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Argirion I, Mahale P, Pfeiffer RM, Liu P, Adimora AA, Akiyama MJ, Bolivar HH, French A, Plankey M, Price JC, Rana A, Sheth A, Koshiol J, Seaberg EC, Kuniholm MH, Glenn J, O’Brien TR. Hepatitis B virus and hepatitis D virus infection in women with or at risk for HIV infection in the United States. Front Med (Lausanne) 2023; 10:1070420. [PMID: 36936213 PMCID: PMC10017733 DOI: 10.3389/fmed.2023.1070420] [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] [Received: 10/14/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Hepatitis D virus (HDV) requires co-infection with hepatitis B virus (HBV). Human immunodeficiency virus (HIV) shares transmission routes with these viruses. Among 4,932 US women infected with or at-risk for HIV during 1994-2015, HBV surface antigen (HBsAg) positivity was more common in women with HIV (2.8% vs. 1.2%; p = 0.001); HDV was more common among participants enrolled during 2013-2015 (p = 0.0004) and those with resolved rather than active hepatitis C (1.9% vs. 0.5%; p = 0.02). Among HBsAg-positive women (n = 117), HDV antibody prevalence was 22% and did not vary by HIV status; HDV infection was associated with the presence of advanced fibrosis/cirrhosis at enrollment (adjusted odds ratio, 5.70; 95% confidence interval, 1.46-22.29). Our results demonstrate the importance of HDV testing in HBV-infected US women.
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Affiliation(s)
- Ilona Argirion
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
- *Correspondence: Ilona Argirion,
| | - Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Ruth M. Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Ping Liu
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Adaora A. Adimora
- School of Medicine and University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew J. Akiyama
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, United States
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, United States
| | - Hector H. Bolivar
- Department of Medicine, University of Miami Health System, Miami, FL, United States
| | - Audrey French
- Division of Neurology, Cook County Health, Chicago, IL, United States
- Cook County Health, Hektoen Institute of Medicine, Chicago, IL, United States
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, United States
| | - Jennifer C. Price
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Aadia Rana
- Division of Infectious Diseases, University of Alabama-Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Anandi Sheth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
- Grady Health System, Infectious Diseases Program, Atlanta, GA, United States
| | - Jill Koshiol
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Eric C. Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mark H. Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, United States
| | - Jeffrey Glenn
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Thomas R. O’Brien
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
- Thomas R. O’Brien,
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Mahale P, Nomburg J, Song JY, Steinberg M, Starrett G, Boland J, Lynch CF, Chadburn A, Rubinstein PG, Hernandez BY, Weisenburger DD, Bullman S, Engels EA. Metagenomic analysis to identify novel infectious agents in systemic anaplastic large cell lymphoma. Infect Agent Cancer 2021; 16:65. [PMID: 34775986 PMCID: PMC8591940 DOI: 10.1186/s13027-021-00404-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/03/2021] [Indexed: 12/03/2022] Open
Abstract
Systemic anaplastic large cell lymphoma (ALCL) is a rare CD30-expressing T-cell non-Hodgkin lymphoma. Risk of systemic ALCL is highly increased among immunosuppressed individuals. Because risk of cancers associated with viruses is increased with immunosuppression, we conducted a metagenomic analysis of systemic ALCL to determine whether a known or novel pathogen is associated with this malignancy. Total RNA was extracted and sequenced from formalin-fixed paraffin-embedded tumor specimens from 19 systemic ALCL cases (including one case from an immunosuppressed individual with human immunodeficiency virus infection), 3 Epstein-Barr virus positive diffuse large B-cell lymphomas (DLBCLs) occurring in solid organ transplant recipients (positive controls), and 3 breast cancers (negative controls). We used a pipeline based on the Genome Analysis Toolkit (GATK)-PathSeq algorithm to subtract out human RNA reads and map the remaining RNA reads to microbes. No microbial association with ALCL was identified, but we found Epstein-Barr virus in the DLBCL positive controls and determined the breast cancers to be negative. In conclusion, we did not find a pathogen associated with systemic ALCL, but because we analyzed only one ALCL tumor from an immunosuppressed person, we cannot exclude the possibility that a pathogen is associated with some cases that arise in the setting of immunosuppression.
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Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jason Nomburg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Joo Y Song
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Mia Steinberg
- Cancer Genomics Research Laboratory, National Cancer Institute, Rockville, MD, USA
| | - Gabriel Starrett
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Joseph Boland
- Cancer Genomics Research Laboratory, National Cancer Institute, Rockville, MD, USA
| | - Charles F Lynch
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Amy Chadburn
- Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Paul G Rubinstein
- Stroger Hospital of Cook County, Ruth M. Rothstein Core Center, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Susan Bullman
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
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Brooks YM, Gryskwicz B, Sheehan S, Piers S, Mahale P, McNeil S, Chase J, Webber D, Borys D, Hilton M, Robinson D, Sears S, Smith E, Lesher EK, Wilson R, Goodwin M, Pardales M. Detection of SARS-CoV-2 in Wastewater at Residential College, Maine, USA, August-November 2020. Emerg Infect Dis 2021; 27:3111-3114. [PMID: 34465415 PMCID: PMC8632168 DOI: 10.3201/eid2712.211199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We used wastewater surveillance to identify 2 coronavirus disease outbreaks at a college in Maine, USA. Cumulative increases of >1 log10 severe acute respiratory syndrome coronavirus 2 RNA in consecutive 24-hour composite samples preceded the outbreaks. For 76% of cases, RNA was identified in grab samples from residence halls <7 days before case discovery.
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D'Arcy ME, Beachler DC, Pfeiffer RM, Curtis JR, Mariette X, Seror R, Mahale P, Rivera DR, Yanik EL, Engels EA. Tumor Necrosis Factor Inhibitors and the Risk of Cancer among Older Americans with Rheumatoid Arthritis. Cancer Epidemiol Biomarkers Prev 2021; 30:2059-2067. [PMID: 34426413 DOI: 10.1158/1055-9965.epi-21-0125] [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: 01/29/2021] [Revised: 04/28/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND TNF inhibitors (TNFi) effectively treat rheumatoid arthritis but may increase patient risk of some malignancies, particularly lymphomas or skin cancers. METHODS We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data to conduct a case-control study in patients with rheumatoid arthritis (2007-2015). Cases were individuals with a first cancer diagnosed in SEER registries (ages 66-99, 22 cancer sites, N = 10,263). Skin cancer cases [nonmelanoma skin cancer (NMSC, N = 501), basal cell carcinoma (BCC, N = 161), squamous cell carcinoma (SCC, N = 150)] and cancer-free controls (N = 30,475) were selected from Medicare beneficiaries residing in SEER areas. Cases and controls had prior Medicare claims-based evidence for rheumatoid arthritis, and TNFi exposure was ascertained from part B and part D claims. Logistic regression was used to estimate adjusted odds ratios (aOR). RESULTS TNFi exposure was present in 16.2% of controls and 12.8% to 33.7% of cancer cases, varying by site. TNFi use was associated with increased risk of NMSC overall (aOR 1.32, 95% confidence interval 1.06-1.63), non-Hodgkin lymphoma (NHL) overall (1.28, 1.06-1.56) and, specifically, follicular lymphoma (2.63, 1.63-4.24). TNFi exposure was not associated with other SEER cancer sites, BCC or SCC specifically, or other common NHL subtypes. CONCLUSIONS Among older adults with rheumatoid arthritis, TNFi exposure was associated with elevated risk of NMSC and NHL, driven specifically by follicular lymphoma. Exposure was not associated with increased risk for other cancer sites. IMPACT Our results support a role for TNF in lymphomagenesis. Given the association with NMSC, patients initiating TNFi therapy may benefit from skin cancer screening and sun protection measures.
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Affiliation(s)
- Monica E D'Arcy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland. monica.d'
| | | | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | | | - Xavier Mariette
- Hôpital Bicêtre, Assistance Publique -Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin Bicêtre, Paris, France
| | - Raphaele Seror
- Hôpital Bicêtre, Assistance Publique -Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin Bicêtre, Paris, France
| | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Donna R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | | | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Mahale P, Shiels MS, Lynch CF, Chinnakotla S, Wong LL, Hernandez BY, Pawlish KS, Li J, Alverson G, Schymura MJ, Engels EA. The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States. Cancer Epidemiol Biomarkers Prev 2021; 30:513-520. [PMID: 33199438 PMCID: PMC8052263 DOI: 10.1158/1055-9965.epi-20-1188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/09/2020] [Revised: 10/12/2020] [Accepted: 11/11/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) carries a poor prognosis. Liver transplantation (LT) is potentially curative for localized HCC. We evaluated the impact of LT on U.S. general population HCC-specific mortality rates. METHODS The Transplant Cancer Match Study links the U.S. transplant registry with 17 cancer registries. We calculated age-standardized incidence (1987-2017) and incidence-based mortality (IBM) rates (1991-2017) for adult HCCs. We partitioned population-level IBM rates by cancer stage and calculated counterfactual IBM rates assuming transplanted cases had not received a transplant. RESULTS Among 129,487 HCC cases, 45.9% had localized cancer. HCC incidence increased on average 4.0% annually [95% confidence interval (CI) = 3.6-4.5]. IBM also increased for HCC overall (2.9% annually; 95% CI = 1.7-4.2) and specifically for localized stage HCC (4.8% annually; 95% CI = 4.0-5.5). The proportion of HCC-related transplants jumped sharply from 6.7% (2001) to 18.0% (2002), and further increased to 40.0% (2017). HCC-specific mortality declined among both nontransplanted and transplanted cases over time. In the absence of transplants, IBM for localized HCC would have increased at 5.3% instead of 4.8% annually. CONCLUSIONS LT has provided survival benefit to patients with localized HCC. However, diagnosis of many cases at advanced stages, limited availability of donor livers, and improved mortality for patients without transplants have limited the impact of transplantation on general population HCC-specific mortality rates. IMPACT Although LT rates continue to rise, better screening and treatment modalities are needed to halt the rising HCC mortality rates in the United States.See related commentary by Zhang and Thrift, p. 435.
