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Foran JM, Sun Z, Lai C, Fernandez HF, Cripe LD, Ketterling RP, Racevskis J, Luger SM, Paietta E, Lazarus HM, Zhang Y, Bennett JM, Levine RL, Rowe JM, Litzow MR, Tallman MS. Obesity in adult acute myeloid leukemia is not associated with inferior response or survival even when dose capping anthracyclines: An ECOG-ACRIN analysis. Cancer 2023; 129:2479-2490. [PMID: 37185873 PMCID: PMC10932613 DOI: 10.1002/cncr.34807] [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: 11/20/2022] [Revised: 02/04/2023] [Accepted: 03/02/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Obesity (body mass index [BMI] ≥30 kg/m2 ) is an important epidemiological risk factor for developing acute myeloid leukemia (AML). Therefore, the authors studied the association of obesity with clinical and genetic phenotype and its impact on outcome in adults with AML. METHODS The authors analyzed BMI in 1088 adults who were receiving intensive remission induction and consolidation therapy in two prospective, randomized therapeutic clinical trials of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network: E1900 (ClinicalTrials.gov identifier NCT00049517; patients younger than 60 years) and E3999 (ClinicalTrials.gov identifier NCT00046930; patients aged 60 years or older). RESULTS Obesity was prevalent at diagnosis (33%) and, compared with nonobesity, was associated with intermediate-risk cytogenetics group (p = .008), poorer performance status (p = .01), and a trend toward older age (p = .06). Obesity was not associated with somatic mutations among a selected 18-gene panel that was tested in a subset of younger patients. Obesity was not associated with clinical outcome (including complete remission, early death, or overall survival), and the authors did not identify any patient subgroup that had inferior outcomes based on BMI. Obese patients were significantly more likely to receive <90% of the intended daunorubicin dose despite protocol specification, particularly in the E1900 high-dose (90 mg/m2 ) daunorubicin arm (p = .002); however, this did not correlate with inferior overall survival on multivariate analysis (hazard ratio, 1.39; 95% confidence interval, 0.90-2.13; p = .14). CONCLUSIONS Obesity is associated with unique clinical and disease-related phenotypic features in AML and may influence physician treatment decisions regarding daunorubicin dosing. However, the current study demonstrates that obesity is not a factor in survival, and strict adherence to body surface area-based dosing is not necessary because dose adjustments do not affect outcomes.
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Affiliation(s)
- James M. Foran
- Division of Hematology and Medical Oncology and Mayo Clinic Cancer Center, Mayo Clinic, Jacksonville, Florida
| | - Zhuoxin Sun
- ECOG-ACRIN Biostatistics Center, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hugo F. Fernandez
- Blood & Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Larry D. Cripe
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Rhett P. Ketterling
- Department of Laboratory Medicine and Pathology and Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Selina M. Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Yanming Zhang
- Cytogenetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John M. Bennett
- Hematopathology Division, Department of Pathology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Ross L. Levine
- Cytogenetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Mark R. Litzow
- Department of Laboratory Medicine and Pathology and Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Martin S. Tallman
- Northwestern University Feinberg School of Medicine, Robert H.Lurie Comprehensive Cancer Center, Chicago, Illinois
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Rapaport F, Seier K, Neelamraju Y, Hassane D, Baslan T, Gildea DT, Haddox S, Lee T, Murdock HM, Sheridan C, Thurmond A, Wang L, Carroll M, Cripe LD, Fernandez H, Mason CE, Paietta E, Roboz GJ, Sun Z, Tallman MS, Zhang Y, Gönen M, Levine R, Melnick AM, Kleppe M, Garrett-Bakelman FE. Correction: Integrative analysis identifies an older female-linked AML patient group with better risk in ECOG-ACRIN Cancer Research Group's clinical trial E3999. Blood Cancer J 2023; 13:103. [PMID: 37407550 PMCID: PMC10322919 DOI: 10.1038/s41408-023-00862-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
- Franck Rapaport
- Human Oncology and Pathogenesis Program, Molecular Cancer Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY, USA
| | - Kenneth Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yaseswini Neelamraju
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Duane Hassane
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Timour Baslan
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel T Gildea
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Samuel Haddox
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Tak Lee
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - H Moses Murdock
- Division of Hematology and Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Caroline Sheridan
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alexis Thurmond
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Ling Wang
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Martin Carroll
- Division of Hematology and Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Larry D Cripe
- Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Hugo Fernandez
- Department of Malignant Hematology & Cellular Therapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Christopher E Mason
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
- The WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, USA
| | | | - Gail J Roboz
- Weill Cornell Medicine and The New York Presbyterian Hospital, New York, NY, USA
| | - Zhuoxin Sun
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Yanming Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ross Levine
- Human Oncology and Pathogenesis Program, Molecular Cancer Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ari M Melnick
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Maria Kleppe
- Human Oncology and Pathogenesis Program, Molecular Cancer Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francine E Garrett-Bakelman
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA.
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- Department of Medicine, University of Virginia, Charlottesville, VA, USA.
- University of Virginia Cancer Center, Charlottesville, VA, USA.
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3
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Cripe LD, Vater LB, Lilly JA, Larimer A, Hoffmann ML, Frankel RM. Goals of care communication and higher-value care for patients with advanced-stage cancer: A systematic review of the evidence. Patient Educ Couns 2022; 105:1138-1151. [PMID: 34489147 DOI: 10.1016/j.pec.2021.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/23/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Goals-of-care communication (GOCC) is recommended to increase the value of cancer care near the end of life (EOL). OBJECTIVES Conduct a systematic review of the evidence that GOCC is associated with higher-value care. METHODS We searched PubMed, Scopus, Ovid MEDLINE, EMBASE, EMB Reviews, CINAHL, and PsycInfo from inception to July 2019. We analyzed the population,design, and results and the authors' definitions of GOCC. Risk of bias was assessed. RESULTS Thirty-two articles were selected. Ten articles reported results from 8 interventions; 17 characterized participants' perspectives; and 5 were retrospective The topics, behaviors, timing, and anticipated outcomes of GOCC varied significantly and were indistinguishable from practices such as advance care planning. GOCC typically focused on treatment outcomes rather than patients' goals. Four of 5 interventions increased evidence of GOCC after clinician training. Only one reported improved patient outcomes. CONCLUSION No consensus exists about what GOCC entails. There is limited evidence that GOCC increases the value of EOL care. PRACTICE IMPLICATIONS Future studies should focus on how to engage patients in conversations about their personal goals and integrate their goals into care planning. Clinicians can encourage GOCC by explaining how patients' goals influence decisions especially as treatment options become limited.
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Affiliation(s)
- Larry D Cripe
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Laura B Vater
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Jason A Lilly
- Indiana University Health, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Medical Library, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Angeline Larimer
- Indiana University Purdue University at Indianapolis (IUPUI), 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Mary Lynn Hoffmann
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Richard M Frankel
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Regenstrief Institute, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Purdue University at Indianapolis (IUPUI), 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Health, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Medical Library, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
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Wiernik PH, Sun Z, Cripe LD, Rowe JM, Fernandez HF, Luger SM, Lazarus HM, Paietta EM, Tallman MS, Litzow MR. Prognostic effect of gender on outcome of treatment for adults with acute myeloid leukaemia. Br J Haematol 2021; 194:309-318. [PMID: 34145576 DOI: 10.1111/bjh.17523] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/21/2021] [Indexed: 12/15/2022]
Abstract
There are conflicting reports in the literature suggesting that one gender or the other has a better survival with acute myeloid leukaemia (AML). The present study was done in an attempt to resolve the issue. The effect of gender was examined on 3546 newly diagnosed patients with AML, including 548 patients with acute promyelocytic leukaemia (APL) enrolled in 10 multi-institutional treatment studies from March 1984 to November 2008. Kaplan-Meier estimates were used to estimate event-time distributions for survival and multivariate models were used to examine the gender effect after adjusting for multiple risk factors. P values were based on two-sided tests. Non-APL female patients had a significantly better overall (OS) but not disease-free survival (DFS) than males, irrespective of age, initial white blood cell count, or dose of daunorubicin. No differences were observed for obese or FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD)-positive patients. Female patients with APL had a significantly better OS and DFS than male patients with APL, and differences in survival were greater for patients with t(15;17) + other cytogenetic abnormalities compared with those with t(15;17) only. Gender is an independent prognostic variable in patients with AML. Whether these survival differences are due to hormonal, genetic or pharmacokinetic differences between the sexes or differential toxin exposure such as smoking is unknown. However, the former seems less likely as patient age did not influence the survival advantage for female patients.
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Affiliation(s)
| | - Zhuoxin Sun
- ECOG-ACRIN Biostatistics Center, Boston, MA, USA
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5
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Cripe LD, Cottingham AH, Martin CE, Hoffmann ML, Sargent K, Baker LB. Bereaved Informal Caregivers Rarely Recall a Relationship Between Transfusions and Hospice in Acute Myeloid Leukemia. Am J Hosp Palliat Care 2021; 39:68-71. [PMID: 33926274 DOI: 10.1177/10499091211013290] [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: 11/16/2022] Open
Abstract
AIMS The inability to prescribe blood transfusions is a potential barrier to timely hospice enrollment for patients with blood cancers. The benefits and harms of transfusions near the end of life (EOL), however, are poorly characterized and patients' preferences are unknown. We sought to characterize the recollections of bereaved caregivers about the relationships between transfusions and hospice enrollment decisions. METHODS We recruited 18 bereaved caregivers of 15 decedents who died within 6-18 months of the interview. Interviews focused on caregivers' recollections of transfusion and hospice enrollment decisions. Transcripts were analyzed for themes. RESULTS We identified 2 themes. First, caregivers described that transfusions were necessary and the decisions to receive transfusions or not were deferred to the clinicians. Second, only 1 caregiver recalled transfusions as relevant to hospice decisions. In that instance there was a delay. Caregivers identified difficulties recognizing death was imminent, hope for miracles, and the necessity of accepting life was ending as more relevant barriers. CONCLUSIONS The results indicate clinicians' beliefs in transfusion at EOL may be a more relevant barrier to hospice enrollment than patients' preferences. Strategies to evaluate accurately and discuss the actual benefits and harms of transfusions at the EOL are necessary to advise patients and integrate their preferences into decisions.
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Affiliation(s)
- Larry D Cripe
- Indiana University Simon Cancer Center, 14686Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Caroline E Martin
- Indiana University Simon Cancer Center, 14686Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mary Lynn Hoffmann
- Indiana University Simon Cancer Center, 14686Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katherine Sargent
- Indiana University Simon Cancer Center, 14686Indiana University School of Medicine, Indianapolis, IN, USA
| | - Layla B Baker
- 50826The Regenstrief Institute, Indianapolis, IN, USA
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Abshiru NA, Sikora JW, Camarillo JM, Morris JA, Compton PD, Lee T, Neelamraju Y, Haddox S, Sheridan C, Carroll M, Cripe LD, Tallman MS, Paietta EM, Melnick AM, Thomas PM, Garrett-Bakelman FE, Kelleher NL. Targeted detection and quantitation of histone modifications from 1,000 cells. PLoS One 2020; 15:e0240829. [PMID: 33104722 PMCID: PMC7588077 DOI: 10.1371/journal.pone.0240829] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/02/2020] [Indexed: 01/30/2023] Open
Abstract
Histone post-translational modifications (PTMs) create a powerful regulatory mechanism for maintaining chromosomal integrity in cells. Histone acetylation and methylation, the most widely studied histone PTMs, act in concert with chromatin-associated proteins to control access to genetic information during transcription. Alterations in cellular histone PTMs have been linked to disease states and have crucial biomarker and therapeutic potential. Traditional bottom-up mass spectrometry of histones requires large numbers of cells, typically one million or more. However, for some cell subtype-specific studies, it is difficult or impossible to obtain such large numbers of cells and quantification of rare histone PTMs is often unachievable. An established targeted LC-MS/MS method was used to quantify the abundance of histone PTMs from cell lines and primary human specimens. Sample preparation was modified by omitting nuclear isolation and reducing the rounds of histone derivatization to improve detection of histone peptides down to 1,000 cells. In the current study, we developed and validated a quantitative LC-MS/MS approach tailored for a targeted histone assay of 75 histone peptides with as few as 10,000 cells. Furthermore, we were able to detect and quantify 61 histone peptides from just 1,000 primary human stem cells. Detection of 37 histone peptides was possible from 1,000 acute myeloid leukemia patient cells. We anticipate that this revised method can be used in many applications where achieving large cell numbers is challenging, including rare human cell populations.
