1
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Yuen S, Phillips TJ, Bannerji R, Marlton P, Gritti G, Seymour JF, Johnston A, Arthur C, Dodero A, Sharma S, Hirata J, Musick L, Flowers CR. Polatuzumab vedotin, venetoclax, and an anti-CD20 monoclonal antibody in relapsed/refractory B-cell non-Hodgkin lymphoma. Am J Hematol 2024. [PMID: 38700035 DOI: 10.1002/ajh.27341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
The Phase 2 portion of this study evaluated safety and efficacy of polatuzumab vedotin 1.8 mg/kg and venetoclax 800 mg, plus fixed-dose obinutuzumab 1000 mg or rituximab 375 mg/m2 in patients with relapsed/refractory (R/R) follicular lymphoma (FL) or diffuse large B-cell lymphoma (DLBCL), respectively. Patients with complete response (CR) or partial response (PR)/stable disease (FL) or CR/PR (DLBCL) at end of induction (EOI; six 21-day cycles) received post-induction therapy with venetoclax and obinutuzumab or rituximab, respectively. Primary endpoint was CR rate at EOI. Safety-evaluable populations included 74 patients (FL cohort; median age 64 years; progression of disease within 24 months on first-line treatment, 25.7%; FL International Prognostic Index 3-5, 54.1%; ≥2 previous therapies, 74.3%) and 57 patients (DLBCL cohort; median age 65 years; International Prognostic Index 3-5, 54.4%; ≥2 previous therapies, 77.2%). The most common non-hematologic adverse events (mostly Grades 1-2) in the FL and DLBCL cohorts were diarrhea (55.4% and 47.4%, respectively) and nausea (47.3% and 36.8%); neutropenia was the most common Grades 3-4 toxicity (39.2% and 52.6%). Efficacy-evaluable populations included patients treated at the recommended Phase 2 dose (FL, n = 49; DLBCL, n = 48). CR rates at EOI were 59.2% (FL) and 31.3% (DLBCL); median progression-free survival was 22.8 months (95% confidence interval [CI], 14.5-not evaluable) and 4.6 months (95% CI, 3.6-8.1), respectively. Polatuzumab vedotin plus venetoclax and obinutuzumab/rituximab had acceptable safety in patients with R/R FL or DLBCL, with promising response rates in R/R FL, including high-risk patients.
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Affiliation(s)
- Sam Yuen
- Calvary Mater Newcastle Hospital, Waratah, New South Wales, Australia
| | - Tycel J Phillips
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Paula Marlton
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | - John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - Anna Johnston
- Royal Hobart Hospital (RHH), Hobart, Tasmania, Australia
| | - Christopher Arthur
- Royal North Shore Hospital (RNSH), St Leonards, New South Wales, Australia
| | - Anna Dodero
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jamie Hirata
- Genentech, Inc., South San Francisco, California, USA
| | - Lisa Musick
- Genentech, Inc., South San Francisco, California, USA
| | - Christopher R Flowers
- The Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, CPRIT Scholar in Cancer Research, Houston, Texas, USA
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2
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Quigley J, Hussain T, Arthur C. False-positive HIV screening test in a healthcare student. Occup Med (Lond) 2024:kqae015. [PMID: 38526854 DOI: 10.1093/occmed/kqae015] [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: 03/27/2024] Open
Abstract
This case report describes a 22-year-old female Ambulance Technician student who displayed human immunodeficiency virus (HIV) false positivity following a recent hepatitis B vaccination. Occupational health clinicians who work in a healthcare setting (with healthcare staff and/or students) should be aware of the possibility of false-positive HIV screening test results, and where a false positive is suspected, they should consider what the underlying cause could be and should consider whether further medical investigation is required.
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Affiliation(s)
- J Quigley
- Consultant Occupational Physician, Independent, Manchester, UK
| | - T Hussain
- Consultant Occupational Physician, Independent, Manchester, UK
| | - C Arthur
- Occupational Health Advisor, Optima Health, Manchester, UK
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3
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Arthur C, Bender A, Perkins M. LONELINESS AND PSYCHOLOGICAL DISTRESS AMONG AFRICAN AMERICAN ASSISTED LIVING RESIDENTS APPROACHING END OF LIFE. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2829] [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: 12/24/2022] Open
Abstract
Abstract
Social isolation and loneliness are common at end of life and important contributors to psychological distress, particularly among older adults. Despite evidence that isolation and loneliness are generally prevalent in assisted living (AL), little research has examined these states within the context of end of life (EOL). This study uses secondary data from an EOL study in assisted living to qualitatively characterize the experience of isolation and loneliness in African American AL residents with varying levels of psychological distress. We performed a thematic analysis using ethnographic and interview data collected from 25 residents (64% female) in a large (90+ bed) all-African American AL community in metropolitan Atlanta. We assessed psychological distress using the PHQ-4 and used this measure in qualitative analysis to explore varying patterns of social isolation and loneliness across residents. Findings showed high variability in psychological distress based on PHQ-4 scores (range 0–12, mean = 3.5, SD = 3.75). Across themes of social isolation and loneliness, we compared experiences of residents with low and high psychological distress. The maintenance of agency in the face of isolation and loneliness was the predominant pattern among the low-distress group, while passive withdrawal was consistently identified among the high-distress group. We classified these themes in terms of individual interpersonal relationships characterized by self-isolation and negotiation of family connections, as well as AL community-level relationships characterized by the liminality of the lived AL experience. Results have important implications for multilevel interventions designed to reduce social isolation, loneliness, and psychological distress among this population.
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Affiliation(s)
| | | | - Molly Perkins
- Emory University School of Medicine , Atlanta, Georgia , United States
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4
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Steenbergen DJ, Raubani J, Gereva S, Naviti W, Arthur C, Arudere A, Ham J, Joy L, Lalavanua W, Neihapi P, Seko A, Terashima H, Andrew NL. Tracing innovation pathways behind fisheries co-management in Vanuatu. Ambio 2022; 51:2359-2375. [PMID: 36138263 PMCID: PMC9510257 DOI: 10.1007/s13280-022-01788-y] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/30/2022] [Accepted: 08/17/2022] [Indexed: 06/16/2023]
Abstract
Co-management approaches have become a core part of coastal fisheries policy and planning practice in Vanuatu. With a long history of supporting community based fisheries management (CBFM), we trace its evolution in Vanuatu to understand how new structures and processes become adopted at scale. A theory of scaling for CBFM guides the analysis of regime shifts over time. We discuss planning for sustained spread under a national programme by categorising multiple drivers of change through three intervention pathways focussed, respectively, on developing (i) an enabling environment, (ii) institutional and individual capacity, and (iii) focussed innovative action in smaller targeted constituencies. Whilst we argue that local fisheries co-management institutions balance competing interests, and so differ amongst places, we also recognise the importance of connectivity and continuity. The realisation of a national programme therefore requires patchworks of siloed projects to be knitted together into coordinated programmatic approaches that strategically integrate activities.
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Affiliation(s)
- Dirk J. Steenbergen
- Australian Centre for Ocean Resources and Security (ANCORS), University of Wollongong (UOW), North Wollongong, Wollongong, NSW 2500 Australia
| | - Jacob Raubani
- Pacific Islands Forum Fisheries Agency (FFA), Honiara, Solomon Islands
| | - Sompert Gereva
- Vanuatu Fisheries Department, Mingkai Building, Teoma Street, PO Box 9045, Port-Vila, Vanuatu
| | - William Naviti
- Vanuatu Fisheries Department, Mingkai Building, Teoma Street, PO Box 9045, Port-Vila, Vanuatu
| | - Christopher Arthur
- Vanuatu Fisheries Department, Mingkai Building, Teoma Street, PO Box 9045, Port-Vila, Vanuatu
| | - Ajay Arudere
- Vanuatu Fisheries Department, Mingkai Building, Teoma Street, PO Box 9045, Port-Vila, Vanuatu
| | - Jayven Ham
- Vanuatu Fisheries Department, Mingkai Building, Teoma Street, PO Box 9045, Port-Vila, Vanuatu
| | - Lucy Joy
- Vanuatu Fisheries Department, Mingkai Building, Teoma Street, PO Box 9045, Port-Vila, Vanuatu
| | - Watisoni Lalavanua
- Pacific Community-Fisheries Aquaculture and Marine Ecosystem Division (SPC-FAME), CPS B.P. D5, 98848 Nouméa, New Caledonia
| | - Pita Neihapi
- Vanuatu Fisheries Department, Mingkai Building, Teoma Street, PO Box 9045, Port-Vila, Vanuatu
| | - Akiya Seko
- IC Net Limited, Land Axis Tower, 27th Floor 11-2 Shintoshin, Chuo-ku, Saitama-shi, Saitama 330-6027 Japan
| | - Hiroaki Terashima
- IC Net Limited, Land Axis Tower, 27th Floor 11-2 Shintoshin, Chuo-ku, Saitama-shi, Saitama 330-6027 Japan
| | - Neil L. Andrew
- Australian Centre for Ocean Resources and Security (ANCORS), University of Wollongong (UOW), North Wollongong, Wollongong, NSW 2500 Australia
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Shen Y, Coyle L, Kerridge I, Stevenson W, Arthur C, McKinlay N, Fay K, Ward C, Greenwood M, Best OG, Solterbeck A, Guminski A, Shumack S, Mulligan SP. Second primary malignancies in chronic lymphocytic leukaemia: Skin, solid organ, haematological and Richter's syndrome. EJHaem 2022; 3:129-138. [PMID: 35846218 PMCID: PMC9175984 DOI: 10.1002/jha2.366] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 05/12/2023]
Abstract
Chronic lymphocytic leukaemia (CLL) is invariably accompanied by some degree of immune failure, and CLL patients have a high rate of second primary malignancy (SPM) compared to the general population. We comprehensively documented the incidence of all forms of SPM including skin cancer (SC), solid organ malignancy (SOM), second haematological malignancy (SHM) and separately Richter's syndrome (RS) across all therapy eras. Among the 517 CLL/small lymphocytic lymphoma (SLL) patients, the overall incidence of SPMs with competing risks was SC 31.07%, SOM 25.99%, SHM 5.19% and RS 7.55%. Of the 216 treated patients, 106 (49.1%) had at least one form of SPM, and 63 of 106 (29.2% of treated patients) developed an SPM 1.5 years (median) after treatment for their CLL. Melanoma accounted for 30.3% of SC. Squamous cell carcinoma (SCC), including eight metastatic SCCs, was 1.8 times more than basal cell carcinoma (BCC), a reversal of the typical BCC:SCC ratio. The most common SOMs were prostate (6.4%) and breast (4.5%). SHM included seven acute myeloid leukaemia (AML) and five myelodysplasia (MDS) of which eight (four AML, four MDS) were therapy-related. Any SPM occurred in 32.1% of 53 Monoclonal B-lymphocytosis (MBL) patients. Age-adjusted standardised rates of SPM (per 100,000) for CLL, MBL and the general Australian population were 2648, 1855 and 486.9, respectively. SPMs are a major health burden with 44.9% of CLL patients with having at least one SPM, and apart from SC, associated with significantly reduced overall survival. Dramatic improvements in CLL treatment and survival have occurred with immunochemotherapy and targeted therapies, but mitigating SPM burden will be important to sustain further progress.
