1
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Behrens J, Gaskin G, Iggo N, Barratt J, Tighe J, Soutar R, Cook G, Drake M, Morris C, Drayson M. What can we do about patients presenting with myeloma and severe renal failure? Observations from the UK MERIT plasma exchange trial. EJHaem 2022; 4:246-250. [PMID: 36819186 PMCID: PMC9928667 DOI: 10.1002/jha2.620] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
Myeloma patients presenting with renal failure continue to have a poor prognosis despite significant advances in anti-myeloma therapy. MERIT was a randomised clinical trial (RCT), set up to evaluate if mechanical reduction of elevated free light chain levels (FLC) would result in clinical benefit. Completion of the planned seven plasma exchanges (PEs) in the first 14 days failed to show, for the exchange group, a greater reduction in FLC or any improvement in dialysis independence at 100 days or subsequently. To improve prognosis for these patients requires earlier diagnosis and prompt anti-myeloma therapy with effectiveness guided by frequent FLC monitoring.
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Affiliation(s)
| | - Gill Gaskin
- Department of Renal MedicineHammersmith HospitalLondonUK
| | - Neil Iggo
- Sussex Kidney UnitBrighton and Sussex University Hospitals NHS TrustBrightonUK
| | - Jonathan Barratt
- Department of Cardiovascular SciencesJohn Walls Renal Unit, Leicester General HospitalLeicesterUK
| | - Jane Tighe
- Department of HaematologyAberdeen Royal InfirmaryForesterhillUK
| | - Richard Soutar
- Department of HaematologyGlasgow Royal Infirmary GlasgowGlasgowUK
| | - Gordon Cook
- Leeds Cancer CentreSt. James University HospitalLeedsUK
| | - Mary Drake
- Haematology DepartmentBelfast City HospitalBelfastUK
| | - Curly Morris
- Centre for Cancer Research and Cell BiologyQueens UniversityBelfastUK
| | - Mark Drayson
- Clinical Immunology ServiceUniversity of BirminghamBirminghamUK
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2
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Milojkovic D, Cross NCP, Ali S, Byrne J, Campbell G, Dignan FL, Drummond M, Huntly B, Marshall S, McMullin MF, Neelakantan P, Raghavan M, Sivakumaran M, Tighe J, Wandroo F, Willis F, Glen F, Fildes L, Collington SJ, Ryan J, Clark RE, Mead AJ. Real-world tyrosine kinase inhibitor treatment pathways, monitoring patterns and responses in patients with chronic myeloid leukaemia in the United Kingdom: the UK TARGET CML study. Br J Haematol 2021; 192:62-74. [PMID: 32449159 DOI: 10.1111/bjh.16733] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/06/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
Management of chronic myeloid leukaemia (CML) has recently undergone dramatic changes, prompting the European LeukemiaNet (ELN) to issue recommendations in 2013; however, it remains unclear whether real-world CML management is consistent with these goals. We report results of UK TARGET CML, a retrospective observational study of 257 patients with chronic-phase CML who had been prescribed a first-line TKI between 2013 and 2017, most of whom received first-line imatinib (n = 203). Although 44% of patients required ≥1 change of TKI, these real-world data revealed that molecular assessments were frequently missed, 23% of patients with ELN-defined treatment failure did not switch TKI, and kinase domain mutation analysis was performed in only 49% of patients who switched TKI for resistance. Major molecular response (MMR; BCR-ABL1IS ≤0·1%) and deep molecular response (DMR; BCR-ABL1IS ≤0·01%) were observed in 50% and 29%, respectively, of patients treated with first-line imatinib, and 63% and 54%, respectively, receiving a second-generation TKI first line. MMR and DMR were also observed in 77% and 44% of evaluable patients with ≥13 months follow-up, receiving a second-generation TKI second line. We found little evidence that cardiovascular risk factors were considered during TKI management. These findings highlight key areas for improvement in providing optimal care to patients with CML.
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Affiliation(s)
| | | | - Sahra Ali
- Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, UK
| | - Jenny Byrne
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gavin Campbell
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Fiona L Dignan
- Manchester Royal Infirmary, Manchester University Hospitals Foundation Trust, Manchester, UK
| | | | - Brian Huntly
- Addenbrookes, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Scott Marshall
- Sunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | | | | | - Manoj Raghavan
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jane Tighe
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Farooq Wandroo
- Sandwells District General Hospital, Sandwells and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Fenella Willis
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Adam J Mead
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK
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3
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Htut TW, Thein KZ, Lawrie A, Tighe J, Preston G. Efficacy of daratumumab combination regimen in patients with multiple myeloma: A combined analysis of phase III randomized controlled trials. eJHaem 2020; 1:262-266. [PMID: 35847725 PMCID: PMC9175766 DOI: 10.1002/jha2.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/23/2022]
Abstract
The use of the CD38 monoclonal antibody daratumumab in combination with standard myeloma chemotherapy regimens has been studied extensively in recent years. We undertook an updated meta‐analysis of phase III randomized controlled trials (RCT) to determine the efficacy of daratumumab combination regimens. The relative risk for progression was significantly lower in daratumumab‐treated cohorts (HR 0.46, 95% CI 0.38‐0.55) and this was consistent across newly diagnosed and relapsed cases. No statistically significant improvement was identified in newly diagnosed patients with high‐risk cytogenetics and this group remains a therapeutic challenge.
