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Bumma N, Dhakal B, Fraser R, Estrada-Merly N, Anderson K, Freytes CO, Hildebrandt GC, Holmberg L, Krem MM, Lee C, Lekakis L, Lazarus HM, Mian H, Murthy HS, Nathan S, Nishihori T, Parrondo R, Patel SS, Solh M, Strouse C, Vesole DH, Kumar S, Qazilbash MH, Shah N, D’Souza A, Sidana S. Impact of bortezomib-based versus lenalidomide maintenance therapy on outcomes of patients with high-risk multiple myeloma. Cancer 2023; 129:2179-2191. [PMID: 37021929 PMCID: PMC10516285 DOI: 10.1002/cncr.34778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Lenalidomide maintenance after autologous stem cell transplant (ASCT) in multiple myeloma (MM) results in superior progression-free survival and overall survival. However, patients with high-risk multiple myeloma (HRMM) do not derive the same survival benefit from lenalidomide maintenance compared with standard-risk patients. The authors sought to determine the outcomes of bortezomib-based maintenance compared with lenalidomide maintenance in patients with HRMM undergoing ASCT. METHODS In total, the authors identified 503 patients with HRMM who were undergoing ASCT within 12 months of diagnosis from January 2013 to December 2018 after receiving triplet novel-agent induction in the Center for International Blood and Marrow Transplant Research database. HRMM was defined as deletion 17p, t(14;16), t(4;14), t(14;20), or chromosome 1q gain. RESULTS Three hundred fifty-seven patients (67%) received lenalidomide alone, and 146 (33%) received bortezomib-based maintenance (with bortezomib alone in 58%). Patients in the bortezomib-based maintenance group were more likely to harbor two or more high-risk abnormalities and International Staging System stage III disease (30% vs. 22%; p = .01) compared with the lenalidomide group (24% vs. 15%; p < .01). Patients who were receiving lenalidomide maintenance had superior progression-free survival at 2 years compared with those who were receiving either bortezomib monotherapy or combination therapy (75% vs. 63%; p = .009). Overall survival at 2 years was also superior in the lenalidomide group (93% vs. 84%; p = .001). CONCLUSIONS No superior outcomes were observed in patients with HRMM who received bortezomib monotherapy or (to a lesser extent) in those who received bortezomib in combination as maintenance compared with lenalidomide alone. Until prospective data from randomized clinical trials are available, post-transplant therapy should be tailored to each patient with consideration for treating patients in clinical trials that target novel therapeutic strategies for HRMM, and lenalidomide should remain a cornerstone of treatment.
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Affiliation(s)
- Naresh Bumma
- James Cancer Center, Ohio State Medical Center, Columbus, Ohio, USA
| | - Binod Dhakal
- Bone Marrow Transplant and Cellular Therapy Program, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Raphael Fraser
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Noel Estrada-Merly
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - César O. Freytes
- Bone Marrow Transplant Program, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Maxwell M. Krem
- Division of Hematology/BMT, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA
| | - Cindy Lee
- Department of Hematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lazaros Lekakis
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Hillard M. Lazarus
- University Hospital Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Hemant S. Murthy
- Blood and Marrow Transplantation Program, Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Division of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Ricardo Parrondo
- Blood and Marrow Transplantation Program, Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sagar S. Patel
- Transplant and Cellular Therapy Program, Huntsman Cancer Center Institute, University of Utah, Salt Lake City, Utah, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia, USA
| | - Christopher Strouse
- Division of Hematology, Oncology, and Bone Marrow Transplantation, University of Iowa, Iowa City, Iowa, USA
| | - David H. Vesole
- Jonn Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Shaji Kumar
- Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Muzaffar H. Qazilbash
- Department of Blood and Marrow Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nina Shah
- Division of Hematology-Oncology, University of California San Francisco, San Francisco, California, USA
| | - Anita D’Souza
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Surbhi Sidana
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford Health Care, Stanford, California, USA
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Zenga J, Atkinson S, Yen T, Massey B, Stadler M, Bruening J, Peppard W, Reuben M, Hayward M, Mesich B, Buchan B, Ledeboer N, Sanchez JL, Fraser R, Lin CW, Holtz ML, Awan M, Wong SJ, Puram SV, Salzman N. A phase 2 trial of a topical antiseptic bundle in head and neck cancer surgery: Effects on surgical site infection and the oral microbiome. EBioMedicine 2022; 81:104099. [PMID: 35671624 PMCID: PMC9168040 DOI: 10.1016/j.ebiom.2022.104099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/27/2022] Open
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Polhemus S, Pickett ML, Liu XJ, Fraser R, Ferguson CC, Drendel AL. Racial Disparities in the Emergency Department Evaluation of Adolescent Girls. Pediatr Emerg Care 2022; 38:307-311. [PMID: 35353799 DOI: 10.1097/pec.0000000000002675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Racial disparities and differences exist in emergency care. Obtaining a sexual history is standard of care for adolescents with abdominal pain. Testing for sexually transmitted infections (STIs) and pregnancy should be based on historical findings. The objective of this study was to determine whether differential care was provided to adolescent female patients with abdominal pain based on patient race or healthcare provider characteristics by evaluating the documentation of sexual history, STI testing, and pregnancy testing. METHODS This was a retrospective chart review of female patients between the ages of 14 and 18 years with abdominal pain presenting to a pediatric emergency department. Patient and provider characteristics, sexual history documentation, STI, and pregnancy testing were abstracted. Data were analyzed using χ 2 test and logistic regression model. RESULTS Eight hundred eighty-six encounters were included in the analysis. Median patient age was 16 years (range, 14-18 years); 359 (40.5%) were non-White. Differential care was provided. Non-White patients compared with White patients were more likely to have a documented sexual history (59.9% vs 44.0%, P < 0.001), STI testing (24.8% vs 7.8%, P < 0.001), and pregnancy testing (76.6% vs 66.2%, P < 0.001). Among sexually active female patients, the racial disparity for STI testing persisted ( P = 0.010). Provider type and sex did not result in differences in sexual history documentation, STI, or pregnancy testing for non-White compared with White patients ( P > 0.05). CONCLUSIONS Differential care was provided to non-White adolescents with abdominal pain compared with White adolescents. They were more likely to have a documented sexual history, STI testing, and pregnancy testing. Healthcare provider characteristics did not impact patient care. This racial disparity resulted in better medical care for non-White adolescents, but this may be the consequence of underlying implicit bias.
