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Evageliou N, Renfro LA, Geller J, Perlman E, Kalapurakal J, Paulino A, Dix D, Eklund MJ, Murphy AJ, Romao RLP, Ehrlich PF, Varela CR, Vallance K, Fernandez Hon CV, Dome JS, Mullen EA. Prognostic impact of lymph node involvement and loss of heterozygosity of 1p or 16q in stage III favorable histology Wilms tumor: A report from Children's Oncology Group Studies AREN03B2 and AREN0532. Cancer 2024; 130:792-802. [PMID: 37902955 PMCID: PMC10993001 DOI: 10.1002/cncr.35084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION The prognostic impact of positive lymph nodes (LN+) and/or singular loss of heterozygosity (LOH) of 1p or 16q were assessed in children with stage III favorable histology Wilms tumor (FHWT) enrolled on AREN0532 or AREN03B2 alone. PATIENTS AND METHODS A total of 635 stage III FHWT vincristine/dactinomycin/doxorubicin (DD4A)-treated patients met inclusion criteria. Event-free survival (EFS) and overall survival are reported overall and by LN sampling, LN status, LOH 1p, LOH 16q, and a combination of LN status and singular LOH. Patients with unknown or positive combined LOH of 1p and 16q status and AREN03B2-only patients with unknown outcomes or treatment other than DD4A were excluded. RESULTS EFS did not differ by study, supporting pooling. Lack of LN sampling (hazard ratio [HR], 2.12; p = .0037), LN positivity (HR, 2.78; p = .0002), LOH 1p (HR, 2.18; p = .0067), and LOH 16q (HR, 1.72; p = .042) were associated with worse EFS. Compared with patients with both LN- and LOH-, those with negative nodes but positive LOH 1p or 16q and those with LN+ but LOH- for 1p or 16q had significantly worse EFS (HR, 3.05 and 3.57, respectively). Patients positive for both LN and LOH had the worst EFS (HR, 6.33; overall group factor, p < .0001). CONCLUSION Findings confirm LN+ status as an adverse prognostic factor amplified by presence of singular LOH 1p or 16q, supporting study of intensified therapy for patients with LN+ in combination with singular LOH in a prospective clinical trial.
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Affiliation(s)
- Nicholas Evageliou
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California and Children’s Oncology Group, Monrovia, CA
| | - James Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Elizabeth Perlman
- Department of Pathology and Laboratory Medicine, the Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago IL
| | - John Kalapurakal
- Department of Radiation Oncology, Robert H. Lurie Cancer Center, Northwestern University, Chicago, IL
| | - Arnold Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - David Dix
- Division of Oncology, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Meryle J Eklund
- Department of Radiology, Medical University of South Carolina, Charleston, SC
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Rodrigo LP Romao
- Departments of Surgery and Urology, IWK Health, Dalhousie University, Halifax, NS, Canada
| | - Peter F Ehrlich
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carly R Varela
- Janssen Research and Development, Spring House, PA. (At the time of this work affiliation was Division of Oncology, Children’s National Hospital, Divisions of Pediatric Hematology and Oncology, Inova Fairfax Hospital and Department of Pediatrics, George Washington University School of Medicine, Falls Church, Virginia.)