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Affiliation(s)
- Thura W. Htut
- Department of Haematology, Aberdeen Royal InfirmaryForesterhill Health Campus Aberdeen UK
| | - Kyaw Z. Thein
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Alastair Lawrie
- Department of Haematology, Aberdeen Royal InfirmaryForesterhill Health Campus Aberdeen UK
| | - Jane Tighe
- Department of Haematology, Aberdeen Royal InfirmaryForesterhill Health Campus Aberdeen UK
| | - Gavin Preston
- Department of Haematology, Aberdeen Royal InfirmaryForesterhill Health Campus Aberdeen UK
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Stanworth SJ, Killick S, McQuilten ZK, Karakantza M, Weinkove R, Smethurst H, Pankhurst LA, Hodge RL, Hopkins V, Thomas HL, Deary AJ, Callum J, Lin Y, Wood EM, Buckstein R, Bowen D, Wallis L, Rabbi T, Serrano M, Williams R, Chacko J, Darlow J, Watson L, Earley K, Haas N, Woods L, Dimitriu C, Croft J, Carvalhosa A, Clarke C, Hickish T, Penny C, Sternberg A, Owen T, Parajes C, Meyer C, Dodge J, Meakin S, Lake D, Culligan D, Fletcher H, Forbes H, Johannesson N, Taylor G, Tomlinson J, Shaw A, Ratcliffe M, Lamacchia M, Vickers M, Duncan C, Untiveros P, Olaiya A, Tighe J, Preston G, Zaidi M, Lawrie A, Robertson C, Saadi H, Onyeakazi U, Radia R, Father T, Stainthorp K, Mc Connell S, Booth T, Langton C, Howcroft C, Saddiq I, Gupta ED, Byrne J, Lindsey‐Hill J, Badder D, Jones M, Pol R, Vyas P, Mead A, Peniket A, Bancroft R, Springett S, Yoganayagam S, Gray L, Friesen H, Wardle K, Murthy V, Pratt G, Kishore B, Mayer G, Nikolousis E, Smith N, Lovell R, Kartsios C, Ewing J, Lumley M, Khawaja J, Ali M, Sutton D, Murray D, Milligan D, Dhani S, O'Sullivan M, Whitehouse J, Schumacher A, Enstone R, Hardy A, Kelly M, Wallis J, Boal L, Davies M, Latter R, Wincup J, Ellis S, Poolan S, Birt M, Watts E, Charlton A, Forsyth H, Waring L, Twohig J, Marr H, Lennard A, Jones G, Menne T, Redding N, Jones S, Robinson K, Grand E, Cullis J, Collins F, Gamble L, Brown J, Tudgay S, Salisbury S, Mathew S, Tipler N, Parker T, Stobie E, Tribbeck M, Hebballi S, Millar C, Allotey D, Lala J, McGee N, Chmeil J, Hufton L, Dawson S, Weincove R, Smyth D, Buyck H, Hayden J, George A, Baluwala I, Wheeler M, Daysh L, Williams O, Millmow S, Miles R, Geller S, Blakemore M, Hargreaves A, Hayden G, Mo A, Van Dam M, Uhe M, Indran T, Wong J, Coughlin L, MacWhannell A, Beardsmore C, Lunn L, Pearson S, Shaw S, Parker J, Bowen A, Jones A, Player M. Red cell transfusion in outpatients with myelodysplastic syndromes: a feasibility and exploratory randomised trial. Br J Haematol 2020; 189:279-290. [PMID: 31960409 DOI: 10.1111/bjh.16347] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Abstract
Optimal red cell transfusion support in myelodysplastic syndromes (MDS) has not been tested and established. The aim of this study was to demonstrate feasibility of recruitment and follow-up in an outpatient setting with an exploratory assessment of quality of life (QoL) outcomes (EORTC QLQ-C30 and EQ-5D-5L). We randomised MDS patients to standardised transfusion algorithms comparing current restrictive transfusion thresholds (80 g/l, to maintain haemoglobin 85-100 g/l) with liberal thresholds (105 g/l, maintaining 110-125 g/l). The primary outcomes were measures of compliance to transfusion thresholds. Altogether 38 patients were randomised (n = 20 restrictive; n = 18 liberal) from 12 participating sites in UK, Australia and New Zealand. The compliance proportion for the intention-to-treat population was 86% (95% confidence interval 75-94%) and 99% (95-100%) for restrictive and liberal arms respectively. Mean pre-transfusion haemoglobin concentrations for restrictive and liberal arms were 80 g/l (SD6) and 97 g/l (SD7). The total number of red cell units transfused on study was 82 in the restrictive and 192 in the liberal arm. In an exploratory analysis, the five main QoL domains were improved for participants in the liberal compared to restrictive arm. Our findings support the feasibility and need for a definitive trial to evaluate the effect of different red cell transfusion thresholds on patient-centred outcomes.