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Affiliation(s)
| | - Michelle L Pickett
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Xuerong Joy Liu
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Raphael Fraser
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Amy L Drendel
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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4
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Ragon BK, D'Souza A, Estrada-Merly N, Fraser R, George G, Gowda L, Shah N, Qazilbash MH, Kumar S, Horowitz MM, Usmani SZ, Shah MV. Impact of second primary malignancy post-autologous hematopoietic stem cell transplantation on outcomes of multiple myeloma: A CIBMTR analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8057] [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
8057 Background: Following autologous hematopoietic stem cell transplant (auto HCT), maintenance therapies improve survival, reduce relapse risk in multiple myeloma (MM), and are the de facto standard-of-care. However, clinical trials have shown an increased risk of second primary malignancies (SPM) with maintenance therapy, including second hematological malignancies (SHM). We examined data from the Center for International Blood and Marrow Transplant Research (CIBMTR) registry to evaluate the impact of SPM on progression-free (PFS) and overall survival (OS) and the utilization of allogeneic HCT in patients with therapy-related myeloid neoplasms (t-MN). Methods: Adult patients (pts) with MM who underwent first auto HCT in the United States with a melphalan conditioning regimen from 2011-2018 and subsequently received maintenance therapy were included (N=3948). The primary endpoint of interest was the impact of SPM and SHM on OS. Multivariate analytic (MVA) modelling was applied, accounting for competing risks while integrating significant covariates to determine the impact of SPM on PFS and OS. Finally, we studied the utilization and survival following allogeneic HCT for SHM. Results: Baseline characteristics were similar between the two groups. Maintenance regimens used were lenalidomide (2836, 72%), bortezomib (370,9 %) or lenalidomide + bortezomib (372, 9%) based combinations. At a median follow up of 37 months, 175 (5%) pts developed SPM, including 112 (64%) solid 36 (21%) myeloid, and 27 (15%) lymphoid cancers. In MVA, the development of SPM and SHM was associated with an inferior PFS (HR 2.62, P<0.001 and HR 5.01, P<0.001, respectively) and OS (HR 3.85, P<0.001 and 8.13, P<0.001, respectively). The two commonest causes of death were MM (42%) and SPM (30%) for those developing SPM. Similarly, MM (53%) and SHM (18%) were the two commonest causes of death for those developing SHM. Nine (14%,5 t-MDS and 4 t-AML) of 63 patients with SHM underwent an allogeneic HCT. Patients undergoing allogeneic HCT were more likely to have Karnofsky score ≥90 (100% vs. 50%, P=0.02) compared to those who did not. One year survival from allo SCT was 66.7% (CI 34.6-92%). Conclusions: The three-year cumulative incidence of SPM was 3.3 (2.6-4)% in this large contemporaneous CIBMTR cohort. Disease relapse remains the primary cause of death in MM patients who develop SPM or SHM. Given the median OS for MM is now > 10 years, longer follow-up is needed to assess the SPM and SHM risks with maintenance therapy post-auto HCT.
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Affiliation(s)
| | | | - Noel Estrada-Merly
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Raphael Fraser
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Lohith Gowda
- Yale Cancer Center and Yale School of Medicine, New Haven, CT
| | - Nina Shah
- Division of Hematology-Oncology, University of California San Francisco, San Francisco, CA
| | - Muzaffar H. Qazilbash
- The University of Texas MD Anderson Cancer Center, Department of Stem Cell Transplantation & Cellular Therapy, Houston, TX
| | | | - Mary M. Horowitz
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Saad Zafar Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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5
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Abou-Ismail MY, Fraser R, Allbee-Johnson M, Metheny L, Ravi G, Ahn KW, Bhatt NS, Lazarus HM, de Lima M, El Jurdy N, Hematti P, Beitinjaneh AM, Nishihori T, Badawy SM, Sharma A, Pasquini MC, Savani BN, Sorror ML, Stadtmauer EA, Chhabra S. Does recipient body mass index inform donor selection for allogeneic haematopoietic cell transplantation? Br J Haematol 2022; 197:326-338. [PMID: 35286719 PMCID: PMC9675037 DOI: 10.1111/bjh.18108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 01/22/2023]
Abstract
It is not known whether obesity has a differential effect on allogeneic haematopoietic cell transplantation outcomes with alternative donor types. We report the results of a retrospective registry study examining the effect of obesity [body mass index (BMI) > 30] on outcomes with alternative donors (haploidentical related donor with two or more mismatches and receiving post-transplant cyclophosphamide [haplo] and cord blood (CBU)] versus matched unrelated donor (MUD). Adult patients receiving haematopoietic cell transplantation for haematologic malignancy (2013-2017) (N = 16 182) using MUD (n = 11 801), haplo (n = 2894) and CBU (n = 1487) were included. The primary outcome was non-relapse mortality (NRM). The analysis demonstrated a significant, non-linear interaction between pretransplant BMI and the three donor groups for NRM: NRM risk was significantly higher with CBU compared to haplo at BMI 25-30 [hazard ratio (HR) 1.66-1.71, p < 0.05] and MUD transplants at a BMI of 25-45 (HR, 1.61-3.47, p < 0.05). The results demonstrated that NRM and survival outcomes are worse in overweight and obese transplant recipients (BMI ≥ 25) with one alternative donor type over MUD, although obesity does not appear to confer a uniform differential mortality risk with one donor type over the other. BMI may serve as a criterion for selecting a donor among the three (MUD, haplo and CBU) options, if matched sibling donor is not available.
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Affiliation(s)
- Mouhamed Yazan Abou-Ismail
- Division of Hematology & Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mariam Allbee-Johnson
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leland Metheny
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Gayathri Ravi
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kwang Woo Ahn
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Marcos de Lima
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Najla El Jurdy
- The Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Amer M Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, FL, USA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Marcelo C Pasquini
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Bumma N, Dhakal B, Fraser R, Estrada-Merly N, Kumar S, Shah N, Qazilbash MH, D’Souza A, Sidana S. Impact of Bortezomib-Based Vs. Lenalidomide Maintenance Therapy on Outcomes of Patients with High-Risk Multiple Myeloma. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Sidana S, Kumar S, Fraser R, Estrada-Merly N, Giralt S, Agrawal V, Anderson LD, Aljurf M, Banerjee R, Bashey A, Battiwalla M, Beitinjaneh A, Chakraborty R, Chhabra S, Dhakal B, Dholaria B, Hashmi S, Janakiram M, Lee C, Lekakis L, Murthy HS, Parrondo R, Wangjam T, Usmani S, Shah N, Qazilbash M, D’Souza A. Impact of Induction Therapy with VRD versus VCD on Outcomes in Patients with Multiple Myeloma in Partial Response or Better Undergoing Upfront Autologous Stem Cell Transplantation. Transplant Cell Ther 2022; 28:83.e1-83.e9. [PMID: 34781066 PMCID: PMC8900987 DOI: 10.1016/j.jtct.2021.10.022] [Citation(s) in RCA: 8] [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: 07/27/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
Bortezomib-based triplet regimens-specifically bortezomib, lenalidomide, and dexamethasone (VRD) and bortezomib, cyclophosphamide, and dexamethasone (VCD)-are the 2 most common induction regimens used in transplantation-eligible patients with newly diagnosed multiple myeloma (NDMM), with conflicting data on comparative efficacy and outcomes in this population. We compared long-term outcomes of patients with NDMM receiving VRD induction and those receiving VCD induction prior to autologous stem cell transplantation (ASCT). Patients registered with the Center for International Blood and Marrow Transplant Registry were included if they had undergone ASCT for MM within 6 months of diagnosis between January 2013 and December 2018, received VRD or VCD induction, and achieved a pretransplantation partial or better response. Of 1135 patients, 914 received VRD and 221 received VCD. The patients receiving VCD were more likely to have renal impairment and International Staging System (ISS) stage III disease and less likely to receive full-dose melphalan (200 mg/m2) conditioning (69% versus 80%; P < .001). Very good partial response rates pretransplantation, post-transplantation, and at best response were not significantly different in the 2 groups. Maintenance use was more common after VRD induction (88% versus 76%; P < .001), with lenalidomide the most common agent (80% versus 63%). Patients in the VRD group had a higher rate of renal recovery (74% versus 43%; P < .001), possibly due to a rapid reduction of light chains in the VRD group or improvement in renal function with VCD, which allowed a switch over to VRD, as patients who switched were classified in the VRD group. Patients receiving VRD had better survival on univariate analysis, with a median progression-free survival (PFS) from transplantation of 44.6 months versus 34.1 months (P = .004) and median 5-year overall survival (OS) of 79% versus 60% (P < .001). Multivariate analysis showed no significant survival difference, with a hazard ratio for VCD versus VRD induction of 1.22 (95% CI, 0.96 to 1.55; P = .10) for PFS and 1.33 (95% CI, 0.93 to 1.92, P = .12) for OS. Maintenance use was independently associated with superior PFS and OS, along with ISS stage, cytogenetics, and pretransplantation response (PFS only). In patients with MM undergoing upfront ASCT after VRD or VCD induction, no independent survival difference was seen based on the induction therapy received after adjusting for other prognostic factors. The use of maintenance treatment was uniformly associated with superior outcomes. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
| | | | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vaibhav Agrawal
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Larry D. Anderson
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Rahul Banerjee
- Division of Hematology-Oncology; University of California San Francisco, San Francisco, CA
| | - Asad Bashey
- Blood and Marrow Transplant Program at the Northside Hospital, Atlanta, GA
| | | | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami, Miami, FL
| | - Rajshekhar Chakraborty
- Multiple Myeloma and Amyloidosis Service, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Binod Dhakal
- BMT and Cellular Therapy, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Shahrukh Hashmi
- 1. Department of Internal Medicine, Mayo Clinic, MN,Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Murali Janakiram
- University of Minnesota, Division of Hematology, Oncology, and Transplantation, Minneapolis, MN
| | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Hemant S. Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Ricardo Parrondo
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | | | - Saad Usmani
- Department of Hematologic Oncology & Blood Disorders Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Nina Shah
- Division of Hematology-Oncology; University of California San Francisco, San Francisco, CA
| | | | - Anita D’Souza
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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8
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Pasvolsky O, Yeshurun M, Fraser R, Estrada-Merly N, Rozovski U, Shargian L, Assal A, Banerjee R, Bumma N, Gale RP, Hagen P, Holmberg L, Hossain NM, Lazarus HM, Lee C, Mian H, Miller KC, Nathan S, Nagler A, Nishihori T, Parrondo RD, Patel S, Schroeder MA, Usmani SZ, Wang T, Wirk B, Kumar S, Shah N, Qazilbash MH, D’Souza A. Maintenance therapy after second autologous hematopoietic cell transplantation for multiple myeloma. A CIBMTR analysis. Bone Marrow Transplant 2022; 57:31-37. [PMID: 34608275 PMCID: PMC8764606 DOI: 10.1038/s41409-021-01455-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023]
Abstract
The role of maintenance therapy after high-dose chemotherapy and first autologous transplantation in multiple myeloma (MM) is well established. We explored the effect of maintenance therapy on outcomes after salvage second autologous hematopoietic cell transplant (AHCT2) using the Center for International Blood and Marrow Transplant Research registry. Outcomes of interest included non-relapse mortality (NRM), relapse/progression (REL), progression-free and overall survival (PFS, OS). Of 522 patients who underwent AHCT2 between 2010 and 2018, 342 received maintenance therapy and 180 did not. Maintenance regimens included lenalidomide (42%), pomalidomide (13%), and bortezomib (13%). Median follow up was 58 months in the maintenance group and 61.5 months in the no-maintenance group. Univariate analysis showed superior outcomes at 5 years in maintenance compared to the no-maintenance group: NRM 2 (0.7-3.9)% vs 9.9 (5.9-14.9)%, (p < 0.01), REL 70.2 (64.4-75.8)% vs 80.3 (73.6-86.3)% (p < 0.01), PFS 27.8 (22.4-33.5)% vs. 9.8 (5.5-15.2)% (p < 0.01), and OS 54 (47.5-60.5)% vs 30.9 (23.2-39.2)% (p < 0.01), respectively. Use of maintenance therapy retained its association with improved outcomes in multivariate analysis. There was no difference in second cancers in the two groups (p = 0.39). We conclude that maintenance after AHCT2 is associated with improved 5-year outcomes.
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Affiliation(s)
- Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel;,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Yeshurun
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel;,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Uri Rozovski
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel
| | - Liat Shargian
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel
| | - Amer Assal
- Columbia University Irving Medical Center, Department of Medicine, Bone Marrow Transplant and Cell Therapy Program, New York, NY
| | - Rahul Banerjee
- Division of Hematology-Oncology, University of California San Francisco, San Francisco, CA
| | - Naresh Bumma
- Ohio State Medical Center, James Cancer Center, Columbus , OH
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | | | | | - Nasheed M. Hossain
- Department of Medicine, Division of Hematology/Oncology, Stem Cell Transplant Program – Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Hillard M. Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Hira Mian
- McMaster University, Hamilton, ON, Canada
| | | | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL
| | - Arnon Nagler
- Hematology Division and BMT, Chaim Sheba Medical Center, Tel Hashomer, Israel;,Tel Aviv University, Tel Aviv, Israel
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ricardo D Parrondo
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonsville, FL
| | - Sagar Patel
- Blood and Marrow Transplant Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Mark A. Schroeder
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Saad Z. Usmani
- Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Trent Wang
- Division of Transplantation and Cellular Therapy, University of Miami, Miami, FL
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | | | - Nina Shah
- Division of Hematology-Oncology, University of California San Francisco, San Francisco, CA
| | | | - Anita D’Souza
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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9
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Fraser R, Smith R, Lin CJ. A 3D endometrial organotypic model simulating the acute inflammatory decidualisation initiation phase with epithelial induction of the key endometrial receptivity marker, integrin αVβ3. Hum Reprod Open 2021; 2021:hoab034. [PMID: 34532597 PMCID: PMC8438487 DOI: 10.1093/hropen/hoab034] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/22/2021] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION Is it possible to develop a simplified physiological in vitro system representing the key cell-types associated with a receptive endometrial phenotype? SUMMARY ANSWER We present a new concept to investigate endometrial receptivity, with a 3D organotypic co-culture model to simulate an early and transient acute autoinflammatory decidual status that resolves in the induction of a receptive endometrial phenotype. WHAT IS KNOWN ALREADY Embryo implantation is dependent on a receptive uterine environment. Ovarian steroids drive post-ovulation structural and functional changes in the endometrium, which becomes transiently receptive for an implanting conceptus, termed the ‘window of implantation’, and dysregulation of endometrial receptivity is implicated in a range of reproductive, obstetric, and gynaecological disorders and malignancies. The interactions that take place within the uterine microenvironment during this time are not fully understood, and human studies are constrained by a lack of access to uterine tissue from specific time-points during the menstrual cycle. Physiologically relevant in vitro model systems are therefore fundamental for conducting investigations to better understand the cellular and molecular mechanisms controlling endometrial receptivity. STUDY DESIGN, SIZE, DURATION We conducted an in vitro cell culture study using human cell lines and primary human cells isolated from endometrial biopsy tissue. The biopsy tissue samples were obtained from three women attending gynaecological outpatient departments in NHS Lothian. The work was carried out between December 2016 and April 2019, at the MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh. PARTICIPANTS/MATERIALS, SETTING, METHODS An endometrial stromal cell (ESC) line, and endometrial epithelial cells (EECs) isolated from endometrial biopsy tissue and expanded in vitro by conditional reprogramming, were used throughout the study. Immunocytochemical and flow cytometric analyses were used to confirm epithelial phenotype following conditional reprogramming of EECs. To construct an endometrial organotypic co-culture model, ESCs were embedded within a 3D growth factor-reduced Matrigel structure, with a single layer of conditionally reprogrammed EECs seeded on top. Cells were stimulated with increasing doses of medroxyprogesterone acetate, cAMP and oestradiol, in order to induce ESC decidual transformation and endometrial receptivity. Decidual response and the induction of a receptive epithelial phenotype were assessed by immunocytochemical detection and quantitative in-cell western analyses, respectively. MAIN RESULTS AND THE ROLE OF CHANCE A transient up-regulation of the interleukin-33 receptor protein, ST2L, was observed in ESCs, indicating a transient autoinflammatory decidual response to the hormonal stimulation, known to induce receptivity gene expression in the overlying epithelium. Hormonal stimulation increased the EEC protein levels of the key marker of endometrial receptivity, integrin αVβ3 (n = 8; *P < 0.05; ***P < 0.0001). To our knowledge, this is the first demonstration of a dedicated endometrial organotypic model, which has been developed to investigate endometrial receptivity, via the recapitulation of an early decidual transitory acute autoinflammatory phase and induction of an epithelial phenotypic change, to represent a receptive endometrial status. LIMITATIONS, REASONS FOR CAUTION This simplified in vitro ESC-EEC co-culture system may be only partly representative of more complex in vivo conditions. WIDER IMPLICATIONS OF THE FINDINGS The 3D endometrial organotypic model presented here may offer a valuable tool for investigating a range of reproductive, obstetric, and gynaecological disorders, to improve outcomes for assisted reproductive technologies, and for the development of advances in contraceptive methods. STUDY FUNDING/COMPETING INTEREST(S) This work was supported in part by a Medical Research Council Centre Grant (project reference MR/N022556/1). R.F. was the recipient of a Moray Endowment award and a Barbour Watson Trust award. C.-J.L. is a Royal Society of Edinburgh Personal Research Fellow, funded by the Scottish Government. The authors have no conflicts of interest to declare.
