3626] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/25/2014] [Accepted: 06/30/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Weight, physical activity, and sleep are modifiable lifestyle factors that impact cognitive functioning in noncancer populations but have yet to be examined in cancer survivors. The aim of the study was to assess the relationship of obesity, physical activity, and sleep, with cognitive functioning among breast cancer survivors. METHODS Participants were 136 early-stage postmenopausal breast cancer survivors who completed an assessment of neuropsychological testing, height, weight, physical activity, and sleep. Linear regression models examined the associations of the seven neuropsychological domains with obesity, physical activity, and sleep. Logistic regression models examined odd of impairment in each domain. All models controlled for breast cancer treatment variables and relevant demographic and clinical variables. RESULTS Obese participants had significantly worse performance (β = -5.04, standard error (SE) = 2.53) and were almost three times more likely to be impaired (odds ratio (OR) = 2.87; 95% CI: 1.02-8.10) on the Information processing domain. The highest tertile of physical activity was significantly related to better performance on the executive functioning domain (β = 5.13, SE = 2.42) and attention domain (β = 4.26, SE = 2.07). The middle tertile of physical activity was significantly related to better performance (β = 9.00, SE = 3.09) and decreased odds of impairment (OR = 0.89, 95% CI: 0.07-0.91) on the visual-spatial domain. More hours of sleep per night was significantly associated with better performance (β = 2.69, SE = 0.98) and decreased odds of impairment (OR = 0.52; 95% CI: 0.33-0.82) on the verbal functioning domain. CONCLUSIONS These findings suggest that obesity, physical activity, and sleep are related to cognitive functioning among breast cancer survivors and have potential to be intervention targets to improve cognitive functioning.
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Affiliation(s)
- Sheri J Hartman
- Moores UCSD Cancer Center, University of California, San Diego, CA, USA.,Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
| | - Catherine R Marinac
- Moores UCSD Cancer Center, University of California, San Diego, CA, USA.,Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Loki Natarajan
- Moores UCSD Cancer Center, University of California, San Diego, CA, USA.,Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
| | - Ruth E Patterson
- Moores UCSD Cancer Center, University of California, San Diego, CA, USA.,Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
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Kerr J, Marshall SJ, Patterson RE, Marinac CR, Natarajan L, Rosenberg D, Wasilenko K, Crist K. Objectively measured physical activity is related to cognitive function in older adults. J Am Geriatr Soc 2014; 61:1927-31. [PMID: 24219194 DOI: 10.1111/jgs.12524] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the relationship between cognitive functioning and time spent at different intensities of physical activity (PA) in free-living older adults. DESIGN Cross sectional analyses. SETTING Continuing care retirement communities. PARTICIPANTS Older adults residing in seven continuing care retirement communities in San Diego County with an average age of 83; 70% were female, and 35% had a graduate-level education (N = 217). MEASUREMENTS PA was measured objectively using hip worn accelerometers with data aggregated to the minute level. Three cut points were used to assess low light-intensity PA (LLPA), high light-intensity PA (HLPA), and moderate- to vigorous-intensity PA (MVPA). The Trail Making Test (TMT) Parts A and B were completed, and time for each test (seconds) and time for Part B minus time for Part A (seconds) were used as measures of cognitive function. Variables were log-transformed and entered into linear regression models adjusting for demographic factors (age, education, sex) and other PA intensity variables. RESULTS LLPA was not related to any TMT test score. HLPA was significantly related to TMT A, B, and B minus A but only in unadjusted models. MVPA was related to TMT B and B minus A after adjusting for demographic variables. CONCLUSION There may be a dose response between PA intensity and cognitive functioning in older adults. The stronger findings supporting a relationship between MVPA and cognitive functioning are consistent with previous observational and intervention studies.
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Affiliation(s)
- Jacqueline Kerr
- Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, California; Moores UCSD Cancer Center, University of California at San Diego, La Jolla, California
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