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Affiliation(s)
- Simon J. Stanworth
- Oxford University Oxford United Kingdom
- The John Radcliffe Hospital Oxford GBR
- NHSBT Oxford United Kingdom
| | - Sally Killick
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Bournemouth United Kingdom
| | | | - Marina Karakantza
- Department of HaematologyLeeds Teaching Hospitals Leeds United Kingdom
| | - Robert Weinkove
- Wellington Blood & Cancer CentreCapital & Coast District Health Board Wellington New Zealand
- Malaghan Institute of Medical Research Wellington New Zealand
| | - Heather Smethurst
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | | | - Renate L. Hodge
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Valerie Hopkins
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Helen L. Thomas
- NHS Blood and Transplant Clinical Trials Unit Bristol United Kingdom
| | - Alison J. Deary
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre Toronto ON Canada
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto Toronto ON Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre Toronto ON Canada
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto Toronto ON Canada
| | - Erica M. Wood
- Transfusion Research UnitMonash University Melbourne Australia
| | - Rena Buckstein
- Odette Cancer CentreSunnybrook Health Sciences Centre Toronto ON Canada
| | - David Bowen
- Department of HaematologyLeeds Teaching Hospitals Leeds United Kingdom
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5
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Nolan JC, Frawley T, Tighe J, Soh H, Curtin C, Piskareva O. Preclinical models for neuroblastoma: Advances and challenges. Cancer Lett 2020; 474:53-62. [PMID: 31962141 DOI: 10.1016/j.canlet.2020.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/12/2022]
Abstract
Neuroblastoma is a paediatric cancer of the sympathetic nervous system and the most common solid tumour of infancy, contributing to 15% of paediatric oncology deaths. Current therapies are not effective in the long-term treatment of almost 80% of patients with this clinically aggressive disease. The primary challenge in the identification and validation of new agents for paediatric drug development is the accurate representation of tumour biology and diversity. In addition to this limitation, the low incidence of neuroblastoma makes the recruitment of eligible patients for early phase clinical trials highly challenging and highlights the need for robust preclinical testing to ensure that the best treatments are selected. The research field requires new preclinical models, technologies, and concepts to tackle these problems. Tissue engineering offers attractive tools to assist in the development of three-dimensional (3D) cell models using various biomaterials and manufacturing approaches that recreate the geometry, mechanics, heterogeneity, metabolic gradients, and cell communication of the native tumour microenvironment. In this review, we discuss current experimental models and assess their abilities to reflect the structural organisation and physiological conditions of the human body, in addition to current and new techniques to recapitulate the tumour niche using tissue-engineered platforms. Finally, we will discuss the possible use of novel 3D in vitro culture systems to address open questions in neuroblastoma biology.
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Affiliation(s)
- J C Nolan
- Cancer Bio-Engineering Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - T Frawley
- Cancer Bio-Engineering Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - J Tighe
- Cancer Bio-Engineering Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H Soh
- Cancer Bio-Engineering Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C Curtin
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - O Piskareva
- Cancer Bio-Engineering Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland; Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland.
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6
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Madattigowda R, Gulati A, Dhanda J, Bisase B, Norris P, Tighe J, Newman L. Developing a dedicated teaching module for free flap monitoring – need of the hour. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.440] [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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7
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Harrop GAJ, Tighe J, MacKenzie A. Primary meningococcal arthritis as a presentation of nodal marginal zone lymphoma. BMJ Case Rep 2018; 2018:bcr-2017-222035. [PMID: 29367362 DOI: 10.1136/bcr-2017-222035] [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] [Indexed: 11/03/2022] Open
Abstract
A 68-year-old man presented with a 4-day history of worsening knee and arm pain. On examination, there was erythema and swelling of the left knee and both wrists. Joint aspiration grew Neisseria meningitidis Blood tests showed an unusually high total protein level (100 g/L) and an IgM kappa paraprotein band of 45 g/L on protein electrophoresis. CT showed widespread lymphadenopathy, hepatosplenomegaly and multilevel thoracic vertebral collapse. A bone marrow biopsy revealed a lymphoplasmacytic infiltrate and a lymph node biopsy showed features of nodal marginal zone lymphoma with plasmacytic differentiation.
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Affiliation(s)
| | - Jane Tighe
- Infectious diseases, NHS Grampian, Aberdeen, UK
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8
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Molloy S, Lai M, Pratt G, Ramasamy K, Wilson D, Quraishi N, Auger M, Cumming D, Punekar M, Quinn M, Ademonkun D, Willis F, Tighe J, Cook G, Stirling A, Bishop T, Williams C, Boszczyk B, Reynolds J, Grainger M, Craig N, Hamilton A, Chalmers I, Ahmedzai S, Selvadurai S, Low E, Kyriakou C. Optimizing the management of patients with spinal myeloma disease. Br J Haematol 2015; 171:332-43. [DOI: 10.1111/bjh.13577] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Sean Molloy
- Royal National Orthopaedic Hospital; London UK
| | | | - Guy Pratt
- Department of Haematology; Heart of England NHS Trust Foundation; Birmingham UK
| | - Karthik Ramasamy
- Department of Haematology; Oxford University Hospitals NHS Trusts; Oxford UK
| | - David Wilson
- St Luke's Radiology; St Luke's Hospital; Oxford UK
| | - Nasir Quraishi
- Centre for Spinal Studies and Surgery; Queen's Medical Centre; Nottingham UK
| | - Martin Auger
- Department of Haematology; Norfolk and Norwich University Hospital; Norwich UK
| | - David Cumming
- Trauma and Orthopaedics Department; Ipswich Hospital NHS Trust; Ipswich UK
| | - Maqsood Punekar
- Department of Haematology; Lancashire Teaching Hospitals NHS Foundations Trust; Preston UK
| | - Michael Quinn
- Department of Haematology; Belfast City Hospital; Belfast UK
| | - Debo Ademonkun
- Trauma and Orthopaedics Department; Ipswich Hospital NHS Trust; Ipswich UK
| | - Fenella Willis
- Department of Haematology; St Georges Hospital; London UK
| | - Jane Tighe
- Department of Haematology; Aberdeen Royal Infirmary; Aberdeen UK
| | - Gordon Cook
- St James’ Institute of Oncology; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | | | - Timothy Bishop
- Centre for Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Cathy Williams
- Centre for Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Bronek Boszczyk
- Centre for Spinal Studies and Surgery; Queen's Medical Centre; Nottingham UK
| | - Jeremy Reynolds
- Spinal Unit; Oxford University Hospitals NHS Trust; Oxford UK
| | - Mel Grainger
- Royal Orthopaedic Hospital NHS Foundations Trust; Birmingham UK
| | - Niall Craig
- Orthopaedic Suite; Woodend Hospital; Aberdeen UK
| | - Alastair Hamilton
- Department of Orthopaedic Surgery; Musgrove Park Hospital; Belfast UK
| | - Isobel Chalmers
- Trauma and Orthopaedics Department; Ipswich Hospital NHS Trust; Ipswich UK
| | - Sam Ahmedzai
- Academic Unit of Supportive Care; Department of Oncology; University of Sheffield; Sheffield UK
| | | | | | - Charalampia Kyriakou
- Department of Haematology; Northwick Park Hospital and Department of Haematology and Stem Cell Transplantation; Royal Free Hospital; London UK
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Abstract
Plasmacytosis of the mucous membrane is a rare, benign, inflammatory condition of poorly understood aetiology that affects the mucous membranes. Most reported cases involve the gingival tissues, larynx, and occasionally the lips. We describe an interesting case of orofacial plasmacytosis that affected the lower lip, mandibular gingiva, and buccal mucosa. It mimicked an oral squamous cell carcinoma and presented a management dilemma.