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Affiliation(s)
- R Fraser
- The University of Edinburgh, MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - R Smith
- The University of Edinburgh, MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - C-J Lin
- The University of Edinburgh, MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
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10
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Abstract
Purpose of Review This review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures. Recent Findings A significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating procedures involved, such as lung isolation, one-lung ventilation, and flexible bronchoscopy. Summary Guidelines recommend appropriate personal protective equipment and numerous procedural modifications to prevent viral transmission to staff and other patients. With appropriate disease mitigation strategies in place, elective thoracic surgery, in particular for lung cancer, has been able to continue safely in many centres.
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Affiliation(s)
- R Fraser
- Cardiothoracic Anaesthesia, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY UK
| | - M Steven
- Cardiothoracic Anaesthesia, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY UK
| | - P McCall
- Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, UK.,Critical Care and Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
| | - B Shelley
- Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, UK.,Critical Care and Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
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11
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Dhakal B, Patel S, Girnius S, Bachegowda L, Fraser R, Davila O, Kanate AS, Assal A, Hanbali A, Bashey A, Pawarode A, Freytes CO, Lee C, Vesole D, Cornell RF, Hildebrandt GC, Murthy HS, Lazarus HM, Cerny J, Yared JA, Schriber J, Berdeja J, Stockerl-Goldstein K, Meehan K, Holmberg L, Solh M, Diaz MA, Kharfan-Dabaja MA, Farhadfar N, Bashir Q, Munker R, Olsson RF, Gale RP, Bayer RL, Seo S, Chhabra S, Hashmi S, Badawy SM, Nishihori T, Gonsalves W, Nieto Y, Efebera Y, Kumar S, Shah N, Qazilbash M, Hari P, D'Souza A. Correction to: Hematopoietic cell transplantation utilization and outcomes for primary plasma cell leukemia in the current era. Leukemia 2021; 35:2141. [PMID: 34091601 DOI: 10.1038/s41375-021-01304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Binod Dhakal
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sagar Patel
- Blood and Marrow Transplant Program, University of Utah, Salt Lake City, UT, USA
| | | | | | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omar Davila
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abraham S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA
| | - Amer Assal
- NYPH/ Columbia University Medical Center, New York, NY, USA
| | - Amr Hanbali
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - David Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | - Robert Frank Cornell
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Hemant S Murthy
- Division of Hematology Oncology, Blood and Marrow Transplantation Program, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Jeffrey Schriber
- Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, AZ, USA.,Arizona Oncology, Scottsdale, AZ, USA
| | | | | | | | - Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology Oncology, Blood and Marrow Transplantation Program, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA.,FLHospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Qaiser Bashir
- Department of Stem Cell Transplantation & Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reinhold Munker
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Robert P Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | | | - Sachiko Seo
- Department of Haematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Yago Nieto
- Department of Stem Cell Transplantation & Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yvonne Efebera
- Ohio State medical Center, James Cancer Center, Columbus, OH, USA
| | | | - Nina Shah
- Department of Stem Cell Transplantation & Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Parameswaran Hari
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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12
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Pasvolsky O, Fraser R, Estrada-Merly N, Yeshurun M, Rozovski U, Shargian-Alon L, Kumar S, Shah N, Qazilbash MH, D'Souza A. Improved outcomes with maintenance therapy after salvage autologous hematopoietic cell transplantation (AHCT) in multiple myeloma: A CIBMTR study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8022 Background: Maintenance therapy in multiple myeloma (MM) after first autologous hematopoietic cell transplantation (AHCT1) is considered standard of care. Data regarding maintenance therapy after a salvage AHCT (AHCT2) in the setting of relapsed MM are scarce. Therefore, we used data from the Center for International Blood and Marrow Transplant Research (CIBMTR) registry to examine the use of maintenance therapy after AHCT2 in MM patients and its effect on post-transplant patient outcomes. Methods: We included US adult MM patients who underwent AHCT2 after melphalan conditioning regimen from 2010-2018, and excluded patients who underwent tandem transplants. Outcomes of interest included non-relapse mortality (NRM), relapse/progression (REL), progression-free and overall survival (PFS, OS). Cox proportional hazards models were developed to study the main effect (maintenance use) with other covariates of interest including age, sex, race, performance status, HCT-comorbidity index, MM subtype, stage, creatinine, cytogenetic, conditioning melphalan dose, disease status at transplant, and time from AHCT1 to AHCT2. Results: Of 522 patients, 342 received maintenance therapy and 180 did not after AHCT2. Baseline characteristics were similar between the two groups. Median follow up was 58 months in the maintenance group and 61.5 months in the no-maintenance group. Common maintenance regimens included immunomodulatory drugs (IMID)-lenalidomide (N = 145, 42%) or pomalidomide (N = 46, 13%) and proteasome inhibitor, bortezomib (N = 45, 13%). Univariate analysis showed superior outcomes at 5 years in maintenance compared to the no-maintenance group: NRM 2 (0.7-3.9)% vs 9.9 (5.9-14.9)%, p < 0.001, REL 70.2 (64.4-75.8)% vs 80.3 (73.6-86.3)%, p 0.003, PFS 27.8% (22.4-33.5) vs. 9.8% (5.5-15.2), p < 0.001, and OS 54% (47.5-60.5) vs 30.9% (23.2-39.2) p < 0.001, respectively. IMID-containing maintenance regimens were associated with an improved 5-year PFS and OS compared to other maintenance regimens. Use of maintenance therapy retained its association with improved outcomes in multivariate analysis, including NRM: hazard ratio (HR) 0.19 (0.08-0.44), p 0.0001, REL: HR 0.58 (0.47-0.72), p < 0.0001, PFS HR 0.52 (0.43-0.64), p < 0.0001, and OS HR 0.46 (0.36-0.60), p < 0.0001. We conducted additional analyses to investigate a possible selection bias in the maintenance group including landmark analysis at 100-days and 6-months post-AHCT2 as well as a subgroup analysis of patients who received melphalan 200mg/m2 as conditioning for AHCT2 (as a surrogate for fitness)- all these analyses also showed improved outcomes in the maintenance group. Second cancers were reported in 17 (5%) patients in the maintenance group and 6 (3%) patients and no-maintenance group (p 0.39). Conclusions: Maintenance therapy after AHCT2 is associated with superior outcomes in MM patients.