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Affiliation(s)
- Nebiyu A. Abshiru
- Departments of Chemistry, Molecular Biosciences, and the Proteomics Center of Excellence, Northwestern University, Evanston, IL, United States of America
| | - Jacek W. Sikora
- Departments of Chemistry, Molecular Biosciences, and the Proteomics Center of Excellence, Northwestern University, Evanston, IL, United States of America
| | - Jeannie M. Camarillo
- Departments of Chemistry, Molecular Biosciences, and the Proteomics Center of Excellence, Northwestern University, Evanston, IL, United States of America
| | - Juliette A. Morris
- Departments of Chemistry, Molecular Biosciences, and the Proteomics Center of Excellence, Northwestern University, Evanston, IL, United States of America
| | - Philip D. Compton
- Departments of Chemistry, Molecular Biosciences, and the Proteomics Center of Excellence, Northwestern University, Evanston, IL, United States of America
| | - Tak Lee
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | - Yaseswini Neelamraju
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, United States of America
| | - Samuel Haddox
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, United States of America
| | - Caroline Sheridan
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | - Martin Carroll
- Division of Hematology and Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Larry D. Cripe
- Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, IN, United States of America
| | - Martin S. Tallman
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | | | - Ari M. Melnick
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | - Paul M. Thomas
- Departments of Chemistry, Molecular Biosciences, and the Proteomics Center of Excellence, Northwestern University, Evanston, IL, United States of America
| | - Francine E. Garrett-Bakelman
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, United States of America
- Division of Hematology/Medical Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, United States of America
- * E-mail: (FEGB); (NLK)
| | - Neil L. Kelleher
- Departments of Chemistry, Molecular Biosciences, and the Proteomics Center of Excellence, Northwestern University, Evanston, IL, United States of America
- * E-mail: (FEGB); (NLK)
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Ustun C, Le-Rademacher J, Wang HL, Othus M, Sun Z, Major B, Zhang MJ, Storrick E, Lafky JM, Chow S, Mrózek K, Attar EC, Nand S, Bloomfield CD, Cripe LD, Tallman MS, Appelbaum F, Larson RA, Marcucci G, Roboz GJ, Uy GL, Stone RM, Jatoi A, Shea TC, de Lima M, Foran JM, Sandmaier BM, Litzow MR, Erba HP, Hurria A, Weisdorf DJ, Artz AS. Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60-75 years in first complete remission (CR1): an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study. Leukemia 2019; 33:2599-2609. [PMID: 31073153 PMCID: PMC6842042 DOI: 10.1038/s41375-019-0477-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 01/15/2019] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 01/21/2023]
Abstract
The preferred post-remission therapy for older patients with acute myeloid leukemia (AML) in first complete remission (CR1) remains uncertain. In this retrospective, multicenter study, we compared the outcomes for older AML patients (age 60-77 years) receiving allogeneic hematopoietic cell transplantation (alloHCT) (n = 431) with those treated on prospective National Clinical Trials Network induction and nontransplantation chemotherapy (CT) consolidation trials (n = 211). AlloHCT patients were younger (median age: 64.2 versus 67.9 years, p < 0.001), but more frequently had high-risk AML (high WBC, secondary AML, and unfavorable cytogenetics). Overall survival (OS) was worse in alloHCT during the first 9 months after CR1 (HR = 1.52, p = 0.02), but was significantly better thereafter (HR = 0.53, p < 0.0001) relative to CT. Treatment-related mortality (TRM) following HCT was worse in the first 9 months (HR = 2.8, 95% CI: 1.5-5.2, p = 0.0009), while post-HCT relapse was significantly less frequent beyond 9 months (HR = 0.42, 95% CI: 0.29-0.61, p < 0.0001). Despite higher early TRM, alloHCT recipients had superior long-term OS [29% (24-34%) versus CT 13.8% (9-21%) at 5 years]. Although this is a retrospective analysis with potential biases, it indicates that alloHCT led to heightened early risks from TRM, yet reduced relapse and superior long-term survival relative to CT in older AML patients in CR1.
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Affiliation(s)
- Celalettin Ustun
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
- Division of Hematology, Oncology and Cellular Therapy, Rush University, Chicago, IL, USA.
| | | | - Hai-Lin Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Zhuoxin Sun
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brittny Major
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mei-Jie Zhang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Selina Chow
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Eyal C Attar
- Massachusetts General Hospital, Boston, MA, USA
- Agios Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Such Nand
- Loyola University Medical Center, Chicago, IL, USA
| | - Clara D Bloomfield
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Larry D Cripe
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | | | - Frederick Appelbaum
- Fred Hutchinson Cancer Research Center and Division of Oncology, University of Washington, Seattle, WA, USA
| | - Richard A Larson
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Guido Marcucci
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, Hematologic Malignancies and Stem Cell Transplantation Institute, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Gail J Roboz
- Weill-Cornell Medical College, New York, NY, USA
| | - Geoffrey L Uy
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | | | - Thomas C Shea
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marcos de Lima
- Adult Hematologic Malignancies & Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - James M Foran
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Brenda M Sandmaier
- Fred Hutchinson Cancer Research Center and Division of Oncology, University of Washington, Seattle, WA, USA
| | - Mark R Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Daniel J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew S Artz
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
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Marcelletti JF, Sikic BI, Cripe LD, Paietta E. Evidence of a role for functional heterogeneity in multidrug resistance transporters in clinical trials of P-glycoprotein modulation in acute myeloid leukemia. Cytometry B Clin Cytom 2018; 96:57-66. [PMID: 30334334 DOI: 10.1002/cyto.b.21737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/08/2018] [Accepted: 08/28/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multidrug resistance (MDR) transporter proteins such as P-glycoprotein (P-gp) efflux a variety of chemotherapeutic drugs from acute myeloid leukemia (AML) blasts leading to clinical drug resistance. METHODS This study examined heterogeneity of MDR functional efflux by AML blasts using two flow cytometry bioassays. Bone marrow specimens (N = 50) from elderly patients with newly diagnosed AML were analyzed for CD34+ blasts with MDR efflux function. Efflux was measured with a fluorescent dye (DiOC2 ) as a surrogate for oncology drugs that are substrates for MDR efflux. P-gp-mediated efflux was differentiated from non-P-gp MDR activities using zosuquidar, a highly selective P-gp modulator. The bioassays included a zosuquidar-dependent DiOC2 accumulation bioassay that measured only P-gp. The second method, termed the efflux bioassay, could detect P-gp and other non-P-gp efflux depending on bioassay culture conditions. RESULTS Sixty-two percent of the specimens were considered positive for blasts with P-gp function, and 26% of such P-gp-positive specimens also exhibited zosuquidar-resistant (i.e., non-P-gp) MDR efflux activity; 37% of P-gp-negative AML blast specimens displayed zosuquidar-resistant MDR function in the efflux bioassay. CONCLUSIONS These results confirm the heterogeneous nature of MDR efflux pumps in AML blasts, and provide support for the hypothesis that non-P-gp MDR contributed to negative results with zosuquidar in AML trials like ECOG-ACRIN E3999. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- John F Marcelletti
- Department of Clinical Development, Kanisa Pharmaceuticals, San Diego, California
| | - Branimir I Sikic
- Department of Medicine, Stanford University, Stanford, California.,Oncology Division, Stanford University, Stanford, California
| | - Larry D Cripe
- Department of Hematology/Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Elisabeth Paietta
- Oncology Department, Albert Einstein College of Medicine, Bronx, New York
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Ganzel C, Sun Z, Cripe LD, Fernandez HF, Douer D, Rowe JM, Paietta EM, Ketterling R, O'Connell MJ, Wiernik PH, Bennett JM, Litzow MR, Luger SM, Lazarus HM, Tallman MS. Very poor long-term survival in past and more recent studies for relapsed AML patients: The ECOG-ACRIN experience. Am J Hematol 2018; 93:1074-1081. [PMID: 29905379 DOI: 10.1002/ajh.25162] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/09/2022]
Abstract
This study examines the long-term OS of relapsed AML patients who were enrolled to 9 successive ECOG-ACRIN trials for newly diagnosed AML, during 1984-2008. The objectives were to examine whether there is a trend of improvement in the survival of relapsed AML patients in the more recent studies and to search for prognostic factors that are associated with long-term OS after relapse. A total of 3012 patients were enrolled, 1779 (59.1%) achieved CR1 and of these, 58.9% relapsed. The median follow-up was 9.7 years. The median OS from relapse was 0.5 years and the 5-year OS was 10 (±1)%. These results were similar even for the most recent studies. A multivariate model showed that age, cytogenetics at diagnosis, duration of CR1 and undergoing allogeneic transplantation were significantly associated with OS from relapse. Even among patients who relapsed with better prognostic factors; age < 40 and CR1 > 12 months, there was no significant OS difference between the studies. In conclusion, this large cohort appears to confirm that the survival of AML patients postrelapse continues to be dismal and has not improved during the past quarter of a century.
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Affiliation(s)
| | - Zhuoxin Sun
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center; Boston Massachusetts
| | | | | | - Dan Douer
- Memorial Sloan Kettering Cancer; New York New York
| | - Jacob M. Rowe
- Shaare Zedek Medical Center; Jerusalem Israel
- Rambam Medical Center; Haifa Israel
| | | | | | | | | | | | | | | | - Hillard M. Lazarus
- Case Western Reserve University, Case Comprehensive Cancer Center; Cleveland Ohio
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10
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Cripe LD, Rand KL, Perkins SM, Tong Y, Schmidt KK, Hedrick DG, Rawl SM. Ambulatory Advanced Cancer Patients' and Oncologists' Estimates of Life Expectancy Are Associated with Patient Psychological Characteristics But Not Chemotherapy Use. J Palliat Med 2018; 21:1107-1113. [PMID: 29905496 DOI: 10.1089/jpm.2017.0686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/28/2022] Open
Abstract
BACKGROUND Patients with advanced cancer often face distressing decisions about chemotherapy. There are conflicting data on the relationships among perceived prognosis, psychological characteristics, and chemotherapy use, which impair the refinement of decision support interventions. OBJECTIVE Clarify the relationships among patient and oncologist estimates of life expectancy for 6 and 12 months, chemotherapy use, and patient psychological characteristics. DESIGN Secondary analysis of data from two cross-sectional studies. SETTING/SUBJECTS One hundred sixty-six patients with advanced stage cancer recruited from ambulatory cancer clinics. MEASUREMENTS All data were obtained at study enrollment. Patients completed the Adult Hope Scale, Hospital Anxiety and Depression Scale, and Life Orientation Test-Revised. Patients and their oncologists provided estimates of surviving beyond 6 and 12 months. Chemotherapy use was determined by chart review. RESULTS There were no significant associations between life-expectancy estimates and chemotherapy use nor patient anxiety, depression, hope, or optimism and chemotherapy use. Patients' life expectancy estimates for 12 months and oncologists' for 6 months were associated with higher patient anxiety and depression. Finally, both oncologist and patient estimates of life expectancy for 6 and 12 months were associated with increased levels of trait hope. CONCLUSION Advanced cancer patients who provide less optimistic estimates of life expectancy have increased anxiety and depression, but do not use chemotherapy more often. Increased patient trait hope is associated with more favorable oncologist estimates. These findings highlight the need for interventions to support both patients and oncologists as they clarify prognostic expectations and patients cope with the psychological distress of a limited life expectancy.