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Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
| | - Meredith S Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
| | - Charles F Lynch
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa
| | | | - Linda L Wong
- University of Hawai'i Cancer Center, Honolulu, Hawaii
| | - Brenda Y Hernandez
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, Hawaii
| | - Karen S Pawlish
- Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
| | - Jie Li
- Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
| | - Georgetta Alverson
- Michigan Cancer Surveillance Program, Michigan Department of Health and Human Services, Lansing, Michigan
| | - Maria J Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Brooks YM, Gryskwicz B, Sheehan S, Piers S, Mahale P, McNeil S, Chase J, Webber D, Borys D, Hilton M, Robinson D, Sears S, Smith E, Lesher EK, Wilson R, Goodwin M, Pardales M. Detection of SARS-CoV-2 in Wastewater at Residential College, Maine, USA, August-November 2020. Emerg Infect Dis 2021. [PMID: 34465415 DOI: 10.3201/eid2712.21119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
We used wastewater surveillance to identify 2 coronavirus disease outbreaks at a college in Maine, USA. Cumulative increases of >1 log10 severe acute respiratory syndrome coronavirus 2 RNA in consecutive 24-hour composite samples preceded the outbreaks. For 76% of cases, RNA was identified in grab samples from residence halls <7 days before case discovery.
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Mahale P, Rothfuss C, Bly S, Kelley M, Bennett S, Huston SL, Robinson S. Multiple COVID-19 Outbreaks Linked to a Wedding Reception in Rural Maine - August 7-September 14, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1686-1690. [PMID: 33180752 PMCID: PMC7660665 DOI: 10.15585/mmwr.mm6945a5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mahale P, Mckenna GJ, Saracino G, Jennings L, Mbulaiteye SM, Klintmalm GB, Engels EA. Hypomagnesemia and risk of post-transplant lymphoproliferative disorder in liver transplant recipients. Transpl Int 2020; 33:1835-1836. [PMID: 32895994 DOI: 10.1111/tri.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Gregory J Mckenna
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Giovanna Saracino
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Linda Jennings
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Sam M Mbulaiteye
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Göran B Klintmalm
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Angelidakis G, Mahale P, Jonasch E, Jiang Y, Torres HA. Chronic hepatitis C virus infection and genitourinary cancers: A case-control study. Semin Oncol 2020; 47:165-167. [PMID: 32507667 DOI: 10.1053/j.seminoncol.2020.04.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/29/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic Hepatitis C virus (HCV) infection has been associated with extrahepatic cancers. Few studies have reported associations between HCV and genitourinary cancers such as kidney and prostate cancers with inconsistent findings. We sought to study associations between HCV and the most common genitourinary cancers including kidney, prostate and urinary bladder. MATERIAL AND METHODS This case-control study included adult (≥18 years at diagnosis) cancer patients who were screened for HCV antibody (anti-HCV) at MD Anderson Cancer Center from June 2004 through January 2018. Cases had incident primary genitourinary cancers (cancers of the kidney, prostate, renal pelvis and ureter, or urinary bladder). Controls had smoking-associated cancers (esophagus, lung and pancreas). Multivariate logistic regression models were used. RESULTS Among 42,244 patients screened for anti-HCV, 1,493 cases (527 kidney, 691 prostate, 58 renal pelvis and ureter, and 217 urinary bladder cancer) and 1,187 controls (242 esophagus, 709 lung, and 236 pancreas cancer) were studied. In the univariate analysis, the prevalence of anti-HCV positivity did not differ significantly between the controls and the cases with cancers of the renal pelvis and ureter (8% v9%, P = .81), prostate (10% v8%, P = .34), or urinary bladder (8% v 6%, P = .18). In contrast, the prevalence of anti-HCV positivity was lower among the cases with kidney cancer than among the controls (4% v 8%, P< .001). However, in the multivariate analyses after adjustment for cofounders, no significant association between anti-HCV positivity and any genitourinary cancer we evaluated. CONCLUSION Our results do not support an association between chronic HCV and common genitourinary cancers.
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Affiliation(s)
| | - Parag Mahale
- Departments of Infectious Diseases, Infection Control and Employee Health
| | | | - Ying Jiang
- Departments of Infectious Diseases, Infection Control and Employee Health
| | - Harrys A Torres
- Departments of Infectious Diseases, Infection Control and Employee Health; Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Mahale P, Weisenburger DD, Kahn AR, Gonsalves L, Pawlish K, Koch L, Tirado-Gomez M, Clarke CA, Alverson G, Shiels MS, Engels EA. Anaplastic large cell lymphoma in human immunodeficiency virus-infected people and solid organ transplant recipients. Br J Haematol 2020; 192:514-521. [PMID: 32510592 DOI: 10.1111/bjh.16778] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/03/2020] [Indexed: 12/20/2022]
Abstract
Human immunodeficiency virus (HIV)-infected people and solid organ transplant recipients have elevated risk of anaplastic large cell lymphoma (ALCL). Little is known regarding ALCL risk factors in immunosuppressed populations. We used data from US cancer registries linked to HIV registries (1996-2016) and to the national transplant registry (1992-2017). ALCL risk in HIV-infected people and transplant recipients relative to the general population was calculated as a standardized incidence ratio (SIR). ALCL risk factors were evaluated using Poisson regression. We identified 121 incident ALCL cases in the HIV (n = 86) and transplant (n = 35) populations. We reviewed pathology reports for 45 cases and most (86·7%) were confirmed as ALCL. Epstein-Barr virus tested positive in 1/8 (12·5%) cases. Compared to the general population, ALCL risk was strongly elevated among HIV-infected people [SIR 5·43; 95% confidence interval (CI) 4·27-6·81] and transplant recipients (5·96; 4·03-8·49). Among HIV-infected people, ALCL incidence was strongly related to CD4 count [adjusted incidence rate ratio (aIRR) 0·15 for ≥500 vs. <200 cells/μl; P trend < 0·001]. Among transplant recipients, risk was highest within the first year (aIRR 6·82) and 10+ years post-transplant (5·99). In conclusion, ALCL risk is strongly increased in these immunosuppressed populations but may be unrelated to EBV infection based on limited reports.
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Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Amy R Kahn
- New York State Cancer Registry, Albany, NY, USA
| | | | - Karen Pawlish
- Cancer Epidemiology Services, Department of Health, New Jersey State Cancer Registry, Trenton, NJ, USA
| | - Lori Koch
- Illinois State Cancer Registry, Springfield, IL, USA
| | - Maribel Tirado-Gomez
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | | | - Georgetta Alverson
- Michigan Department of Community Health, Michigan Cancer Surveillance Program, Lansing, MI, USA
| | - Meredith S Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Liu Z, Mahale P, Engels EA. Sepsis and Risk of Cancer Among Elderly Adults in the United States. Clin Infect Dis 2020; 68:717-724. [PMID: 29982318 DOI: 10.1093/cid/ciy530] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 05/04/2018] [Accepted: 06/27/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sepsis is an important cause of mortality among older adults in the United States. The association between sepsis and subsequent risk of cancer is poorly understood. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we conducted a case-control study in US adults. We included 1801156 cases with a first cancer diagnosis in SEER during 1992-2013 (ages 66-115 years) and 200000 cancer-free controls from a 5% random sample of Medicare beneficiaries. Sepsis was identified using inpatient Medicare claims. Associations with sepsis were estimated using logistic regression. RESULTS After correction for multiple comparisons, sepsis was significantly associated with increased risk for cancers of the colon (adjusted odds ratio [aOR] = 1.12), rectum (1.13), liver (1.47), lung (1.17), and cervix (1.52), as well as acute myeloid leukemia (AML, 1.19), chronic myeloid leukemia (1.54), and myelodysplastic syndrome (1.30). Inverse associations were observed for cancers of the breast (aOR = 0.86), prostate (0.75), kidney (0.90), and thyroid (0.68) and for melanoma (0.83), diffuse large B-cell lymphoma (0.89), and follicular lymphoma (0.65). Sepsis was significantly associated with the following 9 types of cancer in the period >5 years following sepsis diagnosis: thyroid, prostate, colon, rectum, lung, and liver and follicular lymphoma, melanoma, and AML. CONCLUSIONS Sepsis is associated with increased or decreased risks for a small group of cancers. Factors that may explain these associations include etiologic effects. Other associations may reflect the presence of precursor conditions or patterns in ascertainment of cancer and screening.
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Affiliation(s)
- Zhiwei Liu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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12
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Mahale P, Herr MM, Engels EA, Pfeiffer RM, Shiels MS. Autoimmune conditions and primary central nervous system lymphoma risk among older adults. Br J Haematol 2019; 188:516-521. [PMID: 31625136 DOI: 10.1111/bjh.16222] [Citation(s) in RCA: 4] [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] [Received: 05/20/2019] [Accepted: 08/04/2019] [Indexed: 12/26/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) risk is highly increased in immunosuppressed individuals, such as those with human immunodeficiency virus infection and solid organ transplant recipients, but rates are increasing among immunocompetent older adults (age ≥65 years). We utilized data from a large, nationally-representative cohort of older adults in the United States and found that PCNSL is significantly associated with systemic lupus erythematosus, polyarteritis nodusa, autoimmune hepatitis, myasthenia gravis and uveitis. Immunosuppressive drugs given to treat these conditions may increase PCNSL risk, but these associations cannot explain the observed temporal increase in PCNSL rates, given the low prevalence of these conditions.
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Affiliation(s)
- Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Megan M Herr
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.,Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Coghill AE, Engels EA, Schymura MJ, Mahale P, Shiels MS. Risk of Breast, Prostate, and Colorectal Cancer Diagnoses Among HIV-Infected Individuals in the United States. J Natl Cancer Inst 2019. [PMID: 29529223 DOI: 10.1093/jnci/djy010] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Although people living with HIV or AIDS (PLWHA) are at higher risk for many cancers, breast, prostate, and colorectal cancer rates are lower in this patient population. Because these tumors are often screen-detected, these inverse associations could be driven by HIV-related differences in utilization of cancer screening. Methods We ascertained incident breast, prostate, and colorectal cancer in PLWHA using data from the HIV/AIDS Cancer Match Study (1996-2012). Comparisons with general population cancer rates were made using standardized incidence ratios (SIRs), overall and stratified by tumor stage/size, breast cancer estrogen receptor status, and colorectal site. We also examined the potential effect of study design and unmeasured confounding on inverse standardized incidence ratios. Results Compared with the general population, PLWHA had lower rates of invasive breast (SIR = 0.63, 95% confidence interval [CI] = 0.58 to 0.68), prostate (SIR = 0.48, 95% CI = 0.46 to 0.51), proximal colon (SIR = 0.67, 95% CI = 0.59 to 0.75), distal colon (SIR = 0.51, 95% CI = 0.43 to 0.59), and rectal cancers (SIR = 0.69, 95% CI = 0.61 to 0.77). Reduced risk persisted across tumor stage/size for prostate and colorectal cancers. Although distant-stage breast cancer rates were not reduced (SIR = 0.94, 95% CI = 0.73 to 1.20), HIV-infected women had lower rates of large (>5 cm) breast tumors (SIR = 0.65, 95% CI = 0.50 to 0.83). The magnitude of these inverse standardized incidence ratios could not plausibly be attributed to case underascertainment, out-migration, or unmeasured confounding. Conclusions Breast, prostate, and colorectal cancer rates are markedly lower among PLWHA, including rates of distant-stage/large tumors that are not generally screen-detected. This set of inverse HIV-cancer associations is therefore unlikely to be due primarily to differential screening and may instead represent biological relationships requiring future investigation.