| | - Kelly Vallance
- Division of Hematology and Oncology, Cook Children’s Hospital, Fort Worth, TX
| | - Conrad V Fernandez Hon
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey S Dome
- Division of Oncology, Children’s National Hospital and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Elizabeth A Mullen
- Dana-Farber/Boston Children’s Blood Disorders and Cancer Center, MA, USA
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Vuocolo B, Gutierrez AM, Robinson JO, Recinos AM, Desrosiers LR, Majumder MA, Bernini JC, Gill J, Griffin T, Tomlinson GE, Vallance K, McGuire AL, Parsons DW, Plon SE, Scollon S. Families' experiences accessing care after genomic sequencing in the pediatric cancer context: "It's just been a big juggle". J Genet Couns 2024. [PMID: 38225886 DOI: 10.1002/jgc4.1858] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 11/30/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024]
Abstract
Access to genomic sequencing (GS) and resulting recommendations have not been well described in pediatric oncology. GS results may provide a cancer predisposition syndrome (CPS) diagnosis that warrants screening and specialist visits beyond cancer treatment, including testing or surveillance for family members. The Texas KidsCanSeq (KCS) Study evaluated implementation of GS in a diverse pediatric oncology population. We conducted semi-structured interviews (n = 20) to explore experiences of KCS patients' families around learning about a CPS diagnosis and following up on recommended care. We used qualitative content analysis to develop themes and subthemes across families' descriptions of their experiences accessing care and to understand which factors presented barriers and/or facilitators. We found participants had difficulty differentiating which follow-up care recommendations were made for their child's current cancer treatment versus the CPS. In families' access to follow-up care for CPS, organizational factors were crucial: travel time and distance were common hardships, while coordination of care to streamline multiple appointments with different providers helped facilitate CPS care. Financial factors also impacted families' access to CPS-related follow-up care: having financial assistance and insurance were facilitators for families, while costs and lack of insurance posed as barriers for patients who lost coverage during transitions from pediatric to adult care, and for adult family members who had no coverage. Factors related to beliefs and perceptions, specifically perceiving the risk as less salient to them and feeling overwhelmed with the patient's cancer care, presented barriers to follow-up care primarily for family members. Regarding social factors, competing life priorities made it difficult for families to access follow-up care, though having community support alleviated these barriers. We suggest interventions to improve coordination of cancer treatment and CPS-related care and adherence to surveillance protocols for families as children age, such as care navigators and integrating longitudinal genetic counseling into hereditary cancer centers.
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Affiliation(s)
- Blake Vuocolo
- Department of Molecular and Human Genetics, School of Health Professions, Baylor College of Medicine, Houston, Texas, USA
| | - Amanda M Gutierrez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Alva M Recinos
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Lauren R Desrosiers
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Mary A Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Juan Carlos Bernini
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Clinic, Vannie E. Cook Clinic, McAllen, Texas, USA
| | - Jonathan Gill
- UT MD Anderson Cancer Center, Children's Cancer Hospital, Houston, Texas, USA
| | - Timothy Griffin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatric Hematology-Oncology, Children's Hospital of San Antonio, San Antonio, Texas, USA
| | - Gail E Tomlinson
- UT Health Science Center, Greehey Children's Cancer Research Institute and Division of Pediatric Hematology-Oncology, San Antonio, Texas, USA
| | - Kelly Vallance
- Cook Children's Hematology and Oncology, Cook Children's Hospital, Forth Worth, Texas, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - D Williams Parsons
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Sharon E Plon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
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3
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Goldstein JA, Renfro LA, Jennings LJ, Mullen EA, Geller J, Vallance K, Fernandez CV, Perlman EJ. BRAF Exon 15 Mutations in the Evaluation of Well-Differentiated Epithelial Nephroblastic Neoplasms in Children: A Report From the Children's Oncology Group Study AREN03B2. Arch Pathol Lab Med 2023:497838. [PMID: 38116848 DOI: 10.5858/arpa.2022-0528-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 12/21/2023]
Abstract
CONTEXT.— The distinction between well-differentiated epithelial favorable-histology Wilms tumor (EFHWT) and metanephric adenoma (MA) in children has historically been determined by the required absence of both a fibrous pseudocapsule and mitotic activity in MA. More recently these features have been allowed in adult MA. Mutations in exon 15 of the BRAF gene are reported in up to 88% of MAs but have not been reported in EFHWTs. OBJECTIVE.— To clarify the pathologic and molecular features used to distinguish between pediatric MA and EFHWT. DESIGN.— Stage I epithelial tumors classified as EFHWT on central review (36 patients) were identified from the Children's Oncology Group AREN03B2 study. Thirteen tumors had morphologic features overlapping those of MA and 23 lacked such features; 35 of 36 had tissue available for sequencing of BRAF. RESULTS.— Patients with EFHWTs with MA features (13) were older (mean, 8.4 versus 1.9 years; P < .001), had smaller tumor diameters (mean, 6.0 versus 9.7 cm; P < .001), and had fewer mitoses (mean, 1 versus 48 mitoses per 10 high-power fields; P < .001) than patients with EFHWT lacking MA features (23). All EFHWTs with MA features contained at least a partial fibrous pseudocapsule; 7 of 12 (58%) had BRAF exon 15 mutation. No BRAF exon 15 mutations were identified in 23 EFHWTs lacking MA features. None of the 13 EFHWT patients with MA features have experienced relapse (median follow-up 5.9 years). CONCLUSIONS.— Pediatric epithelial neoplasms with features of MA that show partial encapsulation and/or modest mitotic activity may be classified as MAs. Although BRAF mutation supports the diagnosis of MA, it is not required for the diagnosis.