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Affiliation(s)
- Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah- Tikva, Israel
| | - Raphael Fraser
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- CIBMTR (Center for International Blood and Marrow Transplant Research) Medical College of Wisconsin, Milwaukee, WI
| | - Moshe Yeshurun
- BMT Unit, Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - Uri Rozovski
- Institute of hematology, Rabin Medical Center,, Petach-Tikva, Israel
| | - Liat Shargian-Alon
- BMT Unit, Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | | | - Nina Shah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
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13
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Abou-Ismail MY, Metheny L, Fraser R, Johnson MH, Ravi G, de Lima M, Pasquini MC, Savani B, Sorror ML, Stadtmauer EA, Chhabra S. Effect of Obesity on Outcomes after Alternative Donor Allogeneic Hematopoietic Stem Cell Transplant (alloHCT). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00212-8] [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: 11/16/2022]
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14
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Scott BL, Pasquini MC, Fei M, Fraser R, Wu J, Devine SM, Porter DL, Maziarz RT, Warlick E, Fernandez HF, Soiffer RJ, Alyea E, Hamadani M, Bashey A, Giralt S, Geller NL, Leifer E, Hourigan CS, Gui G, Mendizabal A, Horowitz MM, Deeg HJ, Horwitz ME. Myeloablative versus Reduced-Intensity Conditioning for Hematopoietic Cell Transplantation in Acute Myelogenous Leukemia and Myelodysplastic Syndromes-Long-Term Follow-Up of the BMT CTN 0901 Clinical Trial. Transplant Cell Ther 2021; 27:483.e1-483.e6. [PMID: 33775615 DOI: 10.1016/j.jtct.2021.02.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
Several prospective randomized trials comparing conditioning intensity before allogeneic hematopoietic cell transplantation (HCT) have been performed, with conflicting results. Although reduced-intensity conditioning (RIC) leads to lower treatment-related mortality (TRM), this is offset by higher rates of relapse. Long-term follow-up of randomized comparative trials are limited. Here we present long-term follow-up of a randomized comparison of myeloablative conditioning (MAC) compared with RIC before HCT for acute myelogenous leukemia (AML) or myelodysplasia (MDS). Long-term comparative analyses of overall survival, relapse, and relapse-free survival were performed. Patients age 18 to 65 years with <5% marrow myeloblasts were randomized to receive MAC (n = 135) or RIC (n = 137), followed by HCT from an HLA-matched donor. The primary endpoint of the trial was an 18-month pointwise comparison of overall survival. The analyses were performed using a proportional hazards model. The median follow-up of the entire cohort was 51 months. At 4 years, the transplant-related mortality (TRM) was 25.1% for MAC, compared with 9.9% for RIC (P < .001). Patients who received RIC had a significantly higher risk of relapse compared to those who received MAC (hazard ratio [HR], 4.06; 95% CI, 2.59 to 6.35; P < 0.001). Among the patients who relapsed after HCT, postrelapse survival was similar at 3 years (24% for MAC and 26% for RIC). Overall survival was superior for patients who received MAC compared to those who received RIC (HR, 1.54; 95% CI, 1.07 to 2.2; P = .03). Our data show that patients who received MAC were at higher risk of late TRM compared with those who received RIC; however, because of the exceedingly high rates of relapse in the RIC arm, overall survival remained significantly better for patients who received MAC. Among patients with MDS or AML eligible for either MAC or RIC regimens, long-term follow up demonstrates a survival advantage for patients who received MAC.
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Affiliation(s)
- Bart L Scott
- Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Marcelo C Pasquini
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mingwei Fei
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Raphael Fraser
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Juan Wu
- The Emmes Corporation, Rockville, Maryland
| | - Steve M Devine
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | | | | | | | | | | | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Asad Bashey
- Northside Hospital Cancer Institute, Atlanta, Georgia
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy L Geller
- National Heart Lung and Blood Institute, Bethesda, Maryland
| | - Eric Leifer
- National Heart Lung and Blood Institute, Bethesda, Maryland
| | | | - Gege Gui
- National Heart Lung and Blood Institute, Bethesda, Maryland
| | | | - Mary M Horowitz
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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15
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Lach KD, Sorin M, Huynh C, Alirezaie NS, Fiore A, Fiset B, Rayes RF, Camilleri-Broet S, Fraser R, Majewski J, Spicer JD, Walsh LA, Fiset PO. Combined small-cell lung carcinoma revealed to be an intratumoural metastasis by genetic analysis. Ann Oncol 2021; 32:679-681. [PMID: 33577994 DOI: 10.1016/j.annonc.2021.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/19/2020] [Accepted: 01/29/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- K D Lach
- Department of Pathology, McGill University, Montréal, Canada
| | - M Sorin
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montréal, Canada
| | - C Huynh
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montréal, Canada
| | - N S Alirezaie
- Department of Human Genetics, McGill University, Montréal, Canada; Génome Québec Innovation Centre, McGill University, Montréal, Canada
| | - A Fiore
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montréal, Canada; Department of Human Genetics, McGill University, Montréal, Canada
| | - B Fiset
- Department of Human Genetics, McGill University, Montréal, Canada
| | - R F Rayes
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montréal, Canada; Department of Surgery, McGill University, Montréal, Canada
| | | | - R Fraser
- Department of Pathology, McGill University, Montréal, Canada
| | - J Majewski
- Department of Human Genetics, McGill University, Montréal, Canada; Génome Québec Innovation Centre, McGill University, Montréal, Canada
| | - J D Spicer
- Department of Surgery, McGill University, Montréal, Canada
| | - L A Walsh
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montréal, Canada; Department of Human Genetics, McGill University, Montréal, Canada.
| | - P O Fiset
- Department of Pathology, McGill University, Montréal, Canada.