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Affiliation(s)
- S Madhavarajan
- Department of OMFS, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, United Kingdom.
| | - J Tighe
- Department of OMFS, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, United Kingdom.
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10
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Brewis MJ, Church AC, Peacock AJ, Thomson S, Tighe J, Johnson MK. Pulmonary hypertension in POEMS syndrome: resolution following radiotherapy. Pulm Circ 2015; 4:732-5. [PMID: 25610609 DOI: 10.1086/678553] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/13/2014] [Indexed: 11/04/2022] Open
Abstract
Pulmonary hypertension (PH) is defined by the presence of a mean pulmonary artery pressure (mPAP) ≥25 mmHg. It may be idiopathic or arise as a consequence of a number of diverse conditions. PH has been reported in association with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes), with reversal following systemic treatment with corticosteroids. We report a case of pulmonary hypertension associated with POEMS syndrome treated with radical radiotherapy locally to bone lesions with resolution of systemic disease.
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Affiliation(s)
- Melanie J Brewis
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Stephen Thomson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Jane Tighe
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
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11
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Pepper C, Thomas A, Hoy T, Tighe J, Culligan D, Fegan C, Bentley P. Leukemic and Non-Leukemic Lymphocytes from Patients with Li Fraumeni Syndrome Demonstrate Loss of p53 Function, Bcl-2 Family Dysregulation and Intrinsic Resistance to Conventional Chemotherapeutic Drugs But Not Flavopiridol. Cell Cycle 2014. [DOI: 10.4161/cc.2.1.249] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Gallipoli P, Stobo J, Heaney N, Nicolini FE, Clark R, Wilson G, Tighe J, McLintock L, Hughes T, Michor F, Paul J, Drummond M, Holyoake TL. Safety and efficacy of pulsed imatinib with or without G-CSF versus continuous imatinib in chronic phase chronic myeloid leukaemia patients at 5 years follow-up. Br J Haematol 2013; 163:674-6. [PMID: 24032404 DOI: 10.1111/bjh.12532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Paolo Gallipoli
- Paul O'Gorman Leukaemia Research Centre, University of Glasgow, Glasgow, UK
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14
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Morris C, Cook G, Streetly M, Kettle P, Drake M, Quinn M, Cavet J, Tighe J, Kazmi M, Ashcroft J, Cook M, Snowden J, Olujohungbe A, Marshall S, Conn J, Oakervee H, Popat R, Cavenagh J. Re-transplantation after bortezomib-based therapy. Br J Haematol 2011; 153:666-8. [DOI: 10.1111/j.1365-2141.2010.08521.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Tighe J, McManus IC, Dewhurst NG, Chis L, Mucklow J. The standard error of measurement is a more appropriate measure of quality for postgraduate medical assessments than is reliability: an analysis of MRCP(UK) examinations. BMC Med Educ 2010; 10:40. [PMID: 20525220 PMCID: PMC2893515 DOI: 10.1186/1472-6920-10-40] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 06/02/2010] [Indexed: 05/22/2023]
Abstract
BACKGROUND Cronbach's alpha is widely used as the preferred index of reliability for medical postgraduate examinations. A value of 0.8-0.9 is seen by providers and regulators alike as an adequate demonstration of acceptable reliability for any assessment. Of the other statistical parameters, Standard Error of Measurement (SEM) is mainly seen as useful only in determining the accuracy of a pass mark. However the alpha coefficient depends both on SEM and on the ability range (standard deviation, SD) of candidates taking an exam. This study investigated the extent to which the necessarily narrower ability range in candidates taking the second of the three part MRCP(UK) diploma examinations, biases assessment of reliability and SEM. METHODS a) The interrelationships of standard deviation (SD), SEM and reliability were investigated in a Monte Carlo simulation of 10,000 candidates taking a postgraduate examination. b) Reliability and SEM were studied in the MRCP(UK) Part 1 and Part 2 Written Examinations from 2002 to 2008. c) Reliability and SEM were studied in eight Specialty Certificate Examinations introduced in 2008-9. RESULTS The Monte Carlo simulation showed, as expected, that restricting the range of an assessment only to those who had already passed it, dramatically reduced the reliability but did not affect the SEM of a simulated assessment. The analysis of the MRCP(UK) Part 1 and Part 2 written examinations showed that the MRCP(UK) Part 2 written examination had a lower reliability than the Part 1 examination, but, despite that lower reliability, the Part 2 examination also had a smaller SEM (indicating a more accurate assessment). The Specialty Certificate Examinations had small Ns, and as a result, wide variability in their reliabilities, but SEMs were comparable with MRCP(UK) Part 2. CONCLUSIONS An emphasis upon assessing the quality of assessments primarily in terms of reliability alone can produce a paradoxical and distorted picture, particularly in the situation where a narrower range of candidate ability is an inevitable consequence of being able to take a second part examination only after passing the first part examination. Reliability also shows problems when numbers of candidates in examinations are low and sampling error affects the range of candidate ability. SEM is not subject to such problems; it is therefore a better measure of the quality of an assessment and is recommended for routine use.