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Affiliation(s)
- Anna E Coghill
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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14
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Mahale P, Aka PV, Chen X, Liu P, Fram BJ, Wang AS, Simenel S, Tseng FC, Chen S, Edlin BR, Glenn JS, O'Brien TR. Hepatitis D Viremia Among Injection Drug Users in San Francisco. J Infect Dis 2019; 217:1902-1906. [PMID: 29800369 DOI: 10.1093/infdis/jiy157] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/19/2018] [Indexed: 12/11/2022] Open
Abstract
People who inject drugs (PWID) are commonly exposed to hepatitis B virus (HBV) and hepatitis D virus (HDV). We evaluated the prevalence of HDV viremia among hepatitis B surface antigen (HBsAg)-positive PWID (n = 73) using a new quantitative microarray antibody capture (Q-MAC) assay, HDV western blot, and HDV RNA. HDV Q-MAC performed well in this cohort: anti-HDV, 100% sensitivity and specificity; HDV viremia, 61.5% sensitivity and 100% specificity. Hepatitis D viremia was present in 35.6% of HBsAg-positive participants and was more common in those with resolved compared to chronic hepatitis C (5.1% vs 0.6%; adjusted odds ratio, 9.80; P < .0001).
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Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Peter V Aka
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.,Demographic and Health Surveys, ICF International, Rockville, Maryland
| | - Xiaohua Chen
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California.,Department of Infectious Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China
| | - Ping Liu
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Benjamin J Fram
- Department of Microbiology and Immunology, Stanford University School of Medicine, Palo Alto, California
| | - Alan S Wang
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Scott Simenel
- Department of Microbiology and Immunology, Stanford University School of Medicine, Palo Alto, California
| | - Fan-Chen Tseng
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Sabrina Chen
- Information Management Services, Calverton, Maryland
| | - Brian R Edlin
- Urban Health Study, University of California San Francisco.,Department of Medicine, Weill Cornell Medical College, New York
| | - Jeffrey S Glenn
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California.,Department of Microbiology and Immunology, Stanford University School of Medicine, Palo Alto, California
| | - Thomas R O'Brien
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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15
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Mahale P, Engels EA, Lynch CF, Morton LM. Cancer risk following post-transplant lymphoproliferative disorders in solid organ transplant recipients. Br J Haematol 2019; 186:347-351. [PMID: 30820931 PMCID: PMC6606327 DOI: 10.1111/bjh.15828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer
Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer
Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Charles F. Lynch
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute,
National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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16
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Mahale P, Aka P, Chen X, Pfeiffer RM, Liu P, Groover S, Mendy M, Njie R, Goedert JJ, Kirk GD, Glenn JS, O’Brien TR. Hepatitis D virus infection, cirrhosis and hepatocellular carcinoma in The Gambia. J Viral Hepat 2019; 26:738-749. [PMID: 30661282 PMCID: PMC6529252 DOI: 10.1111/jvh.13065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/17/2018] [Indexed: 12/16/2022]
Abstract
Hepatocellular carcinoma (HCC) incidence is high in The Gambia, and hepatitis B virus (HBV) infection is the main cause. People coinfected with HBV and hepatitis D virus (HDV) have an even greater risk of HCC and cirrhosis. Using a new HDV quantitative microarray antibody capture (Q-MAC) assay, we evaluated the association between HDV infection and HCC or cirrhosis among participants in The Gambia Liver Cancer Study. In this case-control study, cases had HCC (n = 312) or cirrhosis (n = 119). Controls (n = 470) had no clinical evidence of liver disease and normal serum alpha-foetoprotein. Participants were previously tested for hepatitis B surface antigen (HBsAg); we tested HBsAg+ specimens by HDV Q-MAC, western blot and RNA assays. We evaluated separate cut-offs of the Q-MAC assay for predicting anti-HDV and RNA positivity. Q-MAC correctly identified 29/29 subjects who were western blot-positive (sensitivity = 100%, specificity = 99.4%) and 16/17 who were RNA-positive (sensitivity = 94.1%, specificity = 100%). Compared to controls, cases more often had HBV monoinfection (HBsAg+/HDV RNA-; 54.1% vs 17.0%; odds ratio [OR] = 6.28; P < 0.001) or HBV-HDV coinfection (HBsAg+/HDV RNA+; 3.9% vs 0%; P < 0.001). Risk estimates (for HCC or cirrhosis) based on HDV antibody status and adjusted for covariates (demographics, alcohol, smoking, body mass index, anti-HCV and aflatoxin B1 exposure) yielded consistent results for both HBV monoinfection (adjusted OR = 8.29; 95% confidence interval = 5.74-11.98) and HBV-HDV coinfection (adjusted OR = 30.66; 95% confidence interval = 6.97-134.95). In this Gambian population, HDV Q-MAC had high sensitivity and specificity for both anti-HDV and HDV RNA. HDV infection contributed to the high risk of HCC in The Gambia.
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Affiliation(s)
- Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Peter Aka
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
- International Health Division, Demographic and Health Surveys, ICF International, Rockville, Maryland, USA
| | - Xiaohua Chen
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Infectious Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Ping Liu
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sarah Groover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
- Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Maimuna Mendy
- International Agency for Research on Cancer, Lyon, France
| | - Ramou Njie
- International Agency for Research on Cancer, Lyon, France
- Hepatitis Unit, Disease Control & Elimination, Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - James J. Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeffrey S. Glenn
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Palo Alto, California
| | - Thomas R. O’Brien
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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17
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Triplette M, Crothers K, Mahale P, Yanik EL, Valapour M, Lynch CF, Schabath MB, Castenson D, Engels EA. Risk of lung cancer in lung transplant recipients in the United States. Am J Transplant 2019; 19:1478-1490. [PMID: 30565414 PMCID: PMC6872188 DOI: 10.1111/ajt.15181] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 07/11/2018] [Revised: 10/23/2018] [Accepted: 11/06/2018] [Indexed: 01/25/2023]
Abstract
Lung transplant recipients have an increased risk of lung cancer that is poorly understood. Prior studies are largely descriptive and single-center, and have not examined risk factors or outcomes in this population. This registry-linkage study utilized matched transplant and cancer registry data from 17 US states/regions during 1987-2012. We used standardized incidence ratios (SIRs) to compare incidence with the general population, Poisson models to identify lung cancer risk factors, and Cox models to compare survival after diagnosis. Lung cancer risk was increased among lung recipients (SIR 4.8, 95% confidence interval [CI] 4.1-5.5). Those with single lung transplant had 13-fold (95% CI 11-15) increased risk in the native lung. Native lung cancer risk factors included age, prior smoking, time since transplant, and idiopathic pulmonary fibrosis. Compared with cases in the general population, lung cancers in recipients were more frequently localized stage (P = .02) and treated surgically (P = .05). However, recipients had higher all-cause (adjusted hazard ratio 1.90, 95% CI 1.52-2.37) and cancer-specific mortality (adjusted hazard ratio 1.67, 95% CI 1.28-2.18). In conclusion, lung cancer risk is increased after lung transplant, especially in the native lung of single lung recipients. Traditional risk factors are associated with lung cancer in these patients. Lung cancer survival is worse among lung recipients despite earlier diagnosis.
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Affiliation(s)
- Matthew Triplette
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Elizabeth L. Yanik
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Maryam Valapour
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Charles F. Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Matthew B. Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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18
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Torres HA, Economides MP, Angelidakis G, Hosry J, Kyvernitakis A, Mahale P, Jiang Y, Miller E, Blechacz B, Naing A, Samaniego F, Kaseb A, Raad II, Granwehr BP. Sofosbuvir-Based Therapy in Hepatitis C Virus-Infected Cancer Patients: A Prospective Observational Study. Am J Gastroenterol 2019; 114:250-257. [PMID: 30410039 DOI: 10.1038/s41395-018-0383-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data are sparse on treatment of chronic hepatitis C virus (HCV) in cancer patients. We evaluated the efficacy and safety of sofosbuvir-based therapy (SOFBT) in cancer patients. METHODS Patients treated with SOFBT at our center during 2014-2017 were included in a prospective observational study. Efficacy [sustained virologic response at 12 weeks after the end of treatment (SVR12)], cancer-related outcomes and adverse events (AEs) were assessed. RESULTS We included 153 patients. Most were men (109; 71%), white (92; 60%), non-cirrhotic (105; 69%), and with HCV genotype 1 (110; 72%). The most common cancers were hepatocellular carcinoma (HCC) (27; 18%) and multiple myeloma (14; 9%). The overall SVR12 rate was 91% (128/141). SVR12 was 100% in patients treated with ledipasvir/sofosbuvir for 8 weeks. Of the 32 patients initially excluded from cancer clinical trials because of HCV, 27 (84%) were granted cancer therapy access after starting SOFBT. Six patients with indolent non-Hodgkin's lymphoma (NHL) received SOFBT without cancer treatment. Two achieved complete remission, one had partial remission, and two had stable cancer. Within 6 months after SOFBT, 5% (6/121) of patients in remission or with stable cancer, had progression or recurrence (two with HCC and one each with esophageal cancer, cholangiocarcinoma, NHL, and tonsillar cancer). No de novo HCCs occurred. AEs were most commonly grade 1-2 (90%). CONCLUSIONS SOFBT in HCV-infected cancer patients is effective and safe, may permit access to investigational cancer therapy expanding treatment options, may induce remission of NHL, and may be used for 8 weeks.
