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Campbell G, Wells S, Huang W, Cooley GM, Jarrard D, Kyriakopoulos C, Cho SY, Lang J, Floberg JM. Disease and Toxicity Outcomes after Salvage Radiotherapy (SRT) for Biochemically Recurrent Prostate Cancer (PC) for Patients Enrolled in a Phase II, Open Label Trial Investigating Neoadjuvant Chemohormonal Therapy Followed by Radical Prostatectomy (RP). Int J Radiat Oncol Biol Phys 2023; 117:e369. [PMID: 37785259 DOI: 10.1016/j.ijrobp.2023.06.2466] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Men with metastatic hormone sensitive prostate cancer have improved progression free and overall survival (PFS/OS) when treated with docetaxel and androgen deprivation therapy (ADT). Our institution conducted a phase II trial (UW17009) investigating the addition of three cycles of neoadjuvant docetaxel and ADT to RP in men with high-risk prostate cancer. Here we report toxicity and freedom from biochemical recurrence (FFBCR) for patients treated with SRT following participation in this trial. MATERIALS/METHODS Between January 17, 2018 and August 10, 2021, 28 patients enrolled on UW17009. Patients who had a recurrence and received SRT were identified. Toxicity was assessed using modified LENT (Late Effects of Normal Tissues)/RTOG (Radiation Therapy Oncology Group) criteria, and time to recurrence following SRT was determined for each patient. Additionally, the months of ADT received by each patient was recorded. FFBCR was then determined for this cohort using the method of Kaplan and Meier. RESULTS Of 28 patients enrolled on UW17009, 20 (71%) had BCR after RP. Of these, 19 received SRT, representing 68% of the patients enrolled on the trial. The rates of acute grade 1 and grade 2 GU toxicity with SRT were 37% (7) and 53% (10), respectively. The rates of acute grade 1 and grade 2 GI toxicity with SRT were 32% (6) and 37% (7), respectively. On patient experienced a grade 4 genitourinary toxicity during SRT. There were no acute grade 3 or grade 5 toxicities. The rates of late grade 1 and grade 2 GU toxicity were 16% (3) and 11% (2), respectively. The rates of late grade 1 and grade 2 GI toxicity were 11% (2) and 5% (1), respectively. There was 1 (5%) late grade 3 GU toxicity. There were no late grade 3-5 GI toxicities, or late grade 4-5 GU toxicities. The average duration of ADT after prostatectomy was 15 months (range: 0-37 months). According to the method of Kaplan and Meier, mean FFBCR after SRT was 34.0 months at a median of 37.8 months. Median FFBCR had not yet been reached. At the time of analysis, 13 patients remained free from biochemical recurrence after SRT. CONCLUSION Rates of biochemical recurrence and SRT following neoadjuvant docetaxel and ADT and then RP were consistent with historical data, as was the rate of successful SRT. Toxicities were also consistent with historical data, though there was notably one acute grade 4 GU toxicity.
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Affiliation(s)
- G Campbell
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - S Wells
- Department of Radiology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - W Huang
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - G M Cooley
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - D Jarrard
- Department of Urology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - C Kyriakopoulos
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - S Y Cho
- Department of Radiology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - J Lang
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - J M Floberg
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Saboyá-Díaz MI, Castellanos LG, Morice A, Ade MP, Rey-Benito G, Cooley GM, Scobie HM, Wiegand RE, Coughlin MM, Martin DL. Lessons learned from the implementation of integrated serosurveillance of communicable diseases in the Americas. Rev Panam Salud Publica 2023; 47:e53. [PMID: 36895677 PMCID: PMC9989549 DOI: 10.26633/rpsp.2023.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/21/2022] [Indexed: 03/09/2023] Open
Abstract
Objective Systematize the experience and identify challenges and lessons learned in the implementation of an initiative for integrated serosurveillance of communicable diseases using a multiplex bead assay in countries of the Americas. Methods Documents produced in the initiative were compiled and reviewed. These included concept notes, internal working papers, regional meetings reports, and survey protocols from the three participating countries (Mexico, Paraguay, and Brazil) and two additional countries (Guyana and Guatemala) where serology for several communicable diseases was included in neglected tropical diseases surveys. Information was extracted and summarized to describe the experience and the most relevant challenges and lessons learned. Results Implementing integrated serosurveys requires interprogrammatic and interdisciplinary work teams for the design of survey protocols to respond to key programmatic questions aligned to the needs of the countries. Valid laboratory results are critical and rely on the standardized installment and roll-out of laboratory techniques. Field teams require adequate training and supervision to properly implement survey procedures. The analysis and interpretation of serosurveys results should be antigen-specific, contextualizing the responses for each disease, and triangulated with programmatic and epidemiological data for making decisions tailored to specific population socioeconomic and ecologic contexts. Conclusions Integrated serosurveillance as a complementary tool for functional epidemiological surveillance systems is feasible to use and key components should be considered: political engagement, technical engagement, and integrated planning. Aspects such as designing the protocol, selecting target populations and diseases, laboratory capacities, anticipating the capacities to analyze and interpret complex data, and how to use it are key.