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Affiliation(s)
- Larry D Cripe
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Kevin L Rand
- 2 Department of Psychology, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana
| | - Susan M Perkins
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Yan Tong
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Karen Krall Schmidt
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - David G Hedrick
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Susan M Rawl
- 3 Indiana University School of Nursing , Indianapolis, Indiana
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11
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Burns DS, Meadows AN, Althouse S, Perkins SM, Cripe LD. Differences between Supportive Music and Imagery and Music Listening during Outpatient Chemotherapy and Potential Moderators of Treatment Effects. J Music Ther 2018; 55:83-108. [PMID: 29471518 DOI: 10.1093/jmt/thy001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Supportive music and imagery and music listening interventions have been effective in decreasing distress and improving mood in cancer patients receiving chemotherapy, but it is unclear whether the two interventions differ in their treatment benefits. Furthermore, previous studies have not examined moderators to determine which subgroup(s) of patients may benefit most from each intervention. OBJECTIVE To examine the effects of supportive music and imagery compared with preferred music listening on responsiveness to music therapy, distress, anxiety and depression, and benefit finding. A secondary purpose was to explore sense of coherence and locus of control as potential moderators of intervention effectiveness. METHODS A single-session, two-group comparative effectiveness randomized trial in two cancer centers. Patients were randomized to supportive music and imagery or preferred music listening during outpatient chemotherapy treatment. Data were collected at baseline and immediately after the 45-minute session. ANCOVA models were used to determine main effects of intervention as well as pairing potential moderators with group assignment to explore differences in intervention effects by moderator. RESULTS There were differential effects between the two interventions with the supportive music and imagery group scoring higher in responsiveness to music therapy and benefit finding. The music listening group scores indicated lower distress. The exploratory moderating analyses suggested Health Locus of Control-Internal and Sense of Coherence influenced intervention effectiveness. CONCLUSIONS Music and imagery and preferred music listening experiences may serve different therapeutic purposes, access and activate different patient resources, and may be helpful at different stages of treatment.
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12
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Abstract
OBJECTIVES Advance care planning (ACP) enables individuals to deliberate about future preferences for care based upon their values and beliefs about what is important in life. For many patients with advanced cancer, however, these critical conversations do not occur. A growing body of literature has examined the end-of-life wishes of seriously ill patients. Few studies have explored what is important to persons as they live with advanced cancer. The aim of the current study was to address this gap and to understand how clinicians can support patients' efforts to live in the present and plan for the future. METHODS Transcriptions of interviews conducted with 36 patients diagnosed with advanced cancer were analyzed using immersion-crystallization, a qualitative research technique. RESULTS Four overarching themes were identified: (I) living in the face of death, (II) who I am, (III) my experience of cancer, and (IV) impact of my illness on others. Twelve subthemes are also reported. SIGNIFICANCE OF RESULTS These findings have significant implications for clinicians as they partner with patients to plan for the future. Our data suggest that clinicians consider the following 4 prompts: (1) "What is important to you now, knowing that you will die sooner than you want or expected?" (2) "Tell me about yourself." (3) "Tell me in your own words about your experience with cancer care and treatment." (4) "What impact has your illness had on others?" In honoring patients' lived experiences, we may establish the mutual understanding necessary to providing high-quality care that supports patients' priorities for life.
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Affiliation(s)
- Ann H Cottingham
- 1 Department of Medicine and Psychology, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Department of Medicine and Psychology, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Larry D Cripe
- 1 Department of Medicine and Psychology, Indiana University School of Medicine, Indianapolis, IN, USA.,3 Department of Medicine and Psychology, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Kevin L Rand
- 4 Department of Medicine and Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Richard M Frankel
- 1 Department of Medicine and Psychology, Indiana University School of Medicine, Indianapolis, IN, USA.,5 Department of Medicine and Psychology, Cleveland Clinic, Cleveland, OH, USA
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13
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Ganzel C, Manola J, Douer D, Rowe JM, Fernandez HF, Paietta EM, Litzow MR, Lee JW, Luger SM, Lazarus HM, Cripe LD, Wiernik PH, Tallman MS. Extramedullary Disease in Adult Acute Myeloid Leukemia Is Common but Lacks Independent Significance: Analysis of Patients in ECOG-ACRIN Cancer Research Group Trials, 1980-2008. J Clin Oncol 2017; 34:3544-3553. [PMID: 27573652 DOI: 10.1200/jco.2016.67.5892] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Extramedullary disease (EMD) at diagnosis in patients with acute myeloid leukemia (AML) has been recognized for decades. Reported herein are results from a large study of patients with AML who were treated in consecutive ECOG-ACRIN Cancer Research Group frontline clinical trials in an attempt to define the incidence and clinical implications of EMD. Methods Patients with newly diagnosed AML, age 15 years and older, who were treated in 11 clinical trials, were studied to identify EMD, as defined by physical examination, laboratory findings, and imaging results. Results Of the 3,522 patients enrolled, 282 were excluded, including patients with acute promyelocytic leukemia, incorrect diagnosis, or no adequate assessment of EMD at baseline. The overall incidence of EMD was 23.7%. The sites involved were: lymph nodes (11.5%), spleen (7.3%), liver (5.3%), skin (4.5%), gingiva (4.4%), and CNS (1.1%). Most patients (65.3%) had only one site of EMD, 20.9% had two sites, 9.5% had three sites, and 3.4% had four sites. The median overall survival was 1.035 years. In univariable analysis, the presence of any EMD ( P = .005), skin involvement ( P = .002), spleen ( P < .001), and liver ( P < .001), but not CNS ( P = .34), nodal involvement ( P = .94), and gingival hypertrophy ( P = .24), was associated with a shorter overall survival. In contrast, in multivariable analysis, adjusted for known prognostic factors such as cytogenetic risk and WBC count, neither the presence of EMD nor the number of specific sites of EMD were independently prognostic. Conclusion This large study demonstrates that EMD at any site is common but is not an independent prognostic factor. Treatment decisions for patients with EMD should be made on the basis of recognized AML prognostic factors, irrespective of the presence of EMD.
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Affiliation(s)
- Chezi Ganzel
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Judith Manola
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Dan Douer
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Jacob M Rowe
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Hugo F Fernandez
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Elisabeth M Paietta
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Mark R Litzow
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Ju-Whei Lee
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Selina M Luger
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Hillard M Lazarus
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Larry D Cripe
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Peter H Wiernik
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Martin S Tallman
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
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14
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Strickland SA, Sun Z, Ketterling RP, Cherry AM, Cripe LD, Dewald G, Fernandez HF, Hicks GA, Higgins RR, Lazarus HM, Litzow MR, Luger SM, Paietta EM, Rowe JM, Vance GH, Wiernik P, Wiktor AE, Zhang Y, Tallman MS. Independent Prognostic Significance of Monosomy 17 and Impact of Karyotype Complexity in Monosomal Karyotype/Complex Karyotype Acute Myeloid Leukemia: Results from Four ECOG-ACRIN Prospective Therapeutic Trials. Leuk Res 2017; 59:55-64. [PMID: 28551161 DOI: 10.1016/j.leukres.2017.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 01/18/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 11/26/2022]
Abstract
The presence of a monosomal karyotype (MK+) and/or a complex karyotype (CK+) identifies subcategories of AML with poor prognosis. The prognostic significance of the most common monosomies (monosomy 5, monosomy 7, and monosomy 17) within MK+/CK+AML is not well defined. We analyzed data from 1,592 AML patients age 17-93 years enrolled on ECOG-ACRIN therapeutic trials. The majority of MK+ patients (182/195; 93%) were MK+/CK+ with 87% (158/182) having ≥5 clonal abnormalities (CK≥5). MK+ patients with karyotype complexity ≤4 had a median overall survival (OS) of 0.4y compared to 1.0y for MK- with complexity ≤4 (p<0.001), whereas no OS difference was seen in MK+vs. MK- patients with CK≥5 (p=0.82). Monosomy 5 (93%; 50/54) typically occurred within a highly complex karyotype and had no impact on OS (0.4y; p=0.95). Monosomy 7 demonstrated no impact on OS in patients with CK≥5 (p=0.39) or CK≤4 (p=0.44). Monosomy 17 appeared in 43% (68/158) of CK≥5 patients and demonstrated statistically significant worse OS (0.4y) compared to CK≥5 patients without monosomy 17 (0.5y; p=0.012). Our data suggest that the prognostic impact of MK+is limited to those with less complex karyotypes and that monosomy 17 may independently predict for worse survival in patients with AML.
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Affiliation(s)
| | - Zhuoxin Sun
- Frontier Science and Technology Research Foundation and Harvard School of Public Health, Boston, MA, United States
| | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, United States
| | - Athena M Cherry
- Stanford University School of Medicine, Stanford, CA, United States
| | - Larry D Cripe
- Indiana University Cancer Center, Indianapolis, IN, United States
| | - Gordon Dewald
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, United States
| | - Hugo F Fernandez
- Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Gary A Hicks
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, United States
| | - Rodney R Higgins
- Cytogenetics Laboratory, Allina Health-Abbott Northwestern Hospital, Minneapolis, MN, United States
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Selina M Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Elisabeth M Paietta
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | | | - Gail H Vance
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Peter Wiernik
- Cancer Research Foundation of New York, United States
| | - Anne E Wiktor
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, United States
| | - Yanming Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, United States
| | - Martin S Tallman
- Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, United States
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15
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Abstract
Medical oncologists and patients with advanced cancer struggle to discuss prognosis, goals, options, and values in a timely fashion. As a consequence, many patients die receiving aggressive treatment potentially inconsistent with their fully informed preferences and experience increased symptom burden and distress. The goals of patient - oncologist communication include exchanging information, building relationship, and engaging in shared decisions. Empathy is perhaps especially essential to effective patient - oncologist communication when the end of life is approaching. We speculate that, in addition to being a skilled response to a patient’s negative emotions, empathy is an emergent property of the relationship that allows the patient and oncologist to imagine what it will be like to navigate the transition from living with to dying from cancer; and to prepare for the transition. We propose that effective empathy: 1) requires an attentive, curious and imaginative physician; 2) acknowledges the complex and shifting goals as the end of life approaches; and 3) begins with a willingness of physicians to check in and find out what she may have misunderstood or misperceived. Empathy in end of life conversations cultivates the shared experiences necessary to co-create the new goals of care that underlie excellent end of life care.