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Affiliation(s)
- Harrys A Torres
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Departments of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Minas P Economides
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Internal Medicine, University of Texas School of Health Sciences at Houston, Houston, Texas, USA
| | - Georgios Angelidakis
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeff Hosry
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andreas Kyvernitakis
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Internal Medicine, Allegheny General Hospital, Houston, Texas, USA
| | - Parag Mahale
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Houston, Texas, USA
| | - Ying Jiang
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ethan Miller
- Departments of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Boris Blechacz
- Departments of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aung Naing
- Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Felipe Samaniego
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahmed Kaseb
- Departments of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bruno P Granwehr
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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19
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Mahale P, Engels EA, Koshiol J. Hepatitis B virus infection and the risk of cancer in the elderly US population. Int J Cancer 2018; 144:431-439. [DOI: 10.1002/ijc.31643] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/08/2018] [Accepted: 05/22/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer Institute Rockville MD
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer Institute Rockville MD
| | - Jill Koshiol
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer Institute Rockville MD
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20
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Suk R, Mahale P, Sonawane K, Sikora AG, Chhatwal J, Schmeler KM, Sigel K, Cantor SB, Chiao EY, Deshmukh AA. Trends in Risks for Second Primary Cancers Associated With Index Human Papillomavirus-Associated Cancers. JAMA Netw Open 2018; 1:e181999. [PMID: 30646145 PMCID: PMC6324459 DOI: 10.1001/jamanetworkopen.2018.1999] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE In the last 4 decades, survival among patients with human papillomavirus (HPV)-associated cancers has improved, while the incidence of these cancers has increased among younger cohorts. Among survivors of HPV-associated cancers, persistent HPV infection may remain a risk factor for preventable HPV-associated second primary cancers (HPV-SPCs). OBJECTIVES To investigate the risk of HPV-SPCs among survivors of HPV-associated index cancers and to test the hypothesis that the HPV-SPC risk among these persons has increased over the last 4 decades. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 9 cancer registries of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HPV-associated (cervical, vaginal, vulvar, oropharyngeal, anal, and penile) cancers diagnosed from January 1, 1973, through December 31, 2014. The dates of analysis were July 1, 2017, to January 31, 2018. MAIN OUTCOMES AND MEASURES The HPV-SPC risk was quantified by calculating standard incidence ratios (SIRs) and excess absolute risks (EARs) per 10 000 person-years at risk (PYR). The HPV-SPC risk by time was estimated using Poisson regression. RESULTS From 113 272 (73 085 female and 40 187 male) survivors of HPV-associated cancers, 1397 women and 1098 men developed HPV-SPCs. The SIRs for HPV-SPCs were 6.2 (95% CI, 5.9-6.6) among women and 15.8 (95% CI, 14.9-16.8) among men. The EARs were 18.2 per 10 000 PYR for women and 53.5 per 10 000 PYR for men. Among both women and men, those who had index oropharyngeal cancers had the highest HPV-SPC risk (SIR, 19.8 [95% CI, 18.4-21.4] and EAR, 80.6 per 10 000 PYR among women; SIR, 18.0 [95% CI, 16.9-19.1] and EAR, 61.5 per 10 000 PYR among men). Women who had index cervical cancers and men who had index anal cancers had the lowest HPV-SPC risk (SIR, 2.4 [95% CI, 2.2-2.7] and EAR, 4.5 per 10 000 PYR among women; SIR, 6.5 [95% CI, 4.7-8.8] and EAR, 18.5 per 10 000 PYR among men). Both women and men who had index HPV-associated cancers of any kind had a significantly higher risk of oropharyngeal HPV-SPCs. Over the last 4 decades, the risk of developing most types of HPV-SPCs after index cervical, vaginal, and vulvar cancers increased. CONCLUSIONS AND RELEVANCE According to this study, the HPV-SPC risk among survivors of HPV-associated cancers is significant, implying that persistent HPV infection at multiple sites may be associated with HPV-SPCs. These findings have the potential to inform surveillance recommendations for survivors of HPV-associated cancers.
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Affiliation(s)
- Ryan Suk
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Kalyani Sonawane
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Andrew G. Sikora
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott B. Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Elizabeth Y. Chiao
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ashish A. Deshmukh
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
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21
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Mahale P, Engels EA, Coghill AE, Kahn AR, Shiels MS. Cancer Risk in Older Persons Living With Human Immunodeficiency Virus Infection in the United States. Clin Infect Dis 2018; 67:50-57. [PMID: 29325033 PMCID: PMC6248478 DOI: 10.1093/cid/ciy012] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 10/02/2017] [Accepted: 01/06/2018] [Indexed: 01/11/2023] Open
Abstract
Background Cancer risk is increased in persons living with human immunodeficiency virus (HIV) (PLWH). Improved survival has led to an aging of PLWH. We evaluated the cancer risk in older PLWH (age ≥50 years). Methods We included data from the HIV/AIDS Cancer Match Study (1996-2012) and evaluated risks of Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, and cervical, anal, lung, liver, oral cavity/pharyngeal, breast, prostate, and colon cancers in older PLWH with risk in the general population by calculating standardized incidence ratios (SIRs) and excess absolute risks (EARs). Cancer risk by time since HIV diagnosis was estimated using Poisson regression. Results We identified 10371 cancers among 183542 older PLWH. Risk was significantly increased for KS (SIR, 103.34), NHL (3.05), Hodgkin lymphoma (7.61), and cervical (2.02), anal (14.00), lung (1.71), liver (2.91), and oral cavity/pharyngeal (1.66) cancers, and reduced for breast (0.61), prostate (0.47), and colon (0.63) cancers. SIRs declined with age for all cancers; however, EARs increased with age for anal, lung, liver, and oral cavity/pharyngeal cancers. Cancer risk was highest for most cancers within 5 years after HIV diagnosis; risk decreased with increasing time since HIV diagnosis for KS, NHL, lung cancer, and Hodgkin lymphoma. Conclusions Cancer risk is elevated among older PLWH. Although SIRs decrease with age, EARs are higher for some cancers, reflecting a greater absolute excess in cancer incidence among older PLWH. High risk in the first 5 years after HIV diagnosis for some cancers highlights the need for early HIV diagnosis and rapid treatment initiation.
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Affiliation(s)
- Parag Mahale
- Division of Cancer Epidemiology & Genetics, National Cancer Institute,
Rockville, Maryland
| | - Eric A Engels
- Division of Cancer Epidemiology & Genetics, National Cancer Institute,
Rockville, Maryland
| | - Anna E Coghill
- Division of Cancer Epidemiology & Genetics, National Cancer Institute,
Rockville, Maryland
| | - Amy R Kahn
- New York State Cancer Registry, New York State Department of Health,
Albany
| | - Meredith S Shiels
- Division of Cancer Epidemiology & Genetics, National Cancer Institute,
Rockville, Maryland
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22
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Suk R, Mahale P, Sonawane K, Sikora AG, Chhatwal J, Schmeler KM, Sigel K, Cantor SB, Chiao E, Deshmukh AA. Risk of second primary HPV-associated cancers after index HPV-associated cancers. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ryan Suk
- University of Florida, Gainesville, FL
| | | | | | | | | | | | - Keith Sigel
- Mount Sinai School of Medicine, New York, NY, US
| | - Scott B. Cantor
- The University of Texas MD Anderson Cancer Center, Houston, TX
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23
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Mahale P, Engels EA, Li R, Torres HA, Hwang LY, Brown EL, Kramer JR. The effect of sustained virological response on the risk of extrahepatic manifestations of hepatitis C virus infection. Gut 2018; 67. [PMID: 28634198 PMCID: PMC6292199 DOI: 10.1136/gutjnl-2017-313983] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Chronic HCV infection is associated with several extrahepatic manifestations (EHMs). Data on the effect of sustained virological response (SVR) on the risk of EHMs are limited. METHODS We conducted a retrospective cohort study using data of patients from the US Veterans Affairs HCV Clinical Case Registry who had a positive HCV RNA test (10/1999-08/2009). Patients receiving interferon-based antiviral therapy (AVT) were identified. SVR was defined as negative HCV RNA at least 12 weeks after end of AVT. Risks of eight incident EHMs were evaluated in Cox regression models. RESULTS Of the 160 875 HCV-infected veterans, 31 143 (19.4%) received AVT, of whom 10 575 (33.9%) experienced SVR. EHM risk was reduced in the SVR group compared with untreated patients for mixed cryoglobulinaemia (adjusted HR (aHR)=0.61; 95% CI 0.39 to 0.94), glomerulonephritis (aHR=0.62; 95% CI 0.48 to 0.79), porphyria cutanea tarda (PCT) (aHR=0.41; 95% CI 0.20 to 0.83), non-Hodgkin's lymphoma (NHL) (aHR=0.64; 95% CI 0.43 to 0.95), diabetes (aHR=0.82; 95% CI 0.76 to 0.88) and stroke (aHR=0.84; 95% CI 0.74 to 0.94), but not for lichen planus (aHR=1.11; 95% CI 0.78 to 1.56) or coronary heart disease (aHR=1.12; 95% CI 0.81 to 1.56). Risk reductions were also observed when patients with SVR were compared with treated patients without SVR for mixed cryoglobulinaemia, glomerulonephritis, PCT and diabetes. Significant reductions in the magnitude of aHRs towards the null with increasing time to initiation of AVT after HCV diagnosis were observed for glomerulonephritis, NHL and stroke. CONCLUSIONS Risks of several EHMs of HCV infection are reduced after AVT with SVR. However, early initiation of AVT may be required to reduce the risk of glomerulonephritis, NHL and stroke.