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Affiliation(s)
- Jane Tighe
- MRCP(UK) Central Office, 11, St. Andrews Place, London NW1 4LE, UK
| | - IC McManus
- Academic Centre for Medical Education and Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Neil G Dewhurst
- MRCP(UK) Central Office, 11, St. Andrews Place, London NW1 4LE, UK
| | - Liliana Chis
- MRCP(UK) Central Office, 11, St. Andrews Place, London NW1 4LE, UK
| | - John Mucklow
- MRCP(UK) Central Office, 11, St. Andrews Place, London NW1 4LE, UK
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Davies F, Morris C, Bird J, Cook G, Williams C, Tighe J, Cavenagh J, Behrens J, Schey S, Morgan G. United Kingdom myeloma forum position statement on the use of lenalidomide in multiple myeloma. Int J Lab Hematol 2008; 31:119-31. [PMID: 19016917 DOI: 10.1111/j.1751-553x.2008.01106.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lenalidomide is an immunomodulatory drug, which has anti-myeloma activity in vitro. Phase II clinical trials have demonstrated lenalidomide in combination with dexamethasone is effective for the treatment of both relapsed refractory myeloma and newly diagnosed patients. Two large phase III studies comparing lenalidomide and dexamethasone to dexamethasone alone in relapsed patients showed superiority in response, progression free and overall survival. It is administered orally for 21 days in a 28 day cycle. Side effects are manageable and include neutropenia and venous thrombotic events. It is currently approved, in combination with dexamethasone, for the treatment of multiple myeloma patients who have received at least one prior therapy. Studies in front line patients and with other drug combinations are ongoing. Given the strength of this data the UK Myeloma Forum believe that lenalidomide in combination with dexamethasone should be available for prescription by UK haematologists according to its licensed indication in patients with relapsed myeloma.
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Affiliation(s)
- F Davies
- Royal Marsden Hospital, London, UK.
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17
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Marshall NA, Culligan DJ, Tighe J, Johnston PW, Barker RN, Vickers MA. The relationships between Epstein-Barr virus latent membrane protein 1 and regulatory T cells in Hodgkin's lymphoma. Exp Hematol 2007; 35:596-604. [PMID: 17379070 DOI: 10.1016/j.exphem.2007.01.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 12/23/2006] [Accepted: 01/12/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Epstein-Barr virus (EBV) encoded latent membrane protein 1 (LMP1) is expressed by the malignant cells of about 30% of cases of Hodgkin's lymphoma (HL) and is therefore a potential target for immune attack. Given the predominantly immunosuppressive nature of HL infiltrating lymphocytes (HLILs) and the ability of LMP1 to stimulate regulatory T (Treg) responses in healthy donors, we hypothesized that LMP1 was important in the generation of Treg responses in HL. METHODS We compared T helper (Th) 1, Th2, and Treg responses to LMP1 by peripheral blood mononuclear cells (PBMCs) and HLILs from EBV-positive and -negative HL patients. The number of Treg cells in patients' PBMCs and HLILs was determined by flow cytometry ex vivo. Proliferation ((3)H-thymidine incorporation) and cytokine (interleukin [IL]-10, IL-4 and gamma-interferon) secretion by LMP1-stimulated PBMCs and HLILs was also measured. RESULTS Ex vivo EBV-positive HL patients had increased numbers of IL-10-secreting/cytotoxic T-lymphocyte-associated antigen-4-expressing cells compared with EBV-negative HL patients. PBMC/HLIL responses to LMP1 from most patients were characterized by IL-10 secretion, although isolated HL patients mounted Th1-like responses. Several responses to LMP1 peptides were made by HLILs, which were otherwise unresponsive to control stimuli. CONCLUSIONS These results suggest that LMP1 epitopes can induce HLIL Treg cells. However, there was no clear evidence of a greater bias toward regulation in EBV-positive HL cases over EBV-negative cases, and thus there are likely to be other mechanisms of Treg cell induction in EBV-negative HL patients. Manipulating the balance of T-helper response to LMP1 might be exploited in immunotherapy of these lymphomas.
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Affiliation(s)
- Neil A Marshall
- Department of Medicine and Therapeutics, Insitute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.
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18
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Abstract
In 2001, reference to the use of imaging in the British Committee for Standards in Haematology guidelines for the diagnosis and management of myeloma was confined to the standard use of plain X-rays in the diagnostic skeletal survey and emergency use of computed tomography (CT) and magnetic resonance (MR) imaging in the setting of cord compression. Since then, there has been a steady rise in interest in the use of various imaging techniques in the management of myeloma. The purpose of imaging in the management of myeloma includes the assessment of the extent and severity of the disease at presentation, the identification and characterisation of complications, and the assessment of response to therapy. Plain radiography, CT, and MR imaging are generally established examination techniques in myeloma whilst positron emission tomography (PET) and (99)Technetium sestamibi (MIBI) imaging are promising newer scanning techniques under current evaluation. These stand-alone imaging guidelines discuss recommendations for the use of each modality of imaging at diagnosis and in the follow up of patients with myeloma.