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Affiliation(s)
- Larry D Cripe
- Indiana University Simon Cancer Center Indianapolis, IN, USA
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16
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Cripe LD, Perkins SM, Cottingham A, Tong Y, Kozak MA, Mehta R. Physicians in Postgraduate Training Characteristics and Support of Palliative Sedation for Existential Distress. Am J Hosp Palliat Care 2016; 34:697-703. [PMID: 27432319 DOI: 10.1177/1049909116660516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Palliative sedation for refractory existential distress (PS-ED) is ethically troubling but potentially critical to quality end-of-life (EOL) care. Physicians' in postgraduate training support toward PS-ED is unknown nor is it known how empathy, hope, optimism, or intrinsic religious motivation (IRM) affect their support. These knowledge gaps hinder efforts to support physicians who struggle with patients' EOL care preferences. METHODS One hundred thirty-four postgraduate physicians rated their support of PS for refractory physical pain (PS-PP) or PS-ED, ranked the importance of patient preferences in ethically challenging situations, and completed measures of empathy, hope, optimism, and IRM. Predictors of PS-ED and PS-PP support were examined using binary and multinomial logistic regression. RESULTS Only 22.7% of residents were very supportive of PS-ED, and 82.0% were very supportive of PS-PP. Support for PS-PP or PS-ED did not correlate with levels of empathy, hope, optimism, or IRM; however, for residents with lower IRM, greater optimism was associated with greater PS-ED support. In contrast, among residents with higher IRM, optimism was not associated with PS-ED support. CONCLUSIONS Comparing current results to published surveys, a similar proportion of residents and practicing physicians support PS-ED and PS-PP. In contrast to practicing physicians, however, IRM does not directly influence residents' supportiveness. The interaction between optimism and IRM suggests residents' beliefs and characteristics are salient to their EOL decisions. End-of-life curricula should provide physicians opportunities to reflect on the personal and ethical factors that influence their support for PS-ED.
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Affiliation(s)
- Larry D Cripe
- 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA.,2 IU Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Susan M Perkins
- 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA.,2 IU Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Ann Cottingham
- 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA
| | - Yan Tong
- 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA
| | - Mary Ann Kozak
- 3 Purdue University School of Pharmacy, West Lafayette, IN, USA
| | - Rakesh Mehta
- 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA.,2 IU Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
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17
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Cripe LD, Hedrick DG, Rand KL, Burns D, Banno D, Cottingham A, Litzelman D, Hoffmann ML, Martenyi N, Frankel RM. Medical Students' Professionalism Narratives Reveal That Experiences With Death, Dying, or Palliative Care Are More Positive Than Other Experiences During Their Internal Medicine Clerkship. Am J Hosp Palliat Care 2016; 34:79-84. [PMID: 26430135 DOI: 10.1177/1049909115609296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/16/2022] Open
Abstract
PURPOSE More physicians need to acquire the skills of primary palliative care. Medical students' clerkship experiences with death, dying, and palliative care (DDPC), however, may create barriers to learning such skills during residency. Whether professional development is differentially affected by DDPC is unknown. This knowledge gap potentially hinders the development of educational strategies to optimize students' preparedness for primary palliative care. METHOD Third-year students submitted professionalism narratives (N = 4062) during their internal medicine clerkship between 2004 and 2011. We identified DDPC-related narratives and then randomly selected control narratives. Narratives were compared by valence (positive or negative) and professionalism-related themes. RESULTS AND CONCLUSION Less than 10% of the narratives were related to DDPC, but the majority was positive. There was a significant overlap in professionalism themes between DDPC and control narratives. The results suggest student preparedness for primary palliative care may be improved by addressing the common professionalism challenges of clinical clerkships.
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Affiliation(s)
- Larry D Cripe
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA.,2 IU Simon Cancer Center, Indianapolis, IN, USA
| | - David G Hedrick
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA.,2 IU Simon Cancer Center, Indianapolis, IN, USA
| | - Kevin L Rand
- 2 IU Simon Cancer Center, Indianapolis, IN, USA.,3 Department of Psychology, IUPUI School of Science, Indianapolis, IN, USA
| | - Debra Burns
- 2 IU Simon Cancer Center, Indianapolis, IN, USA.,4 Department of Music and Arts Technology, Purdue School of Engineering and Technology at IUPUI, Indianapolis, IN, USA
| | - Daniella Banno
- 3 Department of Psychology, IUPUI School of Science, Indianapolis, IN, USA
| | - Ann Cottingham
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA
| | - Debra Litzelman
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA.,5 Regenstrief Institute, Indianapolis, IN, USA
| | - Mary L Hoffmann
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA
| | | | - Richard M Frankel
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA.,5 Regenstrief Institute, Indianapolis, IN, USA.,6 Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
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Rand KL, Banno DA, Shea AM, Cripe LD. Life and treatment goals of patients with advanced, incurable cancer. Support Care Cancer 2016; 24:2953-62. [PMID: 26864986 DOI: 10.1007/s00520-016-3113-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Goals of care conversations have been suggested as a strategy for helping patients with advanced cancer manage the uncertainty and distress associated with end-of-life care. However, knowledge deficits about patient goals limit the utility of such conversations. We described the life and treatment goals of patients with incurable cancers, including goal values and expectancies. We examined the associations between paramount goals and patient prognosis, performance status, and psychological adjustment. METHODS Patients with advanced lung cancer, gastrointestinal cancer, or melanoma (N = 84) completed measures of prognosis for 12-month survival, hope, optimism, depression, and anxiety. Oncologists provided patient performance status and prognosis for 12-month survival. We conducted interviews with a subset of patients (N = 63), eliciting life and treatment goals, values, and expectancies. RESULTS Patient life goals resembled goals among healthy populations; whereas, treatment goals were perceived as separate and more important. Cure and fight cancer emerged as the most important goals. Patients who valued cure the most had worse performance status (M = 1.46 vs. 0.78) and more depressive symptoms (M = 6.30 vs. 3.50). Patients who valued fight cancer the most had worse self-prognosis (M = 69.23 % vs. 86.11 %), fewer treatment goals (M = 2.08 vs. 3.16), and lower optimism (M = 15.00 vs. 18.32). CONCLUSIONS Patients with advanced cancer perceive treatment goals as separate from and more important than life goals. They hold optimistic expectancies for achieving their goals and for survival. Valuing cure highly may put patients at risk for experiencing psychological maladjustment.
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Affiliation(s)
- Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA. .,Indiana University Simon Cancer Center, Indianapolis, IN, USA. .,Walther Program in Palliative Care Research, Indianapolis, IN, USA. .,Research in Palliative and End-of-Life Communication and Training Center, Indianapolis, IN, USA.
| | - Daniella A Banno
- Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA
| | - Amanda M Shea
- Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA
| | - Larry D Cripe
- School of Medicine, Indiana University, Indianapolis, IN, USA.,Indiana University Simon Cancer Center, Indianapolis, IN, USA.,Walther Program in Palliative Care Research, Indianapolis, IN, USA.,Research in Palliative and End-of-Life Communication and Training Center, Indianapolis, IN, USA
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19
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Affiliation(s)
- Larry D Cripe
- Indiana University Simon Cancer Center and Division of Hematology Oncology, Indiana University School of Medicine, Indianapolis
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20
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Burns DS, Perkins SM, Tong Y, Hilliard RE, Cripe LD. Music Therapy is Associated With Family Perception of More Spiritual Support and Decreased Breathing Problems in Cancer Patients Receiving Hospice Care. J Pain Symptom Manage 2015; 50:225-31. [PMID: 25839735 DOI: 10.1016/j.jpainsymman.2015.02.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 11/16/2022]
Abstract
CONTEXT Music therapy is a common discretionary service offered within hospice; however, there are critical gaps in understanding the effects of music therapy on hospice quality indicators, such as family satisfaction with care. OBJECTIVES The purpose of this study was to examine whether music therapy affected family perception of patients' symptoms and family satisfaction with hospice care. METHODS This was a retrospective, cross-sectional analysis of electronic medical records from 10,534 cancer patients cared for between 2006 and 2010 by a large national hospice. Logistic regression was used to estimate the effect of music therapy using propensity scores to adjust for non-random assignment. RESULTS Overall, those receiving music therapy had higher odds of being female, having longer lengths of stay, and receiving more services other than music therapy, and lower odds of being married/partnered or receiving home care. Family satisfaction data were available for 1495 (14%) and were more likely available if the patient received music therapy (16% vs. 12%, P < 0.01). There were no differences in patient pain, anxiety, or overall satisfaction with care between those receiving music therapy vs. those not. Patients who received music therapy were more likely to report discussions about spirituality (odds ratio [OR] = 1.59, P = 0.01), had marginally less trouble breathing (OR = 0.77, P = 0.06), and were marginally more likely to receive the right amount of spiritual support (OR = 1.59, P = 0.06). CONCLUSION Music therapy was associated with perceptions of meaningful spiritual support and less trouble breathing. The results provide preliminary data for a prospective trial to optimize music therapy interventions for integration into clinical practice.
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Affiliation(s)
- Debra S Burns
- School of Engineering and Technology at IUPUI, Indianapolis, Indiana, USA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA.
| | - Susan M Perkins
- Indiana University School of Medicine, Indianapolis, Indiana, USA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Yan Tong
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Larry D Cripe
- Indiana University School of Medicine, Indianapolis, Indiana, USA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
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21
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Cesano A, Willman CL, Kopecky KJ, Gayko U, Putta S, Louie B, Westfall M, Purvis N, Spellmeyer DC, Marimpietri C, Cohen AC, Hackett J, Shi J, Walker MG, Sun Z, Paietta E, Tallman MS, Cripe LD, Atwater S, Appelbaum FR, Radich JP. Cell signaling-based classifier predicts response to induction therapy in elderly patients with acute myeloid leukemia. PLoS One 2015; 10:e0118485. [PMID: 25884949 PMCID: PMC4401549 DOI: 10.1371/journal.pone.0118485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/18/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022] Open
Abstract
Single-cell network profiling (SCNP) data generated from multi-parametric flow cytometry analysis of bone marrow (BM) and peripheral blood (PB) samples collected from patients >55 years old with non-M3 AML were used to train and validate a diagnostic classifier (DXSCNP) for predicting response to standard induction chemotherapy (complete response [CR] or CR with incomplete hematologic recovery [CRi] versus resistant disease [RD]). SCNP-evaluable patients from four SWOG AML trials were randomized between Training (N = 74 patients with CR, CRi or RD; BM set = 43; PB set = 57) and Validation Analysis Sets (N = 71; BM set = 42, PB set = 53). Cell survival, differentiation, and apoptosis pathway signaling were used as potential inputs for DXSCNP. Five DXSCNP classifiers were developed on the SWOG Training set and tested for prediction accuracy in an independent BM verification sample set (N = 24) from ECOG AML trials to select the final classifier, which was a significant predictor of CR/CRi (area under the receiver operating characteristic curve AUROC = 0.76, p = 0.01). The selected classifier was then validated in the SWOG BM Validation Set (AUROC = 0.72, p = 0.02). Importantly, a classifier developed using only clinical and molecular inputs from the same sample set (DXCLINICAL2) lacked prediction accuracy: AUROC = 0.61 (p = 0.18) in the BM Verification Set and 0.53 (p = 0.38) in the BM Validation Set. Notably, the DXSCNP classifier was still significant in predicting response in the BM Validation Analysis Set after controlling for DXCLINICAL2 (p = 0.03), showing that DXSCNP provides information that is independent from that provided by currently used prognostic markers. Taken together, these data show that the proteomic classifier may provide prognostic information relevant to treatment planning beyond genetic mutations and traditional prognostic factors in elderly AML.