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Affiliation(s)
- Parag Mahale
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas,Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas,Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Ruosha Li
- Department of Biostatistics, The University of Texas School of Public Health, Houston, Texas
| | - Harrys A. Torres
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Eric L. Brown
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Jennifer R. Kramer
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas,Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas
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Torres HA, Roach LR, Mahale P, Economides MP, Blechacz B, Miller E, Borchardt R, Rashid A, Oo TH, Shukla B, Farida M, Ericsson CD, Granwehr BP, Raad II. Transdisciplinary Approach to Managing Hepatitis C Virus Infection in Patients at a Tertiary Care Cancer Center. J Natl Compr Canc Netw 2018; 14:1185-8. [PMID: 27587628 DOI: 10.6004/jnccn.2016.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mahale P, Shiels MS, Lynch CF, Engels EA. Incidence and outcomes of primary central nervous system lymphoma in solid organ transplant recipients. Am J Transplant 2018; 18:453-461. [PMID: 28805292 PMCID: PMC5790603 DOI: 10.1111/ajt.14465] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 05/10/2017] [Revised: 07/14/2017] [Accepted: 08/06/2017] [Indexed: 01/25/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) risk is greatly increased in immunosuppressed human immunodeficiency virus-infected people. Using data from the US transplant registry linked with 17 cancer registries (1987-2014), we studied PCNSL and systemic non-Hodgkin lymphoma (NHL) in 288 029 solid organ transplant recipients. Transplant recipients had elevated incidence for PCNSL compared with the general population (standardized incidence ratio = 65.1; N = 168), and this elevation was stronger than for systemic NHL (standardized incidence ratio=11.5; N = 2043). Compared to kidney recipients, PCNSL incidence was lower in liver recipients (adjusted incidence rate ratio [aIRR] = 0.52), similar in heart and/or lung recipients, and higher in other/multiple organ recipients (aIRR = 2.45). PCNSL incidence was higher in Asians/Pacific Islanders than non-Hispanic whites (aIRR = 2.09); after induction immunosuppression with alemtuzumab (aIRR = 3.12), monoclonal antibodies (aIRR = 1.83), or polyclonal antibodies (aIRR = 2.03); in recipients who were Epstein-Barr virus-seronegative at the time of transplant and at risk of primary infection (aIRR = 1.95); and within the first 1.5 years after transplant. Compared to other recipients, those with PCNSL had increased risk of death (adjusted hazard ratio [aHR] = 11.79) or graft failure/retransplantation (aHR = 3.24). Recipients with PCNSL also had higher mortality than those with systemic NHL (aHR = 1.48). In conclusion, PCNSL risk is highly elevated among transplant recipients, and it carries a poor prognosis.
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Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Meredith S. Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Charles F. Lynch
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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Torres HA, Hosry J, Mahale P, Economides MP, Jiang Y, Lok AS. Hepatitis C virus reactivation in patients receiving cancer treatment: A prospective observational study. Hepatology 2018; 67:36-47. [PMID: 28653760 PMCID: PMC5739995 DOI: 10.1002/hep.29344] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/17/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) reactivation in patients receiving cancer treatment has been reported in retrospective studies. We sought to determine prospectively the incidence, predictors, and clinical significance of HCV reactivation during cancer treatment. HCV-infected patients receiving cancer treatment at our institution between November 2012 and July 2016 were studied. Reactivation was defined as an increase in HCV-RNA ≥1 log10 IU/mL over baseline and hepatitis flare as an increase in alanine aminotransferase to ≥3 times the upper limit of normal. One hundred patients were studied, 50 with hematologic malignancies and 50 with solid tumors. Reactivation occurred in 23 (23%) patients, including 18 (36%) patients with hematologic malignancies and 5 (10%) patients with solid tumors. In univariate analysis, patients with reactivation were more likely than those without reactivation to have prolonged lymphopenia (median, 95 versus 22 days; P = 0.01) and to have received rituximab (44% versus 9%; P < 0.0001), bendamustine (22% versus 0%; P < 0.001), high-dose steroids (57% versus 21%; P = 0.001), or purine analogs (22% versus 5%; P = 0.02). Rituximab (odds ratio = 9.52; P = 0.001), and high-dose steroids (odds ratio = 5.05; P = 0.01) retained significance in multivariable analysis. Of the 23 patients with reactivation, 10 (43%) had hepatitis flare. No patient with reactivation experienced liver failure or liver-related death within 36 weeks after initiation of cancer treatment. Fourteen patients with hepatitis flare, six of whom had reactivation, required discontinuation or dose reduction of cancer treatment. CONCLUSION HCV reactivation occurred in 23% of HCV-infected patients receiving cancer treatment, and most had an unremarkable clinical course. However, reactivation can affect the cancer treatment plan. Our findings suggest that HCV infection should not contraindicate cancer therapy and infected patients should have access to multiple cancer treatments with close monitoring while receiving regimens associated with HCV reactivation. (Hepatology 2018;67:36-47).
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Affiliation(s)
- Harrys A. Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeff Hosry
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Minas P. Economides
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anna S. Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Mahale P, Glenn JS, O'Brien TR. Hepatitis B Virus Reactivation Associated With Direct-Acting Antiviral Therapy for Chronic Hepatitis C Virus. Ann Intern Med 2017; 167:759-760. [PMID: 29159388 PMCID: PMC7325517 DOI: 10.7326/l17-0476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Parag Mahale
- From National Cancer Institute, Rockville, Maryland, and Stanford University, Palo Alto, California
| | - Jeffrey S Glenn
- From National Cancer Institute, Rockville, Maryland, and Stanford University, Palo Alto, California
| | - Thomas R O'Brien
- From National Cancer Institute, Rockville, Maryland, and Stanford University, Palo Alto, California
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Mahale P, Shiels MS, Engels EA. Abstract 273: Risk of primary central nervous system lymphomas in solid organ transplant recipients. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The risk of primary central nervous system lymphoma (PCNSL) is greatly increased in HIV-infected people. Case series have described PCNSL in immunosuppressed solid organ transplant (SOT) recipients (SOTRs). Herein, we examine the incidence and risk factors for PCNSL in SOTRs.
Methods: We used data from the Transplant Cancer Match Study, which links the US transplant registry with 17 cancer registries (1987 - 2014). PCNSL risk relative to the general population was estimated as a standardized incidence ratio (SIR = observed/expected cases). Poisson regression was used to estimate adjusted incidence rate ratios (aIRR) of PCNSL across subgroups of SOTRs. Logistic regression was used for case-case comparisons of PCNSL with other non-Hodgkin lymphomas (NHL).
Results: We included 288,637 SOTs. There were 173 PCNSL cases (SIR 57.7; 95%CI 49.4-66.9) and 2,583 other NHLs (SIR 7.3; 95%CI 7.0-7.6). Most PCNSL were diffuse large B-cell lymphomas (n=118; 68.2%). Compared to kidney SOTRs, PCNSL risk was lower in liver SOTRs (aIRR 0.5; 95%CI 0.3-0.9), not different in heart and/or lung SOTRs (aIRR 0.9; 95%CI 0.6-1.5) and higher in other/multiple SOTRs (aIRR 2.4; 95%CI 1.5-3.8). Asians/Pacific Islanders had higher PCNSL risk than non-Hispanic whites (aIRR 2.0; 95%CI 1.2-3.3). People who received induction therapy with alemtuzumab (aIRR 2.8; 95%CI 1.5-5.5) or polyclonal antibodies (aIRR 1.9; 95%CI 1.3-2.8) had higher PCNSL risk. SOTRs who were seronegative for Epstein-Barr virus (EBV) at transplant had higher risk (aIRR 2.0; 95%CI 1.1-3.5) than seropositive SOTRs. PCNSL risk was high in the first 1.5 years after SOT (0.5-1 year, aIRR 2.6; 1-1.5 years, aIRR 2.3; vs. 0-0.5 year) and progressively decreased over time (ptrend<0.0001). Risk did not differ according to the age at SOT, sex, or maintenance immunosuppressive regimen. Compared to other NHL, PCNSL cases were more likely to be middle aged (18-64 years) at transplant (p=0.009), Asians/Pacific Islanders (p=0.02), or have received induction therapy with polyclonal antibodies (p=0.002), and less likely to be liver or heart and/or lung SOTRs (p=0.02). EBV serostatus did not differ between PCNSL and other NHL (p=0.11). Conclusions: PCNSL risk is very elevated among SOTRs. Because EBV-seronegative SOTRs are at risk of primary infection after SOT, these results highlight the important contribution of EBV to PCNSL. Risk is highest within 1.5 years after transplant, in people who receive multiple non-thoracic organs, and is associated with induction therapy with alemtuzumab or polyclonal antibodies. Case-case differences with other NHLs suggest unique etiologic factors leading to PCNSL.
Citation Format: Parag Mahale, Meredith S. Shiels, Eric A. Engels. Risk of primary central nervous system lymphomas in solid organ transplant recipients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 273. doi:10.1158/1538-7445.AM2017-273
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Economides MP, Sturgis EM, Amit M, Hosry J, Mahale P, Jiang Y, Torres HA. The impact of chronic hepatitis C virus infection on survival in oropharyngeal cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e17556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17556 Background: An association between Hepatitis C virus (HCV) infection and oropharyngeal cancers (OPCs) has been reported; however, the clinical significance of this epidemiological finding remains unknown. We therefore analyzed the oncologic outcomes of HCV-infected patients (pts) with OPCs. Methods: In this retrospective cohort study, all pts with OPCs seen at MD Anderson (1/2004-12/2015) were reviewed. HCV infection was defined as detectable HCV RNA in serum. Risk of 5-year (yr) overall survival (OS) and progression-free survival (PFS) was compared between HCV-infected (HCV+) and uninfected (HCV-) pts. OPCs that were positive for p16 by immunohistochemistry were considered HPV-related. Antiviral therapy (AVT) included either interferon (IFN)-based or IFN-free regimens. Multivariate cox proportional hazards model was used to identify independent predictors of mortality. Results: We studied 161 pts. Most of the pts were white (141; 88%), male (132; 82%) and had tumor stage 3 or 4 (147; 92%). The OPC involved tonsils (83; 52%), base of tongue (67; 42%) or soft palate (11; 7%). The median follow-up time after OPC diagnosis was 3 yrs (range: 1-13 yrs). HCV+ (n = 25) and HCV- pts (n = 136) were comparable in regards to smoking and alcohol status. In univariate analysis, HCV+ pts had more OPC progression after 1stline cancer treatment (48% vs 20.6% in HCV-, P = .0009) and were more likely to relapse (26% vs 5% in HCV-, P = .02). In multivariate analysis, HCV was associated with increased all-cause mortality [hazard ratio (HR): 2.15, 95% confidence intervals (CI): 1.08-6.85; P = .02] and risk of OPC progression [HR: 5.42, 95% CI: 2.64-11.14; P = .0008] independent of age and cirrhosis status. In HPV+ OPCs (n = 86), HCV + and HCV- pts did not have significant difference in mortality [HR: 2.03, 95% CI: 0.82-4.98; P = .12]. AVT was administered after OPC diagnosis in 8 of the 25 HCV+ pts (32%), with 6 of them receiving IFN-free AVT. HCV+ pts that received AVT had better 5 yr OS (median of 5.2 vs 2.3 yrs, P = .005) and PFS (median of 3.1 vs 0.7 yrs, P = .007) than the ones who did not. Conclusions: HCV seems to affect the oncologic outcomes of pts with OPCs and treating this infection might be beneficial. HCV screening and treatment should be considered in such pts.