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Affiliation(s)
- Yandong Shen
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Kolling Institute of Medical ResearchRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Luke Coyle
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Ian Kerridge
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - William Stevenson
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Christopher Arthur
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Naomi McKinlay
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Keith Fay
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Christopher Ward
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Matthew Greenwood
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Oliver Giles Best
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Ann Solterbeck
- Statistical Revelations Pty LtdOcean GroveVictoriaAustralia
| | - Alexander Guminski
- Department of Medical OncologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Stephen Shumack
- Department of DermatologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Stephen P. Mulligan
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Kolling Institute of Medical ResearchRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
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6
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Prasselsperger A, Coughlan M, Breslin N, Yeung M, Arthur C, Donnelly H, White S, Afshari M, Speicher M, Yang R, Villagomez-Bernabe B, Currell FJ, Schreiber J, Dromey B. Real-Time Electron Solvation Induced by Bursts of Laser-Accelerated Protons in Liquid Water. Phys Rev Lett 2021; 127:186001. [PMID: 34767414 DOI: 10.1103/physrevlett.127.186001] [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] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Abstract
Understanding the mechanisms of proton energy deposition in matter and subsequent damage formation is fundamental to radiation science. Here we exploit the picosecond (10^{-12} s) resolution of laser-driven accelerators to track ultrafast solvation dynamics for electrons due to proton radiolysis in liquid water (H_{2}O). Comparing these results with modeling that assumes initial conditions similar to those found in photolysis reveals that solvation time due to protons is extended by >20 ps. Supported by magnetohydrodynamic theory this indicates a highly dynamic phase in the immediate aftermath of the proton interaction that is not accounted for in current models.
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Affiliation(s)
- A Prasselsperger
- Fakultät für Physik, Ludwig-Maximilians-Universität München, 85748 Garching, Germany
- Centre for Plasma Physics, School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN, United Kingdom
| | - M Coughlan
- Centre for Plasma Physics, School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN, United Kingdom
| | - N Breslin
- Centre for Plasma Physics, School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN, United Kingdom
| | - M Yeung
- Centre for Plasma Physics, School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN, United Kingdom
| | - C Arthur
- Centre for Plasma Physics, School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN, United Kingdom
| | - H Donnelly
- Centre for Plasma Physics, School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN, United Kingdom
| | - S White
- Centre for Plasma Physics, School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN, United Kingdom
| | - M Afshari
- Centre for Plasma Physics, School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN, United Kingdom
| | - M Speicher
- Fakultät für Physik, Ludwig-Maximilians-Universität München, 85748 Garching, Germany
| | - R Yang
- Fakultät für Physik, Ludwig-Maximilians-Universität München, 85748 Garching, Germany
| | - B Villagomez-Bernabe
- The Dalton Cumbria Facility and the School of Chemistry, The University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - F J Currell
- The Dalton Cumbria Facility and the School of Chemistry, The University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - J Schreiber
- Fakultät für Physik, Ludwig-Maximilians-Universität München, 85748 Garching, Germany
| | - B Dromey
- Centre for Plasma Physics, School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN, United Kingdom
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7
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Jao C, Arthur C, Rohou A, Kschonsak M, Ortwine D, Sellers B, Dragovich P, Volgraf M, Sutherlin D, Koth C, Payanden J, Tellis J, Ciferri C. Taking away PAIN: enabling new structures of the Nav1.7 sodium channel by cryo-EM. Acta Crystallogr A Found Adv 2021. [DOI: 10.1107/s0108767321099839] [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: 11/10/2022] Open
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8
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Bannerji R, Yuen S, Phillips T, Arthur C, Isufi I, Marlton P, Seymour JF, Corradini P, Molinari A, Gritti G, Emmons R, Hirata J, Musick L, Saha S, Croft B, Flowers C. POLATUZUMAB VEDOTIN + OBINUTUZUMAB + VENETOCLAX IN PATIENTS WITH RELAPSED/REFRACTORY (R/R) FOLLICULAR LYMPHOMA (FL): PRIMARY ANALYSIS OF A PHASE 1B/2 TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.23_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R. Bannerji
- Rutgers Cancer Institute of New Jersey Section of Hematologic Malignancies New Brunswick New Jersey USA
| | - S. Yuen
- The Calvary Mater Newcastle Hospital Waratah Australia
| | - T. Phillips
- University of Michigan Medical School, Division of Hematology and Oncology Ann Arbor USA
| | - C. Arthur
- Royal North Shore Hospital Sydney Australia
| | - I. Isufi
- Yale University, Smilow Cancer Hospital Section of Hematology New Haven USA
| | - P. Marlton
- Princess Alexandra Hospital and University of Queensland Department of Haematology Brisbane Australia
| | - J. F. Seymour
- Peter MacCallum Cancer Centre & Royal Melbourne Hospital Department of Haematology Melbourne Australia
| | - P. Corradini
- University of Milan, Istituto Nazionale dei Tumori Medical Oncology and Hematology Department Milan Italy
| | - A. Molinari
- AUSL Romagna Ospedale degli Infirmi Dirigente Medico Ematologia Rimini Italy
| | - G. Gritti
- ASST Papa Giovanni XXIII UOC Ematologia Bergamo Italy
| | - R. Emmons
- James Graham Brown Cancer Center Louisville USA
| | - J. Hirata
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - L. Musick
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - S. Saha
- F. Hoffmann‐La Roche Ltd Product Development Biometrics Welwyn Garden City UK
| | - B. Croft
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - C. Flowers
- M.D. Anderson Cancer Center Department of Lymphoma/Myeloma Houston USA
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Bannerji R, Yuen S, Phillips TJ, Arthur C, Isufi I, Marlton P, Seymour JF, Corradini P, Molinari A, Gritti G, Emmons R, Hirata J, Musick L, Saha S, Croft B, Flowers C. Polatuzumab vedotin + obinutuzumab + venetoclax in patients with relapsed/refractory (R/R) follicular lymphoma (FL): Primary analysis of a phase 1b/2 trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7534 Background: Polatuzumab vedotin (Pola) + obinutuzumab (G) demonstrated activity and tolerability in a Phase 1b/2 trial of patients (pts) with R/R FL (Phillips, et al. Blood 2016). Preclinical studies with venetoclax (Ven) showed that concurrent treatment with Pola promotes MCL-1 degradation, a known mechanism of resistance to Ven, and enhances in vivo anti-tumor efficacy (Amin, et al. AACR 2020). Here, we report the primary safety/efficacy analysis with Pola-G-Ven in a Phase 1b/2 study of pts with R/R FL (GO29833; NCT02611323). Methods: Pts received induction treatment every 21 days (D) x six cycles (C) of: Pola 1.4–1.8mg/kg intravenously (IV) in dose escalation (DE) or recommended Phase 2 dose (RP2D) on D1; G 1000mg IV (C1: D1, D8, D15; C2–6: D1); and oral Ven 200–800mg (DE or RP2D; D1–21). Pts with complete response/partial response/stable disease (CR/PR/SD) at end of induction (EOI) received maintenance with G (1000mg on D1 every 2 months [mo] for 24 mo) and Ven (200–800mg daily) for 8 mo. Primary endpoints were safety/tolerability and positron emission tomography (PET)-CR rate at EOI by independent review committee (IRC) using modified Lugano criteria. Results: At the primary analysis (Oct 05, 2020), 74 pts were enrolled. Median pt age was 64 years (range 36–78); male (57%); Ann Arbor Stage III–IV (86%); FL International Prognostic Index high risk ≥3 (55%); bulky disease ≥7cm (16%); prior lines of therapy ≥2 (74%); refractory to: last prior therapy (51%), any prior anti-CD20 therapy (55%), both anti-CD20 therapy and an alkylating agent (double refractory; 55%). Grade 3–4 adverse events (AEs) were experienced by 73% of pts; most commonly, neutropenia (39%), thrombocytopenia (19%), and infections (16%; mainly pneumonia). AEs led to dose reduction in 38% and interruption in 68% of pts (mainly modifications to Ven). One fatal AE was reported (pneumonia). In total, 49 pts were treated at RP2D (Pola 1.8mg/kg + Ven 800mg) and were evaluable for efficacy. PET-CR rate at EOI by IRC was 57% (Table). With a median follow-up of 14.4 mo (range 8.2–28.4), the 12-mo progression-free survival (PFS) was 73% (95% confidence interval: 59.4–86.9). Median PFS was not reached. Conclusions: The safety profile of Pola-G-Ven is consistent with the known profiles of the individual drugs. Response rates at EOI with Pola-G-Ven are encouraging in this R/R FL patient population. Additional follow-up is needed to assess PFS benefit during maintenance treatment and beyond. Clinical trial information: NCT02611323. [Table: see text]
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Affiliation(s)
- Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sam Yuen
- The Calvary Mater Newcastle Hospital, Waratah, Australia
| | | | | | | | - Paula Marlton
- Princess Alexandra Hospital and University of Queensland, Brisbane, Australia
| | | | - Paolo Corradini
- University of Milan, Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | | | - Sourish Saha
- F. Hoffmann-La Roche Ltd., Welwyn Garden City, United Kingdom
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Balfour J, Powell-Bowns M, Leow J, Arthur C. 83 Closed Loop Audit Examining Documentation of Advanced Trauma and Life Support (ATLS) Secondary Survey in Polytrauma Cases at The Royal Infirmary of Edinburgh (RIE). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.363] [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: 11/14/2022]
Abstract
Abstract
Introduction
Secondary survey is a key aspect of the ATLS guidelines in avoiding missed injuries in polytrauma patients. Aim: Evaluate the documentation of secondary survey in polytrauma cases admitted to the RIE A+E department.
Method
Standard audit protocol, retrospective data collection. Polytrauma patients and patients requiring Trauma CT were identified from the local trauma database. Primary outcome was successful completion and documentation of secondary survey. Cycle 1: All patients from 01/01/2015-01/09/2015. Local policy change included an A+E trauma booklet and policy of secondary survey on admission to Intensive Care. Cycle 2 was completed post-intervention for patients presenting between 11/01/2019-29/05/2019.
Results
Cycle 1 (N = 20, N Secondary survey documented=10, mean=50%). Mean time to secondary survey was 8 hours (range 3-49). Cycle 2 (N = 28, N Secondary survey documented=24, mean=87.5%). Mean time to a secondary survey was 4 hours 30 minutes (range=1-21hrs). Significant improvement in documentation (Fisher’s Exact Test, P = 0.017).
Conclusions
Implementation of the secondary survey protocol and trauma booklet significantly improved documentation of secondary survey in the polytrauma patient. Evidence also suggests improved time to secondary survey. However, documentation of secondary survey is not universal indicating further improvement is required in trauma care, as the RIE moves towards becoming a National Major Trauma Centre.