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Affiliation(s)
- Shirley D'Sa
- Department of Haematology, University College Hospital, London, UK.
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19
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Moreton P, Kennedy B, Lucas G, Leach M, Rassam SMB, Haynes A, Tighe J, Oscier D, Fegan C, Rawstron A, Hillmen P. Eradication of minimal residual disease in B-cell chronic lymphocytic leukemia after alemtuzumab therapy is associated with prolonged survival. J Clin Oncol 2005; 23:2971-9. [PMID: 15738539 DOI: 10.1200/jco.2005.04.021] [Citation(s) in RCA: 341] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To test whether eradication of minimal residual disease (MRD) in B-cell chronic lymphocytic leukemia (CLL) by alemtuzumab is associated with a prolongation of treatment-free and overall survival. PATIENTS AND METHODS Ninety-one previously treated patients with CLL (74 men and 17 women; median age, 58 years [range, 32 to 75 years]; 44 were refractory to purine analogs) received a median of 9 weeks of alemtuzumab treatment between 1996 and 2003. Regular bone marrow assessments by MRD flow cytometry were performed with the aim of eradicating detectable MRD (< 1 CLL cell in 10(5) normal cells). RESULTS Responses according to National Cancer Institute-sponsored working group response criteria were complete remission (CR) in 32 patients (36%), partial remission (PR) in 17 patients (19%), and no response (NR) in 42 patients (46%). Twenty-two (50%) of 44 purine analog-refractory patients responded to alemtuzumab. Detectable CLL was eradicated from the blood and marrow in 18 patients (20%). Median survival was significantly longer in MRD-negative patients compared with those achieving an MRD-positive CR, PR, or NR. Patients achieving an MRD-negative CR had a longer treatment-free survival than patients with MRD-positive CRs, PR, or NR: MRD-negative CRs, not reached; MRD-positive CRs, 20 months; PRs, 13 months; NR, 6 months (P < .0001). Overall survival for the 18 patients with MRD-negative remissions was 84% at 60 months. Eight (47%) of the MRD-negative patients converted to MRD positivity at a median of 28 months. CONCLUSION MRD-negative remission in CLL is achievable with alemtuzumab, leading to an improved overall and treatment-free survival.
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MESH Headings
- Adult
- Aged
- Alemtuzumab
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/therapeutic use
- Antineoplastic Agents/therapeutic use
- Bone Marrow/pathology
- Disease-Free Survival
- Female
- Flow Cytometry
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Neoplasm, Residual
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Affiliation(s)
- Paul Moreton
- Leeds Teaching Hospitals, NHS Trust, Great George St, Leeds, LS1 3EX United Kingdom.
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20
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Morris E, Thomson K, Craddock C, Mahendra P, Milligan D, Cook G, Smith GM, Parker A, Schey S, Chopra R, Hatton C, Tighe J, Hunter A, Peggs K, Linch D, Goldstone A, Mackinnon S. Outcomes after alemtuzumab-containing reduced-intensity allogeneic transplantation regimen for relapsed and refractory non-Hodgkin lymphoma. Blood 2004; 104:3865-71. [PMID: 15304395 DOI: 10.1182/blood-2004-03-1105] [Citation(s) in RCA: 250] [Impact Index Per Article: 12.5] [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: 11/20/2022] Open
Abstract
Abstract
We report the outcomes after reduced-intensity conditioning allogeneic stem cell transplantation (RIT) for non-Hodgkin lymphoma (NHL) in 88 patients (low-grade NHL [LG-NHL], n = 41; high-grade NHL [HG-NHL], n = 37; mantle cell lymphoma [MCL], n = 10). Thirty-seven patients had previously received autografts, and 21 were in complete remission (CR) at transplantation. Conditioning therapy consisted of alemtuzumab, fludarabine, and melphalan. Sixty-five patients received peripheral blood stem cells (PBSCs) from HLA-identical siblings, and 23 received bone marrow (BM) from matched unrelated donors. Prophylaxis for graft-versus-host disease (GVHD) consisted of cyclosporin A. Grade III-IV acute GVHD developed in 4 patients, and chronic GVHD developed in 6 patients. With a median follow-up of 36 months (range, 18-60 months), the actuarial overall survival (OS) rates at 3 years were 34% for HG-NHL, 60% for MCL, and 73% for LG-NHL (P < .001). The 100-day and 3-year transplant-related mortality (TRM) rates for patients with LG-NHL were 2% and 11%, respectively, and were better (P = .01) than they were for patients with HG-NHL (27% and 38%, respectively). The actuarial current progression-free survival (PFS) rate at 3 years, including the rate for patients who achieved remission after donor lymphocyte infusion (DLI) for progression, was 65% for LG-NHL, 50% for MCL, and 34% for HG-NHL (P = .002). Twenty-one patients underwent DLI for matched related donor (MD)-persistent disease or relapse, and 15 underwent DLI for mixed hematopoietic chimerism. Patients who experienced relapses of LG-NHL and chronic lymphocytic leukemia (CLL) achieved excellent PFS with extremely low TRM and GVHD, even when matched related donors were unavailable. (Blood. 2004;104:3865-3871)
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Affiliation(s)
- Emma Morris
- Department of Haematology, Royal Free and University College Hospitals Medical School, 98 Chenies Mews, London WC1E 6HX, United Kingdom.