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Affiliation(s)
- Minas P. Economides
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Jeff Hosry
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ying Jiang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Harrys A. Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
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Torres HA, Economides MP, Kyvernitakis A, Mahale P, Hosry J, Naing A, Turturro F, Kaseb AO, Raad II, Granwehr BP. Sofosbuvir-based therapy in patients with chronic hepatitis C virus infection and malignancies: A prospective study of 143 patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e18152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18152 Background: Data on the management of chronic hepatitis C virus (HCV) infection in cancer patients (pts) are sparse with many of them excluded from cancer clinical trials (CCT). We evaluated the efficacy and safety of sofosbuvir-based therapy (SOFBT) in such pts. Methods: Consecutiveptstreated with SOFBT at MD Anderson (1/2014-2/2017) were included in a prospective observational study. Efficacy (sustained virological response 12 weeks [SVR12] after SOFBT) was assessed based on intention to treat (ITT) analysis. A posthoc per-protocol analysis (PPA) was performed on pts with 12 weeks of follow-up post SOFBT. Adverse events (AEs) and drug-drug interactions (DDIs) were evaluated. Results: Of the 143 pts studied, the majority were men (102; 89%), white (89; 62%) and had genotype 1 (103; 72%). The most common cancers were non-Hodgkin lymphoma (NHL), hepatocellular carcinoma (HCC) (24; 17%, each) and breast cancer (11; 8%). Of the 31 infected pts excluded from CCTs, 27 (87%) were granted access after SVR. The overall SVR12 were 90% ITT (129/143) and 91% PPA (118/130). SVR12 ITT were 80% (8/10) for SOF+peg-interferon+ ribavirin, 86% (24/28) for SOF+ ribavirin, 95% (20/21) for SOF+simeprevir, 90% (64/71) for SOF/ledipasvir, 100% (8/8) for SOF+daclatasvir and 100% (5/5) for SOF/velpatasvir. The most common AEs were grade 1 (50; 35%), predominantly anemia (22%). DDIs or grade 4 AEs did not occur. Two pts died during the study period, both from reasons unrelated to SOFBT. In 3 pts with HCV-associated NHL, SOFBT was used alone without chemotherapy. Two of them had splenic marginal zone NHL and achieved complete remission (CR); the remaining pt had follicular lymphoma with stable cancer (SC) after SOFBT. No cases of de novo HCC occurred within 6 months of SOFBT. In the same period, 10% (4/40) of pts with SC had progression (acute leukemia, breast cancer, HCC and NHL in 1 each) and 5% (4/75) of pts with CR developed relapse (acute leukemia in 3, NHL in 1). More pts who failed SOFBT had cirrhosis (77% vs 27%, P = .001) and poorer adherence (≥ 2 missed appointments) (43% vs 4%, P = .001) than those with SVR. Conclusions: SOFBT is effective and safe in cancer pts; it improves access to CCT and may induce CR in selected NHL pts.
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Affiliation(s)
- Harrys A. Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Minas P. Economides
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andreas Kyvernitakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jeff Hosry
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aung Naing
- Department of Investigational Cancer Therapeutics (Phase I Program), The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Issam I. Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
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Mahale P, Torres HA, Kramer JR, Hwang LY, Li R, Brown EL, Engels EA. Hepatitis C virus infection and the risk of cancer among elderly US adults: A registry-based case-control study. Cancer 2017; 123:1202-1211. [PMID: 28117886 DOI: 10.1002/cncr.30559] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [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: 08/23/2016] [Revised: 10/06/2016] [Accepted: 10/25/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection causes hepatocellular carcinoma (HCC) and subtypes of non-Hodgkin lymphoma (NHL). Associations with other cancers are not established. The authors systematically assessed associations between HCV infection and cancers in the US elderly population. METHODS This was a registry-based case-control study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data in US adults aged ≥66 years. Cases (n = 1,623,538) were patients who had first cancers identified in SEER registries (1993-2011). Controls (n = 200,000) were randomly selected, cancer-free individuals who were frequency-matched to cases on age, sex, race, and calendar year. Associations with HCV (documented by Medicare claims) were determined using logistic regression. RESULTS HCV prevalence was higher in cases than in controls (0.7% vs 0.5%). HCV was positively associated with cancers of the liver (adjusted odds ratio [aOR] = 31.5; 95% confidence interval [CI], 29.0-34.3), intrahepatic bile duct (aOR, 3.40; 95% CI, 2.52-4.58), extrahepatic bile duct (aOR, 1.90; 95% CI, 1.41-2.57), pancreas (aOR, 1.23; 95% CI, 1.09-1.40), and anus (aOR, 1.97; 95% CI, 1.42-2.73); nonmelanoma nonepithelial skin cancer (aOR, 1.53; 95% CI, 1.15-2.04); myelodysplastic syndrome (aOR, 1.56; 95% CI, 1.33-1.83); and diffuse large B-cell lymphoma (aOR, 1.57; 95% CI, 1.34-1.84). Specific skin cancers associated with HCV were Merkel cell carcinoma (aOR, 1.92; 95% CI, 1.30-2.85) and appendageal skin cancers (aOR, 2.02; 95% CI, 1.29-3.16). Inverse associations were observed with uterine cancer (aOR, 0.64; 95% CI, 0.51-0.80) and prostate cancer (aOR, 0.73; 95% CI, 0.66-0.82). Associations were maintained in sensitivity analyses conducted among individuals without documented alcohol abuse, cirrhosis, or hepatitis B or human immunodeficiency virus infections and after adjustment for socioeconomic status. Associations of HCV with other cancers were not observed. CONCLUSIONS HCV is associated with increased risk of cancers other than HCC in the US elderly population, notably bile duct cancers and diffuse large B-cell lymphoma. These results support a possible etiologic role for HCV in an expanded group of cancers. Cancer 2017;123:1202-1211. © 2016 American Cancer Society.
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Affiliation(s)
- Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.,Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Harrys A Torres
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer R Kramer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Ruosha Li
- Department of Biostatistics, The University of Texas School of Public Health, Houston, Texas
| | - Eric L Brown
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Kyvernitakis A, Pappas O, Farmakiotis D, Mahale P, Horn E, Murali S, Benza R, Bailey S, Agarwal R. Predictors and Clinical Implications of Bloodstream Infections in Continuous Flow Left Ventricular Assist Device Recipients: A Single Institutional Experience of 212 Patients. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Economides MP, Mahale P, Kyvernitakis A, Turturo F, Kantarjian H, Naing A, Hosry J, Shigle TL, Kaseb A, Torres HA. Concomitant use of direct-acting antivirals and chemotherapy in hepatitis C virus-infected patients with cancer. Aliment Pharmacol Ther 2016; 44:1235-1241. [PMID: 27730654 PMCID: PMC5123740 DOI: 10.1111/apt.13825] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/11/2016] [Accepted: 09/21/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Antiviral therapy improves hepatic outcomes in hepatitis C virus (HCV)-infected cancer patients. However, such patients are not treated simultaneously with antivirals and chemotherapy, owing to overlapping toxicities with previous standard of care treatment of pegylated interferon and ribavirin. AIM To examine the safety and clinically-significant drug-drug interactions observed in patients who received simultaneous treatment with direct-acting antivirals (DAAs) and chemotherapy. METHODS Safety was determined by the presence of adverse events which were graded according to the division of AIDS Table (version 2.0). Adverse events were monitored throughout antiviral treatment and up to 3 months after its completion. Drug-drug interactions were assessed using current online databases. Sustained virological response (SVR) was defined as absence of serum HCV RNA 12 weeks after end of DAA treatment. Cirrhosis was diagnosed via imaging, biopsy or with the use of non-invasive fibrosis markers. RESULTS Twenty-one patients received concomitant treatment with DAAs and chemotherapy between January 2013 and September 2016. Concomitant treatment was started either for virological (14; 67%) or oncologic (7; 33%) reasons. DAAs used were sofosbuvir, ledipasvir, simeprevir, daclatasvir ± ribavirin. The adverse events observed were mainly constitutional (12; 57%), hematological and gastrointestinal (7; 33% each). Physicians changed the DAA regimens in two patients (10%) in anticipation of drug-drug interactions with daclatasvir and dexamethasone. The overall SVR rate was 95% (20/21). CONCLUSIONS Hepatitis C virus-targeted antiviral therapy can be used concomitantly with selected anti-neoplastic agents under close monitoring for drug-drug interactions. This therapeutic intervention may prevent delay in the administration of chemotherapy in HCV-infected cancer patients.
