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Flora C, Olesnavich M, Zuo Y, Sandford E, Madhukar R, Rozwadowski M, Sugur K, Ly A, Canbaz AA, Shedeck A, Li G, Geer MJ, Yanik GA, Ghosh M, Frame DG, Bonifant CL, Jain T, Knight JS, Choi SW, Tewari M. Longitudinal plasma proteomics in CAR T-cell therapy patients implicates neutrophils and NETosis in the genesis of CRS. Blood Adv 2024; 8:1422-1426. [PMID: 38266157 PMCID: PMC10950819 DOI: 10.1182/bloodadvances.2023010728] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Affiliation(s)
- Christopher Flora
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Mary Olesnavich
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Yu Zuo
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Erin Sandford
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Rashmi Madhukar
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Michelle Rozwadowski
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University of Michigan, Ann Arbor, MI
| | - Kavya Sugur
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Andrew Ly
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ata Alpay Canbaz
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Audra Shedeck
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gen Li
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Marcus J. Geer
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Gregory A. Yanik
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University of Michigan, Ann Arbor, MI
| | - Monalisa Ghosh
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - David G. Frame
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - Challice L. Bonifant
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tania Jain
- Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jason S. Knight
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Sung Won Choi
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University of Michigan, Ann Arbor, MI
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
| | - Muneesh Tewari
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
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Mitbander UB, Geer MJ, Taxbro K, Horowitz JK, Zhang Q, O'Malley ME, Ramnath N, Chopra V. Patterns of use and outcomes of peripherally inserted central catheters in hospitalized patients with solid tumors: A multicenter study. Cancer 2022; 128:3681-3690. [PMID: 35943390 DOI: 10.1002/cncr.34410] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The risk of peripherally inserted central catheter (PICC)-related complications in patients hospitalized with solid tumors remains unclear. Existing studies are limited by single-center, outpatient designs and include heterogenous patients. METHODS A retrospective cohort study was designed and included adult patients with solid organ cancers who were admitted to a general medicine ward or intensive care unit and received a PICC. Data were collected from November 2013 to December 2019 at 50 Michigan hospitals. Major complications were defined as central line-associated bloodstream infection, deep vein thrombosis, pulmonary embolism, and catheter occlusion. Hospital variation in PICC use and outcomes was examined. RESULTS Data included 3235 hospitalized patients with solid tumors who had PICCs placed for 51,047 catheter days. Most catheters were double-lumen devices (57.0%). Notably, 17.5% of patients had another central venous catheter at the time of PICC insertion. The most common indications for PICC use were antibiotics (34.5%) and difficult access or blood draws (21.6%); chemotherapy was the primary indication in only 15.7% of patients. A major PICC-related complication occurred in 491 patients (15.2%); catheter occlusion was the most prevalent complication (n = 322; 10.0%) followed by deep vein thrombosis (n = 116; 3.6%), central line-associated bloodstream infection (n = 82; 2.5%), and pulmonary embolism (n = 20; 0.6%). Significant variation in indications for PICC use, device characteristics, and frequency of major complications across hospitals was observed (p < .001). CONCLUSIONS PICCs were associated with significant complications in hospitalized patients who had solid malignancies and were often used for reasons other than chemotherapy. Policies and guidance for the appropriate use of PICCs in oncologic patients appear necessary. LAY SUMMARY Peripherally inserted central catheters (PICCs) are devices placed in peripheral veins to deliver medication to large veins near the heart. PICCs are used frequently in oncology. The objective of this report was to describe PICC-associated complications in hospitalized patients with solid tumors. This study was performed across 50 Michigan hospitals and included 3235 patients with solid tumor cancers and who had a PICC. Overall, 15.2% of patients experienced a complication, including central line-associated bloodstream infections, deep vein thrombosis, pulmonary embolism, or catheter occlusion. Complication rates varied across hospitals. PICCs are associated with substantial complications in hospitalized patients with solid tumors.
