1
|
Percival MEM, Othus M, Mirahsani S, Gardner KM, Shaw C, Halpern AB, Becker PS, Hendrie PC, Sorror ML, Walter RB, Estey EH. Survival of patients with newly diagnosed high-grade myeloid neoplasms who do not meet standard trial eligibility. Haematologica 2021; 106:2114-2120. [PMID: 32646891 PMCID: PMC8327712 DOI: 10.3324/haematol.2020.254938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/06/2020] [Indexed: 12/11/2022] Open
Abstract
Few patients with cancer, including those with acute myeloid leukemia and high-grade myeloid neoplasms, participate in clinical trials. Broadening standard eligibility criteria may increase clinical trial participation. In this retrospective single-center analysis, we identified 442 consecutive newly diagnosed patients from 2014 to 2016. Patients were considered “eligible” if they had a performance status 0-2, normal renal and hepatic function, no recent solid tumor, left ventricular ejection fraction (EF) ≥50%, and no history of congestive heart failure (CHF) or myocardial infarction (MI); “ineligible” patients failed to meet one or more of these criteria. We included 372 patients who received chemotherapy. Ineligible patients represented 40% of the population and had a 1.79-fold greater risk of death (95% Confidence Interval [CI]: 1.37-2.33) than eligible patients. Very few patients had cardiac comorbidities, including 2% with low EF, 4% with prior CHF, and 5% with prior MI. In multivariable analysis, ineligibility was associated with decreased survival (Hazard ratio [HR] 1.44; 95% CI: 1.07-1.93). Allogeneic transplantation, performed in 150 patients (40%), was associated with improved survival (HR 0.66, 95% CI: 0.48-0.91). Therefore, standard eligibility characteristics identify a patient population with improved survival. Further treatment options are needed for patients considered ineligible for clinical trials.
Collapse
|
2
|
Godwin CD, Zhou Y, Othus M, Asmuth MM, Shaw CM, Gardner KM, Wood BL, Walter RB, Estey EH. Acute myeloid leukemia measurable residual disease detection by flow cytometry in peripheral blood vs bone marrow. Blood 2021; 137:569-572. [PMID: 33507294 PMCID: PMC7845008 DOI: 10.1182/blood.2020006219] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Colin D Godwin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, Division of Hematology, and
| | - Yi Zhou
- Department of Laboratory Medicine, Division of Hematopathology, University of Washington, Seattle, WA
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA; and
| | | | - Carole M Shaw
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Brent L Wood
- Department of Laboratory Medicine, Division of Hematopathology, University of Washington, Seattle, WA
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, Division of Hematology, and
- Department of Pathology, and
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Elihu H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, Division of Hematology, and
| |
Collapse
|
3
|
Halpern AB, Othus M, Huebner EM, Scott BL, Hendrie PC, Percival MEM, Becker PS, Smith HA, Oehler VG, Orozco JJ, Cassaday RD, Gardner KM, Chen TL, Buckley SA, Orlowski KF, Anwar A, Estey EH, Walter RB. Phase I/II trial of cladribine, high-dose cytarabine, mitoxantrone, and G-CSF with dose-escalated mitoxantrone for relapsed/refractory acute myeloid leukemia and other high-grade myeloid neoplasms. Haematologica 2018; 104:e143-e146. [PMID: 30409798 DOI: 10.3324/haematol.2018.204792] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Anna B Halpern
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center
| | - Emily M Huebner
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington
| | - Bart L Scott
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Medical Oncology, University of Washington
| | - Paul C Hendrie
- Department of Medicine, Division of Hematology, University of Washington.,Seattle Cancer Care Alliance
| | - Mary-Elizabeth M Percival
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Pamela S Becker
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | | | - Vivian G Oehler
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Johnnie J Orozco