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Affiliation(s)
- Jeffery A Goldstein
- From the Department of Pathology, Northwestern University School of Medicine, Chicago, llinois (Goldstein, Jennings, Perlman)
| | - Lindsay A Renfro
- The Division of Biostatistics, University of Southern California, Los Angeles (Renfro)
- The Statistics and Data Monitoring Center, Children's Oncology Group, Monrovia, California (Renfro)
| | - Lawrence J Jennings
- From the Department of Pathology, Northwestern University School of Medicine, Chicago, llinois (Goldstein, Jennings, Perlman)
| | - Elizabeth A Mullen
- Pediatric Hematology/Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, Massachusetts (Mullen)
| | - James Geller
- The Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Geller)
| | - Kelly Vallance
- The Division of Hematology/Oncology, Cook Children's Medical Center, Fort Worth, Texas (Vallance)
| | - Conrad V Fernandez
- The Departments of Pediatrics and Bioethics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada (Fernandez)
| | - Elizabeth J Perlman
- From the Department of Pathology, Northwestern University School of Medicine, Chicago, llinois (Goldstein, Jennings, Perlman)
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Ahmad H, Vallance K, Sharma I, Berry S, Orr K, Ray A. Multimodal Management With Immunotherapy, Radiation, and Surgery of Histiocytic Sarcoma Following Acute Lymphoblastic Leukemia: An Unusual Presentation of a Rare Disease. J Pediatr Hematol Oncol 2023; 45:463-466. [PMID: 37691159 DOI: 10.1097/mph.0000000000002751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
Histiocytic sarcoma (HS) is a rare neoplasm with no known cause. This sarcoma is characterized by morphology similar to that demonstrated by mature tissue histiocytes and mostly afflicts adults. HSs typically have a poor prognosis due to a rapidly progressive clinical course. Our patient's case was unique due to its presentation four years after completion of treatment for B-cell acute lymphoblastic leukemia. The patient experienced progression with initial therapy for HS. With dual immunotherapy and radiation, however, the patient has remained clinically stable without detectable disease. Immunotherapy may be a successful and tolerable therapeutic option for histiocytic disease.
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Affiliation(s)
- Hufsa Ahmad
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine
| | | | - Ishna Sharma
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine
| | | | - Kaci Orr
- Texas A&M Health Science Center School of Medicine, Bryan, TX
| | - Anish Ray
- Cook Children's Medical Center, Fort Worth
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5
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Liu A, Vicenzi P, Sharma I, Orr K, Teller C, Koentz M, Trinkman H, Vallance K, Ray A. Molecular Tumor Boards: The Next Step towards Precision Therapy in Cancer Care. Hematol Rep 2023; 15:244-255. [PMID: 37092519 PMCID: PMC10123678 DOI: 10.3390/hematolrep15020025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/05/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
The application of molecular tumor profiles in clinical decision making remains a challenge. To aid in the interpretation of complex biomarkers, molecular tumor boards (MTBs) have been established worldwide. In the present study, we show that a multidisciplinary approach is essential to the success of MTBs. Our MTB, consisting of pediatric oncologists, pathologists, and pharmacists, evaluated 115 cases diagnosed between March 2016 and September 2021. If targetable mutations were identified, pharmacists aided in the evaluation of treatment options based on drug accessibility. Treatable genetic alterations detected through molecular testing most frequently involved the cell cycle. For 85% of the cases evaluated, our MTB provided treatment recommendations based on the patient’s history and results of molecular tumor testing. Only three patients, however, received MTB-recommended targeted therapy, and only one of these patients demonstrated an improved clinical outcome. For the remaining patients, MTB-recommended treatment often was not administered because molecular tumor profiling was not performed until late in the disease course. For the three patients who did receive MTB-recommended therapy, such treatment was not administered until months after diagnosis due to physician preference. Thus, the education of healthcare providers regarding the benefits of targeted therapy may increase acceptance of these novel agents and subsequently improve patient survival.