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Affiliation(s)
- J Balfour
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - J Leow
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - C Arthur
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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11
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Hanna CR, Slevin F, Appelt A, Beavon M, Adams R, Arthur C, Beasley M, Duffton A, Gilbert A, Gollins S, Harrison M, Hawkins MA, Laws K, O'Cathail S, Porcu P, Robinson M, Sebag-Montefiore D, Teo M, Teoh S, Muirhead R. Intensity-modulated Radiotherapy for Rectal Cancer in the UK in 2020. Clin Oncol (R Coll Radiol) 2021; 33:214-223. [PMID: 33423883 PMCID: PMC7985673 DOI: 10.1016/j.clon.2020.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/13/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022]
Abstract
AIMS Preoperative (chemo)radiotherapy followed by total mesorectal excision is the current standard of care for patients with locally advanced rectal cancer. The use of intensity-modulated radiotherapy (IMRT) for rectal cancer is increasing in the UK. However, the extent of IMRT implementation and current practice was not previously known. A national survey was commissioned to investigate the landscape of IMRT use for rectal cancer and to inform the development of national rectal cancer IMRT guidance. MATERIALS AND METHODS A web-based survey was developed by the National Rectal Cancer IMRT Guidance working group in collaboration with the Royal College of Radiologists and disseminated to all UK radiotherapy centres. The survey enquired about the implementation of IMRT with a focus on the following aspects of the workflow: dose fractionation schedules and use of a boost; pre-treatment preparation and simulation; target volume/organ at risk definition; treatment planning and treatment verification. A descriptive statistical analysis was carried out. RESULTS In total, 44 of 63 centres (70%) responded to the survey; 30/44 (68%) and 36/44 (82%) centres currently use IMRT to treat all patients and selected patients with rectal cancer, respectively. There was general agreement concerning several aspects of the IMRT workflow, including patient positioning, use of intravenous contrast and bladder protocols. Greater variation in practice was identified regarding rectal protocols; use of a boost to primary/nodal disease; target volume delineation; organ at risk delineation and dose constraints and treatment verification. Delineation of individual small bowel loops and daily volumetric treatment verification were considered potentially feasible by most centres. CONCLUSION This survey identified that IMRT is already used to treat rectal cancer in many UK radiotherapy centres, but there is heterogeneity between centres in its implementation and practice. These results have been a valuable aid in framing the recommendations within the new National Rectal Cancer IMRT Guidance.
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Affiliation(s)
- C R Hanna
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - F Slevin
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Appelt
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Beavon
- Royal College of Radiologists, London, UK
| | - R Adams
- Velindre Cancer Centre, Cardiff, UK
| | - C Arthur
- The Christie NHS Foundation Trust, Manchester, UK
| | - M Beasley
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Duffton
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Gilbert
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl, UK
| | - M Harrison
- Mount Vernon Cancer Centre, Northwood, UK
| | - M A Hawkins
- Medical Physics and Biochemical Engineering, University College London, London, UK
| | - K Laws
- Aberdeen Cancer Centre, Aberdeen Royal Infirmary, Aberdeen, UK
| | - S O'Cathail
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - P Porcu
- Royal Free London NHS Foundation Trust, London, UK
| | - M Robinson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Sebag-Montefiore
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Teo
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Teoh
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Muirhead
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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12
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Galloway JM, Bray HEV, Shoemark DK, Hodgson LR, Coombs J, Mantell JM, Rose RS, Ross JF, Morris C, Harniman RL, Wood CW, Arthur C, Verkade P, Woolfson DN. De Novo Designed Peptide and Protein Hairpins Self-Assemble into Sheets and Nanoparticles. Small 2021; 17:e2100472. [PMID: 33590708 DOI: 10.1002/smll.202100472] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 06/12/2023]
Abstract
The design and assembly of peptide-based materials has advanced considerably, leading to a variety of fibrous, sheet, and nanoparticle structures. A remaining challenge is to account for and control different possible supramolecular outcomes accessible to the same or similar peptide building blocks. Here a de novo peptide system is presented that forms nanoparticles or sheets depending on the strategic placement of a "disulfide pin" between two elements of secondary structure that drive self-assembly. Specifically, homodimerizing and homotrimerizing de novo coiled-coil α-helices are joined with a flexible linker to generate a series of linear peptides. The helices are pinned back-to-back, constraining them as hairpins by a disulfide bond placed either proximal or distal to the linker. Computational modeling indicates, and advanced microscopy shows, that the proximally pinned hairpins self-assemble into nanoparticles, whereas the distally pinned constructs form sheets. These peptides can be made synthetically or recombinantly to allow both chemical modifications and the introduction of whole protein cargoes as required.
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Affiliation(s)
- Johanna M Galloway
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
- School of Chemistry, University of Leeds, Leeds, LS2 9JT, UK
| | - Harriet E V Bray
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
| | - Deborah K Shoemark
- School of Biochemistry, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Lorna R Hodgson
- School of Biochemistry, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
- BrisSynBio/Bristol Biodesign Institute, University of Bristol, Life Sciences Building, Tyndall Avenue, Bristol, BS8 1TQ, UK
| | - Jennifer Coombs
- School of Biochemistry, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
- Bristol Centre for Functional Nanomaterials, School of Physics, University of Bristol, HH Wills Physics Laboratory, Tyndall Avenue, Bristol, BS8 1TL, UK
| | - Judith M Mantell
- School of Biochemistry, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Ruth S Rose
- School of Biological and Chemical Sciences, Fogg Building, Queen Mary University of London, Mile End Road, London, E1 4QD, UK
| | - James F Ross
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
- School of Chemistry, University of Leeds, Leeds, LS2 9JT, UK
| | - Caroline Morris
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
- BrisSynBio/Bristol Biodesign Institute, University of Bristol, Life Sciences Building, Tyndall Avenue, Bristol, BS8 1TQ, UK
- School of Chemistry, University of Glasgow, 0/1 125 Novar Drive, Glasgow, G12 9TA, UK
| | - Robert L Harniman
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
| | - Christopher W Wood
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
- BrisSynBio/Bristol Biodesign Institute, University of Bristol, Life Sciences Building, Tyndall Avenue, Bristol, BS8 1TQ, UK
- School of Biological Sciences, Roger Land Building, King's Buildings, Edinburgh, EH9 3JQ, UK
| | - Christopher Arthur
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
| | - Paul Verkade
- School of Biochemistry, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
- BrisSynBio/Bristol Biodesign Institute, University of Bristol, Life Sciences Building, Tyndall Avenue, Bristol, BS8 1TQ, UK
| | - Derek N Woolfson
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
- School of Biochemistry, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
- BrisSynBio/Bristol Biodesign Institute, University of Bristol, Life Sciences Building, Tyndall Avenue, Bristol, BS8 1TQ, UK
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13
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Gardiner FW, Richardson A, Roxburgh C, Gillam M, Churilov L, McCuaig R, Carter S, Arthur C, Wong C, Morton A, Callaway L, Lust K, Davidson SJ, Foxcroft K, Oates K, Zhang L, Jayawardane S, Coleman M, Peek M. Characteristics and in-hospital outcomes of patients requiring aeromedical retrieval for pregnancy, compared to non-retrieved metropolitan cohorts. Aust N Z J Obstet Gynaecol 2021; 61:519-527. [PMID: 33426679 DOI: 10.1111/ajo.13308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/23/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Limited access to obstetrics and gynaecology (O&G) services in rural and remote Australia is believed to contribute to suboptimal birth outcomes. AIMS To describe the characteristics of pregnancy aeromedical transfers, in-hospital outcomes, and patient access to O&G services, as compared to whole of Australia data. MATERIALS AND METHODS We conducted a cohort study of women who required aeromedical retrieval for pregnancy-related issues between the 1 January 2015 and 31 December 2017. RESULTS Hospital outcome data were collected on 2171 (65.2%) mothers and 2438 (100.0%) babies. The leading retrieval reason was threatened preterm labour and delivery (n = 883; 40.7%). Most patients were retrieved from rural and remote areas (n = 2224; 93.0%). Retrieved patients were significantly younger (28.0 vs 30.0 years, 95% CI 27.7-28.3), more likely to be overweight or obese (52.2% vs 45.1%, 95% CI 47.5-56.9) and to have smoked during their pregnancy (14.0% vs 9.9%, 95% CI 12.5-15.5) compared to Australian pregnant women overall. Over one-third of transferred women gave birth by Caesarean section (n = 812; 37.4%); the median gestational age at birth was 33.0 (95% CI 32.7-33.3) weeks. Early gestation is associated with low birth weights (median = 2579.5 g; 95% CI 2536.1-2622.9), neonatal resuscitation (35.4%, 95% CI 33.5-37.3), and special care nursery admission (41.2%, 95% CI 39.3-43.2). There were 42 (1.7%, 95% CI 1.2-2.2) stillbirths, which was significantly higher than seen Australia-wide (n = 6441; 0.7%). CONCLUSION This study found that pregnant women retrieved by the Royal Flying Doctor Service were younger, with higher rates of obesity and smoking.
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Affiliation(s)
- Fergus W Gardiner
- Royal Flying Doctor Service, Canberra, Australian Capital Territory, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Alice Richardson
- Statistical Consulting Unit, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Carly Roxburgh
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Ruth McCuaig
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Sean Carter
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | | | - Cynthia Wong
- Townsville University Hospital, Townsville, Queensland, Australia
| | - Adam Morton
- Mater Health Services Public Hospital, Brisbane, Queensland, Australia
| | - Leonie Callaway
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Karin Lust
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Sarah J Davidson
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Katie Foxcroft
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Kiri Oates
- Dubbo Hospital, Dubbo, New South Wales, Australia
| | - Lucy Zhang
- Dubbo Hospital, Dubbo, New South Wales, Australia
| | | | - Mathew Coleman
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Michael Peek
- Australian National University Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
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14
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Cortes J, Lomaia E, Turkina A, Moiraghi B, Sutton MU, Pavlovsky C, Rojas C, Chuah C, Arthur C, Apperley J, Kim DW, Hochhaus A, Rousselot P, Rosti G, Mauro M, Lipton J, Naranjo D, Liu G, Srivastava S, Deininger M. CML-114: Interim Analysis from the OPTIC Trial - A Dose-Ranging Study of 3 Starting Doses of Ponatinib. Clinical Lymphoma Myeloma and Leukemia 2020. [DOI: 10.1016/s2152-2650(20)30815-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Arthur C, Di Corleto E, Ballard E, Kothari A. A randomized controlled trial of daily weighing in pregnancy to control gestational weight gain. BMC Pregnancy Childbirth 2020; 20:223. [PMID: 32299371 PMCID: PMC7164155 DOI: 10.1186/s12884-020-02884-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 03/20/2020] [Indexed: 12/30/2022] Open
Abstract
Background Excessive gestational weight gain is a modifiable risk factor for the development of obstetric and neonatal complications, and can have a lifelong impact on the health of both mother and offspring. The purpose of this study was to assess whether in addition to standardized medical advice regarding weight gain in pregnancy (including adherence to the Institute of Medicine (IOM) guidelines) (IOM (Institute of Medicine) and NRC (National Research Council, Weight Gain During Pregnancy: Re-examining the guidelines, 2009)), the addition of daily weighing would provide a low cost and simple intervention to reduce excessive weight gain in pregnancy by maintaining weight gain within the target range. Methods Women presenting for antenatal care to a secondary level hospital were randomised to routine care or daily weight monitoring. Both groups received nutrition and exercise advice. Results Three hundred and ninety-six women were randomised to either the daily weight monitoring group or control group with complete data available for 326 women. The percentage weight gain above target (86.9% (SD 52.3) v 92.7% (SD 50.8) p = 0.31) and change in weight per week during the study period (0.59 kg (SD 0.30) v 0.63 kg (SD 0.31) p = 0.22) were lesser in those undergoing daily weighing compared to routine management, however these did not reach statistical significance. Conclusion Daily weight monitoring as a stand-alone intervention has potential to reduce excessive gestational weight gain. It may have a role as a part of a larger intervention involving dietary and exercise modifications. Trial registration The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry. (ACTRN12613001165774, 23/10/ 2013).
