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Nastoupil LJ, Shenoy PJ, Ambinder A, Koff JL, Nooka AK, Waller EK, Langston A, Seward M, Kaufman JL, Bernal-Mizrachi L, King N, Lechowicz MJ, Lonial S, Sinha R, Flowers CR. Intensive chemotherapy and consolidation with high dose therapy and autologous stem cell transplant in patients with mantle cell lymphoma. Leuk Lymphoma 2014; 56:383-9. [PMID: 24828864 DOI: 10.3109/10428194.2014.921296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mantle cell lymphoma (MCL) remains incurable with conventional chemotherapy without consensus on the optimal initial treatment. We examined our single center experience with frontline therapy for patients with MCL in consecutive cases diagnosed 1995-2011. Among 81 patients, median age was 59 (28% were ≥65 years of age), 95% had stage III/IV disease and 54% had a low risk MCL International Prognostic Index score. Thirty-five percent (n=28) received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and 65% received R-HCVAD (rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with high-dose methotrexate/cytarabine; n=53). Forty-one patients were consolidated with autologous stem cell transplant (ASCT). There were no significant differences in 2-year survival for R-CHOP versus R-HCVAD (p=0.10) or for ASCT versus observation (p=0.06). After controlling for clinical factors, R-HCVAD followed by ASCT was associated with superior progression-free survival (hazard ratio 0.26, 95% confidence interval 0.09-0.75).
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Affiliation(s)
- Loretta J Nastoupil
- Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine , Atlanta, GA , USA
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Sinha R, Shenoy PJ, King N, Lechowicz MJ, Bumpers K, Hutcherson D, Arellano M, Langston A, Kaufman J, Heffner LT, Waller EK, Nooka A, Flowers CR, Lonial S. Vinorelbine, paclitaxel, etoposide, cisplatin, and cytarabine (VTEPA) is an effective second salvage therapy for relapsed/refractory Hodgkin lymphoma. Clin Lymphoma Myeloma Leuk 2013. [PMID: 24094894 DOI: 10.1016/2013.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND For Hodgkin lymphoma (HL) patients with refractory or relapsed (R/R) disease after primary therapy, the standard of care is a salvage regimen followed by autologous stem cell transplant (ASCT). However, patients who fail to respond to a salvage regimen have limited options. Our phase I study of cytarabine combined with fixed doses of vinorelbine, paclitaxel, etoposide, and cisplatin (VTEPA) for patients with R/R lymphoma showed an overall response rate (ORR) of 33%. PATIENTS AND METHODS To further examine the effectiveness of VTEPA, we conducted a retrospective review of 30 cases of R/R HL who received a salvage combination of VTEPA. RESULTS This population included 15 men (50%), 18 stage III/IV (60%), and 14 with an International Prognostic Score ≥3 (47%). The median number of previous regimens was 2 (range, 1-4), 19 patients (63%) received previous salvage therapy with ifosfamide, carboplatin, and etoposide. Twenty-seven patients were evaluable for response. The most common Grade 3/4 toxicities were pancytopenia (19 patients, 97%), nausea/vomiting (17, 57%), fatigue (14, 47%), and infection (6, 20%). Of the 27 patients evaluable for response, the ORR was 70% (7 complete response and 12 partial response). Twenty patients (66%) went on to ASCT and 1 patient underwent allogeneic transplant. With a median follow-up of 32 months, the median progression-free survival (PFS) and overall survival (OS) in patients who received transplantation after VTEPA were 28 and 38 months, respectively. CONCLUSION Treatment with VTEPA for R/R HL is feasible with manageable side effects. With a high ORR, the PFS and OS for this group of patients suggest that VTEPA is a promising regimen for HL patients in whom previous lines of therapy have failed.