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Affiliation(s)
- Alessandra Cesano
- Nodality, Inc., South San Francisco, California, United States of America
| | - Cheryl L Willman
- University of New Mexico Cancer Center, Albuquerque, New Mexico, United States of America
| | - Kenneth J Kopecky
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Urte Gayko
- Nodality, Inc., South San Francisco, California, United States of America
| | - Santosh Putta
- Nodality, Inc., South San Francisco, California, United States of America
| | - Brent Louie
- Nodality, Inc., South San Francisco, California, United States of America
| | - Matt Westfall
- Nodality, Inc., South San Francisco, California, United States of America
| | - Norman Purvis
- Nodality, Inc., South San Francisco, California, United States of America
| | - David C Spellmeyer
- Nodality, Inc., South San Francisco, California, United States of America
| | - Carol Marimpietri
- Nodality, Inc., South San Francisco, California, United States of America
| | - Aileen C Cohen
- Nodality, Inc., South San Francisco, California, United States of America
| | - James Hackett
- Nodality, Inc., South San Francisco, California, United States of America
| | - Jing Shi
- Nodality, Inc., South San Francisco, California, United States of America
| | - Michael G Walker
- Nodality, Inc., South San Francisco, California, United States of America
| | - Zhuoxin Sun
- ECOG Coordinating Center, Frontier Science, Boston, Massachusetts, United States of America
| | - Elisabeth Paietta
- Montefiore Medical Center North Division, Bronx, New York, United States of America
| | - Martin S Tallman
- Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Larry D Cripe
- Indiana University Simon Cancer Center, Indianapolis, Indiana, United States of America
| | - Susan Atwater
- Stanford University, Palo Alto, California, United States of America
| | - Frederick R Appelbaum
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Jerald P Radich
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
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22
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Khawaja MR, Perkins SM, Schwartz JE, Robertson MJ, Kiel PJ, Sayar H, Cox EA, Vance GH, Farag SS, Cripe LD, Nelson RP. Cyclophosphamide/fludarabine nonmyeloablative allotransplant for acute myeloid leukemia. Am J Hematol 2015; 90:97-9. [PMID: 25345651 DOI: 10.1002/ajh.23875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022]
Abstract
We compared survival outcomes following myeloablative allotransplant (MAT) or cyclophosphamide/fludarabine (Cy/Flu) nonmyeloablative allotransplant (NMAT) for 165 patients with acute myelogenous leukemia (AML) in remission or without frank relapse. Patients who received NMAT were more likely to be older and have secondary AML and lower performance status. At a median follow-up of 61 months, median event-free survival and overall survival survival were not different between NMAT and MAT in univariate as well as multivariate analyses. Cy/Flu NMAT may provide similar disease control and survival when compared with MAT in patients with AML in remission or without frank relapse.
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Affiliation(s)
- Muhammad Rizwan Khawaja
- Division of Hematology/Oncology, Department of Medicine; Indiana University School of Medicine, Melvin and Bren Simon Cancer Center; Indianapolis Indiana
| | - Susan M. Perkins
- Department of Biostatistics; Indiana University School of Medicine; Indianapolis Indiana
| | - Jennifer E. Schwartz
- Division of Hematology/Oncology, Department of Medicine; Indiana University School of Medicine, Melvin and Bren Simon Cancer Center; Indianapolis Indiana
| | - Michael J. Robertson
- Division of Hematology/Oncology, Department of Medicine; Indiana University School of Medicine, Melvin and Bren Simon Cancer Center; Indianapolis Indiana
| | - Patrick J. Kiel
- Division of Hematology/Oncology, Department of Medicine; Indiana University School of Medicine, Melvin and Bren Simon Cancer Center; Indianapolis Indiana
| | - Hamid Sayar
- Division of Hematology/Oncology, Department of Medicine; Indiana University School of Medicine, Melvin and Bren Simon Cancer Center; Indianapolis Indiana
| | - Elizabeth A. Cox
- Division of Hematology/Oncology, Department of Medicine; Indiana University School of Medicine, Melvin and Bren Simon Cancer Center; Indianapolis Indiana
| | - Gail H. Vance
- Department of Medical and Molecular Genetics; Indiana University School of Medicine; Indianapolis Indiana
| | - Sherif S. Farag
- Division of Hematology/Oncology, Department of Medicine; Indiana University School of Medicine, Melvin and Bren Simon Cancer Center; Indianapolis Indiana
- Department of Medical and Molecular Genetics; Indiana University School of Medicine; Indianapolis Indiana
- Department of Microbiology and Immunology; Indiana University School of Medicine; Indianapolis Indiana
| | - Larry D. Cripe
- Division of Hematology/Oncology, Department of Medicine; Indiana University School of Medicine, Melvin and Bren Simon Cancer Center; Indianapolis Indiana
| | - Robert P. Nelson
- Division of Hematology/Oncology, Department of Medicine; Indiana University School of Medicine, Melvin and Bren Simon Cancer Center; Indianapolis Indiana
- Department of Pediatrics; Indiana University School of Medicine; Indianapolis Indiana
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Sayar H, Czader M, Amin C, Cangany M, Konig H, Cripe LD. Pilot study of erlotinib in patients with acute myeloid leukemia. Leuk Res 2014; 39:170-2. [PMID: 25498508 DOI: 10.1016/j.leukres.2014.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
We conducted a pilot study to investigate clinical efficacy of tyrosine kinase inhibitor erlotinib in the treatment of acute myeloid leukemia (AML). A total of 11 patients with de novo AML were treated, including 2 with relapsed and/or refractory disease and 9 older patients with previously untreated AML. Patients with high baseline leukocyte count were excluded. Erlotinib was given orally at 150 mg per day continuously in 28-day cycles. The treatment was tolerated well, and no toxicities were observed. An initial reduction in circulating blasts, followed by disease progression, was observed in 2 patients. Nine other patients did not demonstrate any response in blood or bone marrow. Baseline and post-cycle 1 flow-cytometry were performed on bone marrow blasts to investigate signs of differentiation. No immunophenotypic changes suggestive of differentiation were observed. This pilot study did not demonstrate response to standard doses of erlotinib in patients with AML.
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Affiliation(s)
- Hamid Sayar
- Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Magdalena Czader
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Chirag Amin
- Hematology, Indiana Hemophilia Thrombosis Center, Indianapolis, IN, United States
| | - Mary Cangany
- Hematology-Oncology, Indiana University Simon Cancer Center, Indianapolis, IN, United States
| | - Heiko Konig
- Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Larry D Cripe
- Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States
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Stuart RK, Cripe LD, Maris MB, Cooper MA, Stone RM, Dakhil SR, Turturro F, Stock W, Mason J, Shami PJ, Strickland SA, Costa LJ, Borthakur G, Michelson GC, Fox JA, Leavitt RD, Ravandi F. REVEAL-1, a phase 2 dose regimen optimization study of vosaroxin in older poor-risk patients with previously untreated acute myeloid leukaemia. Br J Haematol 2014; 168:796-805. [PMID: 25403830 PMCID: PMC4354261 DOI: 10.1111/bjh.13214] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/03/2014] [Indexed: 01/05/2023]
Abstract
This phase 2 study (N = 116) evaluated single-agent vosaroxin, a first-in-class anticancer quinolone derivative, in patients ≥60 years of age with previously untreated unfavourable prognosis acute myeloid leukaemia. Dose regimen optimization was explored in sequential cohorts (A: 72 mg/m2 d 1, 8, 15; B: 72 mg/m2 d 1, 8; C: 72 mg/m2 or 90 mg/m2 d 1, 4). The primary endpoint was combined complete remission rate (complete remission [CR] plus CR with incomplete platelet recovery [CRp]). Common (>20%) grade ≥3 adverse events were thrombocytopenia, febrile neutropenia, anaemia, neutropenia, sepsis, pneumonia, stomatitis and hypokalaemia. Overall CR and CR/CRp rates were 29% and 32%; median overall survival (OS) was 7·0 months; 1-year OS was 34%. Schedule C (72 mg/m2) had the most favourable safety and efficacy profile, with faster haematological recovery (median 27 d) and lowest incidence of aggregate sepsis (24%) and 30-d (7%) and 60-d (17%) all-cause mortality; at this dose and schedule, CR and CR/CRp rates were 31% and 35%, median OS was 7·7 months and 1-year OS was 38%. Overall, vosaroxin resulted in low early mortality and an encouraging response rate; vosaroxin 72 mg/m2 d 1, 4 is recommended for further study in this population. Registered at www.clinicaltrials.gov: #NCT00607997.
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Lancet JE, Roboz GJ, Cripe LD, Michelson GC, Fox JA, Leavitt RD, Chen T, Hawtin R, Craig AR, Ravandi F, Maris MB, Stuart RK, Karp JE. A phase 1b/2 study of vosaroxin in combination with cytarabine in patients with relapsed or refractory acute myeloid leukemia. Haematologica 2014; 100:231-7. [PMID: 25381131 DOI: 10.3324/haematol.2014.114769] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Vosaroxin is a first-in-class anticancer quinolone derivative that intercalates DNA and inhibits topoisomerase II. This study assessed the safety and tolerability of vosaroxin plus cytarabine in patients with relapsed/refractory acute myeloid leukemia. Escalating vosaroxin doses (10-minute infusion; 10-90 mg/m(2); days 1, 4) were given in combination with cytarabine on one of two schedules: schedule A (24-hour continuous intravenous infusion, 400 mg/m(2)/day, days 1-5) or schedule B (2-hour intravenous infusion, 1 g/m(2)/day, days 1-5). Following dose escalation, enrollment was expanded at the maximum tolerated dose. Of 110 patients enrolled, 108 received treatment. The maximum tolerated dose of vosaroxin was 80 mg/m(2) for schedule A (dose-limiting toxicities: grade 3 bowel obstruction and stomatitis) and was not reached for schedule B (recommended phase 2 dose: 90 mg/m(2)). In the efficacy population (all patients in first relapse or with primary refractory disease treated with vosaroxin 80-90 mg/m(2); n=69), the complete remission rate was 25% and the complete remission/complete remission with incomplete blood count recovery rate was 28%. The 30-day all-cause mortality rate was 2.5% among all patients treated at a dose of 80-90 mg/m(2). Based upon these results, a phase 3 trial of vosaroxin plus cytarabine was initiated in patients with relapsed/refractory acute myeloid leukemia. (Clinicaltrials.gov identifier: NCT00541866).
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Affiliation(s)
| | - Gail J Roboz
- Cornell University/New York Presbyterian Hospital, New York, NY
| | | | | | - Judith A Fox
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA
| | | | - Tianling Chen
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA
| | | | - Adam R Craig
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA
| | | | - Michael B Maris
- Rocky Mountain Blood and Marrow Transplant Center, Denver, CO
| | | | - Judith E Karp
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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26
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Cripe LD, Rawl SM, Schmidt KK, Tong Y, Monahan PO, Rand KL. Discussions of life expectancy moderate relationships between prognosis and anxiety or depression in men with advanced cancer. J Palliat Med 2012; 15:99-105. [PMID: 22268405 DOI: 10.1089/jpm.2011.0249] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Oncologists avoid prognostic discussions due to concerns about increasing patients' anxiety or depression. We sought to determine if perceived prognosis or extent of prognostic discussions predicted anxiety or depression and whether prognostic discussions moderated the relationship between prognosis and anxiety or depression. METHODS Men with advanced cancer and their oncologists estimated the likelihood of survival at 6 months and reported extent of prognostic discussions. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS Men who died within 6 months reported higher scores on depression but not anxiety. Men who estimated a lower (10%-75%) likelihood of surviving at least 6 months were more depressed and anxious than men who estimated a higher (>90%) likelihood of survival. A similar relationship was seen with oncologists' prognostications. Men who reported having had full prognostic discussions with their oncologist had less depression compared with men who reported having had brief or no discussions. Men for whom the oncologists reported a full discussion had greater anxiety. The relationships between patient-perceived prognosis and depression or anxiety were moderated by extent of prognostic discussions as reported by the patient or oncologist, respectively. CONCLUSION Full prognostic discussions are associated with less depression among men who perceive a poor prognosis. Anxiety is increased in men if the oncologists report a full discussion. Oncologists should engage in prognostic discussions but assess for increased anxiety to facilitate coping with advanced cancer.