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Affiliation(s)
- Urvashi B Mitbander
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Marcus J Geer
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Knut Taxbro
- Department of Anesthesia and Intensive Care Medicine, Ryhov County Hospital, Jonkoping, Sweden.,Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Jennifer K Horowitz
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Qisu Zhang
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Megan E O'Malley
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Nithya Ramnath
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.,Medical Oncology, Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- Department of Medicine, University of Colorado, Denver, Aurora, Colorado, USA
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Geer MJ, Foucar CE, Devata S, Benitez L, Perissinotti AJ, Marini BL, Bixby D. Clinical Availability of ATRA for Patients With Suspected Acute Promyelocytic Leukemia: Why Guidelines May Not Be Followed. J Natl Compr Canc Netw 2021; 19:1272-1275. [PMID: 34404029 DOI: 10.6004/jnccn.2021.7013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/23/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND All-trans retinoic acid (ATRA) serves as the backbone of the management of patients with acute promyelocytic leukemia (APL), with guidelines recommending the initiation of ATRA as soon as APL is suspected. As a regional referral center for patients with acute leukemia, those who are suspected of having APL are often transferred to our facility. However, many referring centers are unable to initiate treatment using ATRA. We conducted an exploratory analysis of the clinical availability of ATRA and the factors limiting access to this critical drug. PATIENTS AND METHODS The United States was divided into 6 geographic regions: Northwest, Southwest, Central, Southeast, Northeast, and the Great Lakes. Twenty hospitals were randomly selected from states within each of these regions and were surveyed as to whether they typically treated patients with acute leukemia, the availability of ATRA at their institution, and reported reasons for not stocking ATRA (if not available). RESULTS Less than one-third of hospitals queried (31%) had ATRA in stock. Neither the size of the hospital nor the hospital's status as academic versus nonacademic (53% vs 31%; P=.08) influenced ATRA availability. Of the hospitals that referred patients with APL, only 14% (7/49) had ATRA readily available. Hospitals that treated patients with APL were more likely to have ATRA available than referring centers (58% vs 14%; P=.000002). CONCLUSIONS Nearly two-thirds of the hospitals surveyed that cared for patients with acute leukemia do not have ATRA immediately available. Moreover, the vast majority of hospitals that refer patients to other centers do not have ATRA. These findings should spur investigation into the impact of immediate ATRA availability on the morbidity and mortality of patients with APL. A call by hematologists nationwide to their formulary committees is warranted to ensure that this lifesaving medication is available to patients suspected of having APL.
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Affiliation(s)
- Marcus J Geer
- 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Michigan Medicine and University of Michigan Medical School, Ann Arbor, Michigan
| | - Charles E Foucar
- 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Michigan Medicine and University of Michigan Medical School, Ann Arbor, Michigan
| | - Sumana Devata
- 2Division of Hematology and Medical Oncology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Lydia Benitez
- 3Department of Pharmacy Services and Clinical Science, Michigan Medicine, and University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Anthony J Perissinotti
- 3Department of Pharmacy Services and Clinical Science, Michigan Medicine, and University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Bernard L Marini
- 3Department of Pharmacy Services and Clinical Science, Michigan Medicine, and University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Dale Bixby
- 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Michigan Medicine and University of Michigan Medical School, Ann Arbor, Michigan
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Geer MJ, Yeow RY, Hartley S. Words Matter: Reexamining Our Vernacular. J Grad Med Educ 2021; 13:291. [PMID: 33897966 PMCID: PMC8054603 DOI: 10.4300/jgme-d-21-00011.1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marcus J Geer
- Hematology/Oncology Fellow, Department of Internal Medicine, University of Michigan
- denotes co-first author
| | - Raymond Y Yeow
- Cardiology Fellow, Department of Internal Medicine, University of Michigan
- denotes co-first author
| | - Sarah Hartley
- Associate Professor and Associate Program Director, Department of Internal Medicine, University of Michigan
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Dean KE, Fields A, Geer MJ, King EC, Lynch BT, Manohar RR, McCall JR, Palozola KC, Zhang Y, Liebl EC. An allele of sequoia dominantly enhances a trio mutant phenotype to influence Drosophila larval behavior. PLoS One 2014; 8:e84149. [PMID: 24376789 PMCID: PMC3869853 DOI: 10.1371/journal.pone.0084149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/20/2013] [Indexed: 11/18/2022] Open
Abstract
The transition of Drosophila third instar larvae from feeding, photo-phobic foragers to non-feeding, photo-neutral wanderers is a classic behavioral switch that precedes pupariation. The neuronal network responsible for this behavior has recently begun to be defined. Previous genetic analyses have identified signaling components for food and light sensory inputs and neuropeptide hormonal outputs as being critical for the forager to wanderer transition. Trio is a Rho-Guanine Nucleotide Exchange Factor integrated into a variety of signaling networks including those governing axon pathfinding in early development. Sequoia is a pan-neuronally expressed zinc-finger transcription factor that governs dendrite and axon outgrowth. Using pre-pupal lethality as an endpoint, we have screened for dominant second-site enhancers of a weakly lethal trio mutant background. In these screens, an allele of sequoia has been identified. While these mutants have no obvious disruption of embryonic central nervous system architecture and survive to third instar larvae similar to controls, they retain forager behavior and thus fail to pupariate at high frequency.