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Ryan D Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Kelda M Gardner
- Department of Medicine, Division of Hematology, University of Washington
| | - Tara L Chen
- Deparment of Pharmacy Services, University of Washington
| | - Sarah A Buckley
- Hematology/Oncology Fellowship Program, University of Washington/Fred Hutchinson Cancer Research Center
| | - Kaysey F Orlowski
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington
| | - Asma Anwar
- Hematology/Oncology Fellowship Program, University of Washington/Fred Hutchinson Cancer Research Center
| | - Elihu H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington.,Department of Medicine, Division of Hematology, University of Washington
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington .,Department of Medicine, Division of Hematology, University of Washington.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
4
|
Vaughn JE, Othus M, Powell MA, Gardner KM, Rizzuto DL, Hendrie PC, Becker PS, Pottinger PS, Estey EH, Walter RB. Resource Utilization and Safety of Outpatient Management Following Intensive Induction or Salvage Chemotherapy for Acute Myeloid Leukemia or Myelodysplastic Syndrome: A Nonrandomized Clinical Comparative Analysis. JAMA Oncol 2016; 1:1120-7. [PMID: 26355382 DOI: 10.1001/jamaoncol.2015.2969] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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
IMPORTANCE Adults with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) typically remain hospitalized after induction or salvage chemotherapy until blood cell count recovery, with resulting prolonged inpatient stays being a primary driver of health care costs. Pilot studies suggest that outpatient management following chemotherapy might be safe and could reduce costs for these patients. OBJECTIVE To compare safety, resource utilization, infections, and costs between adults discharged early following AML or MDS induction or salvage chemotherapy and inpatient controls. DESIGN Nonrandomized, phase 2, single-center study conducted at the University of Washington Medical Center. Over a 43-month period (January 1, 2011, through July 31, 2014), 178 adults receiving intensive AML or MDS chemotherapy were enrolled. After completion of chemotherapy, 107 patients met predesignated medical and logistical criteria for early discharge, while 29 met medical criteria only and served as inpatient controls. INTERVENTIONS Early-discharge patients were released from the hospital at the completion of chemotherapy, and supportive care was provided in the outpatient setting until blood cell count recovery (median, 21 days; range, 2-45 days). Controls received inpatient supportive care (median, 16 days; range, 3-42 days). MAIN OUTCOMES AND MEASURES We analyzed differences in early mortality, resource utilization including intensive care unit (ICU) days, transfusions per study day, and use of intravenous (IV) antibiotics per study day), numbers of infections, and total and inpatient charges per study day among early-discharge patients vs controls. RESULTS Four of the 107 early-discharge patients and none of the 29 control patients died within 30 days of enrollment (P=.58). Nine early-discharge patients (8%) but no controls required ICU-level care (P=.20). No differences were noted in the median daily number of transfused red blood cell units (0.27 vs 0.29; P=.55) or number of transfused platelet units (0.26 vs 0.29; P=.31). Early-discharge patients had more positive blood cultures (37 [35%] vs 4 [14%]; P=.04) but required fewer IV antibiotic days per study day (0.48 vs 0.71; P=.01). Overall, daily charges among early-discharge patients were significantly lower than for inpatients (median, $3840 vs $5852; P<.001) despite increased charges per inpatient day when readmitted (median, $7405 vs $5852; P<.001). CONCLUSIONS AND RELEVANCE Early discharge following intensive AML or MDS chemotherapy can reduce costs and use of IV antibiotics, but attention should be paid to complications that may occur in the outpatient setting.