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Affiliation(s)
- Larry D Cripe
- Indiana University Simon Cancer Center, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
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27
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Hardesty BM, Cripe LD. Cytarabine in relapsed acute myeloid leukemia. Leuk Res 2012; 36:387-8. [DOI: 10.1016/j.leukres.2011.12.001] [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] [Received: 11/30/2011] [Revised: 11/30/2011] [Accepted: 12/01/2011] [Indexed: 11/25/2022]
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28
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Cesano A, Rosen DB, O'Meara P, Putta S, Gayko U, Spellmeyer DC, Cripe LD, Sun Z, Uno H, Litzow MR, Tallman MS, Paietta E. Functional pathway analysis in acute myeloid leukemia using single cell network profiling assay: effect of specimen source (bone marrow or peripheral blood) on assay readouts. Cytometry B Clin Cytom 2012; 82:158-72. [PMID: 22334473 DOI: 10.1002/cyto.b.21007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 12/06/2011] [Accepted: 12/17/2011] [Indexed: 11/05/2022]
Abstract
BACKGROUND Single cell network profiling (SCNP) is used to simultaneously measure the effects of modulators on signaling networks at the single cell level. SCNP-based biomarker assays predictive of response to induction therapy and relapse risk in acute myeloid leukemia (AML) patients are being developed. Such assays have typically used bone marrow (BM) as the sample source of blasts. Because circulating peripheral blasts are detectable in ∼65% of AML patients and peripheral blood (PB) sampling is less invasive than BM sampling, this study was performed to assess the effect of sample source on AML blasts signaling as measured in SCNP assay. METHODS SCNP using multiparametric flow cytometry was used to evaluate the activation state of intracellular signaling molecules in leukemic blasts under basal conditions and after treatment with modulators in 46 pairs of BM mononuclear cells/PB mononuclear cells. The relationship between readouts of modulated intracellular proteins ("nodes") was measured using linear regression, Bland-Altman method, and Lin's concordance correlation coefficient. RESULTS The majority (156/161) of signaling nodes show strong correlations between paired PB and BM samples independently from the statistical method used. Notable exceptions were two PB samples with almost undetectable levels of circulating blasts compared with paired BM samples. CONCLUSIONS Our results demonstrate that specimen source (BM or PB) does not significantly affect proteomic signaling in patients with AML and circulating blasts. The ability to use PB as a sample source will facilitate the monitoring of cellular signaling effects following administration of targeted therapies and at time points when BM aspirates are not clinically justifiable.
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Affiliation(s)
- Alessandra Cesano
- Clinical Affairs, Nodality Inc., South San Francisco, California 94080, USA.
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Shanmugam R, Gade P, Wilson-Weekes A, Sayar H, Suvannasankha A, Goswami C, Li L, Gupta S, Cardoso AA, Baghdadi TA, Sargent KJ, Cripe LD, Kalvakolanu DV, Boswell HS. A noncanonical Flt3ITD/NF-κB signaling pathway represses DAPK1 in acute myeloid leukemia. Clin Cancer Res 2011; 18:360-369. [PMID: 22096027 DOI: 10.1158/1078-0432.ccr-10-3022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Death-associated protein kinase 1 (DAPK1), a tumor suppressor, is a rate-limiting effector in an endoplasmic reticulum (ER) stress-dependent apoptotic pathway. Its expression is epigenetically suppressed in several tumors. A mechanistic basis for epigenetic/transcriptional repression of DAPK1 was investigated in certain forms of acute myeloid leukemia (AML) with poor prognosis, which lacked ER stress-induced apoptosis. EXPERIMENTAL DESIGN Heterogeneous primary AMLs were screened to identify a subgroup with Flt3ITD in which repression of DAPK1, among NF-κB-and c-Jun-responsive genes, was studied. RNA interference knockdown studies were carried out in an Flt3ITD(+) cell line, MV-4-11, to establish genetic epistasis in the pathway Flt3ITD-TAK1-DAPK1 repression, and chromatin immunoprecipitations were carried out to identify proximate effector proteins, including TAK1-activated p52NF-κB, at the DAPK1 locus. RESULTS AMLs characterized by normal karyotype with Flt3ITD were found to have 10- to 100-fold lower DAPK1 transcripts normalized to the expression of c-Jun, a transcriptional activator of DAPK1, as compared with a heterogeneous cytogenetic category. In addition, Meis1, a c-Jun-responsive adverse AML prognostic gene signature was measured as control. These Flt3ITD(+) AMLs overexpress relB, a transcriptional repressor, which forms active heterodimers with p52NF-κB. Chromatin immunoprecipitation assays identified p52NF-κB binding to the DAPK1 promoter together with histone deacetylase 2 (HDAC2) and HDAC6 in the Flt3ITD(+) human AML cell line MV-4-11. Knockdown of p52NF-κB or its upstream regulator, NF-κB-inducing kinase (NIK), de-repressed DAPK1. DAPK1-repressed primary Flt3ITD(+) AMLs had selective nuclear activation of p52NF-κB. CONCLUSIONS Flt3ITD promotes a noncanonical pathway via TAK1 and p52NF-κB to suppress DAPK1 in association with HDACs, which explains DAPK1 repression in Flt3ITD(+) AML.
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Affiliation(s)
- Rajasubramaniam Shanmugam
- Indiana University Melvin and Bren Simon Cancer Center, Departments of Medicine (Hematology/Oncology Division), Indiana University School of Medicine, Indianapolis, IN 46202.,Veterans Affairs Medical Center, Indianapolis, IN 46202
| | - Padmaja Gade
- Department of Microbiology and Immunology, Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD
| | - Annique Wilson-Weekes
- Indiana University Melvin and Bren Simon Cancer Center, Departments of Medicine (Hematology/Oncology Division), Indiana University School of Medicine, Indianapolis, IN 46202.,Veterans Affairs Medical Center, Indianapolis, IN 46202
| | - Hamid Sayar
- Indiana University Melvin and Bren Simon Cancer Center, Departments of Medicine (Hematology/Oncology Division), Indiana University School of Medicine, Indianapolis, IN 46202
| | - Attaya Suvannasankha
- Indiana University Melvin and Bren Simon Cancer Center, Departments of Medicine (Hematology/Oncology Division), Indiana University School of Medicine, Indianapolis, IN 46202.,Veterans Affairs Medical Center, Indianapolis, IN 46202
| | - Chirayu Goswami
- Biostatistics and Computational Biology, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Lang Li
- Biostatistics and Computational Biology, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Sushil Gupta
- Indiana University Melvin and Bren Simon Cancer Center, Departments of Medicine (Hematology/Oncology Division), Indiana University School of Medicine, Indianapolis, IN 46202
| | - Angelo A Cardoso
- Indiana University Melvin and Bren Simon Cancer Center, Departments of Medicine (Hematology/Oncology Division), Indiana University School of Medicine, Indianapolis, IN 46202
| | - Tareq Al Baghdadi
- Indiana University Melvin and Bren Simon Cancer Center, Departments of Medicine (Hematology/Oncology Division), Indiana University School of Medicine, Indianapolis, IN 46202
| | | | - Larry D Cripe
- Indiana University Melvin and Bren Simon Cancer Center, Departments of Medicine (Hematology/Oncology Division), Indiana University School of Medicine, Indianapolis, IN 46202
| | - Dhananjaya V Kalvakolanu
- Department of Microbiology and Immunology, Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD
| | - H Scott Boswell
- Indiana University Melvin and Bren Simon Cancer Center, Departments of Medicine (Hematology/Oncology Division), Indiana University School of Medicine, Indianapolis, IN 46202.,Veterans Affairs Medical Center, Indianapolis, IN 46202
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Lancet JE, Ravandi F, Ricklis RM, Cripe LD, Kantarjian HM, Giles FJ, List AF, Chen T, Allen RS, Fox JA, Michelson GC, Karp JE. A phase Ib study of vosaroxin, an anticancer quinolone derivative, in patients with relapsed or refractory acute leukemia. Leukemia 2011; 25:1808-14. [PMID: 21760592 PMCID: PMC4576993 DOI: 10.1038/leu.2011.157] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [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] [Indexed: 12/20/2022]
Abstract
This study of vosaroxin evaluated dose-limiting toxicity (DLT), maximum-tolerated dose (MTD), pharmacokinetics (PK), clinical activity and pharmacodynamics in relapsed/refractory leukemia. Dosing was weekly (days 1, 8 and 15) or twice weekly (days 1, 4, 8 and 11). Seventy-three treated patients had a median age of 65 years, 85% had acute myeloid leukemia and 78% had refractory disease. Weekly schedule: 42 patients received 18-90 mg/m(2); MTD was 72 mg/m(2). Twice-weekly schedule: 31 patients received 9-50 mg/m(2); MTD was 40 mg/m(2). DLT was stomatitis; primary non-hematologic toxicity was reversible gastrointestinal symptoms and febrile neutropenia. Thirty-day all-cause mortality was 11%. Five patients had complete or incomplete remissions; median duration was 3.1 months. A morphologic leukemia-free state (bone marrow blast reduction to <5%) occurred in 11 additional patients. Antileukemic activity was associated with total dose or weekly time above 1 μmol/l plasma vosaroxin concentration (P<0.05). Vosaroxin exposure was dose proportional over 9-90 mg/m(2). The average terminal half-life was ~25 h and clearance was non-renal. No induction or inhibition of vosaroxin metabolism was evident. Vosaroxin-induced DNA damage was detected as increased intracellular γH2AX. Vosaroxin had an acceptable safety profile, linear PK and encouraging clinical activity in relapsed/refractory leukemia.
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Affiliation(s)
- J E Lancet
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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Litzow MR, Othus M, Cripe LD, Gore SD, Lazarus HM, Lee SJ, Bennett JM, Paietta EM, Dewald GW, Rowe JM, Tallman MS. Failure of three novel regimens to improve outcome for patients with relapsed or refractory acute myeloid leukaemia: a report from the Eastern Cooperative Oncology Group. Br J Haematol 2009; 148:217-25. [PMID: 19804455 DOI: 10.1111/j.1365-2141.2009.07917.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The treatment of relapsed acute myeloid leukaemia (AML) remains unsatisfactory. We conducted a phase II randomized trial where patients received intermediate-dose cytarabine for 4 d followed by gemtuzumab ozogamicin on day 5 (Arm A), or combined with liposomal daunorubicin for 3 d (Arm B), or cytarabine given for 5 d combined with cyclophosphamide for 3 d and topotecan by continuous infusion for 5 d (Arm C). Eligible patients had primary refractory AML, a first relapse after a remission of <1 year, or a second or greater relapse. The primary objective of this trial was attainment of a conventional complete remission (CR) or a CR without platelet recovery (CRp) in at least 40% of patients. The CR/CRp rates for the 82 eligible patients were 3/26 (12%) in Arm A, 2/29 (7%) in Arm B, and 1/27 (4%) in Arm C. No patients who had relapsed within 6 months of initial CR or who had suffered multiple relapses responded. More than 95% of patients subsequently died of AML. No unexpected toxicities were encountered. We conclude that none of these three regimens were effective enough in the treatment of high-risk relapsed or refractory AML to warrant further study. This trial was registered at http://www.clinicaltrials.gov as #NCT00005962.