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Affiliation(s)
- Angela Liu
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Paige Vicenzi
- Department of Pediatrics, Dell Children’s Medical Center, Austin, TX 78723, USA
| | - Ishna Sharma
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Kaci Orr
- Texas A&M Health Science Center School of Medicine, Bryan, TX 77807, USA
| | - Christa Teller
- Department of Pediatric Hematology/Oncology, Cook Children’s Medical Center, Fort Worth, TX 76104, USA
| | - Micha Koentz
- Department of Pharmacy, Cook Children’s Medical Center, Fort Worth, TX 76104, USA
| | - Heidi Trinkman
- Department of Pharmacy, Cook Children’s Medical Center, Fort Worth, TX 76104, USA
| | - Kelly Vallance
- Department of Pediatric Hematology/Oncology, Cook Children’s Medical Center, Fort Worth, TX 76104, USA
| | - Anish Ray
- Department of Pediatric Hematology/Oncology, Cook Children’s Medical Center, Fort Worth, TX 76104, USA
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6
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Swilling A, Pham R, Wang J, Vallance K, Hamby T, Ray A. Lessons Learned: Utilization of a Reference Laboratory for Targeted Sequencing of Pediatric Tumors at a Single Institution. J Pediatr Hematol Oncol 2023; 45:63-69. [PMID: 35537075 DOI: 10.1097/mph.0000000000002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/03/2022] [Indexed: 11/26/2022]
Abstract
Our study aims to report the prevalence of potentially actionable oncogenic variants in a sample of pediatric tumors from a single institution using a reference laboratory for tumor profiling. We investigated genomic alterations and immunotherapy biomarkers such a tumor mutation burden, microsatellite instability, and programmed death-ligand 1. Patients treated in the Cook Children's Health Care System who had tumor profiling performed by Foundation Medicine between January 1, 2013, and May 1, 2019, were included. Demographic variables, results of tumor profiling, and subsequent use of targeted therapies were captured. Eighty-one patients were in our final data set; patients had diagnoses of central nervous system tumors (n=5), leukemia and lymphoma (n=4), neuroblastoma (n=32), and other solid tumors (n=40). One or more genomic alterations were identified in 68 (84%) of patients, 34 of which had potential targeted therapies available. In all, 44/51 patients tested for tumor mutation burden had low tumor burden, and the rest had intermediate burden. All 41 patients tested for microsatellite instability status were microsatellite stable. Six of 34 patients tested for programmed death-ligand 1 status were positive. Twelve patients received targeted therapy. This study highlights a subset of pediatric tumors harboring targetable genetic alterations and describes the use of a reference laboratory for tumor profiling.