Collapse
Affiliation(s)
- Jennifer E Vaughn
- Hematology/Oncology Fellowship Program, University of Washington, Seattle2Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington3now with Blue Ridge Cancer Care, Department of Medicine, Virginia Tech Carilion School of Med
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Morgan A Powell
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Paul C Hendrie
- Division of Hematology, Department of Medicine, University of Washington, Seattle
| | - Pamela S Becker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington6Division of Hematology, Department of Medicine, University of Washington, Seattle
| | - Paul S Pottinger
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | - Elihu H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington6Division of Hematology, Department of Medicine, University of Washington, Seattle
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington6Division of Hematology, Department of Medicine, University of Washington, Seattle8Department of Epidemiology, University of Washington, Seattle
| |
Collapse
|
5
|
Becker PS, Medeiros BC, Stein AS, Othus M, Appelbaum FR, Forman SJ, Scott BL, Hendrie PC, Gardner KM, Pagel JM, Walter RB, Parks C, Wood BL, Abkowitz JL, Estey EH. G-CSF priming, clofarabine, and high dose cytarabine (GCLAC) for upfront treatment of acute myeloid leukemia, advanced myelodysplastic syndrome or advanced myeloproliferative neoplasm. Am J Hematol 2015; 90:295-300. [PMID: 25545153 DOI: 10.1002/ajh.23927] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/20/2014] [Indexed: 11/11/2022]
Abstract
Prior study of the combination of clofarabine and high dose cytarabine with granulocyte colony-stimulating factor (G-CSF) priming (GCLAC) in relapsed or refractory acute myeloid leukemia resulted in a 46% rate of complete remission despite unfavorable risk cytogenetics. A multivariate analysis demonstrated that the remission rate and survival with GCLAC were superior to FLAG (fludarabine, cytarabine, G-CSF) in the relapsed setting. We therefore initiated a study of the GCLAC regimen in the upfront setting in a multicenter trial. The objectives were to evaluate the rates of complete remission (CR), overall and relapse-free survival (OS and RFS), and toxicity of GCLAC. Clofarabine was administered at 30 mg m(-2) day(-1) × 5 and cytarabine at 2 g m(-2) day(-1) × 5 after G-CSF priming in 50 newly-diagnosed patients ages 18-64 with AML or advanced myelodysplastic syndrome (MDS) or advanced myeloproliferative neoplasm (MPN). Responses were assessed in the different cytogenetic risk groups and in patients with antecedent hematologic disorder. The overall CR rate was 76% (95% confidence interval [CI] 64-88%) and the CR + CRp (CR with incomplete platelet count recovery) was 82% (95% CI 71-93%). The CR rate was 100% for patients with favorable, 84% for those with intermediate, and 62% for those with unfavorable risk cytogenetics. For patients with an antecedent hematologic disorder (AHD), the CR rate was 65%, compared to 85% for those without an AHD. The 60 day mortality was 2%. Thus, front line GCLAC is a well-tolerated, effective induction regimen for AML and advanced myelodysplastic or myeloproliferative disorders.
Collapse
Affiliation(s)
- Pamela S. Becker
- Division of Hematology, Department of Medicine; University of Washington; Seattle Washington
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
| | - Bruno C. Medeiros
- Division of Hematology; Department of Medicine; Stanford School of Medicine; Palo Alto California
| | - Anthony S. Stein
- Department of Hematology and Hematopoietic Cell Transplantation; City of Hope Duarte California
| | - Megan Othus
- Public Health Sciences Division; Fred Hutchinson Cancer Research Center; Seattle Washington
| | - Frederick R. Appelbaum
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Division of Medical Oncology, Department of Medicine; University of Washington; Seattle Washington
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell Transplantation; City of Hope Duarte California
| | - Bart L. Scott
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Division of Medical Oncology, Department of Medicine; University of Washington; Seattle Washington
| | - Paul C. Hendrie
- Division of Hematology, Department of Medicine; University of Washington; Seattle Washington
| | - Kelda M. Gardner
- Division of Medical Oncology, Department of Medicine; University of Washington; Seattle Washington
| | - John M. Pagel
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Division of Medical Oncology, Department of Medicine; University of Washington; Seattle Washington
| | - Roland B. Walter
- Division of Hematology, Department of Medicine; University of Washington; Seattle Washington
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
| | - Cynthia Parks
- Division of Hematology, Department of Medicine; University of Washington; Seattle Washington
| | - Brent L. Wood