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Affiliation(s)
- Larry D. Cripe
- Department of Hematology-Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
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Cripe LD. Foreword. The discovered story: the evolution of truth in cancer narratives. Lit Med 2009; 28:vi-x. [PMID: 21141791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Cripe LD. Treating low-risk myelodysplastic syndromes in the community setting. Clin Adv Hematol Oncol 2008; 6:418-420. [PMID: 18567986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Larry D Cripe
- Division of Hematology and Oncology, School of Medicine, Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN 46202, USA
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Burns DS, Azzouz F, Sledge R, Rutledge C, Hincher K, Monahan PO, Cripe LD. Music imagery for adults with acute leukemia in protective environments: a feasibility study. Support Care Cancer 2007; 16:507-13. [PMID: 17891547 DOI: 10.1007/s00520-007-0330-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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: 04/03/2007] [Accepted: 08/21/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients receiving intensive chemotherapy can experience increased distressed related to both the cancer diagnosis and treatment isolation. If not addressed, distress can lead to anxiety, depression, and post-traumatic stress disorder. The purpose of this study was to determine the feasibility and possible benefits of a music imagery intervention for patients hospitalized in a protective environment for the treatment of acute leukemia or high-grade non-Hodgkin's lymphoma. MATERIALS AND METHODS Adults receiving intensive myelosuppressive chemotherapy in a protective environment were randomized to standard care or standard care plus music imagery. The music imagery sessions occurred twice weekly for up to eight sessions. Patients were encouraged to use the music imagery daily. RESULTS The principal criteria of feasibility were rate of consent, rate of completion of scheduled sessions, and rate of questionnaire completion. Forty-nine out of 78 patients consented, a 63% consent rate. Seventy-two percent of all scheduled music imagery sessions were completed. The rate of questionnaire completion was 60% with missing data because of illness severity and early discharge. The principal outcomes of benefit (e.g., efficacy) were positive and negative affects, fatigue, and anxiety. Both groups improved over time on all outcomes (all p < 0.001). However, a subgroup of individuals with low baseline negative affect who received the intervention reported significantly less anxiety at discharge than individuals with low baseline negative affect who did not receive the intervention. CONCLUSIONS Music imagery is feasible for adults with acute leukemia in protected environments. Patients with lower initial distress may benefit from a music imagery program in terms of reduced anxiety at discharge.
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Affiliation(s)
- Debra S Burns
- Indiana University School of Music, Indianapolis, IN 46202, USA.
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Suvannasankha A, Fausel C, Juliar BE, Yiannoutsos CT, Fisher WB, Ansari RH, Wood LL, Smith GG, Cripe LD, Abonour R. Final Report of Toxicity and Efficacy of a Phase II Study of Oral Cyclophosphamide, Thalidomide, and Prednisone for Patients with Relapsed or Refractory Multiple Myeloma: A Hoosier Oncology Group Trial, HEM01‐21. Oncologist 2007; 12:99-106. [PMID: 17227904 DOI: 10.1634/theoncologist.12-1-99] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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] [Indexed: 11/17/2022] Open
Abstract
Thalidomide has direct antimyeloma and immunomodulatory effects. In addition, both thalidomide and metronomic chemotherapy inhibit angiogenesis. The synergy of such a combination may decrease toxicity while maintaining efficacy. The Hoosier Oncology Group conducted a phase II trial of oral cyclophosphamide (50 mg b.i.d. for 21 days), thalidomide (200 mg/day), and prednisone (50 mg q.o.d.) (CTP) per 28-day course in patients with relapsed multiple myeloma (MM). Of the 37 patients enrolled, 16 had prior stem cell transplantation. The median follow-up time was 25.3 months (95% confidence interval [CI] 23.2-27.7). Of 35 patients treated, 22 patients (62.9%) responded: 7 (20.0%) complete responses, 2 (5.7%) near-complete responses, and 13 (37.1%) partial responses. Eight patients (22.9%) had stable disease, and three (8.6%) had disease progression. Two patients withdrew from the study early due to reasons unrelated to progression or toxicity and were treated as nonresponders. The median time to best response and time to progression were 3.6 months (95% CI 2.8-10.9) and 13.2 months (95% CI 9.4-21.0), respectively. The median number of treatment cycles was seven (range 1-12 cycles). Grade III to IV toxicities included leukopenia (42.9%; febrile neutropenia, 11.4%), hyperglycemia (20%), sensory neuropathy (11.4%), thromboses (8%), and motor neuropathy (5.7%). No patient withdrew from the study due to toxicity. The efficacy and low toxicity of the CTP regimen support the future development of such an approach in MM.
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Affiliation(s)
- Attaya Suvannasankha
- Division of Hematology and Oncology, Department of Medicine, Indiana University School of Medicine, 1044 West Walnut Street, Indianapolis, Indiana 46202, USA
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Hartman AD, Wilson-Weekes A, Suvannasankha A, Burgess GS, Phillips CA, Hincher KJ, Cripe LD, Boswell HS. Constitutive c-jun N-terminal kinase activity in acute myeloid leukemia derives from Flt3 and affects survival and proliferation. Exp Hematol 2006; 34:1360-76. [PMID: 16982329 DOI: 10.1016/j.exphem.2006.05.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 05/18/2006] [Accepted: 05/30/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE c-jun N-terminal kinase (JNK) has been implicated in proliferation and survival downstream from the tyrosine kinase oncogene, p210 BCR-ABL, in chronic myeloid leukemia. We studied whether a similar relationship between JNK and FMS-like tyrosine kinase 3 (Flt3) describes acute myeloid leukemia (AML). METHODS By immunoprecipitation, Flt3 was found to be activated and identified as the potential origin of JNK activity in a heavy majority of JNK+ve AML blasts tested. Often, Flt3 activity is associated with activating mutation of the gene locus. However, statistical linkage tied JNK activity with Flt3 expression levels rather than with mutation. An adaptor network to describe the signal cascade Flt3-to-JNK was uncovered. RESULTS Active Flt3 was linked to p85 phosphoinositide-3 (PI-3) kinase, and p85 with cbl and CrkII/CrkL by co-immunoprecipitaton assays from lysates of model cell lines and primary AML blasts. JNK1 co-immunoprecipitated from such lysates with p85-cbl-crkII/L and bound to Crk species SH3 domain in pull-down assay. siRNA-mediated depletion of Flt3 or of cbl, the adaptor at the nexus of this signaling group, inhibited JNK activity on substrate c-jun. Within AML blast cells influenced by Flt3 signaling, selective inhibition of JNK by a small molecule inhibitor, led to proliferative inhibition, apoptosis, and sensitizing cells to the anthracycline, daunorubicin. These effects occurred upon JNK inhibition without off-target inhibition of extracellular signal-regulated kinase or AKT pathways, and p38-kinase activation, an effector in the p53/p14 arf tumor suppressor pathway, was also maintained or augmented. CONCLUSION JNK is a bonafide signaling pathway from Flt3 in AML whose function for proliferation and survival is required in a significant AML cohort with active Flt3 signaling, by mutation or overexpression of Flt3.
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MESH Headings
- Apoptosis/drug effects
- Apoptosis/genetics
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cell Survival/genetics
- Enzyme Activation/drug effects
- Enzyme Activation/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Expression Regulation, Enzymologic/drug effects
- Gene Expression Regulation, Enzymologic/genetics
- Gene Expression Regulation, Leukemic/drug effects
- Gene Expression Regulation, Leukemic/genetics
- Humans
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/genetics
- Mitogen-Activated Protein Kinase 8/metabolism
- Mutation
- Phosphatidylinositol 3-Kinases/genetics
- Phosphatidylinositol 3-Kinases/metabolism
- Proto-Oncogene Proteins c-cbl/metabolism
- Quantitative Trait Loci/genetics
- RNA, Small Interfering/genetics
- RNA, Small Interfering/pharmacology
- Signal Transduction/drug effects
- Signal Transduction/genetics
- Tumor Suppressor Protein p14ARF/metabolism
- Tumor Suppressor Protein p53/metabolism
- fms-Like Tyrosine Kinase 3/genetics
- fms-Like Tyrosine Kinase 3/metabolism
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Affiliation(s)
- Amy D Hartman
- Walther Cancer Institute, Indianapolis, IN 46202, USA
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Abstract
BACKGROUND Imatinib mesylate is a tyrosine kinase inhibitor used for the treatment of chronic myeloid leukemia and hypereosinophilic syndrome. Imatinib is associated with a variety of adverse cutaneous reactions, including urticaria, maculopapular exanthem, generalized exanthematous pustulosis, exfoliative dermatitis, and Stevens-Johnson syndrome. OBJECTIVE To evaluate the safety and efficacy of oral desensitization by administering incremental dosages of imatinib mesylate to patients with leukemia who have had rashes associated with prior exposure. METHODS Ten patients with leukemia and imatinib-associated recurrent rash underwent a 4-hour outpatient oral desensitization procedure. Beginning with 10 ng, we administered oral imatinib elixir in increasing dosages every 15 minutes. Patient outcomes were monitored by a return clinic visit and by telephone follow-up for a median of approximately 3 years. RESULTS No episodes of anaphylaxis or serious adverse effects occurred during or immediately after desensitization. Four patients (all with urticaria) had no recurrence of rash after desensitization, and 4 had recurrent rash that resolved after temporary glucocorticosteroid and antihistamine administration. Two patients developed a recurrent rash 5 hours and several days after the procedure and were unable to resume therapy. CONCLUSION This oral desensitization protocol appears to help some leukemic patients with recurrent rash tolerate imatinib mesylate, thus permitting continuation of this life-prolonging therapy. These findings suggest that some adverse cutaneous reactions to imatinib may be due to a hypersensitivity mechanism rather than a pharmacologic effect.
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Affiliation(s)
- Robert P Nelson
- Hematological Malignancy Program/Immunology, Division of Hematology/Oncology, Indiana University Hospital, Clarion Health Partners, USA.
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Cripe LD, Rader K, Tallman MS, Gordon MS, Paietta E, Bennett J, Neuberg D, Litzow MR, O'brien TE, Rowe JM. Phase II trial of subcutaneous recombinant human interleukin 11 with subcutaneous recombinant human granulocyte-macrophage colony stimulating factor in patients with acute myeloid leukemia (AML) receiving high-dose cytarabine during induction: ECOG 3997. Leuk Res 2006; 30:823-7. [PMID: 16413056 DOI: 10.1016/j.leukres.2005.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/01/2005] [Revised: 11/01/2005] [Accepted: 11/18/2005] [Indexed: 11/22/2022]
Abstract
Randomized trials of substituting high-dose cytarabine (HiDAC) for standard dose cytarabine (SDAC) during induction therapy for newly diagnosed AML have not demonstrated an improvement in the complete remission (CR) rate. Phase II trials of the scheduled administration of HiDAC after SDAC suggest an improved outcome. The hematological complications of intensification are considerable. GM-CSF after chemotherapy improved the survival of older patients in a randomized trial. Recombinant human interleukin 11, a thrombopoietic cytokine, reduced the incidence of chemotherapy-induced thrombocytopenia in patients with solid tumors. Therefore, 34 patients were treated, with newly diagnosed AML less than 56 years of age, with daunorubicin 45 mg/m2 on days 1-3, cytarabine 100mg/m2 days 1-7 and cytarabine 2g/m2 for 12 h on days 8-10 (7+3+3). rhIL-11 (50 microg/kg/day,) and GM-CSF (250 microg/kg/day) were administered subcutaneously from day 11 until recovery. The complete remission rate was 59% (90% C.I. 43-73%). The median time to recovery of neutrophils to >500 and platelets to > or =20,000 microl(-1) was 27 days (95% C.I. 27-30 days) and 25 days (95% C.I. 24-29 days), respectively. The trial does not confirm the high CR rate observed in phase II trials, despite optimal supportive care.
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Affiliation(s)
- Larry D Cripe
- Indiana University Medical Center, Indianapolis, IN, United States.