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Affiliation(s)
- Rajni Sinha
- Winship Cancer Institute, Hematology and Medical Oncology, Emory University, School of Medicine, Atlanta, GA
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Flowers CR, Shenoy PJ, Borate U, Bumpers K, Douglas-Holland T, King N, Brawley OW, Lipscomb J, Lechowicz MJ, Sinha R, Grover RS, Bernal-Mizrachi L, Kowalski J, Donnellan W, The A, Reddy V, Jaye DL, Foran J. Examining racial differences in diffuse large B-cell lymphoma presentation and survival. Leuk Lymphoma 2013; 54:268-76. [PMID: 22800091 DOI: 10.3109/10428194.2012.708751] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We performed a retrospective cohort analysis of 701 (533 white and 144 black) patients with diffuse large B-cell lymphoma (DLBCL) treated at two referral centers in southern United States between 1981 and 2010. Median age of diagnosis for blacks was 50 years vs. 57 years for whites (p < 0.001). A greater percentage of blacks presented with elevated lactate dehydrogenase levels, B-symptoms and performance status ≥ 2. More whites (8%) than blacks (3%) had a positive family history of lymphoma (p = 0.048). There were no racial differences in the use of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; 52% black vs. 47% white, p = 0.73). While black race predicted worse survival among patients treated with CHOP (hazard ratio [HR] 1.8, p < 0.001), treatment with R-CHOP was associated with improved survival irrespective of race (HR 0.61, p = 0.01). Future studies should examine biological differences that may underlie the observed racial differences in presentation and outcome.
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Affiliation(s)
- Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
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Nooka AK, Nabhan C, Zhou X, Taylor MD, Byrtek M, Miller TP, Friedberg JW, Zelenetz AD, Link BK, Cerhan JR, Dillon H, Sinha R, Shenoy PJ, Levy D, Dawson K, Hirata JH, Flowers CR. Examination of the follicular lymphoma international prognostic index (FLIPI) in the National LymphoCare study (NLCS): a prospective US patient cohort treated predominantly in community practices. Ann Oncol 2013; 24:441-448. [PMID: 23041589 DOI: 10.1093/annonc/mds429] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Because follicular lymphoma (FL) patients have heterogeneous outcomes, the FL international prognostic index (FLIPI) was developed to risk-stratify patients and to predict survival. However, limited data exist regarding the role of FLIPI in the era of routine first-line rituximab (R) and R-chemotherapy regimens and in the setting of community oncology practices. PATIENTS AND METHODS We evaluated the outcome data from the National LymphoCare Study (NLCS), a prospective, observational cohort study, which collects data on patients with FL in the United States (US) community practices. RESULTS Among 1068 male and 1124 female patients with FLIPI data, most were treated in US community practices (79%); 35% were FLIPI good risk, 30% intermediate risk, and 35% poor risk. FLIPI risk groups were significant predictors of overall survival (OS) and progression-free survival (PFS) for patients who undergo watchful waiting (WW), and those who receive non-R-containing regimens, R-alone, and R-chemotherapy combinations. CONCLUSIONS In the setting of contemporary practice with routine R use, stratifying patients into good, intermediate, and poor FLIPI risk groups predicts distinct outcomes in terms of OS and PFS. FLIPI remains an important prognostic index in the R era and should be used in clinical practices to support discussions about prognosis.
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Affiliation(s)
- A K Nooka
- Winship Cancer Institute, Division of Hematology and Oncology, Emory University-School of Medicine, Atlanta.