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Affiliation(s)
- Martha-Idalí Saboyá-Díaz
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Luis Gerardo Castellanos
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Ana Morice
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Maria Paz Ade
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Gloria Rey-Benito
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Gretchen M Cooley
- Centers for Disease Control and Prevention Atlanta United States of America Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Heather M Scobie
- Centers for Disease Control and Prevention Atlanta United States of America Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Ryan E Wiegand
- Centers for Disease Control and Prevention Atlanta United States of America Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Melissa M Coughlin
- Centers for Disease Control and Prevention Atlanta United States of America Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Diana L Martin
- Centers for Disease Control and Prevention Atlanta United States of America Centers for Disease Control and Prevention, Atlanta, United States of America
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Cooley GM, Feldstein LR, Bennett SD, Estivariz CF, Weil L, Bohara R, Vandenent M, Mainul Hasan A, Akhtar MS, Uzzaman MS, Billah MM, Conklin L, Ehlman DC, Asiedu K, Solomon AW, Alamgir A, Flora MS, Martin DL. No Serological Evidence of Trachoma or Yaws Among Residents of Registered Camps and Makeshift Settlements in Cox's Bazar, Bangladesh. Am J Trop Med Hyg 2021; 104:2031-2037. [PMID: 33939630 PMCID: PMC8176462 DOI: 10.4269/ajtmh.21-0124] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022] Open
Abstract
Successful achievement of global targets for elimination of trachoma as a public health problem and eradication of yaws will require control efforts to reach marginalized populations, including refugees. Testing for serologic evidence of transmission of trachoma and yaws in residents of registered camps and a Makeshift Settlement in Cox’s Bazar District, Bangladesh, was added to a serosurvey for vaccine-preventable diseases (VPDs) conducted April–May 2018. The survey was primarily designed to estimate remaining immunity gaps for VPDs, including diphtheria, measles, rubella, and polio. Blood specimens from 1- to 14-year-olds from selected households were collected and tested for antibody responses against antigens from Treponema pallidum and Chlamydia trachomatis using a multiplex bead assay to evaluate for serologic evidence of the neglected tropical diseases (NTDs) yaws and trachoma, respectively. The prevalence of antibodies against two C. trachomatis antigens in children ranged from 1.4% to 1.5% for Pgp3 and 2.8% to 7.0% for CT694. The prevalence of antibody responses against both of two treponemal antigens (recombinant protein17 and treponemal membrane protein A) tested was 0% to 0.15% in two camps. The data are suggestive of very low or no transmission of trachoma and yaws, currently or previously, in children resident in these communities. This study illustrates how integrated serologic testing can provide needed data to help NTD programs prioritize limited resources.
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Affiliation(s)
- Gretchen M Cooley
- 1Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leora R Feldstein
- 2Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah D Bennett
- 3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Concepcion F Estivariz
- 3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Weil
- 4National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - M Salim Uzzaman
- 8Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | | | - Laura Conklin
- 3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel C Ehlman
- 3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Asm Alamgir
- 8Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | | | - Diana L Martin
- 1Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Padilla AM, Yao PY, Landry TJ, Cooley GM, Mahaney SM, Ribeiro I, VandeBerg JL, Tarleton RL. High variation in immune responses and parasite phenotypes in naturally acquired Trypanosoma cruzi infection in a captive non-human primate breeding colony in Texas, USA. PLoS Negl Trop Dis 2021; 15:e0009141. [PMID: 33788859 PMCID: PMC8041201 DOI: 10.1371/journal.pntd.0009141] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/12/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
Trypanosoma cruzi, the causative agent of human Chagas disease, is endemic to the southern region of the United States where it routinely infects many host species. The indoor/outdoor housing configuration used in many non-human primate research and breeding facilities in the southern of the USA provides the opportunity for infection by T. cruzi and thus provides source material for in-depth investigation of host and parasite dynamics in a natural host species under highly controlled and restricted conditions. For cynomolgus macaques housed at such a facility, we used a combination of serial blood quantitative PCR (qPCR) and hemoculture to confirm infection in >92% of seropositive animals, although each method alone failed to detect infection in >20% of cases. Parasite isolates obtained from 43 of the 64 seropositive macaques were of 2 broad genetic types (discrete typing units, (DTU's) I and IV); both within and between these DTU groupings, isolates displayed a wide variation in growth characteristics and virulence, elicited host immune responses, and susceptibility to drug treatment in a mouse model. Likewise, the macaques displayed a diversity in T cell and antibody response profiles that rarely correlated with parasite DTU type, minimum length of infection, or age of the primate. This study reveals the complexity of infection dynamics, parasite phenotypes, and immune response patterns that can occur in a primate group, despite being housed in a uniform environment at a single location, and the limited time period over which the T. cruzi infections were established.