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Affiliation(s)
- Kathryn E. Dean
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
| | - April Fields
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
| | - Marcus J. Geer
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
| | - Eric C. King
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
| | - Brian T. Lynch
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
| | - Rohan R. Manohar
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
| | - Julianne R. McCall
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
| | - Katherine C. Palozola
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
| | - Yan Zhang
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
| | - Eric C. Liebl
- Department of Biology, Denison University, Talbot Hall of Biological Science, Granville, Ohio, United States of America
- * E-mail:
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Lin RL, Lin YJ, Geer MJ, Kryscio R, Lee LY. Pulmonary chemoreflex responses are potentiated by tumor necrosis factor-alpha in mice. J Appl Physiol (1985) 2013; 114:1536-43. [PMID: 23539315 DOI: 10.1152/japplphysiol.01301.2012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Inhalation of tumor necrosis factor-alpha (TNF-α), a proinflammatory cytokine, induces airway hyperresponsiveness, and the underlying mechanism is not fully understood. Hypersensitivity of vagal bronchopulmonary C-fiber afferents is known to contribute to the airway hyperresponsiveness during an airway inflammatory reaction. Because activation of these afferents can elicit pulmonary chemoreflexes, this study was designed to determine if a pretreatment with TNF-α induced airway inflammation and enhanced the pulmonary chemoreflex sensitivity in anesthetized mice; and if so, whether the effect was mediated through activation of either or both of the TNF receptors, p55 and p75. Our results showed that TNF-α instilled into the lung caused an increased sensitivity of pulmonary chemoreflex responses to various chemical stimulants of the vagal bronchopulmonary C-fiber afferents. The increased sensitivity was found 24 h later, persisted at 48 h, and then gradually declined after several days. The TNF-α-induced airway hypersensitivity was accompanied by airway inflammation as shown by a striking elevation of the levels of eosinophils and neutrophils, several potent bronchoactive inflammatory mediators, and proinflammatory cytokines in the bronchoalveolar lavage fluid. Furthermore, the increase in pulmonary chemoreflex response caused by TNF-α was partially abrogated in both p55-null and p75-null mice, but completely abolished in p55/p75-null mice. In conclusion, TNF-α pretreatment induced airway inflammation and a sustained elevation of pulmonary chemoreflex sensitivity, which was mediated through an activation of both types of TNF receptors.
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Affiliation(s)
- Ruei-Lung Lin
- Department of Physiology, University of Kentucky, Lexington, Kentucky 40536-0298, USA
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Abstract
The hypothesis tested was that, in schizophrenia, corpus callosum size would be reduced, particularly in the region responsible for communication between both temporal lobes. This is supported by knowledge of: (a) anatomical homotopicity and functional specialization of fibres within the corpus callosum; (b) evidence linking structural and functional deficits of the corpus callosum and left temporal lobe with schizophrenia; and (c) that temporal lobe neuronal fibres pass through the middle region of the corpus callosum. Brain area and corpus callosum areas, widths and length were measured on mid-sagittal MRI scans using a computer outlining method. Scans from 30 schizophrenics and 44 normal subjects were compared. Mid-sagittal brain area, corpus callosum area, length and anterior widths were reduced in the schizophrenic group compared with controls. A significant area difference between schizophrenics and controls was seen in the mid-corpus callosum which communicates between the temporal lobes, including the superior temporal gyri. In schizophrenics, corpus callosum area reduction was not accounted for by brain area shrinkage alone. Differences between the two groups were accounted for by comparisons between males only. These findings support the hypothesis and the possibility that localized abnormalities of bilaterally connected brain regions might have secondary effects on their homotopically distributed fibres within the corpus callosum.
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Affiliation(s)
- P W Woodruff
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
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