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21
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Dyson MJ, Talley PJ, Reilly JT, Stevenson D, Parsons E, Tighe J. Detection of cryptic MLL insertions using a commercial dual-color fluorescence in situ hybridization probe. ACTA ACUST UNITED AC 2003; 147:81-3. [PMID: 14580777 DOI: 10.1016/s0165-4608(03)00158-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 10/26/2022]
Abstract
Involvement of the MLL gene located at chromosome region 11q23 is a frequent occurrence in both acute myelocytic leukemia and acute lymphoblastic leukemia. More than 30 loci have now been associated with MLL, usually by reciprocal translocation. Deletions, insertions, and more complex rearrangements of MLL are rarely seen. We present three cases of AML M5 showing no cytogenetic evidence of 11q23 rearrangement, in which a commercial MLL dual-color fluorescence in situ hybridization probe revealed a nonstandard abnormal signal pattern, suggesting cryptic insertion of the MLL gene into its partner gene site.
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Affiliation(s)
- Michael J Dyson
- North Trent Cytogenetics Department, Sheffield Children's NHS Trust, Western Bank, S10 2TH, Sheffield, UK.
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22
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Pepper C, Thomas A, Hoy T, Tighe J, Culligan D, Fegan C, Bentley P. Leukemic and non-leukemic lymphocytes from patients with Li Fraumeni syndrome demonstrate loss of p53 function, Bcl-2 family dysregulation and intrinsic resistance to conventional chemotherapeutic drugs but not flavopiridol. Cell Cycle 2003; 2:53-8. [PMID: 12695689] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Li Fraumeni syndrome (LFS) is characterised by a predisposition to the early onset of certain tumors and is associated with germline mutation of the anti-oncogene p53. In this study we analysed the in vitro responses of lymphocytes from two LFS patients to chemotherapeutic drugs in terms of apoptosis induction and the expression of key intracellular proteins that regulate this process. One of the LFS patients also suffered from B-cell chronic lymphocytic leukemia (B-CLL) and hence presented with a light-chain restricted B-cell lymphocytosis while the other patient had entirely normal blood counts. The B-lymphocytes from both LFS patients showed a marked degree of resistance to chlorambucil and fludarabine when compared to age-matched controls but were remarkably sensitive to the novel flavone, flavopiridol. Loss of function of p53 was demonstrated by a failure to induce Bax and p21 protein expression. In addition, altered basal expression patterns of Bcl-2 and Bax, two key regulators of apoptosis, were found in the LFS lymphocytes when compared with controls. These results suggest that LFS lymphocytes carrying a p53 mutation show intrinsic resistance to conventional chemotherapeutic drugs and this is associated with dysregulation of Bcl-2 family proteins. Furthermore, The innate resistance profile was similar in leukemic and non-leukemic lymphocytes and was therefore independent of genetic changes acquired during malignant transformation. Novel agents that induce p53-independent cell killing may be useful not only in the treatment of LFS-associated tumors but also drug resistant tumors in general where p53 and/or Bcl-2 family dysregulation is a feature.
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Affiliation(s)
- Chris Pepper
- Llandough Hospital, Penlan Road, Penarth, Vale of Glamorgan CF64 2XX, Wales, UK.
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23
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Affiliation(s)
- G Preston
- Oxleas NHS Trust, Bracton Centre, Bexley Hospital, Old Bexley Lane, DA5 2BW, UK
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24
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Abstract
Purified preparations of circulating leukaemic blast cells from patients with acute myeloid (M1-7) or acute lymphoblastic leukaemia, and the myeloid or lymphoid cells from patients with chronic myeloid or lymphocytic forms of leukaemia, were incorporated into clots prepared from fibrinogen and plasminogen. Patterns of lysis were followed and measured by light transmission in a microtitre plate reader. Mature polymorphonuclear and mononuclear cell fractions from normal individuals were studied concurrently for comparison. Blast cells from the myeloid forms of acute leukaemia (M2-4) and 'myeloid' cell fractions from patients with chronic myeloid leukaemia were capable of lysing plasminogen-containing clots; this activity was neutralized by addition of immunoglobulin against urokinase plasminogen activator (u-PA), but not by anti-tissue plasmogen activator (t-PA). Mature polymorphonuclear and mononuclear cells from normal individuals lacked lytic activity, as did the leukaemic cells from patients with acute lymphoblastic or chronic lymphocytic leukaemia. Lysed blast cells showed the presence of free plasminogen activator on sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) with overlay zymography, also neutralized by anti-u-PA, whereas normal polymorphonuclear and mononuclear cells did not. These observations suggest that mechanisms underlying some forms of severe bleeding in acute myeloid leukaemias have a critical fibrinolytic component generated by the blast cells themselves.
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Affiliation(s)
- L Robbie
- Department of Medicine and Therapeutics, University of Aberdeen, UK
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25
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Robbie L, Berry S, Moir E, Booth NA, Culligan D, Tighe J, Watson H, King D, Bennett B. Myeloid leukaemic cells can lyse fibrin directly. Br J Haematol 2000. [DOI: 10.1111/j.1365-2141.2000.02381.x] [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: 12/01/2022]
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Gerada C, Tighe J. A review of shared care protocols for the treatment of problem drug use in England, Scotland, and Wales. Br J Gen Pract 1999; 49:125-6. [PMID: 10326266 PMCID: PMC1313348] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
In 1995, the Department of Health instructed health authorities to establish protocols for the shared care of problem drug users. Response to this has been disappointing: 26 out of 120 health authorities have shared care arrangements in place, with the content of these differing widely.