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Affiliation(s)
- Angel M. Padilla
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Phil Y. Yao
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Tre J. Landry
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Gretchen M. Cooley
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Susan M. Mahaney
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, and Center for Vector-Borne Diseases, The University of Texas Rio Grande Valley, Brownsville/Edinburg/Harlingen, Texas, United States of America
| | - Isabela Ribeiro
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - John L. VandeBerg
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, and Center for Vector-Borne Diseases, The University of Texas Rio Grande Valley, Brownsville/Edinburg/Harlingen, Texas, United States of America
| | - Rick L. Tarleton
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
- * E-mail:
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Arnold BF, Martin DL, Juma J, Mkocha H, Ochieng JB, Cooley GM, Omore R, Goodhew EB, Morris JF, Costantini V, Vinjé J, Lammie PJ, Priest JW. Enteropathogen antibody dynamics and force of infection among children in low-resource settings. eLife 2019; 8:45594. [PMID: 31424386 PMCID: PMC6746552 DOI: 10.7554/elife.45594] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/15/2019] [Indexed: 01/22/2023] Open
Abstract
Little is known about enteropathogen seroepidemiology among children in low-resource settings. We measured serological IgG responses to eight enteropathogens (Giardia intestinalis, Cryptosporidium parvum, Entamoeba histolytica, Salmonella enterica, enterotoxigenic Escherichia coli, Vibrio cholerae, Campylobacter jejuni, norovirus) in cohorts from Haiti, Kenya, and Tanzania. We studied antibody dynamics and force of infection across pathogens and cohorts. Enteropathogens shared common seroepidemiologic features that enabled between-pathogen comparisons of transmission. Overall, exposure was intense: for most pathogens the window of primary infection was <3 years old; for highest transmission pathogens primary infection occurred within the first year. Longitudinal profiles demonstrated significant IgG boosting and waning above seropositivity cutoffs, underscoring the value of longitudinal designs to estimate force of infection. Seroprevalence and force of infection were rank-preserving across pathogens, illustrating the measures provide similar information about transmission heterogeneity. Our findings suggest antibody response can be used to measure population-level transmission of diverse enteropathogens in serologic surveillance. Diarrhea, which is caused by bacteria such as Salmonella or by viruses like norovirus, is the fourth leading cause of death among children worldwide, with children in low-resource settings being at highest risk. The pathogens that cause diarrhea spread when stool from infected people comes into contact with new hosts, for example, through inadequate sanitation or by drinking contaminated water. Currently, the best way to track these infections is to collect stool samples from people and test them for the presence of the pathogens. Unfortunately, this is costly and difficult to do on a large scale outside of clinical settings, making it hard to track the spread of diarrhea-causing pathogens. The body produces antibodies – small proteins that can detect specific pathogens – in response to an infection. These antibodies help ward off future infections by the same pathogen, so if they are present in the blood, this indicates a current or previous infection. Scientists already collect blood samples to track malaria, HIV and vaccine-preventable diseases in low-resource settings. These samples could be tested more broadly to measure the levels of antibodies against diarrhea-causing pathogens. Now, Arnold et al. have used blood samples collected from children in Haiti, Kenya, and Tanzania to measure antibody responses to 8 diarrhea-causing pathogens. The results showed that many children in these settings had been infected with all 8 pathogens before age three, and that all of the pathogens shared similar age-dependent patterns of antibody response. This finding enabled Arnold et al. to combine antibody measurements with statistical models to estimate each pathogen’s force of infection, that is, the rate at which susceptible individuals in the population become infected. This is a key step for epidemiologists to understand which pathogens cause the most infections in a population. The experiments show that testing blood samples for antibodies could provide scientists with a new tool to track the transmission of diarrhea-causing pathogens in low-resource settings. This information could help public health officials design and test efforts to prevent diarrhea, for example, by improving water treatment or developing vaccines.
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Affiliation(s)
- Benjamin F Arnold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, United States.,Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, United States.,Department of Ophthalmology, University of California, San Francisco, San Francisco, United States
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Jane Juma
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Harran Mkocha
- Kongwa Trachoma Project, Kongwa, United Republic of Tanzania
| | - John B Ochieng
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Gretchen M Cooley
- Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Richard Omore
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - E Brook Goodhew
- Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Jamae F Morris
- Department of African-American Studies, Georgia State University, Atlanta, United States
| | - Veronica Costantini
- Division of Viral Diseases, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Jan Vinjé
- Division of Viral Diseases, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Patrick J Lammie
- Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, United States.,Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, United States
| | - Jeffrey W Priest
- Division of Foodborne, Waterborne, and Environmental Diseases, United States Centers for Disease Control and Prevention, Atlanta, United States
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