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Affiliation(s)
| | - Ellen Di Corleto
- University of Queensland, St Lucia, Queensland, Australia.,Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, Australia
| | - Emma Ballard
- University of Queensland, St Lucia, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Alka Kothari
- University of Queensland, St Lucia, Queensland, Australia. .,Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, Australia.
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16
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Othman J, Armytage T, Wong K, Arthur C, Fay K, Stevenson W, MacKinlay N, Ward C, Pechey V, Coyle L, Kerridge I, Greenwood M. Intensive chemotherapy and up-front stem cell transplant for double hit lymphoma. Bone Marrow Transplant 2020; 55:1460-1463. [DOI: 10.1038/s41409-020-0789-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 01/11/2023]
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17
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Arthur C, Jeffrey A, Yip E, Katsioulas V, Nalpantidis A, Kerridge I, Greenwood M, Coyle L, Mackinlay N, Fay K, Enjeti A, Shortt J, Stevenson W. Prolonged administration of low-dose cytarabine and thioguanine in elderly patients with acute myeloid leukaemia (AML) achieves high complete remission rates and prolonged survival. Leuk Lymphoma 2019; 61:831-839. [PMID: 31809629 DOI: 10.1080/10428194.2019.1697876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The prognosis of AML in elderly patients is poor and research into novel therapeutic approaches is urgently needed. This study examined the use of low-dose chemotherapy with cytarabine and thioguanine administered in repetitive cycles in 62 elderly patients with newly diagnosed or relapsed/refractory AML. The overall response rate was 58% in the total cohort. Response rates (CR/CRi) were significantly higher in patients with newly diagnosed AML (74%) compared to patients with relapsed/refractory disease (25%, p = .0004). Kaplan-Meier estimate of overall survival was 289 days (95% CI; 183-395 days) with a relapse rate of 65.7%. The induction mortality rate was 16.1% with treatment successfully undertaken in the outpatient setting. Similar clinical outcomes were observed in a retrospective analysis of a second cohort of 25 AML patients treated at a different site. These results support the use of a sustained low intensity chemotherapy approach as a therapeutic option for elderly patients with AML.
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Affiliation(s)
- Christopher Arthur
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Anthony Jeffrey
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Eva Yip
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Vicki Katsioulas
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | | | - Ian Kerridge
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Department of Medicine, University of Sydney, Sydney, Australia
| | - Matthew Greenwood
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Department of Medicine, University of Sydney, Sydney, Australia
| | - Luke Coyle
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Naomi Mackinlay
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Keith Fay
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Anoop Enjeti
- Department of Haematology, Pathology North, John Hunter Hospital, Newcastle, Australia
| | - Jake Shortt
- Department of Clinical Haematology, Monash Health, Clayton, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - William Stevenson
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Department of Medicine, University of Sydney, Sydney, Australia
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18
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Barbany G, Arthur C, Liedén A, Nordenskjöld M, Rosenquist R, Tesi B, Wallander K, Tham E. Cell-free tumour DNA testing for early detection of cancer - a potential future tool. J Intern Med 2019; 286:118-136. [PMID: 30861222 DOI: 10.1111/joim.12897] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, detection of cell-free tumour DNA (ctDNA) or liquid biopsy has emerged as an attractive noninvasive methodology to detect cancer-specific genetic aberrations in plasma, and numerous studies have reported on the feasibility of ctDNA in advanced cancer. In particular, ctDNA assays can capture a more 'global' portrait of tumour heterogeneity, monitor therapy response, and lead to early detection of resistance mutations. More recently, ctDNA analysis has also been proposed as a promising future tool for detection of early cancer and/or cancer screening. As the average proportion of mutated DNA in plasma is very low (0.4% even in advanced cancer), exceedingly sensitive techniques need to be developed. In addition, as tumours are genetically heterogeneous, any screening test needs to assay multiple genetic targets in order to increase the chances of detection. Further research on the genetic progression from normal to cancer cells and their release of ctDNA is imperative in order to avoid overtreating benign/indolent lesions, causing more harm than good by early diagnosis. More knowledge on the sources and elimination of cell-free DNA will enable better interpretation in older individuals and those with comorbidities. In addition, as white blood cells are the major source of cell-free DNA in plasma, it is important to distinguish acquired mutations in leukocytes (benign clonal haematopoiesis) from an upcoming haematological malignancy or other cancer. In conclusion, although many studies report encouraging results, further technical development and larger studies are warranted before applying ctDNA analysis for early cancer detection in the clinic.
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Affiliation(s)
- G Barbany
- Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - C Arthur
- Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Liedén
- Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - M Nordenskjöld
- Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - R Rosenquist
- Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - B Tesi
- Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - K Wallander
- Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - E Tham
- Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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19
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Xu H, Li T, Rohou A, Arthur C, Tzakoniati F, Wong E, Estevez A, Kugel C, Franke Y, Chen J, Ciferri C, Hackos D, Koth C, Payandeh J. Structural Basis of Nav1.7 Inhibition by the Tarantula Toxin Protoxin-II. Biophys J 2019. [DOI: 10.1016/j.bpj.2018.11.1687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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20
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Talaulikar D, Biscoe A, Lim JH, Gibson J, Arthur C, Mackinlay N, Saxena K, Cheng YY, Chen VM. Genetic analysis of Diffuse Large B‐cell Lymphoma occurring in cases with antecedent Waldenström Macroglobulinaemia reveals different patterns of clonal evolution. Br J Haematol 2018; 185:767-770. [DOI: 10.1111/bjh.15610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Dipti Talaulikar
- Haematology Translational Research Unit Canberra Hospital Canberra Australia
- Australian National University Medical School Canberra Australia
| | - Amber Biscoe
- Haematology Concord Repatriation General Hospital Sydney Australia
| | - Jun H. Lim
- Australian National University Medical School Canberra Australia
| | - John Gibson
- Royal Prince Alfred Hospital Sydney Australia
| | | | | | - Kartik Saxena
- Haematology Translational Research Unit Canberra Hospital Canberra Australia
| | - Yuen Y. Cheng
- Asbestos Diseases Research Institute The University of Sydney Sydney Australia
| | - Vivien M. Chen
- Haematology Concord Repatriation General Hospital Sydney Australia
- ANZAC Research Institute Sydney Australia
- University of Sydney Sydney Australia
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21
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Smail SJ, Arthur C, Hylands K, Stewart CJ. 'Bastard bush': acacia thorn injuries and management. J ROY ARMY MED CORPS 2018; 165:204-205. [PMID: 30206102 DOI: 10.1136/jramc-2018-000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/03/2022]
Abstract
This case report outlines the presentation and management of a young soldier who sustained a lower limb acacia thorn injury while on exercise in Kenya. The injury failed to heal with a subsequent ultrasound scan revealing a large retained thorn requiring surgical removal and wash out. From this case, lessons can be learnt regarding the management of thorn injuries, which are common in exercising troops in Kenya and indeed around the world. The key take-home messages are always consider a retained thorn if wounds fail to settle, use ultrasound as the imaging modality of choice, always remove identified retained thorns and if antibiotics are required use broad-spectrum antibiotics pending culture results.
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Affiliation(s)
- Simon Johnstone Smail
- Defence Primary Health Care, Medical Reception Station Redford Barracks, Edinburgh, UK
| | - C Arthur
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - K Hylands
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - C J Stewart
- Defence Primary Health Care, Medical Reception Station Redford Barracks, Edinburgh, UK
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22
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Talaulikar D, Biscoe A, Lim JH, Gibson J, Arthur C, Mackinlay N, Saxena K, Cheng YY, Chen V. Genetic analysis of diffuse large B-cell lymphoma occurring in cases with antecedent Waldenström macroglobulinaemia. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e19544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Amber Biscoe
- Concord Repatriation General Hospital, Sydney, Australia
| | - Jun Hee Lim
- Australian National University, Canberra, Australia
| | - John Gibson
- Royal Prince Alfred Hospital, Sydney, Australia
| | | | | | | | | | - Vivien Chen
- Concord Repatriation General Hospital, Sydney, Australia
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23
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Lindsay J, Sandaradura I, Wong K, Arthur C, Stevenson W, Kerridge I, Fay K, Coyle L, Greenwood M. New Formulation Suba-Itraconazole Prophylaxis in Patients with Haematological Malignancy or Undergoing Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.282] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chong BH, Cade JF, Magnani H, Manoharan A, Oldmeadow M, Arthur C, Rickard K, Gallo J, Lloyd J, Seshadri P, Gallus AS, Chesterman CN. Prospective Randomised Open-label Comparison of Danaparoid with Dextran 70 in the Treatment of Heparin-induced Thrombocytopaenia with Thrombosis. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1616046] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: To compare clinical outcomes in a randomised comparison of treatment with danaparoid sodium (a heparinoid), or dextran 70, for heparin-induced thrombocytopaenia (HIT) plus thrombosis. Methods: Forty-two patients with recent thrombosis and a clinical diagnosis of probable HIT who presented at ten Australian hospitals during a study period of six and one half years were randomly assigned to open-label treatment with intravenous danaparoid or dextran 70, each combined with oral warfarin. Thirty-four patients (83%) had a positive platelet aggregation or 14C-serotonin release test for HIT antibody. Twenty-five received danaparoid as a bolus injection of 2400 anti-Xa units followed by 400 units per hour for 2 h, 300 units per hour for 2 h, and then 200 units per hour for five days. Seventeen received 1000 mL dextran 70 on day one and then 500 mL on days 2-5. Patients were reviewed daily for clinical evidence of thrombus progression or resolution, fresh thrombosis or embolism, bleeding or other complications. The primary trial endpoint was the proportion of thromboembolic events with complete clinical resolution by the time of discharge from hospital. Results: With danaparoid, there was complete clinical recovery from 56% of thromboembolic events compared to 14% after dextran 70 (Odds Ratio 10.53, 95% Confidence Interval 1.6–71.4; p = 0.02). Clinical recovery with danaparoid was complete or partial in 86% of thromboembolic events compared with 53% after dextran 70 (Odds Ratio 4.55, 95% Confidence Interval 1.2–16.7; p = 0.03). Overall clinical effectiveness of danaparoid was rated as high or moderate in 88% of patients compared with 47% for dextran 70 (p = 0.01). One patient given danaparoid died of thrombosis compared with three patients given dextran 70. The platelet count returned to normal after a mean of 6.7 days with danaparoid and 7.3 days with dextran 70. There was no major bleeding with either treatment. Conclusion: danaparoid plus warfarin treatment for HIT with thrombosis is effective, safe, and superior to dextran 70 plus warfarin.