| | - C Nabhan
- Division of Hematology/Oncology, Advocate Lutheran General Hospital and Oncology Specialists, Park Ridge
| | - X Zhou
- RTI Health Solutions, Research Triangle Park
| | | | | | - T P Miller
- Section of Hematology/Oncology, University of Arizona, Tucson
| | - J W Friedberg
- Department of Medicine, James P. Wilmont Cancer Center, Rochester
| | - A D Zelenetz
- Department of Medicine, Lymphoma Program, Memorial Sloan-Kettering Cancer Center, New York
| | - B K Link
- Oncology and Bone & Marrow Transplantation, Division of Hematology, University of Iowa, Iowa City
| | - J R Cerhan
- Department of Health Sciences Research, Mayo Clinic-College of Medicine, Rochester
| | - H Dillon
- The Leukemia & Lymphoma Society, White Plains, USA
| | - R Sinha
- Winship Cancer Institute, Division of Hematology and Oncology, Emory University-School of Medicine, Atlanta
| | - P J Shenoy
- Winship Cancer Institute, Division of Hematology and Oncology, Emory University-School of Medicine, Atlanta
| | - D Levy
- Genentech, South San Francisco
| | | | | | - C R Flowers
- Winship Cancer Institute, Division of Hematology and Oncology, Emory University-School of Medicine, Atlanta
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Ambinder AJ, Shenoy PJ, Nastoupil LJ, Flowers CR. Using primary site as a predictor of survival in mantle cell lymphoma. Cancer 2013; 119:1570-7. [PMID: 23341329 DOI: 10.1002/cncr.27898] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/13/2012] [Accepted: 10/09/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND Mantle cell lymphoma (MCL) is a rare B cell lymphoma that varies in clinical behavior with some patients experiencing aggressive disease with short survival, whereas others have indolent behavior. We examined the association between primary disease site and survival in MCL patients to identify subgroups with distinct characteristics. METHODS We analyzed the United States Surveillance, Epidemiology and End Results Program database for MCL cases reported from 2000 through 2009. Kaplan-Meier curves and Cox proportional hazard models were used to estimate the effect of primary site on survival. RESULTS Among 4477 cases included in our study, 19.6% of patients presented with an extranodal primary site. The most common extranodal primary sites were of the gastrointestinal (GI) tract (7.8%), the head and neck (6.2%), and the hematologic/reticuloendothelial systems (3.6%). Asians/Pacific Islanders were more likely than whites or blacks to have GI tract or head and neck disease (P < .0001 and P = .002, respectively). Advanced disease and B symptoms were less common in those with primary disease of the GI tract or head and neck than in those with primary disease of the lymph nodes (both P < .0001). In a multivariate Cox regression model, patients with primary disease of the GI tract and head and neck had superior survival compared to those with primary disease of the lymph nodes; hazard ratios 0.75 (95% CI = 0.62-0.90) and 0.68 (95% CI = 0.55-0.85), respectively. CONCLUSIONS Primary site of disease may be an important prognostic factor for patients with MCL. Further studies elucidating a biological basis for these differences are needed.
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Affiliation(s)
- Alexander J Ambinder
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Imam MH, Shenoy PJ, Flowers CR, Phillips A, Lechowicz MJ. Incidence and survival patterns of cutaneous T-cell lymphomas in the United States. Leuk Lymphoma 2013; 54:752-9. [PMID: 23004352 DOI: 10.3109/10428194.2012.729831] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Using the United States Surveillance, Epidemiology and End Results (SEER) 17 dataset, we examined incidence and survival patterns for patients with cutaneous T-cell lymphomas (CTCLs) diagnosed following institution of the World Health Organization-European Organisation for Research and Treatment of Cancer (WHO-EORTC) classification. From 2005 to 2008, 2273 cases of CTCL were diagnosed. The age-adjusted incidence rate per 100,000 person-years for mycosis fungoides (MF) was 0.55 and for Sézary syndrome (SS) was 0.01. Incidence was higher among males (MF/SS male-to-female incidence rate ratio [IRR] 1.57) and black patients (MF black-to-white IRR 1.55). Black patients with CTCL were diagnosed at a younger age and black patients with MF/SS presented with advanced stage and had worse survival than white patients. In multiple-variable Cox-regression models, age > 60 (hazard ratio [HR] 4.78, 95% confidence interval [CI] 2.97-7.70), black race (HR 2.09, 95% CI 1.29-3.37) and advanced stage (HR 6.06, 95% CI 3.66-10.05) predicted worse survival for patients with MF/SS. Additional research identifying reasons for these differences are necessary to better understand these diseases and for new strategies in the treatment of CTCL.