- Department of Laboratory Medicine; University of Washington; Seattle Washington
| | - Janis L. Abkowitz
- Division of Hematology, Department of Medicine; University of Washington; Seattle Washington
| | - Elihu H. Estey
- Division of Hematology, Department of Medicine; University of Washington; Seattle Washington
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
| |
Collapse
|
6
|
Walter RB, Medeiros BC, Gardner KM, Orlowski KF, Gallegos L, Scott BL, Hendrie PC, Estey EH. Gemtuzumab ozogamicin in combination with vorinostat and azacitidine in older patients with relapsed or refractory acute myeloid leukemia: a phase I/II study. Haematologica 2013; 99:54-9. [PMID: 24142996 DOI: 10.3324/haematol.2013.096545] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Epigenetic therapeutics such as the histone deacetylase inhibitor, vorinostat, and the DNA methyltransferase I inhibitor, azacitidine, enhance gemtuzumab ozogamicin efficacy in vitro. We therefore investigated vorinostat/azacitidine/gemtuzumab ozogamicin in 52 adults aged 50 years or over with acute myeloid leukemia requiring therapy for first relapse (remission duration ≤ 12 months) or primary refractory disease in a phase I/II trial. Vorinostat and gemtuzumab ozogamicin were escalated step-wise during the phase I portion of the trial. Vorinostat (400 mg/day orally from Days 1-9), azacitidine (75 mg/m(2)/day intravenously or subcutaneously from Days 1-7), and gemtuzumab ozogamicin (3 mg/m(2)/day intravenously on Days 4 and 8) were identified as the maximum tolerated dose. Among the 43 patients treated at this dose, 10 achieved a complete remission and 8 achieved a complete remission with incomplete blood count recovery, for an overall response rate of 41.9% (exact 95% confidence interval (CI): 27.0-57.9%). Four of these 18 patients (2 with complete remission and 2 with complete remission with incomplete blood count recovery) had persistence of minimal residual disease by flow cytometry at the time of best response. Four patients died within 28 days of treatment initiation. Median overall survival for the 18 patients achieving complete remission/complete remission with incomplete blood count recovery was significantly longer than for those 21 patients who failed therapy but lived at least 29 days after treatment initiation (224.5 days (range 70-798) vs. 95 days (range 36-900); P=0.0023). These data indicate that vorinostat/azacitidine/gemtuzumab ozogamicin has activity in this difficult-to-treat acute myeloid leukemia patient subset. (ClinicalTrials.gov: identifier 00895934).
Collapse
|
7
|
Chen TL, Estey EH, Othus M, Gardner KM, Markle LJ, Walter RB. Cyclosporine modulation of multidrug resistance in combination with pravastatin, mitoxantrone and etoposide for adult patients with relapsed/refractory acute myeloid leukemia: a phase 1/2 study. Leuk Lymphoma 2013; 54:2534-6. [PMID: 23432687 DOI: 10.3109/10428194.2013.777836] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tara L Chen
- Pharmacy Services, University of Washington Medical Center , Seattle, WA , USA
| | | | | | | | | | | |
Collapse
|
8
|
Walter RB, Taylor LR, Gardner KM, Dorcy KS, Vaughn JE, Estey EH. Outpatient management following intensive induction or salvage chemotherapy for acute myeloid leukemia. Clin Adv Hematol Oncol 2013; 11:571-577. [PMID: 24518520 PMCID: PMC4212516] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Adults with newly diagnosed or relapsed acute myeloid leukemia (AML) commonly receive intensive chemotherapy to achieve disease remission. In the United States and many other countries, it is standard practice that these patients remain hospitalized "preemptively" until blood count recovery, owing to the risk for overwhelming infections and bleeding during pancytopenia. This care policy requires hospitalization for an average of 3 to 4 weeks after completion of chemotherapy. However, highly effective oral prophylactic antimicrobials are now available, and transfusion support of outpatients has become routine in recent years. As a result, the care of patients with hematologic malignancies treated with intensive modalities is increasingly shifting from inpatient to outpatient settings. Benefits of this shift could include the reduced need for medical resources (eg, transfusions or intravenous antimicrobial therapy), improved quality of life (QOL), decreased rates of nosocomial infections, and lower costs. Increasing evidence indicates that select AML patients undergoing intensive remission induction or salvage chemotherapy can be discharged early after completion of chemotherapy and followed closely in a well-equipped outpatient facility in a safe and costeffective manner. Further demonstration that the current approach of preemptive hospitalization is medically unjustified, economically more burdensome, and adversely affects health-related QOL would very likely change the management of these patients throughout this country and elsewhere, resulting in the establishment of a new standard practice that improves cancer care.