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Unnikrishnan A, Papaemmanuil E, Beck D, Deshpande NP, Verma A, Kumari A, Woll PS, Richards LA, Knezevic K, Chandrakanthan V, Thoms JAI, Tursky ML, Huang Y, Ali Z, Olivier J, Galbraith S, Kulasekararaj AG, Tobiasson M, Karimi M, Pellagatti A, Wilson SR, Lindeman R, Young B, Ramakrishna R, Arthur C, Stark R, Crispin P, Curnow J, Warburton P, Roncolato F, Boultwood J, Lynch K, Jacobsen SEW, Mufti GJ, Hellstrom-Lindberg E, Wilkins MR, MacKenzie KL, Wong JWH, Campbell PJ, Pimanda JE. Integrative Genomics Identifies the Molecular Basis of Resistance to Azacitidine Therapy in Myelodysplastic Syndromes. Cell Rep 2017; 20:572-585. [PMID: 28723562 DOI: 10.1016/j.celrep.2017.06.067] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [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: 12/24/2015] [Revised: 03/20/2017] [Accepted: 06/22/2017] [Indexed: 11/30/2022] Open
Abstract
Myelodysplastic syndromes and chronic myelomonocytic leukemia are blood disorders characterized by ineffective hematopoiesis and progressive marrow failure that can transform into acute leukemia. The DNA methyltransferase inhibitor 5-azacytidine (AZA) is the most effective pharmacological option, but only ∼50% of patients respond. A response only manifests after many months of treatment and is transient. The reasons underlying AZA resistance are unknown, and few alternatives exist for non-responders. Here, we show that AZA responders have more hematopoietic progenitor cells (HPCs) in the cell cycle. Non-responder HPC quiescence is mediated by integrin α5 (ITGA5) signaling and their hematopoietic potential improved by combining AZA with an ITGA5 inhibitor. AZA response is associated with the induction of an inflammatory response in HPCs in vivo. By molecular bar coding and tracking individual clones, we found that, although AZA alters the sub-clonal contribution to different lineages, founder clones are not eliminated and continue to drive hematopoiesis even in complete responders.
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Affiliation(s)
- Ashwin Unnikrishnan
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia.
| | - Elli Papaemmanuil
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Saffron Walden CB10 1SA, UK; Center for Molecular Oncology and Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Dominik Beck
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia; Centre for Health Technologies and the School of Software, University of Technology, Sydney, NSW 2007, Australia
| | - Nandan P Deshpande
- Systems Biology Initiative, School of Biotechnology and Biomolecular Sciences, UNSW, Sydney, NSW 2052, Australia; School of Biotechnology and Biomolecular Sciences, UNSW, Sydney, NSW 2052, Australia
| | - Arjun Verma
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia; Climate Change Cluster, University of Technology, Sydney, NSW 2007, Australia
| | - Ashu Kumari
- Children's Cancer Institute Australia, Sydney, NSW 2052, Australia
| | - Petter S Woll
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; Haematopoietic Stem Cell Biology Laboratory, MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - Laura A Richards
- Children's Cancer Institute Australia, Sydney, NSW 2052, Australia
| | - Kathy Knezevic
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia
| | - Vashe Chandrakanthan
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia
| | - Julie A I Thoms
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia
| | - Melinda L Tursky
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia; Children's Cancer Institute Australia, Sydney, NSW 2052, Australia; Blood, Stem Cells and Cancer Research, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Yizhou Huang
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia; Centre for Health Technologies and the School of Software, University of Technology, Sydney, NSW 2007, Australia
| | - Zara Ali
- Children's Cancer Institute Australia, Sydney, NSW 2052, Australia
| | - Jake Olivier
- School of Mathematics and Statistics, UNSW, Sydney, NSW 2052, Australia
| | - Sally Galbraith
- School of Mathematics and Statistics, UNSW, Sydney, NSW 2052, Australia
| | - Austin G Kulasekararaj
- Department of Haematological Medicine, King's College London School of Medicine, London WC2R 2LS, UK
| | - Magnus Tobiasson
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
| | - Mohsen Karimi
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
| | - Andrea Pellagatti
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Susan R Wilson
- School of Mathematics and Statistics, UNSW, Sydney, NSW 2052, Australia; Mathematical Sciences Institute, ANU, Canberra, ACT 0200, Australia
| | - Robert Lindeman
- Haematology Department, South Eastern Area Laboratory Services, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Boris Young
- Haematology Department, South Eastern Area Laboratory Services, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | | | | | - Richard Stark
- North Coast Cancer Institute, Port Macquarie, NSW 2444, Australia
| | | | - Jennifer Curnow
- Concord Repatriation General Hospital, Concord, NSW 2139, Australia
| | | | | | - Jacqueline Boultwood
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Kevin Lynch
- Celgene International, 2017 Boudry, Switzerland
| | - Sten Eirik W Jacobsen
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; Haematopoietic Stem Cell Biology Laboratory, MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - Ghulam J Mufti
- Department of Haematological Medicine, King's College London School of Medicine, London WC2R 2LS, UK
| | - Eva Hellstrom-Lindberg
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
| | - Marc R Wilkins
- Systems Biology Initiative, School of Biotechnology and Biomolecular Sciences, UNSW, Sydney, NSW 2052, Australia; School of Biotechnology and Biomolecular Sciences, UNSW, Sydney, NSW 2052, Australia; Ramaciotti Centre for Gene Function Analysis, UNSW, Sydney, NSW 2052, Australia
| | | | - Jason W H Wong
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia
| | - Peter J Campbell
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Saffron Walden CB10 1SA, UK.
| | - John E Pimanda
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW, Sydney, NSW 2052, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW 2052, Australia; Haematology Department, South Eastern Area Laboratory Services, Prince of Wales Hospital, Randwick, NSW 2031, Australia.
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McCullough J, Clippinger AK, Talledge N, Skowyra ML, Saunders MG, Naismith TV, Colf LA, Afonine P, Arthur C, Sundquist WI, Hanson PI, Frost A. Structure and membrane remodeling activity of ESCRT-III helical polymers. Science 2015; 350:1548-51. [PMID: 26634441 PMCID: PMC4684769 DOI: 10.1126/science.aad8305] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [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: 09/14/2015] [Accepted: 11/16/2015] [Indexed: 01/24/2023]
Abstract
The endosomal sorting complexes required for transport (ESCRT) proteins mediate fundamental membrane remodeling events that require stabilizing negative membrane curvature. These include endosomal intralumenal vesicle formation, HIV budding, nuclear envelope closure, and cytokinetic abscission. ESCRT-III subunits perform key roles in these processes by changing conformation and polymerizing into membrane-remodeling filaments. Here, we report the 4 angstrom resolution cryogenic electron microscopy reconstruction of a one-start, double-stranded helical copolymer composed of two different human ESCRT-III subunits, charged multivesicular body protein 1B (CHMP1B) and increased sodium tolerance 1 (IST1). The inner strand comprises "open" CHMP1B subunits that interlock in an elaborate domain-swapped architecture and is encircled by an outer strand of "closed" IST1 subunits. Unlike other ESCRT-III proteins, CHMP1B and IST1 polymers form external coats on positively curved membranes in vitro and in vivo. Our analysis suggests how common ESCRT-III filament architectures could stabilize different degrees and directions of membrane curvature.
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Affiliation(s)
- John McCullough
- Department of Biochemistry, University of Utah, Salt Lake City, UT 84112, USA
| | - Amy K Clippinger
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nathaniel Talledge
- Department of Biochemistry, University of Utah, Salt Lake City, UT 84112, USA. Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Michael L Skowyra
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Marissa G Saunders
- Department of Biochemistry, University of Utah, Salt Lake City, UT 84112, USA
| | - Teresa V Naismith
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Leremy A Colf
- Department of Biochemistry, University of Utah, Salt Lake City, UT 84112, USA
| | - Pavel Afonine
- Physical Bioscience Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | | | - Wesley I Sundquist
- Department of Biochemistry, University of Utah, Salt Lake City, UT 84112, USA.
| | - Phyllis I Hanson
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Adam Frost
- Department of Biochemistry, University of Utah, Salt Lake City, UT 84112, USA. Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94158, USA.
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Sumra P, Arthur C, Jackson A, Bhatt L, Sheikh H. 2270 Patterns of relapse following definitive chemoradiotherapy for oesophageal carcinoma - is there a case for elective nodal irradiation? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kadia TM, Thomas XG, Dmoszynska A, Wierzbowska A, Minden M, Arthur C, Delaunay J, Ravandi F, Kantarjian H. Decitabine improves outcomes in older patients with acute myeloid leukemia and higher blast counts. Am J Hematol 2015; 90:E139-41. [PMID: 25858582 DOI: 10.1002/ajh.24036] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Tapan M. Kadia
- Department of Leukemia; University of Texas MD Anderson Cancer Center; Houston Texas
| | | | - Anna Dmoszynska
- Department of Hematooncology and Bone Marrow Transplantation; Medical University of Lublin; Lublin Poland
| | | | - Mark Minden
- Princess Margaret Cancer Center; Toronto Canada
| | - Christopher Arthur
- Department of Haematology; Royal North Shore Hospital; St. Leonards New South Wales Australia
| | | | - Farhad Ravandi
- Department of Leukemia; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Hagop Kantarjian
- Department of Leukemia; University of Texas MD Anderson Cancer Center; Houston Texas
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Mehta S, Mcpartlin A, NikMutasim A, Arthur C, Bhatt L, Jackson A, Sheikh H. EP-1207: Relapse patterns and outcomes following radiotherapy alone for oesophageal cancer: a single UK centre experience. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41199-5] [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: 11/24/2022]
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Imlay-Gillespie L, Srinivasan M, Wong K, Arthur C, Fay K, Kerridge I, Stevenson W, Greenwood M. Identification of Respiratory Viral Infection in Hematopoietic Stem Cell Transplant Recipients - Impact on Non Relapse Mortality. Biol Blood Marrow Transplant 2015. [PMCID: PMC7128486 DOI: 10.1016/j.bbmt.2014.11.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arthur C, Cermak J, Delaunay J, Mayer J, Mazur G, Thomas X, Wierzbowska A, Jones MM, Berrak E, Kantarjian H. Post hoc analysis of the relationship between baseline white blood cell count and survival outcome in a randomized Phase III trial of decitabine in older patients with newly diagnosed acute myeloid leukemia. J Blood Med 2015; 6:25-9. [PMID: 25678833 PMCID: PMC4295530 DOI: 10.2147/jbm.s64067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 01/30/2023] Open
Abstract
Background In a Phase III trial, 485 patients (≥65 years) with newly diagnosed acute myeloid leukemia received decitabine 20 mg/m2 intravenously for 5 days every 4 weeks or a treatment choice (supportive care or cytarabine 20 mg/m2 subcutaneously for 10 days every 4 weeks). Materials and methods We summarized overall and progression-free survival by baseline white blood cell count using two analyses: <1, 1–5, >5×109/L; ≤10 or >10×109/L. Results There were 446 deaths (treatment choice, n=227; decitabine, n=219). Median overall survival was 5.0 (treatment choice) versus 7.7 months (decitabine; nominal P=0.037). Overall survival differences between white blood cell groups were not significant; hazard ratios (HRs) favored decitabine. Significant progression-free survival differences favored decitabine for groups 1–5×109/L (P=0.005, HR =0.67), greater than 5×109/L (P=0.027, HR =0.71), and up to 10×109/L (P=0.003, HR =0.72). Conclusion There was a trend toward improved outcome with decitabine, regardless of baseline white blood cell count.