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Affiliation(s)
- Minas P. Economides
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andreas Kyvernitakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Francesco Turturo
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeff Hosry
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Terri L. Shigle
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed Kaseb
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Harrys A. Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Correspondence: Dr. Harrys A. Torres, Department of Infectious Diseases, Infection Control and Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: 713-792-6503; Fax: 713-745-6839;
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Economides MP, Mahale P, Hosry J, Jiang Y, Granwehr B, Torres H. Sofosbuvir-Based Therapy in Patients With Chronic Hepatitis C Virus Infection and Malignancies: A Prospective Observational Study of 60 Patients. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Parag Mahale
- Infectious Department, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeff Hosry
- Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Jiang
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno Granwehr
- Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Harrys Torres
- Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas
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Torres HA, Vauthey JN, Economides MP, Mahale P, Kaseb A. Hepatocellular carcinoma recurrence after treatment with direct-acting antivirals: First, do no harm by withdrawing treatment. J Hepatol 2016; 65:862-864. [PMID: 27255582 DOI: 10.1016/j.jhep.2016.05.034] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Minas Platon Economides
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed Kaseb
- Department of Gastroentestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Hosry J, Mahale P, Turturro F, Miranda RN, Economides MP, Granwehr BP, Torres HA. Antiviral therapy improves overall survival in hepatitis C virus-infected patients who develop diffuse large B-cell lymphoma. Int J Cancer 2016; 139:2519-28. [PMID: 27501007 DOI: 10.1002/ijc.30372] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/07/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022]
Abstract
Chronic Hepatitis C virus (HCV) infection is associated with increased incidence of non-Hodgkin lymphoma. Several studies have demonstrated regression of indolent lymphoma with antiviral therapy (AVT) alone. However, the role of AVT in HCV-infected patients with diffuse large B-cell lymphoma (DLBCL) is unclear. We therefore analyzed AVT's impact on oncologic outcomes of HCV-infected patients (cases) who developed DLBCL. Cases seen at our institution (June 2004-May 2014) were matched with uninfected counterparts (controls) and then divided according to prior AVT consisting of interferon-based regimens. We studied 304 patients (76 cases and 228 controls). More cases than controls had extranodal (79% vs. 72%; p = 0.07) and upper gastrointestinal (GI; 42% vs. 24%; p = 0.004) involvement. Cases never given AVT had DLBCL more refractory to first-line chemotherapy than that in the controls (33% vs. 17%; p = 0.05) and exhibited a trend toward more progressive lymphoma at last examination compared to controls (50% vs. 32%; p = 0.09) or cases given AVT (50% vs. 27%; p = 0.06). Cases never given AVT had worse 5-year overall survival (OS) rates than did the controls (HR, 2.3 [95% CI, 1.01-5.3]; p = 0.04). Furthermore, AVT improved 5-year OS rates among cases in both univariate (median [Interquartile range]: 39 [26-56] vs. 16 [6-41] months, p = 0.02) and multivariate analyses (HR = 0.21 [95% CI, 0.06-0.69]; p = 0.01). This study highlights the negative impact of chronic HCV on survival of DLBCL patients and shows that treatment of HCV infection is associated with a better cancer response to chemotherapy and improves 5-year OS.
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Affiliation(s)
- Jeff Hosry
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Francesco Turturro
- Department of Lymphoma & Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roberto N Miranda
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Minas P Economides
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bruno P Granwehr
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Economides MP, Mahale P, Turturro F, Hosry J, Samaniego F, Granwehr BP, Torres HA. Development of non-Hodgkin lymphoma as a second primary cancer in hepatitis C virus-infected patients with a different primary malignancy. Leuk Lymphoma 2016; 58:485-488. [PMID: 27348218 DOI: 10.1080/10428194.2016.1196817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Minas P Economides
- a Department of Infectious Diseases, Infection Control, and Employee Health , The University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Parag Mahale
- a Department of Infectious Diseases, Infection Control, and Employee Health , The University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Francesco Turturro
- b Department of Lymphoma/Myeloma , The University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Jeff Hosry
- a Department of Infectious Diseases, Infection Control, and Employee Health , The University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Felipe Samaniego
- b Department of Lymphoma/Myeloma , The University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Bruno P Granwehr
- a Department of Infectious Diseases, Infection Control, and Employee Health , The University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Harrys A Torres
- a Department of Infectious Diseases, Infection Control, and Employee Health , The University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
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Hosry J, Mahale P, Turturro F, Miranda RN, Economides MP, Granwehr BP, Torres HA. Effect of antiviral therapy on overall survival in hepatitis c virus-infected patients with diffuse large b-cell lymphoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jeff Hosry
- Department of Infectious Diseases,The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Parag Mahale
- The University of Texas, School of Public Health, Houston, TX
| | | | | | - Minas P. Economides
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Harrys A. Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
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39
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Economides MP, Mahale P, Turturro F, Hosry J, Granwehr BP, Torres HA. Development of non-Hodgkin lymphoma as a second primary cancer in patients with chronic hepatitis C virus infection. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e19059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Minas P. Economides
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | - Jeff Hosry
- Department of Infectious Diseases,The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Harrys A. Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
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Mahale P, Sturgis EM, Tweardy DJ, Ariza-Heredia EJ, Torres HA. Association Between Hepatitis C Virus and Head and Neck Cancers. J Natl Cancer Inst 2016; 108:djw035. [PMID: 27075854 DOI: 10.1093/jnci/djw035] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/09/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is associated with hepatocellular carcinoma and non-Hodgkin's lymphoma. In 2009, MD Anderson established the first US clinic for treating HCV-infected cancer patients, where we observed an unexpectedly large number of patients with head and neck cancers (HNCs). We sought to determine whether HCV is associated with HNCs. METHODS In this case-control study, medical records of cancer patients tested for HCV antibodies at our center from 2004 through 2014 were identified. Case subjects had new-onset primary oropharyngeal or nonoropharyngeal (oral cavity, nasopharynx, hypopharynx, or larynx) HNCs. Control subjects had smoking-associated (lung, esophagus, or urinary bladder) cancers. Biopsy reports of oropharyngeal cancers tested for human papillomavirus (HPV) were reviewed. Patients with lymphoma were excluded. Multivariable logistic regression models were constructed. All statistical tests were two-sided. RESULTS Of 34 545 cancer patients tested for HCV antibodies, 409 case subjects (164 oropharyngeal and 245 nonoropharyngeal) and 694 control subjects (378 lung, 168 esophagus, and 148 urinary bladder) were studied. The prevalence of HCV seropositivity was higher in oropharyngeal cancer patients (14.0%, 95% confidence interval [CI] = 8.7% to 19.4%, vs 6.5%, 95% CI = 4.6% to 8.3%), particularly HPV-positive oropharyngeal cancer patients (16.9%, 95% CI = 8.7% to 24.9%, vs 6.5%, 95% CI = 4.6% to 8.3%), and nonoropharyngeal HNC patients (20.0%, 95% CI = 14.9% to 25.0%, vs 6.5%, 95% CI = 4.6% to 8.3%) than in control subjects. Adjusted models showed a statistically significant association of HCV seropositivity with nonoropharyngeal (except nasopharyngeal) HNCs (odds ratio [OR] = 2.85, 95% CI = 1.38 to 5.88) and HPV-positive oropharyngeal cancers (OR = 2.97, 95% CI = 1.31 to 6.76). CONCLUSIONS HCV is associated with nonoropharyngeal (except nasopharyngeal) and HPV-positive oropharyngeal HNCs. Further studies are required to explore the possible interaction between HCV and HPV, and the association between HCV and other HPV-related malignancies.
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Affiliation(s)
- Parag Mahale
- Affiliations of authors: Department of Infectious Diseases, Infection Control, and Employee Health (PM, DJT, EJAH, HAT), Department of Head and Neck Surgery (EMS), Department of Epidemiology (EMS), and Department of Molecular and Cellular Oncology (DJT), The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX (PM)
| | - Erich M Sturgis
- Affiliations of authors: Department of Infectious Diseases, Infection Control, and Employee Health (PM, DJT, EJAH, HAT), Department of Head and Neck Surgery (EMS), Department of Epidemiology (EMS), and Department of Molecular and Cellular Oncology (DJT), The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX (PM)
| | - David J Tweardy
- Affiliations of authors: Department of Infectious Diseases, Infection Control, and Employee Health (PM, DJT, EJAH, HAT), Department of Head and Neck Surgery (EMS), Department of Epidemiology (EMS), and Department of Molecular and Cellular Oncology (DJT), The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX (PM)
| | - Ella J Ariza-Heredia
- Affiliations of authors: Department of Infectious Diseases, Infection Control, and Employee Health (PM, DJT, EJAH, HAT), Department of Head and Neck Surgery (EMS), Department of Epidemiology (EMS), and Department of Molecular and Cellular Oncology (DJT), The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX (PM)
| | - Harrys A Torres
- Affiliations of authors: Department of Infectious Diseases, Infection Control, and Employee Health (PM, DJT, EJAH, HAT), Department of Head and Neck Surgery (EMS), Department of Epidemiology (EMS), and Department of Molecular and Cellular Oncology (DJT), The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX (PM)
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Hosry J, Kyvernitakis A, Mahale P, Champlin RE, Torres HA. Interferon-Free Regimens in Hepatitis C Virus-Infected Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mahale P, Thomas SK, Kyvernitakis A, Torres HA. Management of Multiple Myeloma Complicated by Hepatitis C Virus Reactivation: The Role of New Antiviral Therapy. Open Forum Infect Dis 2015; 3:ofv211. [PMID: 26885541 PMCID: PMC4751339 DOI: 10.1093/ofid/ofv211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 10/05/2015] [Accepted: 12/23/2015] [Indexed: 01/29/2023] Open
Abstract
Reactivation of chronic hepatitis C virus (HCV) infection has been reported in cancer patients receiving chemotherapy. In this study, we report the first case, to our knowledge, of thalidomide-induced acute exacerbation and reactivation of chronic HCV infection complicating management of multiple myeloma. Sofosbuvir-based antiviral therapy helped achieve viral clearance and normalization of liver enzymes, thus allowing access to future potentially life-saving chemotherapy agents.
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Affiliation(s)
- Parag Mahale
- Departments of Infectious Diseases, Infection Control, and Employee Health
| | - Sheeba K Thomas
- Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston, Texas
| | | | - Harrys A Torres
- Departments of Infectious Diseases, Infection Control, and Employee Health
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Kyvernitakis A, Mahale P, Popat UR, Jiang Y, Hosry J, Champlin RE, Torres HA. Hepatitis C Virus Infection in Patients Undergoing Hematopoietic Cell Transplantation in the Era of Direct-Acting Antiviral Agents. Biol Blood Marrow Transplant 2015; 22:717-722. [PMID: 26712592 DOI: 10.1016/j.bbmt.2015.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023]
Abstract
There is paucity of literature regarding hepatitis C virus (HCV) infection in hematopoietic cell transplant (HCT) recipients. In the study described herein we evaluated several aspects of HCV infection in HCT recipients, including the impact of this infection on cancer status, liver-related outcomes, mortality, and the role of antiviral treatment (AVT), including direct-acting antivirals (DAAs). The medical records of HCV-infected allogeneic and autologous HCT recipients, seen at The University of Texas MD Anderson Cancer Center from August 2009 to November 2015, were reviewed. Patients seen from August 1, 2009 to October 30, 2012 were reviewed retrospectively, whereas those seen from November 1, 2012 to November 30, 2015 were analyzed prospectively in an observational study. Of 434 HCV-infected cancer patients evaluated, 64 underwent 69 HCTs. Most (78%) underwent autologous transplantation. Thirteen percent of patients became HCV-seronegative post-HCT. Compared with patients who did not receive AVT, treated patients had fewer relapses of HCV-associated non-Hodgkin lymphomas (20% versus 86%; P = .015), higher 5-year survival rates (75% versus 39%; P = .02), and a trend toward lower rate of progression to cirrhosis (5% versus 21%; P = .06). AVT discontinuation rate post-HCT was 71% in those receiving IFN-containing regimens and 0% in those receiving DAAs (P < .01). AVT was effective in 12 of 37 patients (32%) and 11 of 13 patients (85%) receiving IFN-based and DAA regimens, respectively (P = .003). HCV is an important cause of morbidity and mortality in this population. HCV seropositivity can be lost post-HCT, posing a diagnostic challenge. Treatment of HCV infection in HCT recipients improves both oncologic and hepatic outcomes. These patients can be successfully treated with DAAs.