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Affiliation(s)
| | - Robin Pham
- University of North Texas Health Science Center
| | | | | | - Tyler Hamby
- Research Operations, Cook Children's Medical Center, Fort Worth, TX
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7
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Plon S, Desrosiers L, Robinson J, Russell H, Scollon S, Dai H, Raesz-Martinez R, Recinos A, Reuther J, Naik M, Miles G, Ramamurthy U, Muzny D, Roy A, Gibbs R, Tomlinson G, Bernini JC, Gill J, Griffin T, Vallance K, McGuire A, Parsons DW. OP011: Physician recommendations after germline sequencing in pediatric cancer patients: Texas KidsCanSeq study. Genet Med 2022. [DOI: 10.1016/j.gim.2022.01.562] [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] Open
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8
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Stockwell T, Zhao J, Pauly B, Chow C, Vallance K, Wettlaufer A, Saunders JB, Chick J. Trajectories of Alcohol Use and Related Harms for Managed Alcohol Program Participants over 12 Months Compared with Local Controls: A Quasi-Experimental Study. Alcohol Alcohol 2021; 56:651-659. [PMID: 33418568 DOI: 10.1093/alcalc/agaa134] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 11/14/2022] Open
Abstract
AIM Investigate changes in alcohol use and related harm using the first multisite, controlled, longitudinal study of Managed Alcohol Programs (MAPs). MAPs provide regular doses of alcohol, accommodation, social supports and healthcare to unstably housed people with alcohol dependence. METHODS A multisite, quasi-experimental, longitudinal study was conducted in day centres, shelters and residential programs for unstably housed people. There were 59 MAP participants from six Canadian cities and 116 local controls. Self-reported alcohol consumption and harms were assessed at 0-2, 6 and 12 months. Liver function test results were accessed for MAP participants. RESULTS Both groups had similar reductions in mean drinks per day (MAP: -8.11; controls: -8.54 controls, P < 0.001) and days drinking per month (MAP: -2.51 days, P < 0.05; control: -4.81 days, P = 0.0001) over 6--12 months. Both reduced non-beverage alcohol consumption. MAP participants reported significantly fewer harms at both 0-2 and 6 months than controls. MAP participants had similar total consumption to controls, but spread out over more days (25.41 versus 19.64 days per month, P = 0.001). After leaving a MAP, participants' liver status deteriorated, with increases in both aspartate transaminase and bilirubin levels. MAP sites with effective policies on outside drinking drank less and had fewer harms. CONCLUSION MAP participants drank less hazardously than controls, especially with effective management of non-MAP drinking. Reductions in alcohol use and harms occurred for both groups, although MAP participants reported fewer harms at 0-6 months. Departing an MAP was associated with deterioration in liver status. Although providing stable housing, MAPs did not worsen health or increase alcohol use.
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Affiliation(s)
- T Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada.,Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - J Zhao
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - B Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada.,School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - C Chow
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada.,Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - K Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - A Wettlaufer
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
| | - J B Saunders
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Australia
| | - J Chick
- Castle Craig Hospital, UK.,School Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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9
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Lin FY, Mangum R, Reuther J, Potter SL, López-Terrada DH, Adesina AM, Mohila CA, Aldave G, Chintagumpala MM, Muzny DM, Bernini JC, Gill J, Griffin T, Tomlinson G, Vallance K, Fisher KE, Roy A, Plon SE, Parsons DW. PATH-29. HIGH FREQUENCY OF CLINICALLY-RELEVANT TUMOR VARIANTS DETECTED BY MOLECULAR TESTING OF HIGH-RISK PEDIATRIC CNS TUMORS – PRELIMINARY FINDINGS FROM THE TEXAS KidsCanSeq STUDY. Neuro Oncol 2020. [PMCID: PMC7715857 DOI: 10.1093/neuonc/noaa222.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND DNA and RNA-based tumor sequencing tests have the potential to guide the clinical management of children with CNS tumors. However, data describing the utility of these tests are limited. METHODS Children with high-risk or recurrent CNS tumors are included in the diverse cohort of patients enrolling in the KidsCanSeq study from six Texas sites. DNA and RNA from FFPE tumor is subjected to targeted sequencing using a 124-gene mutation panel and an 81-gene fusion panel. Tumor capture transcriptome sequencing, exome sequencing, and copy number array (as well as germline panel and exome testing) are also performed. Tumor variants are classified using AMP/ASCO/CAP consensus guidelines. RESULTS A total of 74 children with high-risk/recurrent CNS tumors enrolled as of 1/28/20. Targeted tumor DNA and RNA panel testing was completed for 57 patients with varied diagnoses. At least one tumor variant with strong or potential clinical significance was identified in 43 of 57 (75%) tumors, with therapeutic significance in 20 of 57 (35%) tumors. The 38 therapeutically-relevant variants most frequently affected MAPK signaling (BRAF x9, EGFR x3, FGFR2, FGFR3, KRAS, NF1, NTRK2) and the AKT/mTOR pathway (PIK3CA x3, PTEN x2, mTOR, TSC1, PIK3R1). Most had not been detected by prior targeted diagnostic testing (27/38, 71%). CONCLUSION Integrated DNA and RNA-based panel testing identified variants with potential to impact clinical decision-making in a majority of children with high-risk/recurrent CNS tumors. The comparative yield of panel testing vs. exome/transcriptome/array will be evaluated in the KidsCanSeq study cohort.