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16
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Cornell RF, Fraser R, Costa L, Goodman S, Estrada-Merly N, Lee C, Hildebrandt G, Gergis U, Farhadfar N, Freytes CO, Kamble RT, Krem M, Kyle RA, Lazarus HM, Marks DI, Meehan K, Patel SS, Ramanathan M, Olsson RF, Wagner JL, Kumar S, Qazilbash MH, Shah N, Hari P, D'Souza A. Bortezomib-Based Induction Is Associated with Superior Outcomes in Light Chain Amyloidosis Patients Treated with Autologous Hematopoietic Cell Transplantation Regardless of Plasma Cell Burden. Transplant Cell Ther 2020; 27:264.e1-264.e7. [PMID: 33781533 DOI: 10.1016/j.jtct.2020.11.018] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 01/03/2023]
Abstract
The benefits of pre-transplant induction chemotherapy in light chain (AL) amyloidosis, a low burden plasma cell (PC) neoplasm associated with multiorgan dysfunction, is debatable, although with the availability of bortezomib, this approach is being increasingly pursued. We analyzed the outcomes of AL amyloidosis patients undergoing autologous hematopoietic cell transplant between 2014 and 2018 that were reported to the Center for International Blood and Marrow Transplant Research database. Of 440 patients, 294 received bortezomib-based induction, and 146 received no induction. Patients receiving induction had greater PC burden compared to no induction (PC 10% or more, 39% versus 11%; P < .01). At 2 years, the induction group compared to no induction had lower relapse/progression: 13% (9% to 18%) versus 23% (16% to 32%) (P = .02); better progression-free survival (PFS): 82% (77% to 87%) versus 69% (61% to 77%) (P < .01); and similar overall survival (OS): 92% (88% to 95%) versus 89% (84% to 94%) (P = .22), findings that were confirmed on multivariate analysis. A subset analysis limited to patients with <10% PC also showed superior relapse/progression (hazard ratio [HR], .43; 95% confidence interval [CI], .24 to .78; P < .01) and PFS (HR, .43; 95% CI, .26 to .72; P < .01) for induction compared to no induction. Thus, we conclude that pre-transplant bortezomib-based induction was associated with improved relapse/progression and PFS in AL amyloidosis. Longer survival follow-up is warranted, as OS was excellent in both cohorts at 2 years.
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Affiliation(s)
| | - Raphael Fraser
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Luciano Costa
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stacey Goodman
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Noel Estrada-Merly
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Usama Gergis
- Department of Medical Oncology, Division of Hematological Malignancies, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL
| | | | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Maxwell Krem
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | | | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Kenneth Meehan
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Sagar S Patel
- Blood and Marrow Transplant Program, University of Utah, Salt Lake City, Utah
| | - Muthalagu Ramanathan
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - John L Wagner
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - Ninah Shah
- Division of Hematology-Oncology, University of California San Francisco, San Francisco, California
| | - Parameswaran Hari
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Dhakal B, D'Souza A, Callander N, Chhabra S, Fraser R, Davila O, Anderson K, Assal A, Badawy SM, Berdeja J, Cerny J, Comenzo R, Chakraborty R, Peter Gale R, Kamble R, Kharfan-Dabaja MA, Krem M, Ganguly S, Janakiram M, Kansagra A, Munker R, Murthy H, Patel S, Kumar S, Shah N, Qazilbash M, Hari P. Novel prognostic scoring system for autologous hematopoietic cell transplantation in multiple myeloma. Br J Haematol 2020; 191:442-452. [PMID: 33094839 DOI: 10.1111/bjh.16987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/27/2020] [Accepted: 06/11/2020] [Indexed: 11/28/2022]
Abstract
We studied 2,528 patients with upfront autologous haematopoietic cell transplantation (AHCT) for multiple myeloma (MM) from 2008-2017 to develop a prognostic model to predict outcomes. High-risk cytogenetics included t(4;14), t(14;16), t(14;20), del13q on karyotype, del17p, +1q or 1pdel. A Cox model identified factors prognostic of progression/relapse in a training subset (n = 1,246). A weighted score using these factors was assigned to a validation cohort (n = 774). Presence of high-risk cytogenetics [hazard ratio, (HR) 1·68 (1·3-2·17)] and pre-AHCT bone marrow plasma cells (BMPCs) ≥10% [1·68 (1·33-2·12)] were assigned 4 points each; albumin at diagnosis <3·5 g/dl [1·31 (1·07-1·61)] 2; standard risk cytogenetics 1, and no cytogenetics abnormality, BMPCs <10% at AHCT and albumin ≥3·5 g/dl at diagnosis 0 points each. A three-category system with low risk (0-3), intermediate risk (4-8) and high risk (9-10) showed 3-year progression-free survival in the low vs. intermediate vs. high risk of 58% (95% CI: 52-63) vs. 49% (95% CI: 43-56) vs. 31% (95% CI: 12-51), P < 0.001 respectively, and 3-year OS in low vs. intermediate vs. high risk of 88% (95% CI: 84-91) vs. 81% (95% CI: 76-86) vs. 64% (95% CI: 39-80); P < 0·001. Our prognostic scoring system can identify MM patients at risk for early relapse after AHCT.
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Affiliation(s)
- Binod Dhakal
- BMT and Cellular Therapy, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omar Davila
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Amer Assal
- Department of Medicine, Bone Marrow Transplant and Cell Therapy Program, Columbia University Irving Medical Center, New York, NY, USA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | | | | | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rammurti Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Maxwell Krem
- University of Louisville Hospital/James Brown Cancer Center, Louisville, KY, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | | | - Ankit Kansagra
- UT Southwestern Medical Center - BMT Program, Dallas, TX, USA
| | - Reinhold Munker
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Hemant Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Sagar Patel
- Blood and Marrow Transplant Program, University of Utah, Salt Lake City, UT, USA
| | - Shaji Kumar
- Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nina Shah
- Division of Hematology-Oncology, University of California San Francisco, San Francisco, CA, USA
| | | | - Parameswaran Hari
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Schroter S, Thomas D, Nimmer M, Visotcky A, Fraser R, Colella MR, Browne LR. Multimedia Evaluation of EMT-Paramedic Assessment and Management of Pediatric Respiratory Distress. PREHOSP EMERG CARE 2020; 25:664-674. [PMID: 32870748 DOI: 10.1080/10903127.2020.1817211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The prehospital care of asthma, bronchiolitis and croup is directed by evidence-based Emergency Medical Services (EMS) protocols. Determining the appropriate intervention for these conditions requires Emergency Medical Technicians-Paramedics (EMT-Ps) to correctly differentiate asthma/bronchospasm, bronchiolitis, and croup. The diagnostic accuracy of EMT-Ps for these pediatric respiratory distress conditions is unknown. OBJECTIVE We hypothesized increasing provider age, years of provider experience, higher volume of pediatric cases, self-reported comfort with pediatric patients, and having children of one's own would be associated with increased accuracy in diagnosis on a validated multimedia questionnaire. METHODS This is a cross-sectional study of paramedics from a single EMS agency who completed a validated, case-based questionnaire between July and September 2018. The multimedia questionnaire consisted of four cases, each of which included patient videos and lung sound recordings. Paramedics were asked to assess the severity of distress and ascribe the correct diagnosis and prehospital intervention for each case. Each paramedic completed the questionnaire independently. We defined high questionnaire performance a priori as correctly identifying the diagnosis for ≥75% of cases and used multivariate regression to assess factors associated with high questionnaire performance. Provider age and EMS experience were reported in years and analyzed as continuous variables. Volume of pediatric cases was dichotomized to <1 and ≥1 case per shift and having children was dichotomized to either having children or not having children. RESULTS Of 514 paramedics, 420 (82%) completed the questionnaire. Overall, paramedics correctly assessed the severity of respiratory distress 92% of the time. However, they only ascribed the correct diagnosis 50% and selected the correct intervention(s) 38% of the time. Increasing age, years of experience, higher volume of pediatric cases, self-reported comfort with pediatric patients, and having children of their own were not associated with questionnaire performance. CONCLUSION Paramedics accurately assessed severity of distress in multimedia cases of asthma/bronchospasm, bronchiolitis and croup in children, but showed significant room for improvement in correctly identifying the diagnosis and in selecting appropriate intervention(s). Age, years of EMS experience, higher volume of clinical pediatric cases, self-reported comfort with pediatric patients, and having children of their own were not associated with questionnaire performance.