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Sinha R, Kaufman JL, Khoury HJ, King N, Shenoy PJ, Lewis C, Bumpers K, Hutchison-Rzepka A, Tighiouart M, Heffner LT, Lechowicz MJ, Lonial S, Flowers CR. A phase 1 dose escalation study of bortezomib combined with rituximab, cyclophosphamide, doxorubicin, modified vincristine, and prednisone for untreated follicular lymphoma and other low-grade B-cell lymphomas. Cancer 2012; 118:3538-48. [DOI: 10.1002/cncr.26660] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/06/2011] [Accepted: 09/30/2011] [Indexed: 11/09/2022]
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AbouYabis AN, Shenoy PJ, Sinha R, Flowers CR, Lechowicz MJ. A Systematic Review and Meta-Analysis of Front-line Anthracycline-Based Chemotherapy Regimens for Peripheral T-Cell Lymphoma. ISRN Hematol 2011; 2011:623924. [PMID: 22084700 PMCID: PMC3197255 DOI: 10.5402/2011/623924] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 04/20/2011] [Indexed: 12/21/2022]
Abstract
Anthracycline-based chemotherapy remains standard treatment for peripheral T-cell lymphoma (PTCL) although its benefits have been questioned. We performed systematic literature review and meta-analyses examining the complete response (CR) and overall survival (OS) rates for patients with PTCL. The CR rate for PTCL patients ranged from 35.9% (95% CI 23.4-50.7%) for enteropathy-type T-cell lymphoma (ETTL) to 65.8% (95% CI 54.0-75.9%) for anaplastic large cell lymphoma (ALCL). The 5-year OS was 38.5% (95% CI 35.5-41.6%) for all PTCL patients and ranged from 20.3% (95% CI 12.5-31.2%) for ETTL to 56.5% (95% CI 42.8-69.2%) for ALCL. These data suggest that there is marked heterogeneity across PTCL subtypes in the benefits of anthracycline-based chemotherapy. While anthracyclines produce CR in half of PTCL patients, this yields reasonable 5-year OS for patients with ALCL but not for those with PTCL-NOS or ETTL. Novel agents and regimens are needed to improve outcomes for these patients.
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Affiliation(s)
- Abeer N. AbouYabis
- Department of Internal Medicine, Mercer University, Central Georgia Cancer Care, 1062 Forsyth Street, Suite 1B Macon, Georgia, GA 31201, USA
| | - Pareen J. Shenoy
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 2365 Clifton Road, N.E. Building C, Atlanta, GA 30322, USA
| | - Rajni Sinha
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 2365 Clifton Road, N.E. Building C, Atlanta, GA 30322, USA
| | - Christopher R. Flowers
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 2365 Clifton Road, N.E. Building C, Atlanta, GA 30322, USA
| | - Mary Jo Lechowicz
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 2365 Clifton Road, N.E. Building C, Atlanta, GA 30322, USA
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Shenoy PJ, Malik N, Nooka A, Sinha R, Ward KC, Brawley OW, Lipscomb J, Flowers CR. Racial differences in the presentation and outcomes of diffuse large B-cell lymphoma in the United States. Cancer 2011; 117:2530-2540. [DOI: 10.1002/cncr.25765] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Nooka A, Shenoy PJ, Sinha R, Lonial S, Flowers CR. Hepatitis C reactivation in patients who have diffuse large B-cell lymphoma treated with rituximab: a case report and review of literature. Clin Lymphoma Myeloma Leuk 2011; 11:379-84. [PMID: 21729690 DOI: 10.1016/j.clml.2011.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/17/2011] [Accepted: 04/08/2011] [Indexed: 01/27/2023]
Abstract
BACKGROUND Whether to interrupt or to continue induction therapy for lymphoma when hepatitis C virus (HCV) reactivation occurs during therapy with rituximab and chemotherapy remains a controversial question. There is limited evidence-based literature to help guide the management of patients with lymphoma in the setting of HCV reactivation. To address this issue we report an illustrative case and review the prevalence of non-Hodgkin lymphoma (NHL) in HCV-infected patients; the role of HCV in lymphomagenesis; the role of antiviral therapy in the management of HCV-associated lymphomas; as well as comparing the outcomes for NHL patients with and without HCV infection. CASE REPORT A patient diagnosed with diffuse large B-cell lymphoma was treated with rituximab and chemotherapy with the patient achieving a complete remission, but treatment was complicated by asymptomatic HCV reactivation. Because conflicting data exist regarding management of such cases, the criteria for discontinuing chemotherapy, in the event of escalation in HCV replication in an asymptomatic patient, remain unclear. CONCLUSION Patients with HCV have increased prevalence of marginal zone lymphoma, diffuse large B-cell lymphoma, and lymphoplasmacytic lymphoma. Whether HCV has a role in the lymphomagenesis is still uncertain, and limited to conjecture. The question whether to treat HCV-related lymphomas with antiviral therapy is debatable and not well-supported. Without initial liver dysfunction, HCV-infected patients can experience a similar outcome compared to their HCV-negative counterparts when treated with standard chemotherapy/immunotherapy despite differences in the presentation of the disease.