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Affiliation(s)
- Christopher Arthur
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jaroslav Cermak
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jacques Delaunay
- Department of Clinical Hematology, University of Nantes, Nantes, France
| | - Jiří Mayer
- Department of Internal Medicine, Masaryk University Hospital Brno, Central European Institute of Technology, Brno, Czech Republic
| | - Grzegorz Mazur
- Department of Hematology, Wrocław Medical University, Wrocław, Poland
| | - Xavier Thomas
- Department of Hematology, Edouard Herriot Hospital, Lyon, France
| | | | - Mark M Jones
- Oncology Product Creation Unit, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Erhan Berrak
- Oncology Product Creation Unit, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Hagop Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Phillips JRA, Hopwood B, Arthur C, Stroud R, Toms AD. The natural history of pain and neuropathic pain after knee replacement: a prospective cohort study of the point prevalence of pain and neuropathic pain to a minimum three-year follow-up. Bone Joint J 2014; 96-B:1227-33. [PMID: 25183595 DOI: 10.1302/0301-620x.96b9.33756] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A small proportion of patients have persistent pain after total knee replacement (TKR). The primary aim of this study was to record the prevalence of pain after TKR at specific intervals post-operatively and to ascertain the impact of neuropathic pain. The secondary aim was to establish any predictive factors that could be used to identify patients who were likely to have high levels of pain or neuropathic pain after TKR. A total of 96 patients were included in the study. Their mean age was 71 years (48 to 89); 54 (56%) were female. The mean follow-up was 46 months (39 to 51). Pre-operative demographic details were recorded including a Visual Analogue Score (VAS) for pain, the Hospital Anxiety and Depression score as well as the painDETECT score for neuropathic pain. Functional outcome was assessed using the Oxford Knee score. The mean pre-operative VAS was 5.8 (1 to 10); and it improved significantly at all time periods post-operatively (p < 0.001): (from 4.5 at day three to five (1 to 10), 3.2 at six weeks (0 to 9), 2.4 at three months (0 to 7), 2.0 at six months (0 to 9), 1.7 at nine months (0 to 9), 1.5 at one year (0 to 8) and 2.0 at mean 46 months (0 to 10)). There was a high correlation (r > 0.7; p < 0.001) between the mean VAS scores for pain and the mean painDETECT scores at three months, one year and three years post-operatively. There was no correlation between the pre-operative scores and any post-operative scores at any time point. We report the prevalence of pain and neuropathic pain at various intervals up to three years after TKR. Neuropathic pain is an underestimated problem in patients with pain after TKR. It peaks at between six weeks and three-months post-operatively. However, from these data we were unable to predict which patients are most likely to be affected.
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Affiliation(s)
- J R A Phillips
- Royal Devon and Exeter Hospital, Exeter Knee Reconstruction Unit, Barrack Road, Exeter, UK
| | - B Hopwood
- Royal Devon and Exeter Hospital, Exeter Knee Reconstruction Unit, Barrack Road, Exeter, UK
| | - C Arthur
- Royal Devon and Exeter Hospital, Exeter Knee Reconstruction Unit, Barrack Road, Exeter, UK
| | - R Stroud
- Royal Devon and Exeter Hospital, Exeter Knee Reconstruction Unit, Barrack Road, Exeter, UK
| | - A D Toms
- Royal Devon and Exeter Hospital, Exeter Knee Reconstruction Unit, Barrack Road, Exeter, UK
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Choudhury A, Arthur C, Malik J, Mandall P, Taylor C, Alam N, Tran A, Livsey J, Elliott T, Davidson S, Logue J, Wylie J. Patient-reported Outcomes and Health-related Quality of Life in Prostate Cancer Treated with a Single Fraction of High Dose Rate Brachytherapy Combined with Hypofractionated External Beam Radiotherapy. Clin Oncol (R Coll Radiol) 2014; 26:661-7. [DOI: 10.1016/j.clon.2014.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/29/2014] [Accepted: 06/23/2014] [Indexed: 11/29/2022]
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Davidson L, Saunders M, McBain C, Alam N, Misra V, Arthur C. The incidence and Time to Presentation of Capecitabine Induced Cardiovascular Toxicity in Rectal Cancer Patients Receiving Concurrent Chemo-radiotherapy. Clin Oncol (R Coll Radiol) 2014. [DOI: 10.1016/j.clon.2014.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lickliter JD, Taylor K, Szer J, Grigg A, Arthur C, Hughes TP, Durrant S, Filshie R, Irving I, Seldon M, Ellacott J, Boyd AW, D'Rozario J, Rooney K, Lynch K, Bradstock K. An imatinib-only window followed by imatinib and chemotherapy for Philadelphia chromosome-positive acute leukemia: long-term results of the CMLALL1 trial. Leuk Lymphoma 2014; 56:630-8. [PMID: 24844361 DOI: 10.3109/10428194.2014.925547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report long-term results in 40 patients with Philadlephia chromosome-positive (Ph+) acute leukemia who received an imatinib monotherapy window to evaluate in vivo effects on BCR-ABL signaling prior to induction chemotherapy. The first 25 patients (cohort 1) received the LALA-94 protocol without further imatinib (newly diagnosed Ph+ acute lymphoblastic leukemia [ALL]) or induction chemotherapy followed by single-agent imatinib. Subsequent patients (cohort 2) continued imatinib concurrently with either LALA-94 (newly diagnosed Ph + ALL) or other intensive chemotherapy regimens. Cohort 2 had a complete response (CR) rate of 93% and 5-year survival of 69%. For newly diagnosed Ph+ ALL, survival was superior in cohort 2 compared with cohort 1. Toxicity was similar to that expected for chemotherapy alone. Among 10 evaluable patients, rapid loss of phospho-CRKL occurred during the imatinib window in seven patients (all achieved CR) and incomplete inhibition in three patients (none with CR). In summary, a pharmacodynamic window design permitted biomarker assessment of BCR-ABL targeting without compromising clinical outcomes.
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Affiliation(s)
- Jason D Lickliter
- Cancer Therapeutics Unit, Nucleus Network , Melbourne, Victoria , Australia
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Mayer J, Arthur C, Delaunay J, Mazur G, Thomas XG, Wierzbowska A, Ravandi F, Berrak E, Jones M, Li Y, Kantarjian HM. Multivariate and subgroup analyses of a randomized, multinational, phase 3 trial of decitabine vs treatment choice of supportive care or cytarabine in older patients with newly diagnosed acute myeloid leukemia and poor- or intermediate-risk cytogenetics. BMC Cancer 2014; 14:69. [PMID: 24498872 PMCID: PMC3928608 DOI: 10.1186/1471-2407-14-69] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/24/2014] [Indexed: 11/24/2022] Open
Abstract
Background Compared with younger patients, older adults with acute myeloid leukemia (AML) generally have poorer survival outcomes and less benefit from clinical trials. A recent phase 3 trial demonstrated a trend toward improved overall survival (OS) with decitabine, a hypomethylating agent, compared with treatment choice of either cytarabine or supportive care (7.7 months, 95% CI: 6.2–9.2 vs 5.0 months, 95% CI: 4.3–6.3, respectively) in older adults with newly diagnosed AML. The current analyses investigated prognostic factors for outcomes in this trial and examined OS and responses in prespecified subgroups. Methods A multivariate Cox proportional hazards model was used to investigate effects of demographic and baseline characteristics, including age, sex, cytogenetic risk, AML type, ECOG Performance Status, geographic region, bone marrow blasts, platelets, and white blood cells on OS, based on mature data. Similar analyses were conducted with a logistic regression model to predict response rates. Prespecified subgroup analyses were performed for OS and response rates, also using mature data. Results Patient characteristics that appeared to negatively influence OS included more advanced age (hazard ratio [HR] 1.560 for ≥75 vs <70 years; p = 0.0010), poorer performance status at baseline (HR 0.771 for 0 or 1 vs 2; p = 0.0321), poor cytogenetics (HR 0.699 for intermediate vs poor; p = 0.0010), higher bone marrow blast counts (HR 1.355 for >50% vs ≤50%; p = 0.0045), low baseline platelet counts (HR 0.775 for each additional 100 × 109/L; p = 0.0015), and high white blood cell counts (HR 1.256 for each additional 25 × 109/L; p = 0.0151). Regarding geographic regions, patients from Western Europe had the longest median OS. Response rates favored decitabine for all subgroups investigated, including patients ≥75 years (odds ratio 5.94, p = 0.0006). Conclusion Response to decitabine in AML is associated with known prognostic factors related to both patient demographics and disease characteristics. Trial registration ClinicalTrials.gov identifier NCT00260832
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Affiliation(s)
- Jiří Mayer
- Masaryk University Hospital Brno and Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic.