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Affiliation(s)
- Frank Y Lin
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Ross Mangum
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Jacquelyn Reuther
- Dept of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Samara L Potter
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Adekunle M Adesina
- Dept of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Carrie A Mohila
- Dept of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Guillermo Aldave
- Div of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Donna M Muzny
- Dept Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Jonathan Gill
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy Griffin
- Children’s Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, USA
| | - Gail Tomlinson
- Pediatric Blood & Cancer Center, UT Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Kelly Vallance
- Department of Hematology/Oncology, Cook Children’s Medical Center, Fort Worth, TX, USA
| | - Kevin E Fisher
- Dept of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Angshumoy Roy
- Dept of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Sharon E Plon
- Dept Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - D Williams Parsons
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX, USA
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10
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Pauly B, Brown M, Evans J, Gray E, Schiff R, Ivsins A, Krysowaty B, Vallance K, Stockwell T. "There is a Place": impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness. Harm Reduct J 2019; 16:70. [PMID: 31842903 PMCID: PMC6916004 DOI: 10.1186/s12954-019-0332-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/29/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The twin problems of severe alcohol dependence and homelessness are associated with precarious living and multiple acute, social and chronic harms. While much attention has been focused on harm reduction services for illicit drug use, there has been less attention to harm reduction for this group. Managed alcohol programs (MAPs) are harm reduction interventions that aim to reduce the harms of severe alcohol use, poverty and homelessness. MAPs typically provide accommodation, health and social supports alongside regularly administered sources of beverage alcohol to stabilize drinking patterns and replace use of non-beverage alcohol (NBA). METHODS We examined impacts of MAPs in reducing harms and risks associated with substance use and homelessness. Using case study methodology, data were collected from five MAPs in five Canadian cities with each program constituting a case. In total, 53 program participants, 4 past participants and 50 program staff were interviewed. We used situational analysis to produce a series of "messy", "ordered" and "social arenas" maps that provide insight into the social worlds of participants and the impact of MAPs. RESULTS Prior to entering a MAP, participants were often in a revolving world of cycling through multiple arenas (health, justice, housing and shelters) where abstinence from alcohol is often required in order to receive assistance. Residents described living in a street-based survival world characterized by criminalization, unmet health needs, stigma and unsafe spaces for drinking and a world punctuated by multiple losses and disconnections. MAPs disrupt these patterns by providing a harm reduction world in which obtaining accommodation and supports are not contingent on sobriety. MAPs represent a new arena that focuses on reducing harms through provision of safer spaces and supply of alcohol, with opportunities for reconnection with family and friends and for Indigenous participants, Indigenous traditions and cultures. Thus, MAPs are safer spaces but also potentially spaces for healing. CONCLUSIONS In a landscape of limited alcohol harm reduction options, MAPs create a new arena for people experiencing severe alcohol dependence and homelessness. While MAPs reduce precarity for participants, programs themselves remain precarious due to ongoing challenges related to lack of understanding of alcohol harm reduction and insecure program funding.