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Affiliation(s)
- Ajay Nooka
- Winship Cancer Institute-Hematology and Medical Oncology, Emory University-School of Medicine, Atlanta, GA, USA
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Abstract
Follicular lymphoma is an indolent lymphoma associated with a relapsing course. Immunization with tumor B cell idiotype (Id; a unique variable region of surface B cell immunoglobulin) may induce humoral and cellular immune response against the tumor. Based on promising results from early phase clinical trials with Id vaccine, three Phase III trials were initiated, which, despite failing to meet their primary end points, still provided a glimmer of optimism. This article describes the clinical development of the Id vaccine against follicular lymphoma, outlines the outcomes of clinical trials and delineates the future prospects for the integration of the idiotype vaccine into follicular lymphoma treatment.
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Affiliation(s)
| | - Joshua D Brody
- Division of Oncology, Department of Medicine, Stanford University Medical Center, CA 94305, USA
| | - Rajni Sinha
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 1365 Clifton Road, NE Building B, Suite 4302, Atlanta, GA 30322, USA
| | - Pareen J Shenoy
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 1365 Clifton Road, NE Building B, Suite 4302, Atlanta, GA 30322, USA
| | - Christopher R Flowers
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 1365 Clifton Road, NE Building B, Suite 4302, Atlanta, GA 30322, USA
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Abouyabis AN, Shenoy PJ, Lechowicz MJ, Flowers CR. Stem cell transplantation as a biological therapy for peripheral T-cell lymphomas. Expert Opin Biol Ther 2010; 11:31-40. [DOI: 10.1517/14712598.2011.534451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Reisman RM, Shenoy PJ, Atherly AJ, Flowers CR. Prescription opioid usage and abuse relationships: an evaluation of state prescription drug monitoring program efficacy. Subst Abuse 2009; 3:41-51. [PMID: 24357929 PMCID: PMC3865068 DOI: 10.4137/sart.s2345] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Context The dramatic rise in the use of prescription opioids to treat non-cancer pain has been paralleled by increasing prescription opioid abuse. However, detailed analyses of these trends and programs to address them are lacking. Objective To study the association between state shipments of prescription opioids for medical use and prescription opioid abuse admissions and to assess the effects of state prescription drug monitoring programs (PDMPs) on prescription opioid abuse admissions. Design and Setting A retrospective ecological cohort study comparing state prescription opioid shipments (source: Automation of Reports and Consolidated Orders Systems database) and inpatient admissions for prescription opioid abuse (source: Treatment Episode Data Set) in 14 states with PDMPs (intervention group) and 36 states without PDMPs (control group) for the period 1997–2003. Results From 1997 to 2003, oxycodone, morphine, and hydrocodone shipments increased by 479%, 100%, and 148% respectively. Increasing prescription oxycodone shipments were significantly associated with increasing prescription opioid admission rates (p < 0.001). PDMP states had significantly lower oxycodone shipments than the control group. PDMP states had less increase in prescription opioid admissions per year (p = 0.063). A patient admitted to an inpatient drug abuse rehabilitation program in a PDMP state was less likely to be admitted for prescription opioid drug abuse (Odds ratio = 0.775, 95% Confidence Interval 0.764–0.785). Conclusions PDMPs appear to decrease the quantity of oxycodone shipments and the prescription opioid admission rate for states with these programs. Overall, opioid shipments rose significantly in PDMP states during the study period indicating a negligible “chilling effect” on physician prescribing.