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Affiliation(s)
- Stephanie Schroter
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (SS, DT, MN, LRB); Department of Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin (AV, RF, MRC); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (MRC, LRB)
| | - Danny Thomas
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (SS, DT, MN, LRB); Department of Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin (AV, RF, MRC); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (MRC, LRB)
| | - Mark Nimmer
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (SS, DT, MN, LRB); Department of Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin (AV, RF, MRC); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (MRC, LRB)
| | - Alexis Visotcky
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (SS, DT, MN, LRB); Department of Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin (AV, RF, MRC); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (MRC, LRB)
| | - Raphael Fraser
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (SS, DT, MN, LRB); Department of Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin (AV, RF, MRC); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (MRC, LRB)
| | - M Riccardo Colella
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (SS, DT, MN, LRB); Department of Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin (AV, RF, MRC); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (MRC, LRB)
| | - Lorin R Browne
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (SS, DT, MN, LRB); Department of Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin (AV, RF, MRC); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (MRC, LRB)
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19
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Muslu CS, Kopetsky M, Nimmer M, Visotcky A, Fraser R, Brousseau DC. The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain. Pediatr Blood Cancer 2020; 67:e28268. [PMID: 32614150 PMCID: PMC7674235 DOI: 10.1002/pbc.28268] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The National Heart, Lung, and Blood Institute guidelines for sickle cell disease (SCD) pain crisis management recommend opioids within 60 minutes of emergency department (ED) registration and every 30 minutes thereafter until acute pain is managed. These guidelines are based on expert opinion without published, supporting data. OBJECTIVE To evaluate the association between timely ED opioid administration and hospitalization rates in children with SCD. METHODS Retrospective cohort of children presenting to a children's hospital ED with SCD pain between January 1, 2014, and April 30, 2018. Visits were extracted using ICD codes, chief complaints, and receipt of at least one opioid, and then reviewed to confirm the visit was an uncomplicated pain crisis. The primary outcome was hospitalization, yes or no. Generalized estimating equations were used to determine adjusted odds of hospitalization for the timely administration of initial and second doses of opioids. RESULTS Of the 902 eligible visits, 368 (40.8%) resulted in hospitalization. The mean (SD) age was 11.9 (± 5.2) years. The first opioid was administered within 60 minutes of arrival in 601 (66.6%) visits. The second opioid was administered within 30 minutes of the first in 84 (12.3%) visits. Receipt of the first opioid within 60 minutes of arrival was not associated with decreased hospitalization (1.30 [0.96-1.76]). However, receipt of the second dose within 30 minutes of the first was associated with decreased hospitalization (0.56 [0.33-0.94]). CONCLUSION This study suggests an association between children with SCD receiving a second dose within 30 minutes of the first opioid dose and decreased hospitalizations.
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Affiliation(s)
| | | | - Mark Nimmer
- Medical College of Wisconsin, Milwaukee, WI,Pediatric Emergency Medicine and the Children’s Research Institute of the Children’s Hospital of Wisconsin, Milwaukee, WI
| | - Alexis Visotcky
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Raphael Fraser
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - David C. Brousseau
- Medical College of Wisconsin, Milwaukee, WI,Pediatric Emergency Medicine and the Children’s Research Institute of the Children’s Hospital of Wisconsin, Milwaukee, WI
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Hari P, Pasquini MC, Stadtmauer EA, Fraser R, Fei M, Devine SM, Efebera YA, Geller N, Horowitz MM, Koreth J, Landau HJ, McCarthy PL, Qazilbash MH, Shah N, Vesole DH, Vogl DT, Somlo G, Krishnan AY, Giralt S. Long-term follow-up of BMT CTN 0702 (STaMINA) of postautologous hematopoietic cell transplantation (autoHCT) strategies in the upfront treatment of multiple myeloma (MM). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8506] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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
8506 Background: STaMINA was a phase III trial comparing progression-free survival (PFS) among 758 pts randomized to: 1. second autoHCT then lenalidomide (Len) maintenance (Auto/Auto, n = 247); 2. consolidation with Len/bortezomib/ dexamethasone (RVD) followed by Len maintenance (Auto/RVD, 254); 3. Len maintenance (Auto/Len, 257). All three arms were similar (Stadtmauer JCO 2018). Len maintenance was designed to continue for 3 years and amended to allow continuation until disease progression through a follow up protocol (07LT, NCT#02322320). We report 6 yr follow up for STaMINA and the results of Len discontinuation beyond 3 years. Methods: 07LT was offered to pts who were progression-free at 38 mo; completed planned Len maintenance and were within 4 years of BMT CTN 0702 follow up. Among 431 07LT eligible patients, 273 enrolled and 179 opted to continue maintenance until disease progression. All patients enrolled in STaMINA were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) and long-term outcomes for patients not enrolled on 07LT (N = 166) were available through this mechanism. Before combining 07LT data and CIBMTR data for LTFU analysis, outcomes in both databases were analyzed separately and confirmed to be comparable. Results: Using intent-to-treat (ITT), 6yr PFS and overall survival (OS) was the same among Auto/Auto (43.9%; 73.1%), Auto/RVD (39.7%, 74.9%) and Auto/Len (40.9%, 76.4%)(p = 0.6; p = 0.8). Protocol defined high risk disease, (HR = 1.53, p < 0.0001) and age (p = 0.03) were adverse risks for PFS. In as treated analysis, 6yr PFS were 49.4%, 39.7% and 38.6% for Auto/auto (170), Auto/RVD (222) and Auto/Len (361), respectively (p = 0.01). 6yr PFS in high risk pts as treated analysis were 43.6% and 26% for Auto/auto and Auto/Len, respectively (p = 0.03). Landmark analysis at 38 mo included 215 pts who continued Len maintenance (either on 07LT study or commercial Len) vs. 207 who stopped. Baseline demographics; study arm on 0702, induction pre-autoHCT were similar. Len discontinuation after 38 mo was associated with inferior PFS (79.5% vs. 61% at 5yr; HR = 1.91, p = 0.0004) but similar OS. Incidence of all second primary malignancies (SPM)(81 cases with 43 heme-malignancies) was associated with age. Conclusions: Long term outcomes are similar using ITT, but as treated analysis suggested a PFS benefit for tandem autoHCT, driven mainly by pts with high risk MM. Len discontinuation even at 38 mo was associated with inferior PFS. Clinical trial information: NCT02322320 .