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Davidson L, Alam N, Misra V, Bridson J, Prescott D, Arthur C. PD-0295: Capecitabine induced cardiovascular toxicities during chemoradiotherapy for rectal cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30400-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chan SR, Rickert CG, Vermi W, Sheehan KCF, Arthur C, Allen JA, White JM, Archambault J, Lonardi S, McDevitt TM, Bhattacharya D, Lorenzi MV, Allred DC, Schreiber RD. Dysregulated STAT1-SOCS1 control of JAK2 promotes mammary luminal progenitor cell survival and drives ERα(+) tumorigenesis. Cell Death Differ 2013; 21:234-46. [PMID: 24037089 DOI: 10.1038/cdd.2013.116] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 01/05/2023] Open
Abstract
We previously reported that STAT1 expression is frequently abrogated in human estrogen receptor-α-positive (ERα(+)) breast cancers and mice lacking STAT1 spontaneously develop ERα(+) mammary tumors. However, the precise mechanism by which STAT1 suppresses mammary gland tumorigenesis has not been fully elucidated. Here we show that STAT1-deficient mammary epithelial cells (MECs) display persistent prolactin receptor (PrlR) signaling, resulting in activation of JAK2, STAT3 and STAT5A/5B, expansion of CD61(+) luminal progenitor cells and development of ERα(+) mammary tumors. A failure to upregulate SOCS1, a STAT1-induced inhibitor of JAK2, leads to unopposed oncogenic PrlR signaling in STAT1(-/-) MECs. Prophylactic use of a pharmacological JAK2 inhibitor restrains the proportion of luminal progenitors and prevents disease induction. Systemic inhibition of activated JAK2 induces tumor cell death and produces therapeutic regression of pre-existing endocrine-sensitive and refractory mammary tumors. Thus, STAT1 suppresses tumor formation in mammary glands by preventing the natural developmental function of a growth factor signaling pathway from becoming pro-oncogenic. In addition, targeted inhibition of JAK2 may have significant therapeutic potential in controlling ERα(+) breast cancer in humans.
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Affiliation(s)
- S R Chan
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
| | - C G Rickert
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
| | - W Vermi
- 1] Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA [2] Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia School of Medicine, Piazzale Spedali Civili 1, Brescia 25123, Italy
| | - K C F Sheehan
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
| | - C Arthur
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
| | - J A Allen
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
| | - J M White
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
| | - J Archambault
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
| | - S Lonardi
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia School of Medicine, Piazzale Spedali Civili 1, Brescia 25123, Italy
| | - T M McDevitt
- Oncology Drug Discovery, Research and Development, Bristol-Myers Squibb, Princeton, NJ 08543, USA
| | - D Bhattacharya
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
| | - M V Lorenzi
- Oncology Drug Discovery, Research and Development, Bristol-Myers Squibb, Princeton, NJ 08543, USA
| | - D C Allred
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
| | - R D Schreiber
- Department of Pathology and Immunology, Washington University School of Medicine, 425S Euclid Avenue, St. Louis, MO 63110, USA
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Thankappan KR, Yamini TR, Mini GK, Arthur C, Sairu P, Leelamoni K, Sani M, Unnikrishnan B, Basha SR, Nichter M. Assessing the readiness to integrate tobacco control in medical curriculum: experiences from five medical colleges in Southern India. Natl Med J India 2013; 26:18-23. [PMID: 24066988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Making tobacco cessation a normative part of all clinical practice is the only way to substantially reduce tobacco-related deaths and the burden of tobacco-related morbidity in the short term. This study was undertaken because information on receptivity to integrate tobacco control education in the medical curriculum is extremely limited in low- and middle-income countries. METHODS From five medical colleges (two government) in southern India, 713 (men 59%) faculty and 2585 (men 48%) students participated in our cross-sectional survey. Information on self-reported tobacco use and readiness to integrate tobacco control education in the medical curriculum was collected from both the faculty and students using a pretested structured questionnaire. Multiple logistic regression analysis was done to find the associated factors. RESULTS Current smoking was reported by 9.0% (95% CI 6.6-12.1) of men faculty and 13.7% (CI 11.8-15.9) by men students. Faculty who were teaching tobacco-related topics [odds ratio (OR) 2.29; 95% CI 1.65-3.20] compared to those who were not, faculty in government colleges (OR 1.69; CI 1.22-2.35) compared to those in private colleges and medical pecialists (OR 1.79; CI 1.23-2.59) compared to surgical and non-clinical specialists were more likely to be ready to integrate tobacco control education in the medical curriculum. Non-smoking students (OR 2.58; CI 2.01-3.33) compared to smokers, and women students (OR 1.80; CI 1.50-2.17) compared to men were more likely to be ready to integrate a tobacco control education in the curriculum. CONCLUSION Faculty and students are receptive to introduce tobacco control in the medical curriculum. Government faculty, medical specialists and faculty who already teach tobacco-related topics are likely to be early introducers of this new curriculum.
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Affiliation(s)
- K R Thankappan
- Achutha Menon Centre for Health Science Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Science and Technology (SCTIMST), Thiruvananthapuram 695011, Kerala, India. Quit Tobacco India Project
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Kantarjian HM, Thomas XG, Dmoszynska A, Wierzbowska A, Mazur G, Mayer J, Gau JP, Chou WC, Buckstein R, Cermak J, Kuo CY, Oriol A, Ravandi F, Faderl S, Delaunay J, Lysák D, Minden M, Arthur C. Multicenter, randomized, open-label, phase III trial of decitabine versus patient choice, with physician advice, of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia. J Clin Oncol 2012; 30:2670-7. [PMID: 22689805 DOI: 10.1200/jco.2011.38.9429] [Citation(s) in RCA: 869] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE This multicenter, randomized, open-label, phase III trial compared the efficacy and safety of decitabine with treatment choice (TC) in older patients with newly diagnosed acute myeloid leukemia (AML) and poor- or intermediate-risk cytogenetics. PATIENTS AND METHODS Patients (N = 485) age ≥ 65 years were randomly assigned 1:1 to receive decitabine 20 mg/m(2) per day as a 1-hour intravenous infusion for five consecutive days every 4 weeks or TC (supportive care or cytarabine 20 mg/m(2) per day as a subcutaneous injection for 10 consecutive days every 4 weeks). The primary end point was overall survival (OS); the secondary end point was the complete remission (CR) rate plus the CR rate without platelet recovery (CRp). Adverse events (AEs) were recorded. RESULTS The primary analysis with 396 deaths (81.6%) showed a nonsignificant increase in median OS with decitabine (7.7 months; 95% CI, 6.2 to 9.2) versus TC (5.0 months; 95% CI, 4.3 to 6.3; P = .108; hazard ratio [HR], 0.85; 95% CI, 0.69 to 1.04). An unplanned analysis with 446 deaths (92%) indicated the same median OS (HR, 0.82; 95% CI, 0.68 to 0.99; nominal P = .037). The CR rate plus CRp was 17.8% with decitabine versus 7.8% with TC (odds ratio, 2.5; 95% CI, 1.4 to 4.8; P = .001). AEs were similar for decitabine and cytarabine, although patients received a median of four cycles of decitabine versus two cycles of TC. The most common drug-related AEs with decitabine were thrombocytopenia (27%) and neutropenia (24%). CONCLUSION In older patients with AML, decitabine improved response rates compared with standard therapies without major differences in safety. An unplanned survival analysis showed a benefit for decitabine, which was not observed at the time of the primary analysis.
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Affiliation(s)
- Hagop M Kantarjian
- Department of Leukemia, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Heathfield S, Parker B, Zeef L, Bruce I, Alexander Y, Collins F, Stone M, Wang E, Williams AS, Wright HL, Thomas HB, Moots RJ, Edwards SW, Bullock C, Chapman V, Walsh DA, Mobasheri A, Kendall D, Kelly S, Bayley R, Buckley CD, Young SP, Rump-Goodrich L, Middleton J, Chen L, Fisher R, Kollnberger S, Shastri N, Kessler BM, Bowness P, Nazeer Moideen A, Evans L, Osgood L, Williams AS, Jones SA, Nowell MA, Mahadik Y, Young S, Morgan M, Gordon C, Harper L, Giles JL, Paul Morgan B, Harris CL, Rysnik OJ, McHugh K, Kollnberger S, Payeli S, Marroquin O, Shaw J, Renner C, Bowness P, Nayar S, Cloake T, Bombardieri M, Pitzalis C, Buckley C, Barone F, Barone F, Nayar S, Cloake T, Lane P, Coles M, Buckley C, Williams EL, Edwards CJ, Cooper C, Oreffo RO, Dunn S, Crawford A, Wilkinson M, Le Maitre C, Bunning R, Daniels J, Phillips KLE, Chiverton N, Le Maitre CL, Kollnberger S, Shaw J, Ridley A, Wong-Baeza I, McHugh K, Keidel S, Chan A, Bowness P, Gullick NJ, Abozaid HS, Jayaraj DM, Evans HG, Scott DL, Choy EH, Taams LS, Hickling M, Golor G, Jullion A, Shaw S, Kretsos K, Bari SF, Rhys-Dillon B, Amos N, Siebert S, Phillips KLE, Chiverton N, Bunning RD, Haddock G, Cross AK, Le Maitre CL, Kate I, Phillips E, Cross A, Chiverton N, Haddock G, Bunning RAD, Le Maitre CL, Ceeraz S, Spencer J, Choy E, Corrigall V, Crilly A, Palmer H, Lockhart J, Plevin R, Ferrell WR, McInnes I, Hutchinson D, Perry L, DiCicco M, Humby F, Kelly S, Hands R, Buckley C, McInnes I, Taylor P, Bombardieri M, Pitzalis C, Mehta P, Mitchell A, Tysoe C, Caswell R, Owens M, Vincent T, Hashmi TM, Price-Forbes A, Sharp CA, Murphy H, Wood EF, Doherty T, Sheldon J, Sofat N, Goff I, Platt PN, Abdulkader R, Clunie G, Ismajli M, Nikiphorou E, Young A, Tugnet N, Dixey J, Banik S, Alcorn D, Hunter J, Win Maw W, Patil P, Hayes F, Main Wong W, Borg FA, Dasgupta B, Malaviya AP, Ostor AJ, Chana JK, Ahmed AA, Edmonds S, Hayes F, Coward L, Borg F, Heaney J, Amft N, Simpson J, Dhillon V, Ayalew Y, Khattak F, Gayed M, Amarasena RI, McKenna F, Amarasena RI, McKenna F, Mc Laughlin M, Baburaj K, Fattah Z, Ng N, Wilson J, Colaco B, Williams MR, Adizie T, Dasgupta B, Casey M, Lip S, Tan S, Anderson D, Robertson C, Devanny I, Field M, Walker D, Robinson S, Ryan S, Hassell A, Bateman J, Allen M, Davies D, Crouch C, Walker-Bone K, Gainsborough N, Gullick NJ, Lutalo PM, Davies UM, Walker-Bone