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Affiliation(s)
- Richard M Reisman
- Gwinnett Hospital System Pain Management Center, Lawrenceville, GA, U.S.A
| | | | - Adam J Atherly
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, U.S.A
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Huang T, Shenoy PJ, Sinha R, Graiser M, Bumpers KW, Flowers CR. Development of the Lymphoma Enterprise Architecture Database: a caBIG Silver level compliant system. Cancer Inform 2009; 8:45-64. [PMID: 19492074 PMCID: PMC2675136 DOI: 10.4137/cin.s940] [Citation(s) in RCA: 13] [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] [Indexed: 11/25/2022] Open
Abstract
Lymphomas are the fifth most common cancer in United States with numerous histological subtypes. Integrating existing clinical information on lymphoma patients provides a platform for understanding biological variability in presentation and treatment response and aids development of novel therapies. We developed a cancer Biomedical Informatics Grid™ (caBIG™) Silver level compliant lymphoma database, called the Lymphoma Enterprise Architecture Data-system™ (LEAD™), which integrates the pathology, pharmacy, laboratory, cancer registry, clinical trials, and clinical data from institutional databases. We utilized the Cancer Common Ontological Representation Environment Software Development Kit (caCORE SDK) provided by National Cancer Institute’s Center for Bioinformatics to establish the LEAD™ platform for data management. The caCORE SDK generated system utilizes an n-tier architecture with open Application Programming Interfaces, controlled vocabularies, and registered metadata to achieve semantic integration across multiple cancer databases. We demonstrated that the data elements and structures within LEAD™ could be used to manage clinical research data from phase 1 clinical trials, cohort studies, and registry data from the Surveillance Epidemiology and End Results database. This work provides a clear example of how semantic technologies from caBIG™ can be applied to support a wide range of clinical and research tasks, and integrate data from disparate systems into a single architecture. This illustrates the central importance of caBIG™ to the management of clinical and biological data.