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Affiliation(s)
- Andreas Kyvernitakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeff Hosry
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Torres HA, Roach L, Mahale P, Granwehr B, Blechacz B, Miller E, Borchardt R, Shukla B, Ericsson C, Raad I. Transdisciplinary Approach to Managing Hepatitis C Virus Infection in Patients at a Tertiary Care Cancer Center. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mahale P, Yanik EL, Engels EA. Herpes Zoster and Risk of Cancer in the Elderly U.S. Population. Cancer Epidemiol Biomarkers Prev 2015; 25:28-35. [PMID: 26578536 DOI: 10.1158/1055-9965.epi-15-1033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/05/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Herpes zoster (HZ) arises in older people due to age-related decline in immunity. We assessed whether HZ, as a marker of immune suppression, is associated with increased cancer risk. METHODS We conducted a case-control study in U.S. adults with ages ≥ 65 years using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Cases (n = 1,108,986) were people with first cancers identified in cancer registries (1992-2005). Controls (n = 100,000) were cancer-free individuals frequency matched to cases on age, sex, and year of selection. We identified HZ diagnosis using Medicare claims. Logistic regression models were constructed to determine adjusted associations between cancer and HZ. RESULTS HZ prevalence was modestly higher in cases than controls (1.4% vs. 1.2%). We identified significant associations between HZ and oral cavity/pharyngeal [adjusted OR (aOR) = 1.21], colon (aOR = 1.10), lung (aOR = 1.11), and non-melanoma skin (aOR = 1.46) cancers; myeloma (aOR = 1.38); diffuse large B-cell lymphoma (aOR = 1.30); lymphoplasmacytic lymphoma (aOR = 1.99); and chronic lymphocytic leukemia/small lymphocytic lymphoma (aOR = 1.55). Among solid cancers, HZ was mostly associated with regional and/or distant stage tumors. Associations were strongest when HZ was diagnosed 13 to 35 months before cancer diagnosis/selection; they were significant for some cancers in the 36 to 59 months period, and 60+ months for lymphoplasmacytic lymphoma (OR = 1.99). CONCLUSION HZ is associated with modestly increased risk of a few cancers, particularly hematologic malignancies. Associations were strongest at short latency intervals for many cancers, and for regional/distant stages among solid cancers, perhaps reflecting reverse causality. IMPACT Age-related immune decline does not play a major role in cancer development in older people, but it may be important for some lymphomas.
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Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland. Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Elizabeth L Yanik
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
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Kyvernitakis A, Taremi M, Blechacz B, Hwang J, Jiang Y, Mahale P, Torres HA. Impact of hepatitis E virus seropositivity on chronic liver disease in cancer patients with hepatitis C virus infection. Hepatol Res 2015; 45:1146-51. [PMID: 25488194 DOI: 10.1111/hepr.12460] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/17/2014] [Accepted: 12/06/2014] [Indexed: 01/17/2023]
Abstract
AIM Immunocompromised patients can develop chronic hepatitis E virus (HEV) infection and progress to cirrhosis. Hepatitis C virus (HCV)-infected cancer patients who have received chemotherapeutic agents experience accelerated liver fibrosis progression. Our aim was to investigate the prevalence and impact of HEV seropositivity on liver-related outcomes in HCV-infected cancer patients. METHODS As part of a prospective study of HCV-infected cancer patients conducted at our center, we investigate the characteristics associated with progression of their liver disease. RESULTS Of the 115 patients tested, 13 (11%) were positive for HEV immunoglobulin G. HEV seropositivity was associated with advanced age (P = 0.004), race (P = 0.02), place of birth outside the USA (P = 0.021), cirrhosis (P = 0.027), history of reused needles/syringes during massive vaccination campaigns (P = 0.015) and coronary artery disease (P = 0.039). Overall, 47 (41%) of the patients had cirrhosis. Factors independently associated with cirrhosis were male sex (odds ratio [OR], 2.8; P = 0.028) and HEV seropositivity (OR, 4.1; P = 0.032). CONCLUSION HEV seropositivity is present in 11% of HCV-infected cancer patients and seems to be associated with cirrhosis. Our results suggest that HEV screening should be implemented in HCV-infected patients with cancer.
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Affiliation(s)
- Andreas Kyvernitakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mahnaz Taremi
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Boris Blechacz
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica Hwang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Mahale P, Turturro F, Romaguera JE, Fowler N, Torres HA. The effect of different rituximab-containing chemotherapy strategies on hepatitis C viremia. Leuk Lymphoma 2015; 57:1487-90. [PMID: 26402559 DOI: 10.3109/10428194.2015.1099649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Parag Mahale
- a Department of Infectious Diseases , Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Francesco Turturro
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jorge E Romaguera
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Nathan Fowler
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Harrys A Torres
- a Department of Infectious Diseases , Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Iqbal T, Mahale P, Turturro F, Kyvernitakis A, Torres HA. Prevalence and association of hepatitis C virus infection with different types of lymphoma. Int J Cancer 2015; 138:1035-7. [PMID: 26356141 DOI: 10.1002/ijc.29845] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/28/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Tehseen Iqbal
- Department of Infectious Diseases, Infection Control and Employee Health, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Francesco Turturro
- Department of Lymphoma/Myeloma, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andreas Kyvernitakis
- Department of Infectious Diseases, Infection Control and Employee Health, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, the University of Texas MD Anderson Cancer Center, Houston, TX
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Torres HA, Mahale P, Blechacz B, Miller E, Kaseb A, Herlong HF, Fowler N, Jiang Y, Raad II, Kontoyiannis DP. Effect of hepatitis C virus infection in patients with cancer: addressing a neglected population. J Natl Compr Canc Netw 2015; 13:41-50. [PMID: 25583768 DOI: 10.6004/jnccn.2015.0007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a neglected disease in patients with cancer. Therefore, this study examined the impact of HCV infections in these patients. METHODS The records of HCV-infected patients with cancer seen at The University of Texas MD Anderson Cancer Center (2008-2011) were reviewed. The outcomes of those who underwent HCV treatment were analyzed. RESULTS Of 1291 patients who had positive test results for an antibody to HCV (anti-HCV), 744 (58%) were tested for HCV-RNA; 642 (86%) of which had chronic HCV infections. Most had solid tumors (72%) and genotype-1 (G-1) infections (66%). HCV therapy was administered in 348 patients (98 of them after cancer diagnosis). Sustained virologic response (SVR) occurred in 27 (35%) of the 78 patients treated for whom outcome data were available. Compared with patients who experienced an SVR, more patients who did not were black (29% vs 4%; P=.007), had G-1 infections (72% vs 6%; P<.0001), and had higher baseline aspartate aminotransferase (78 vs 47 IU/L; P=.006) and alanine aminotransferase levels (71.1 vs 43.3 IU/L; P=.009). Overall, progression to cirrhosis (hazard ratio [HR], 0.38; P=.03) and portal hypertension (HR, 0.19; P=.009) was less common in those treated, irrespective of the treatment outcome (SVR or non-SVR). Hepatocellular carcinoma (HCC) developed as a second primary malignancy in 7% of patients with non-HCC cancer. CONCLUSIONS This is the largest series to analyze HCV infections in patients with cancer. HCV therapy is feasible and prevents liver disease progression in this forgotten population. A treatment algorithm is provided.
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Affiliation(s)
- Harrys A Torres
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Parag Mahale
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas. From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Blechacz
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ethan Miller
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmed Kaseb
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - H Franklin Herlong
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathan Fowler
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Jiang
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issam I Raad
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dimitrios P Kontoyiannis
- From the Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center; The University of Texas School of Public Health; and the Departments of Gastroenterology, Hepatology and Nutrition, Gastrointestinal Medical Oncology, and Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Torres HA, Mahale P. Most patients with HCV-associated lymphoma present with mild liver disease: a call to revise antiviral treatment prioritization. Liver Int 2015; 35:1661-4. [PMID: 25779000 DOI: 10.1111/liv.12825] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/10/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) is associated with development of B-cell non-Hodgkin lymphoma (HCV-NHL). Antiviral therapy (AVT) is prioritized in HCV-infected patients with significant fibrosis/cirrhosis. It is unknown whether current recommendations based on liver parameters cover the risk of HCV-NHL development. We aimed to evaluate the liver disease stages of patients with HCV-NHL. METHODS Hepatitis C virus-NHL patients seen at MD Anderson Cancer Center between 2008 and 2014 were evaluated for underlying liver disease within a year of HCV-NHL diagnosis by non-invasive fibrosis markers, radiology or liver biopsy. Included patients were observed retrospectively (2008-2012) or prospectively (2012-2014). RESULTS Eighty nine patients with HCV-NHL were evaluated. Most patients had genotype 1 (62%) infection, had diffuse large B cell lymphomas (62%), and detectable HCV RNA (90%) at NHL diagnosis. Notably, advanced liver disease (Metavir stage ≥ 3) was present in only 18% of the patients at the time of HCV-NHL diagnosis. All 53 patients with chronic HCV infection documented before lymphoma diagnosis were seen by HCV-treating physicians. Providers did not recommend AVT in almost one half of cases (44%), mostly because of the lack of advanced liver disease at HCV diagnosis (38%). CONCLUSIONS Most patients with HCV-NHL have mild liver disease at cancer diagnosis. Our findings suggest the need for early initiation of AVT in infected patients to eradicate HCV infection and its extra-hepatic manifestations. Treatment prioritization and cost must be weighed against the potential benefits of preventing NHL.
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Affiliation(s)
- Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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