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Affiliation(s)
- C Gerada
- Consultancy Liaison Addiction Service, Hurley Clinic, Ebenezer House, London
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27
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Affiliation(s)
- S J Howling
- Department of Radiology, University College London Hospitals Trust, UK
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28
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Tighe J. Acoustic Densitometry - A New Method for Ultrasonic Plaque Characterization. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)83797-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Stringfield D, Prybil L, Tighe J. A unified health ministry in central Tennessee: eleven years of successful partnership. Hosp Health Serv Adm 1997; 42:473-88. [PMID: 10174461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Middle Tennessee Medical Center (MTMC) is a not-for-profit community hospital located in Murfreesboro, Tennessee. Eleven years ago, a large investor-owned hospital company presented the institution's board of trustees with a purchase offer. As an alternative, two church-related institutions in Nashville--Baptist Hospital and Saint Thomas Hospital, which is part of the Daughters of Charity National Health System--presented the board of trustees with a plan whereby a new not-for-profit holding company sponsored jointly by Baptist Hospital and Saint Thomas Hospital would become the corporate member of Middle Tennessee Medical Center. Funds contributed by Baptist and Saint Thomas Hospitals would be infused into the Christy-Houston Foundation, a not-for-profit entity devoted to identifying and serving community needs in Murfreesboro and the surrounding area. Their proposal was accepted, and the two church-related institutions became partners in jointly sponsoring and governing an important not-for-profit healthcare institution in central Tennessee. In 1996, The Lewin Group, a healthcare consulting firm based in Fairfax, Virginia, was commissioned by Baptist Hospital, Saint Thomas Hospital, and Daughters of Charity National Health System to conduct a retrospective assessment of the progress of this jointly sponsored ministry in relation to the original vision and goals. Historical and operational data were analyzed, and interviews were conducted with 24 people who were directly involved in conceiving, developing, or implementing this ministry. This article summarizes the principal findings and conclusions of this ten-year assessment.
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Tighe J. Counseling about unclear risks. Focus 1995; 10:suppl 1-2. [PMID: 11362585] [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: 04/16/2023]
Affiliation(s)
- J Tighe
- University of California San Francisco, AIDS Clinic, San Francisco, CA
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32
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Sanfilippo PJ, Urbanski MJ, Beers KN, Eckardt A, Falotico R, Ginsberg MH, Offord S, Press JB, Tighe J, Tomko K. Novel thiazole-based heterocycles as selective inhibitors of fibrinogen-mediated platelet aggregation. J Med Chem 1995; 38:34-41. [PMID: 7837237 DOI: 10.1021/jm00001a008] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The synthesis and biological activity of novel thiazole-based heterocycles as inhibitors of thrombin-induced human platelet aggregation are described. Further evaluation of selected compounds show they inhibit platelet aggregation as stimulated by a variety of agonists. The more active compounds also were found to inhibit fibrinogen binding to platelets. To further delineate the mechanism of action of these compounds, direct binding studies with the purified glycoprotein (GP) IIb/IIIa receptor were performed. Flow cytometry analyses of 24 and 32 indicate that these compounds block the activation process of the GPIIb/IIIa receptor without denaturing the integrin receptor. On the basis of these studies, 32 exhibited the best profile as a novel nonpeptide inhibitor of fibrinogen-mediated platelet aggregation.
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Affiliation(s)
- P J Sanfilippo
- Drug Discovery Division, R. W. Johnson Pharmaceutical Research Institute, Spring House, Pennsylvania 19477
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33
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Hart GJ, Woodward N, Johnson AM, Tighe J, Parry JV, Adler MW. Prevalence of HIV, hepatitis B and associated risk behaviours in clients of a needle-exchange in central London. AIDS 1991; 5:543-7. [PMID: 1863406 DOI: 10.1097/00002030-199105000-00010] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In order to determine the prevalence of risk behaviour for, and antibodies to HIV and hepatitis B in clients of a needle-exchange scheme in central London we employed an anonymous, self-administered questionnaire along with salivary antibody testing by immunoglobulin (Ig) G antibody capture immunoassay. Two hundred and thirty-two subjects (193 men, 39 women; median age 32) participated; a response rate of 89%. Clients were long-term, frequent injectors. Lending used equipment at any time was reported by 55%, and borrowing by 52%. Of those who had shared needles and syringes during the last year, the majority had lent to, or borrowed from, one person only (53 and 55%, respectively). Younger clients (less than 29 years of age) reported more recent sharing than older clients (greater than 30 years of age). Five out of 211 (2.4%) samples tested for anti-HIV were positive. One hundred and eleven out of 199 (56%) samples were positive for anti-hepatitis B core (HBc). In this population of needle-exchange attenders there is no evidence of further spread of HIV, and a low prevalence of HIV infection appears to have been sustained. However, the high prevalence of anti-HBc provides evidence of previous risk behaviour and so constant vigilance is necessary if further viral spread is to be avoided. This study has established an acceptable method for the anonymous surveillance of current risk behaviour and salivary antibodies to HIV and hepatitis B virus (HBV) in a drug-using population.
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Affiliation(s)
- G J Hart
- Academic Department of Genito-Urinary Medicine, University College and Middlesex School of Medicine, London, UK
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Abstract
Contractile responses of the isolated iris sphincter muscle from the rabbit, cow, pig, cat, dog, baboon and man to substance P were compared under isotonic conditions using carbachol as a reference standard. Iris preparations from the rabbit, pig and cow showed strong and consistent responses to substance P whilst those from the cat, dog, baboon and human eyes did not contract.
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36
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Tighe J. Functional Ultrastructure of the Kidney. Clin Mol Pathol 1981. [DOI: 10.1136/jcp.34.8.941-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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38
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