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Affiliation(s)
- Taoying Huang
- Winship Cancer Institute, School of Medicine, Emory University, Atlanta, GA, USA
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Moore SG, Shenoy PJ, Fanucchi L, Tumeh JW, Flowers CR. Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population. BMC Health Serv Res 2009; 9:9. [PMID: 19144138 PMCID: PMC2630922 DOI: 10.1186/1472-6963-9-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 01/13/2009] [Indexed: 01/05/2023] Open
Abstract
Background Breast magnetic resonance imaging (MRI) is a sensitive method of breast imaging virtually uninfluenced by breast density. Because of the improved sensitivity, breast MRI is increasingly being used for detection of breast cancer among high risk young women. However, the specificity of breast MRI is variable and costs are high. The purpose of this study was to determine if breast MRI is a cost-effective approach for the detection of breast cancer among young women at high risk. Methods A Markov model was created to compare annual breast cancer screening over 25 years with either breast MRI or mammography among young women at high risk. Data from published studies provided probabilities for the model including sensitivity and specificity of each screening strategy. Costs were based on Medicare reimbursement rates for hospital and physician services while medication costs were obtained from the Federal Supply Scale. Utilities from the literature were applied to each health outcome in the model including a disutility for the temporary health state following breast biopsy for a false positive test result. All costs and benefits were discounted at 5% per year. The analysis was performed from the payer perspective with results reported in 2006 U.S. dollars. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters. Results Breast MRI provided 14.1 discounted quality-adjusted life-years (QALYs) at a discounted cost of $18,167 while mammography provided 14.0 QALYs at a cost of $4,760 over 25 years of screening. The incremental cost-effectiveness ratio of breast MRI compared to mammography was $179,599/QALY. In univariate analysis, breast MRI screening became < $50,000/QALY when the cost of the MRI was < $315. In the probabilistic sensitivity analysis, MRI screening produced a net health benefit of -0.202 QALYs (95% central range: -0.767 QALYs to +0.439 QALYs) compared to mammography at a willingness-to-pay threshold of $50,000/QALY. Breast MRI screening was superior in 0%, < $50,000/QALY in 22%, > $50,000/QALY in 34%, and inferior in 44% of trials. Conclusion Although breast MRI may provide health benefits when compared to mammographic screening for some high risk women, it does not appear to be cost-effective even at willingness to pay thresholds above $120,000/QALY.
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Affiliation(s)
- Susan G Moore
- Department of Hematology and Oncology, School of Medicine, Winship Cancer Institute, Emory University, Atlanta, USA.
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Abouyabis AN, Shenoy PJ, Lechowicz MJ, Flowers CR. Incidence and outcomes of the peripheral T-cell lymphoma subtypes in the United States. Leuk Lymphoma 2009; 49:2099-107. [PMID: 19021052 DOI: 10.1080/10428190802455867] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Peripheral T-cell lymphomas (PTCL) represent a small subgroup of non-Hodgkin lymphomas historically difficult to diagnose. We conducted a comprehensive assessment of 3287 PTCL cases diagnosed from 1992 to 2005 in 13 Surveillance, Epidemiology and End Results registries. Incidence trends, age-adjusted incidence rates and relative survival rates were compared across the study period, and by sex, race and age groups. From 1992 to 2005, PTCL incidence increased by 280%. Age-adjusted incidence rates were higher in males (Male/Female incidence rate ratio (IRR) 1.8) and in Blacks (Black/White IRR 1.2). Asian predominance was pronounced for extranodal NK/T-cell lymphoma, nasal type. Whites had higher 5-year survival than other racial groups for most histologic subtypes; however, the differences were not statistically significant. The variance in incidence rates and outcomes across PTCL subtypes support the pursuit of ongoing research to identify the etiology, pathophysiology, treatment patterns and differences in treatment response for PTCL subsets.
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Affiliation(s)
- Abeer N Abouyabis
- Winship Cancer Institute, School of Medicine, Emory University, Atlanta, GA 30322, USA
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Abstract
BACKGROUND Follicular lymphoma (FL) is a common indolent lymphoma associated with a relapsing course. Preclinical models and clinical studies demonstrate that immunizing FL patients against their own tumor idiotype induces humoral and cellular immunity and supresses tumor growth. METHODS We review idiotype vaccine strategies that have been tested in FL patients in frontline and relapsed settings to examine the safety and efficacy of this approach. RESULTS Several Phase II trials of recombinant or hybridoma-produced vaccines or vaccines combined with other immunotherapy demonstrate cellular and humoral anti-idiotype responses and clinical responses, indicating that idiotype vaccines provide promise for improving FL outcomes. CONCLUSION These strategies are now being evaluated in Phase III trials but have yet to demonstrate clear advantages in progression-free survival.
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