Collapse
Affiliation(s)
- Roland B. Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | | | | | - Jennifer E. Vaughn
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elihu H. Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
| |
Collapse
|
9
|
Walter RB, Lee SJ, Gardner KM, Chai X, Shannon-Dorcy K, Appelbaum FR, Estey EH. Outpatient management following intensive induction chemotherapy for myelodysplastic syndromes and acute myeloid leukemia: a pilot study. Haematologica 2011; 96:914-7. [PMID: 21393334 DOI: 10.3324/haematol.2011.040220] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Due to infectious and bleeding risks, adults with acute myeloid leukemia or high-risk myelodysplastic syndromes typically remain hospitalized after remission induction chemotherapy until blood count recovery. Here, we explored the medical and financial effects of discharge immediately after chemotherapy completion with close outpatient follow up. Within 12 months, 15 patients fulfilling both medical and logistical criteria were discharged early, whereas 5 patients meeting medical criteria only served as inpatient controls. No patient died. Patients discharged early spent a median of 8 days (range 3-36 days), or 54% of their study time, as outpatients. These patients required less time on intravenous antibiotics (6 vs. 16 days; P=0.11), received fewer red blood cell transfusions (0.25 vs. 0.48 units/day; P=0.08), and incurred lower median daily charges ($3,270 vs. $5,467; P=0.01) than controls. Thus, early discharge of selected patients appears, safe and may reduce cost and resource utilization. (ClinicalTrials.gov Identifier: NCT00844441).
Collapse
Affiliation(s)
- Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190; Seattle, WA 98109-1024, USA.
| | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
We examined heritable variation for quantitative traits within and between naturally occurring mesic and xeric ecotypes of the slender wild oat (Avena barbata), and in 188 recombinant inbred lines derived from a cross between the ecotypes. We measured a suite of seedling and adult traits in the greenhouse, as well as performance-related traits in field sites native to the two ecotypes. Although the ecotypes were genetically diverged for most traits, few traits showed significant heritable variation within either ecotype. In contrast, considerable heritable variation was released in the recombinant progeny of the cross, and transgressive segregation was apparent in all traits. Heritabilities were substantially greater in the greenhouse than in the field, and this was associated with an increase in environmental variance in the field, rather than a decrease in genetic variance. Strong genetic correlations were evident among the recombinants, such that 22 measured traits could be well represented by only seven underlying factors, which accounted for 80% of the total variation. The primary axis of variation in the greenhouse described a trade-off between vegetative and reproductive allocation, mediated by the date of first flowering, and fitness was strongly correlated with this trade-off. Other factors in the greenhouse described variation in size and in seedling traits. Lack of correlation among these factors represents the release of multivariate trait variation through recombination. In the field, a separate axis of variation in overall performance was found for each year/site combination. Performance was significantly correlated across field environments, but not significantly correlated between greenhouse and field.
Collapse
Affiliation(s)
- K M Gardner
- Department of Biology, Dalhousie University, Halifax, NS, Canada
| | | |
Collapse
|
11
|
Muir KT, Kook KA, Stern C, Gardner KM. Analysis of amiodarone and desethylamiodarone in serum and tears by reversed-phase high-performance liquid chromatography. J Chromatogr 1986; 374:394-9. [PMID: 3958097 DOI: 10.1016/s0378-4347(00)83298-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
12
|
Abstract
We compared the distribution of HLA-ABC (class I) and HLA-DR (class II) antigens on fresh human donor corneal tissue, donor corneas following a 72-hour storage in McCarey-Kaufman (M-K) medium, and corneal buttons from patients with allograft rejection and with chronic herpetic stromal keratitis. Incubation in M-K media had little or no effect on the distribution of HLA antigens as compared with fresh tissue. In contrast to control corneas, both HLA class I and II antigens were detected on corneal endothelial cells, cells in the stroma, and on basal epithelial cells in rejected allografts. Corneal endothelium in herpetic buttons did not express detectable HLA antigens. HLA-DR positive Langerhan's cells were demonstrated in the central corneal epithelium of rejected allografts, as well as in herpetic corneas, but not in control corneas except at the limbus. Based upon these observations, a theory of corneal allograft rejection in humans is proposed based upon the induction of class I HLA-ABC and class II HLA-DR antigens on cells in the donor button by a factor(s) associated with cellular inflammation.