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Affiliation(s)
- B. Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
- School of Nursing, University of Victoria, HSD Building A402A, Victoria, BC V8P 5C2 Canada
| | - M. Brown
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
- School of Nursing, University of Victoria, HSD Building A402A, Victoria, BC V8P 5C2 Canada
| | - J. Evans
- Department of Earth and Atmospheric Sciences, University of Alberta, 1-26 Earth Sciences Building, Edmonton, AB T6G 2E9 Canada
| | - E. Gray
- School of Social Work, MacEwan University, 9-505 Robbins Building, Box 1796, 10700-104 Avenue, Edmonton, AB T5J 2P2 Canada
| | - R. Schiff
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - A. Ivsins
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
| | - B. Krysowaty
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
| | - K. Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
| | - T. Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
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Vallance K, Yang J, Li J, Crabtree VM, Hinds PS, Mandrell BN. Disturbed Sleep in Pediatric Patients With Leukemia: The Potential Role of Interleukin-6 (-174GC) and Tumor Necrosis Factor (-308GA) Polymorphism. Oncol Nurs Forum 2011; 38:E365-72. [DOI: 10.1188/11.onf.e365-e372] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Vallance K, Liu W, Mandrell BN, Panetta JC, Gattuso JS, Hockenberry M, Zupanec S, Yang L, Yang J, Hinds PS. Mechanisms of dexamethasone-induced disturbed sleep and fatigue in paediatric patients receiving treatment for ALL. Eur J Cancer 2010; 46:1848-55. [PMID: 20400291 DOI: 10.1016/j.ejca.2010.03.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 02/12/2010] [Accepted: 03/23/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dexamethasone contributes to high cure rates in paediatric acute lymphoblastic leukaemia (ALL) but significantly and adversely alters sleep and fatigue. Herein we explored three mechanisms (pharmacokinetics, serum albumin and pharmacogenetics) through which dexamethasone may cause debilitating fatigue and disrupted sleep. METHODS We enrolled 100 patients on a 10-d study: 5-d of no dexamethasone (OFF DEX) followed by 5-d of dexamethasone (ON DEX) during continuation chemotherapy. Sleep variables were collected with continuous actigraphy on days 1 through 5, both OFF DEX and ON DEX. On days 2 and 5 of each 5-d period, parents and patients 7 years of age and older completed a sleep diary and Fatigue Scale questionnaire. Blood was collected at 0 (pre-dexamethasone), 1, 2, 4 and 8 h after the first oral dexamethasone dose for pharmacokinetic analysis. Serum albumin concentration was retrospectively analysed in stored samples. Patient DNA was genotyped for 99 polymorphic loci in candidate genes associated with glucocorticoid metabolism. RESULTS Dexamethasone clearance was significantly greater in younger patients than in older ones and in lower risk patients. In multiple regression models, risk group was significantly related to pharmacokinetic parameters. We found that polymorphisms in three genes (AHSG, IL6, POLDIP3) were significantly associated with sleep measures but not with fatigue. CONCLUSION Risk group had the most significant relationship with disrupted sleep in patients while on dexamethasone. Serum albumin levels had neither a direct relationship with sleep or fatigue variables nor an indirect relationship through systemic exposure to dexamethasone. We identified candidate genes that may help explain the adverse events of disrupted sleep in paediatric patients receiving dexamethasone.
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Affiliation(s)
- Kelly Vallance
- Department of Hematology, Cook Children's Medical Center, Fort Worth, TX, USA
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13
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Hinds PS, Yang J, Gattuso JS, Hockenberry M, Jones H, Zupanec S, Li C, Crabtree VM, Mandrell BN, Schoumacher RA, Vallance K, Sanford S, Srivastava DK. Psychometric and clinical assessment of the 10-item reduced version of the Fatigue Scale-Child instrument. J Pain Symptom Manage 2010; 39:572-8. [PMID: 20303031 PMCID: PMC2941159 DOI: 10.1016/j.jpainsymman.2009.07.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 07/31/2009] [Accepted: 07/31/2009] [Indexed: 10/19/2022]
Abstract
Fatigue is one of the most debilitating conditions associated with cancer and anticancer therapy. The lack of reliable and valid self-report instruments has prevented accurate assessment of fatigue in pediatric oncology patients. The purpose of this study was to identify the most sensitive and specific score, that is, the "cut score," on the Fatigue Scale-Child (FS-C) to identify those children with high cancer-related fatigue in need of clinical intervention. We first used Rasch methods to identify the items on the FS-C that distinguished children with high cancer-related fatigue from other children; our findings indicated that the FS-C needed to be reduced from 14 items to 10 items. We then assessed the 10-item FS-C for its psychometric properties and applied the receiver operating characteristics curve analysis to the FS-C responses from 221 children (aged 7-12 years) receiving anticancer treatment. The cut score identified with 75% sensitivity and 73.5% specificity was 12; 73 (33%) patients scored 12 or higher. Findings from this validated instrument provide a needed guide for clinicians to interpret fatigue scores and provide clinical interventions for this debilitating condition to their pediatric patients with cancer.