K, Mckew JR, Millar AM, Wright SA, Bell AL, Thapper M, Roussou T, Cumming J, Hull RG, Thapper M, Roussou T, McKeogh J, O'Connor MB, Hassan AI, Bond U, Swan J, Phelan MJ, Coady D, Kumar N, Farrow L, Bukhari M, Oldroyd AG, Greenbank C, McBeth J, Duncan R, Brown D, Horan M, Pendleton N, Littlewood A, Cordingley L, Mulvey M, Curtis EM, Cole ZA, Crozier SR, Georgia N, Robinson SM, Godfrey KM, Sayer AA, Inskip HM, Cooper C, Harvey NC, Davies R, Mercer L, Galloway J, Low A, Watson K, Lunt M, Symmons D, Hyrich K, Chitale S, Estrach C, Moots RJ, Goodson NJ, Rankin E, Jiang CQ, Cheng KK, Lam TH, Adab P, Ling S, Chitale S, Moots RJ, Estrach C, Goodson NJ, Humphreys J, Ellis C, Bunn D, Verstappen SM, Symmons D, Fluess E, Macfarlane GJ, Bond C, Jones GT, Scott IC, Steer S, Lewis CM, Cope A, Mulvey MR, Macfarlane GJ, Symmons D, Lovell K, Keeley P, Woby S, Beasley M, McBeth J, Viatte S, Plant D, Lunt M, Fu B, Parker B, Galloway J, Solymossy C, Worthington J, Symmons D, Dixey J, Young A, Barton A, Williams FM, Osei-Bordom DC, Popham M, MacGregor A, Spector T, Little J, Herrick A, Pushpakom S, Ennis H, McBurney H, Worthington J, Newman W, Ibrahim I, Plant D, Hyrich K, Morgan A, Wilson A, Isaacs J, Barton A, Sanderson T, Hewlett S, Calnan M, Morris M, Raza K, Kumar K, Cardy CM, Pauling JD, Jenkins J, Brown SJ, McHugh N, Nikiphorou E, Mugford M, Davies C, Cooper N, Brooksby A, Bunn D, Symmons D, MacGregor A, Dures E, Ambler N, Fletcher D, Pope D, Robinson F, Rooke R, Hewlett S, Gorman CL, Reynolds P, Hakim AJ, Bosworth A, Weaver D, Kiely PD, Skeoch S, Jani M, Amarasena R, Rao C, Macphie E, McLoughlin Y, Shah P, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Patel Y, Baguley E, Jani M, Halsey J, Severn A, Bukhari M, Selvan S, Price E, Husain MJ, Brophy S, Phillips CJ, Cooksey R, Irvine E, Siebert S, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Griffiths B, Foggo H, Edgar S, Vadivelu S, Coady D, McHugh N, Ng WF, Dasgupta B, Taylor P, Iqbal I, Heron L, Pilling C, Marks J, Hull R, Ledingham J, Han C, Gathany T, Tandon N, Hsia E, Taylor P, Strand V, Sensky T, Harta N, Fleming S, Kay L, Rutherford M, Nicholl K, Kay L, Rutherford M, Nicholl K, Eyre T, Wilson G, Johnson P, Russell M, Timoshanko J, Duncan G, Spandley A, Roskell S, Coady D, West L, Adshead R, Donnelly SP, Ashton S, Tahir H, Patel D, Darroch J, Goodson NJ, Boulton J, Ellis B, Finlay R, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Vadivelu S, Coady D, McHugh N, Griffiths B, Foggo H, Edgar S, Ng WF, Murray-Brown W, Priori R, Tappuni T, Vartoukian S, Seoudi N, Picarelli G, Fortune F, Valesini G, Pitzalis C, Bombardieri M, Ball E, Rooney M, Bell A, Merida AA, Isenberg D, Tarelli E, Axford J, Giles I, Pericleous C, Pierangeli SS, Ioannou J, Rahman A, Alavi A, Hughes M, Evans B, Bukhari M, Parker B, Zaki A, Alexander Y, Bruce I, Hui M, Garner R, Rees F, Bavakunji R, Daniel P, Varughese S, Srikanth A, Andres M, Pearce F, Leung J, Lim K, Regan M, Lanyon P, Oomatia A, Petri M, Fang H, Birnbaum J, Amissah-Arthur M, Gayed M, Stewart K, Jennens H, Braude S, Gordon C, Sutton EJ, Watson KD, Gordon C, Yee CS, Lanyon P, Jayne D, Isenberg D, Rahman A, Akil M, McHugh N, Ahmad Y, Amft N, D'Cruz D, Edwards CJ, Griffiths B, Khamashta M, Teh LS, Zoma A, Bruce I, Dey ID, Kenu E, Isenberg D, Pericleous C, Garza-Garcia A, Murfitt L, Driscoll PC, Isenberg D, Pierangeli S, Giles I, Ioannou Y, Rahman A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Segeda I, Shevchuk S, Kuvikova I, Brown N, Bruce I, Venning M, Mehta P, Dhanjal M, Mason J, Nelson-Piercy C, Basu N, Paudyal P, Stockton M, Lawton S, Dent C, Kindness K, Meldrum G, John E, Arthur C, West L, Macfarlane MV, Reid DM, Jones GT, Macfarlane GJ, Yates M, Loke Y, Watts R, MacGregor A, Adizie T, Christidis D, Dasgupta B, Williams M, Sivakumar R, Misra R, Danda D, Mahendranath KM, Bacon PA, Mackie SL, Pease CT. Basic science * 232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes108] [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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Arthur C, Malik J, Swindell R, Mandali P, Choudhury A, Logue J, Wylie J. OC-26 PROSTATE CANCER: SINGLE FRACTION HDR BOOST – 12.5GY OR 15GY -WITH EXTERNAL BEAM RADIATION. A COMPARISON OF TOXICITY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71994-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Arthur C, Mandall P, Swindell R, Logue J, Wylie J. Single Fraction HDR Boost and Dose Escalation for Intermediate and High Risk Prostate Cancer. A Report of Toxicity from a Single Centre Experience. Clin Oncol (R Coll Radiol) 2012. [DOI: 10.1016/j.clon.2011.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bell DJ, Morrison R, Wood AM, Keenan A, Arthur C. Knee dislocation in touch rugby: a case study. J R Nav Med Serv 2011; 97:5-10. [PMID: 21714305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Wood AM, Keenan ACM, Arthur C, Wood IM. Common training injuries concerning potential Royal Marine applicants. J R Nav Med Serv 2011; 97:106-109. [PMID: 22372015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Keenan A, Wood AM, Arthur C, Bakker-Dyos JJ. Royal Marine Arctic Warfare Training: early field reduction of clinically diagnosed anterior shoulder dislocation. J R Nav Med Serv 2010; 96:136-138. [PMID: 21443046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
Gene targeting in mice has been used extensively to elucidate gene function in vivo. However, for gene targeting to be successful, the targeting vector must be carefully designed. This chapter addresses the rationale behind designing targeting vectors, detailing the essential components, and highlighting specific considerations for different types of vectors, from gene deletions to point mutations and insertions. Examples of vector designs, cloning strategies, and approaches for successful screening of recombinants are described. The use of Cre/LoxP and Flp/frt systems for conditional targeting is described, together with strategies for generating conditional deletions. Methods for generating conditional point mutations are also described and their potential drawbacks discussed.
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Affiliation(s)
- J Simon
- Transgenic Service, College of Life Sciences, University of Dundee, Dundee, UK
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Le Gouar P, Rigal F, Boisselier-Dubayle MC, Sarrazin F, Arthur C, Choisy JP, Hatzofe O, Henriquet S, Lécuyer P, Tessier C, Susic G, Samadi S. Genetic variation in a network of natural and reintroduced populations of Griffon vulture (Gyps fulvus) in Europe. CONSERV GENET 2007. [DOI: 10.1007/s10592-007-9347-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Vinorelbine and gemcitabine have demonstrable single-agent activity against lymphoma, show differing toxicity profiles and can be given in an outpatient setting. AIMS We have evaluated the feasibility of an outpatient-based combination of vinorelbine and gemcitabine with filgrastim support (VGF) in patients with advanced lymphoma. METHODS An open-label, single-arm study of 40 consecutive patients with relapsed (n = 24) or refractory (n = 16) lymphoma was undertaken. The median number of prior regimens was three (range 1-11) and 12 had undergone prior stem cell transplantation. Patients received vinorelbine 25 mg/m(2) and gemcitabine 1000 mg/m(2) on days 1 and 8 of each 21-day cycle. Patients showing no response after two cycles (early response) were offered alternative therapy. Responding patients received two more cycles. Primary end-points were the early and overall response rates. RESULTS One hundred and sixteen cycles of therapy were delivered. Hospital admissions were required following 27 treatment cycles (24%), predominantly following cycle 1. Febrile neutropenia followed 6% of cycles. The early and overall response rates on an intention-to-treat basis were 60 and 53%, respectively. Responses for peripheral T-cell lymphoma and Hodgkin lymphoma were particularly encouraging, 70 and 75%, respectively. With a median follow up of 34 months overall survival for the entire cohort at 2 years is 50%. Furthermore, for the 23 patients who did not receive high-dose consolidative therapy 2-year survival was 35%. CONCLUSIONS Vinorelbine and gemcitabine with filgrastim support can be safely delivered in an outpatient setting and shows clinically meaningful activity against a range of advanced lymphoma subtypes.
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Affiliation(s)
- A Spencer
- Clinical Haematology and BMT, Alfred Hospital, and Myeloma Research Group, Alfred Hospital, Melbourne, Victoria, Australia.
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Mollee P, Arthur C, Hughes T, Januszewicz H, Grigg A, Bradstock K, Wolf M, Gibson J, Schwarer AP, Spencer A, Browett P, Hawkins T, Seldon M, Herrmann R, Watson A, Seymour JF, Martin N, Shina S, Low C, Wright S, Rodwell R, Coulston J, Morton J, Blacklock H, Taylor D, Taylor KM. Interferon-alpha-2b and oral cytarabine ocfosfate for newly diagnosed chronic myeloid leukaemia. Ann Oncol 2005; 15:1810-5. [PMID: 15550587 DOI: 10.1093/annonc/mdh468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment with interferon and subcutaneous cytarabine produces superior cytogenetic responses in chronic myeloid leukaemia (CML) than treatment with interferon alone, but at the expense of greater toxicity. Cytarabine ocfosfate (YNK01) is an oral precursor of cytarabine that may overcome some of the inconvenience and toxicities associated with subcutaneous cytarabine administration. PATIENTS AND METHODS We studied the efficacy and tolerability of combination therapy with interferon-alpha-2b and YNK01 in patients with newly diagnosed, untreated CML. Forty patients were treated with interferon-alpha-2b (5 MU/m2/day) plus monthly courses of YNK01 (600 mg/day for 10 days) for 1 year. RESULTS The 6-month complete haematological response rate was 63% and the 1-year major cytogenetic response rate was 30%, with 10% of cytogenetic responses being complete. With a median follow-up of 57 months, the estimated 5-year overall survival was 86% (95% confidence interval 70% to 94%). Treatment tolerability was poor, with toxicity leading to discontinuation of one or both drugs in 60% of cases. The median daily dose of interferon alpha-2b was 7.75 MU and the median dose of YNK01 was 600 mg/day for each 10-day treatment cycle. CONCLUSIONS Interferon-alpha-2b and YNK01 produce cytogenetic responses comparable to those achieved with interferon-alpha-2b and parenteral cytarabine, although toxicity was excessive. Alternate dosing strategies may enhance the tolerability of YNK01.
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Affiliation(s)
- P Mollee
- Haematology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
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