Collapse
|
13
|
|
14
|
Gardner KM, Straatsma BR, Pettit TH. Neodymium: YAG laser posterior capsulotomy: the first 100 cases at UCLA. Ophthalmic Surg 1985; 16:24-8. [PMID: 3838376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Initial anatomic success was reported in 97 of the first 100 neodymium: YAG laser posterior capsulotomies performed at the Jules Stein Eye Institute. Visual acuity improved in 90 patients, was unchanged in five, and decreased in five. In the five patients with decreased visual acuity after posterior capsulotomy, the decrease was unrelated to capsulotomy and caused by progression of preexisting retinal disease. Our experience suggests that attention to patient evaluation and surgical technique can help minimize complications and assure best results.
Collapse
|
15
|
Pepose JS, Nestor MS, Gardner KM, Foos RY, Pettit TH. Composition of cellular infiltrates in rejected human corneal allografts. Graefes Arch Clin Exp Ophthalmol 1985; 222:128-33. [PMID: 3884454 DOI: 10.1007/bf02173536] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We utilized the leu series of monoclonal antibodies and an indirect immunoperoxidase technique to quantitate the cellular infiltrates in seven rejected human corneal allografts and compared them to nine identically processed corneas from patients with chronic herpetic stromal keratitis and to three control corneas. The cellular infiltrates in the rejected allografts were of mixed composition, comprised predominantly of leu-1 positive T-lymphocytes and leu-M3 positive macrophages. Both helper and cytotoxic-suppressor T-cells were identified in the stromal lesions. Statistically significant differences were noted in the absolute number of mononuclear cells and macrophages seen infiltrating the rejected corneal allografts compared to the herpetic corneas. We discuss the implications of these findings with regard to possible mechanisms underlying corneal allograft rejection in man.
Collapse
|
16
|
Abstract
Cataract disrupts the crystalline lens, a transparent, elastic, avascular, biconvex structure composed of a capsule, lens epithelium, and lens fiber cells. Many factors contribute to the progression of lens opacity, but aging is most frequently associated with cataract. As aging-related cataract develops, many biochemical and biophysical changes occur, most notably a marked increase in the insolubilization of the crystallin and extensive oxidation damage to many of the lens constituents. Cataract management should include ophthalmologic history and examination, medical evaluation, optical correction, control of ocular and systemic disease that may contribute to cataract, discontinuation of cataractogenic drugs, and periodic reexamination. Surgery is indicated when cataract is associated with vision decrease interfering with activities important to the patient, intraocular inflammation or glaucoma, or interference with management of posterior segment disease. More than 600 000 cataract operations are done in the United States each year; in 1982 an estimated 496 000 cataract operations were combined with intraocular lens implantation.
Collapse
|
17
|
Abstract
We use a new model for describing the flexure of hydrogel lenses in situ to evaluate toric hydrogel lenses. The mathematical development of the model precludes use of prism ballasted lenses (because of differential thickness in the vertical meridian and possible lenticulation in the midperiphery), and so double-thin zone lenses were used here. Our results suggest that such lenses (low-minus power) align almost perfectly with the anterior corneal surface creating minimal tear layers.
Collapse
|
18
|
Abstract
We have developed a computer program which allows analysis of soft contact lens flexure without assuming a priori that the posterior surface of the lens aligns with the central anterior cornea. Such analysis leads to the conclusion that thin low-minus lenses entrap tear layers of low volume (about 5.5 microliter) and minimum power, whereas low-plus lens systems can develop tear layers of greater volume (about 9.5 microliter), and significant power (about -2.00 D). The later finding supports clinical impressions that plus lenses "lose" power when placed on the eye. In some cases our data suggest that the lens posterior surface closely aligns with the anterior cornea, whereas in other cases such alignment is unlikely. It also appears that mathematical models for the simultaneous flexure of front and back radii of soft lenses may be described for specific lens designs. This current study suggests that delta r2 congruent to 2 delta r1 describes the relation for low-plus lenses, and delta r2 congruent to 0.75 delta r1 is the relation for low-minus lenses.
Collapse
|
19
|
Gardner KM, DiDario B, De Voldre B. Toward better control: a medical record department management reporting system. Top Health Rec Manage 1983; 3:53-8. [PMID: 10258909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|