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Affiliation(s)
- Pamela S Hinds
- Department of Nursing Research, Children's National Medical Center, George Washington University, Washington, DC 20010, USA.
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14
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Reinkensmeyer D, Aoyagi D, Emken J, Galvez J, Ichinose W, Kerdanyan G, Nessler J, Maneekobkunwong S, Timoszyk B, Vallance K, Weber R, de Leon R, Bobrow J, Harkema S, Wynne J, Edgerton V. Robotic gait training: toward more natural movements and optimal training algorithms. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:4818-21. [PMID: 17271389 DOI: 10.1109/iembs.2004.1404333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This paper overviews our recent efforts to develop robotic devices to help people relearn how to walk after spinal cord injury. Our efforts are focused on two goals. The first is to develop robotic devices that allow natural gait movements and good force control. We have developed a five degrees-of-freedom robot (PAM) that accommodates natural pelvic movement during walking. PAM uses pneumatic actuators and a nonlinear control algorithm to achieve good force control. We have also developed a novel leg robot, ARTHuR, which makes use of a linear motor to precisely apply forces to the leg during stepping. Our second goal is to develop optimal training algorithms for robotic gait training. Toward this goal, we have developed a small-scale robotic device that allows us to test locomotor training techniques in rodent models. We have also developed an instrumentation system that allows us to measure how experienced therapists manually assist limb movement. Finally, we are developing computational models of motor rehabilitation. These models suggest that assisting in stepping only as needed with a force-controlled robotic device may be an effective method for improving locomotor recovery.
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Day MK, Monti RJ, Vallance K, McGuan S, Roy RR, Edgerton VR. Modelling the neuromechanical events of locomotion at varying gravitational levels. J Gravit Physiol 2000; 7:P35-7. [PMID: 12697539] [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: 03/01/2023]
Abstract
The purpose of the present study was to determine the feasibility of using a neuromechanical model of human locomotion based on a model previously published by Taga et al. to simulate gait at various speeds and gravitational levels. The results indicate that this model may be appropriate for studying walking at 1 G but not for higher speed or lower G locomotion.
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Affiliation(s)
- M K Day
- Department of Physiological Science, University of California, Los Angeles, CA 90095, USA
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16
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Abstract
Transforming growth factor alpha (TGFalpha) is a cytokine that belongs to the epidermal growth factor (EGF) family of growth factors. EGF has a fast and saturable entry from blood to brain that is inhibitable by TGFalpha (18). In this report, we studied the passage of TGFalpha from blood to brain after an i.v. bolus injection. Using radioactively labeled peptide, we found that TGFalpha had an apparent rate of entry of 0.7 microl/g/min. However, most of the TGFalpha was trapped in the capillary endothelial cells of the cerebral vasculature rather than entering the brain parenchyma. No saturation was detected. TGFalpha was relatively stable in blood for 20 min after i.v. injection, but dissociation of the isotope 125I was more evident in brain. The accumulation of TGFalpha in the cerebral vasculature was similar to that of amyloid-beta protein1-40. Therefore, we conclude that TGFalpha from the periphery interacts with the blood-brain barrier without substantial uptake into brain parenchyma. This raises the possibility that TGFalpha might be involved in intracranial vascular disorders such as angiopathy.
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Affiliation(s)
- W Pan
- Department of Neurology, Tulane University, New Orleans, Louisiana 70112-1262, USA
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17
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Abstract
A retrospective review of admissions to the Wessex Regional Burn Centre was made to determine the incidence and causes of childhood scalds during the periods 1960-65 and 1979-84. No reduction in numbers injured or significant change in causes were observed. Children aged 1-2 years old are still the most prone to scalding injury.
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Affiliation(s)
- C Bradshaw
- Wessex Regional Burns Centre, Salisbury, UK
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