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Abstract
PURPOSE Individuals with serious illness often desire to discuss spiritual concerns with their physician, yet substantial barriers exist to doing so, including limited evidence of value. This study evaluated acceptability, impact on satisfaction with care and on quality of life (QOL) of a brief (5-7 minute) semi-structured exploration of spiritual/religious concerns. PATIENTS AND METHODS 118 consecutive patients of four oncologist-hematologists (95% recruitment; 55.1% female, 91.5% Caucasian, 81.3% Christian) with mixed diagnoses, duration (51.7% diagnosed within 2 years) and prognosis (54.2% in active treatment) were alternately assigned to receive the intervention or usual care during an office visit. Assessment occurred just prior to the visit, immediately after, and after 3 weeks. Measures included the FACT-G QOL and FACIT-Sp (Spiritual Well-Being) Scales; BSI Depression Scale; the PCAS Interpersonal and Communication scales; and ratings of acceptability. RESULTS Oncologists rated themselves as comfortable during the inquiry with 85% of patients. Of patients, 76% felt the inquiry was "somewhat" to "very" useful. At 3 weeks, the intervention group had greater reductions in depressive symptoms (F= 7.57,p < .01), more improvement in QOL (F = 4.04, p < .05), and an improved sense of interpersonal caring from their physician (F = 4.79, p < .05) relative to control patients. Effects on QOL remained after adjusting for other variables, including relationship to physician. Improvement on Functional Well-being was accounted for primarily by patients lower on baseline spiritual well-being (beta = .293, p < .001). CONCLUSIONS This study supports the acceptability of a semi-structured inquiry into spiritual concerns related to coping with cancer; furthermore, the inquiry appears to have a positive impact on perception of care and well-being.
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Affiliation(s)
- Jean L Kristeller
- Dept of Psychology, Indiana State University, Terre Haute 47809, USA.
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Frankel AE, Surendranathan A, Black JH, White A, Ganjoo K, Cripe LD. Phase II clinical studies of denileukin diftitox diphtheria toxin fusion protein in patients with previously treated chronic lymphocytic leukemia. Cancer 2006; 106:2158-64. [PMID: 16586495 DOI: 10.1002/cncr.21851] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [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: 11/08/2022]
Abstract
BACKGROUND The safety and efficacy of the interleukin-2 diphtheria toxin fusion protein (DAB(389)IL2; denileukin diftitox) directed against the IL-2 receptor (IL-2R) was tested in patients with recurrent or refractory chronic lymphocytic leukemia (CLL). METHODS Denileukin diftitox was administered as 60-minute intravenous infusions for 5 days every 21 days at a dose of 18 mug/kg per day for up to 8 cycles. In total, 28 patients were treated in 2 multiinstitutional studies with similar eligibility criteria and treatment protocols. Twenty-two patients receive > or = 2 cycles of denileukin diftitox and were evaluable for response. RESULTS Twelve of 22 patients achieved reductions of peripheral CLL cells, with 5 of 12 patients achieving >80% reductions. Six of 22 patients achieved reductions in the size of lymph node on examination and computed tomography scans, and all 6 of those patients met the criteria for a partial or complete response that lasted > or = 2 months. Bone marrow biopsies before and after treatment confirmed a complete remission that lasted for 1 year in 1 patient. Overall, denileukin diftitox produced complete remission in 1 of 22 patients (4%) and partial remission in 5 of 22 patients (23%) for a total remission rate of 27%. Progression-free intervals in the responders were 2 months in 2 patients and 4 months, 6 months, 7 months, and 12 months in 1 patient each. Toxicities were moderate. No infections associated with immunosuppression were seen. There was no significant correlation of response or toxicities with the numbers of denileukin diftitox cycles received or with CD25 levels. CONCLUSIONS Follow-up studies will be required to identify predictors of response that may improve the response rate to denileukin diftitox in patients with CLL.
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MESH Headings
- Aged
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Biopsy, Needle
- Bone Marrow/pathology
- Diphtheria Toxin/administration & dosage
- Diphtheria Toxin/adverse effects
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Female
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Infusions, Intravenous
- Interleukin-2/administration & dosage
- Interleukin-2/adverse effects
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Maximum Tolerated Dose
- Middle Aged
- Neoplasm Staging
- Probability
- Recombinant Fusion Proteins/administration & dosage
- Recombinant Fusion Proteins/adverse effects
- Risk Assessment
- Salvage Therapy
- Survival Analysis
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Arthur E Frankel
- Department of Medicine, Scott and White Hospital, Temple, Texas 76508, USA.
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Ganjoo KN, Robertson MJ, Fisher W, Jung SH, McClean J, Huh SY, Bufill J, Williams S, Cripe LD. A Phase II Study of Single Agent Gemcitabine in Relapsed or Refractory Follicular or Small Lymphocytic Non-Hodgkin Lymphomas. Am J Clin Oncol 2005; 28:169-72. [PMID: 15803012 DOI: 10.1097/01.coc.0000144812.74663.d0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gemcitabine is a pyrimidine analog that is active in patients with aggressive lymphomas and Hodgkin disease. This study assessed tumor response in patients with previously treated follicular or small lymphocytic non-Hodgkin lymphoma. This was a 2-stage phase II trial with the first stage requiring 2 of 13 responses to proceed to the second stage. Gemcitabine was given as a single agent to patients with previously treated follicular or small lymphocytic lymphomas. Gemcitabine was administered at 1250 mg/m2 over 30 minutes on days 1 and 8 of a 21-day cycle for a maximum of 6 cycles. Thirteen patients were treated with 1 to 6 cycles of chemotherapy. Two patients experienced grade 4 toxicity with neutropenia. No grade 4 nonhematologic toxicity was seen. There was 1 partial response and 8 patients (61%) had either minimal response or stable disease. Single-agent gemcitabine administered at this dose and schedule produced 1 partial remission and half the patients had stable disease. However, the study had to be stopped early because of lack of meaningful response.
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Affiliation(s)
- Kristen N Ganjoo
- Hematology/Oncology Department, Indiana University Medical Center, Indianapolis, Indiana, USA.
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47
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Vaena DA, Walker P, Pennington K, Stephens A, Stender MJ, Yiannoutsos CT, Young C, Stoner C, Cripe LD. Phase II study of low-dose topotecan in myelodysplastic syndromes: a Hoosier Oncology Group (HOG) study. Leuk Res 2004; 28:49-52. [PMID: 14630080 DOI: 10.1016/s0145-2126(03)00181-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Topotecan has demonstrable activity in high-risk MDS and CMMoL. However, the significant toxicity of topotecan administered at a dose of 2mg/m2 i.v. daily for 5 days as a continuous infusion limits its use in older patients. Therefore, we studied topotecan 1.5mg/m2 per day i.v. over 2 h for three consecutive days in 20 patients with high-risk MDS (12 RAEB; 4 RAEB-T; 4 CMMoL). Cycles were given every 4-6 weeks. Fifteen patients were evaluable for response. Only one patient achieved a durable complete remission (CR). There were three deaths within the first cycle of therapy. Severe myelosuppression was the most common toxicity. Grades 3-4 infections were documented in four patients. We conclude that topotecan administered at this dose and schedule has no clinically significant activity.
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MESH Headings
- Aged
- Aged, 80 and over
- Anemia, Refractory, with Excess of Blasts/diagnosis
- Anemia, Refractory, with Excess of Blasts/drug therapy
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Drug Administration Schedule
- Enzyme Inhibitors/administration & dosage
- Enzyme Inhibitors/adverse effects
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Middle Aged
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/drug therapy
- Remission Induction
- Topotecan/administration & dosage
- Topotecan/adverse effects
- Treatment Outcome
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Affiliation(s)
- Daniel A Vaena
- Division of Hematology-Oncology, Indiana Cancer Pavilion, Indiana University, 535 Barnhill Dr RT 473, Indianapolis, IN 46202, USA
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48
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Fisch M, Zichi Cohen M, Rutledge C, Cripe LD. Teaching patients how to improve communication with their health care providers: a unique workshop experience. J Cancer Educ 2003; 18:188-193. [PMID: 14766328 DOI: 10.1207/s15430154jce1804_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND A one-day workshop was held to educate cancer patients about improving communication with their cancer care providers. METHODS The workshop included three sessions: 1) Getting through the Diagnosis/Prognosis Phase, 2) Exploring Treatment Options, and 3) Asking Difficult Questions (when medicines no longer work). RESULTS Qualitative and survey data revealed that many participated in order to share their experiences with others rather than to be taught effective communication skills. Humor, spirituality, and the association between cancer and death were prevalent issues. CONCLUSION This workshop represented an enjoyable and informative venue for approaching communication issues from patients' and family members' perspective.
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Affiliation(s)
- Michael Fisch
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
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49
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Douglas VK, Tallman MS, Cripe LD, Peterson LC. Thrombopoietin administered during induction chemotherapy to patients with acute myeloid leukemia induces transient morphologic changes that may resemble chronic myeloproliferative disorders. Am J Clin Pathol 2002; 117:844-50. [PMID: 12047134 DOI: 10.1309/09np-3dfg-blm9-e5le] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [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: 10/26/2022] Open
Abstract
Thrombopoietin (TPO), a potent stimulator of megakaryocyte and platelet production, has been used in clinical trials to reduce thrombocytopenia after chemotherapy in patients with acute myeloid leukemia (AML). We report that TPO therapy is associated with peripheral blood and bone marrow findings that can mimic myeloproliferative disorders. Peripheral blood and bone marrow samples of 13 patients with AML who received TPO were examined. A subset of bone marrow samples exhibited hypercellularity, megakaryocytic hyperplasia, and reticulin fibrosis after TPO administration. Cases demonstrated as many as 58.4 megakaryocytes per high-powerfield (MHPF) compared with 3.7 MHPF in the control group. Megakaryocytic atypia, increased mitoses, emperipolesis, intrasinusoidal megakaryocytes, and thickened trabeculae also were seen. Peripheral blood findings included leukoerythroblastosis, leukocytosis, thrombocytosis, and circulating megakaryocyte nuclei. Changes resolved within 3 months after discontinuation of TPO. This rapid resolution of the morphologic abnormalities induced by TPO distinguishes these findings from those seen in true chronic myeloproliferative disorders.
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Affiliation(s)
- Vonda K Douglas
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville 32610-0275, USA
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50
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Cripe LD, Gelfanov VM, Smith EA, Spigel DR, Phillips CA, Gabig TG, Jung SH, Fyffe J, Hartman AD, Kneebone P, Mercola D, Burgess GS, Boswell HS. Role for c-jun N-terminal kinase in treatment-refractory acute myeloid leukemia (AML): signaling to multidrug-efflux and hyperproliferation. Leukemia 2002; 16:799-812. [PMID: 11986940 DOI: 10.1038/sj.leu.2402457] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [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: 04/12/2001] [Accepted: 01/15/2002] [Indexed: 11/09/2022]
Abstract
A relationship was proved between constitutive activity of leukemic cell c-jun-N-terminal kinase (JNK) and treatment failure in AML. Specifically, early treatment failure was predicted by the presence of constitutive JNK activity. The mechanistic origins of this association was sought. A multidrug resistant leukemic cell line, HL-60/ADR, characterized by hyperexpression of c-jun and JNK activity, was transfected with a mutant c-jun vector, whose substrate N-terminal c-jun serines were mutated. Down-regulated expression occurred of c-jun/AP-1-dependent genes, catalase and glutathione-S-transferase (GST) pi, which participate in cellular homeostasis to oxidative stress and xenobiotic exposure. MRP-efflux was abrogated in HL-60/ADR cells with dominant-negative c-jun, perhaps because MRP1 protein expression was also lost. Heightened sensitivity to daunorubicin resulted in cells subjected to this change. Biochemical analysis in 67 primary adult AML samples established a statistical correlation between cellular expression of c-jun and JNK activity, JNK activity with hyperleukocytosis at presentation of disease, and with exuberant MRP efflux. These findings reflect the survival role for c-jun/AP-1 and its regulatory kinase previously demonstrated for yeast in homeostatic response to oxidative stress and in operation of ATP-binding cassette efflux pumps, and may support evolutionary conservation of such function. Thus, JNK and c-jun may be salient drug targets in multidrug resistant AML.
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Affiliation(s)
- L D Cripe
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, 1044 W Walnut Street, Indianapolis, IN 46202, USA
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