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Affiliation(s)
- Parameswaran Hari
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Marcelo C. Pasquini
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Raphael Fraser
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Mingwei Fei
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Steven Michael Devine
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | | | - Nancy Geller
- NIH - NHLBI Government Agency Partners, Bethesda, MD
| | - Mary M. Horowitz
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nina Shah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David H. Vesole
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - Dan T. Vogl
- University of Pennsylvania, Philadelphia, PA
| | | | | | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Cornell RF, Hari P, Goodman S, Costa LJ, Fraser R, Estrada-Merly N, Kumar S, Qazilbash MH, D'Souza A. Bortezomib induction prior to autologous hematopoietic cell transplantation (AHCT) for newly diagnosed light chain amyloidosis (AL): A study of 426 patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8515] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8515 Background: AL is a clonal plasma cell (PC) disorder causing multiorgan dysfunction from amyloid fibril deposition. While bortezomib (B) induction has been used prior to AHCT recently, AHCT without prior induction has been a common practice. The primary objective of this study was to compare outcomes of AL patients who proceeded to AHCT without induction to those receiving pre-AHCT induction with B. Methods: Outcomes of 426 systemic AL AHCT recipients between 2014-2018 reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) were reviewed. Patients receiving induction with therapy other than B, AHCT occurring > 9 months after diagnosis, no documented AL end-organ involvement, myeloma-defining events and conditioning other than melphalan (MEL) monotherapy were excluded. Multivariate analysis (MVA) was conducted to identify prognostic factors associated with relapse, PFS and overall survival (OS). Results: 286 patients received B induction therapy vs 140 patients receiving no induction. Age, gender, number and type of organs involved, and AL AHCT center volume were similar between the groups. Patients receiving induction had greater PC burden compared with no induction (PC ≥ 10%, 41% vs 11%, p < 0.01). Induction was B, cyclophosphamide and dexamethasone (D) in 83% followed by B, lenalidomide and D (10%) or B+D (7%). Median follow-up was 24.9 months. At 2 years, B induction vs. no induction was associated with 13% (95% CI 10-17%) vs 22% (95% CI 15-30%) relapse risk (p = 0.03); 83% (95% CI 79-87%) vs 74% (95% CI 66-81%) PFS (p = 0.04); 93% (95% CI 90-95%) vs 94% (95% CI 89-97%) OS (p = 0.7). On MVA, the B induction group had improved PFS (HR 0.46, 95% CI 0.3-0.7, p < 0.001) with similar OS (HR 0.6, 95% CI 0.3-1.2, p = 0.1) compared with no induction. Creatinine < 2 mg/dl (HR 0.55, 95% CI 0.3-0.9, p = 0.02) and Karnofsky score ≥90 (HR 0.51, 95% CI 0.33-0.78, p < 0.01) were also associated with improved PFS. MEL dose < 180 mg/m2 was associated with inferior PFS (HR 2.17, 95% CI 1.31-3.61, p < 0.01) and OS (HR 3.6, 95% CI 1.5-8.6, p < 0.01). No deaths were seen in the first 100 days post-AHCT. At last follow-up, 32 deaths occurred, 26 (81%) due to AL. Conclusions: Compared with prior CIBMTR analyses, B induction use has increased in AL AHCT recipients and a higher PC burden was the only clinical determinant. Furthermore, B induction was associated with lower relapse and improved PFS at 2 years with no OS difference despite higher proportion of patients with > 10% PC, which has been associated with poor outcomes.
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Affiliation(s)
| | | | | | | | - Raphael Fraser
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- CIBMTR (Center for International Blood and Marrow Transplant Research) Medical College of Wisconsin, Milwaukee, WI
| | | | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
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22
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Badar T, Hari P, Dávila O, Fraser R, Wirk B, Dhakal B, Freytes CO, Valdes CR, Lee C, Vesole DH, Malek E, Hildebrandt GC, Landau H, Murthy HS, Lazarus HM, Berdeja JG, Meehan KR, Solh M, Diaz MA, Kharfan-Dabaja MA, Callander NS, Farhadfar N, Bashir Q, Kamble RT, Vij R, Munker R, Kyle RA, Chhabra S, Hashmi S, Siddhartha Ganguly, Jagannath S, Nishihori T, Nieto Y, Kumar S, Shah N, D’Souza A. African Americans with translocation t(11;14) have superior survival after autologous hematopoietic cell transplantation for multiple myeloma in comparison with Whites in the United States. Cancer 2020; 127:82-92. [PMID: 32966625 PMCID: PMC7736245 DOI: 10.1002/cncr.33208] [Citation(s) in RCA: 15] [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: 03/23/2020] [Revised: 05/07/2020] [Accepted: 06/13/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Multiple myeloma (MM) with the translocation t(11;14) may have inferior outcomes in comparison with other standard-risk MM, and it has been suggested to portend a worse prognosis in African Americans in comparison with Whites. This study used the Center for International Blood and Marrow Transplant Research (CIBMTR) database to examine the impact of t(11;14) on the clinical outcomes of patients with MM of African American and White descent. METHODS This study evaluated 3538 patients who underwent autologous hematopoietic cell transplantation (autoHCT) for MM from 2008 to 2016 and were reported to the CIBMTR. Patients were analyzed in 4 groups: African Americans with t(11;14) (n = 117), African Americans without t(11;14) (n = 968), Whites with t(11;14) (n = 266), and Whites without t(11;14) (n = 2187). RESULTS African Americans with t(11;14) were younger, had lower Karnofsky scores, and had more advanced stage MM with a higher Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI). Fewer African Americans with t(11;14) (21%) had a coexistent high-risk marker in comparison with Whites with t(11;14) (27%). In a multivariate analysis, race and t(11;14) had no association with progression-free survival. However, overall survival was superior among African Americans with t(11;14) in comparison with Whites with t(11;14) (hazard ratio, 0.53; 95% confidence interval, 0.30-0.93; P = .03). Survival was also associated with female sex, stage, time from diagnosis to transplant, a low HCT-CI, and receipt of maintenance. CONCLUSIONS Race may have a differential impact on the survival of patients with t(11;14) MM who undergo autoHCT and needs to be further studied.
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Affiliation(s)
- Talha Badar
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Parameswaran Hari
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Omar Dávila
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Baldeep Wirk
- Penn State Cancer Institute, Bone Marrow Transplant Program, Hershey, PA
| | - Binod Dhakal
- BMT and Cellular Therapy, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, Australia
| | - David H. Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ
| | - Ehsan Malek
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Heather Landau
- Bone Marrow Transplant Service, Division of Hematology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hemant S. Murthy
- Division of Hematology Oncology, Blood and Marrow Transplantation Program, Mayo Clinic Florida, Jacksonville, FL
| | - Hillard M. Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | | | | | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Mohamed A. Kharfan-Dabaja
- Division of Hematology Oncology, Blood and Marrow Transplantation Program, Mayo Clinic Florida, Jacksonville, FL
| | | | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Qaiser Bashir
- Department of Stem Cell Transplantation & Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rammurti T. Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO
| | | | | | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, MS,Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS
| | | | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, FL
| | - Yago Nieto
- Department of Stem Cell Transplantation & Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Nina Shah
- Department of Stem Cell Transplantation & Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anita D’Souza
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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23
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Bemanian A, Cassidy LD, Fraser R, Laud PW, Saeian K, Beyer KMM. Racial disparities of liver cancer mortality in Wisconsin. Cancer Causes Control 2019; 30:1277-1282. [PMID: 31531799 PMCID: PMC6858574 DOI: 10.1007/s10552-019-01232-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To calculate tract-level estimates of liver cancer mortality in Wisconsin and identify relationships with racial and socioeconomic variables. METHODS County-level standardized mortality ratios (SMRs) of liver cancer in Wisconsin were calculated using traditional indirect adjustment methods for cases from 2003 to 2012. Tract-level SMRs were calculated using adaptive spatial filtering (ASF). The tract-level SMRs were checked for correlations to a socioeconomic advantage index (SEA) and percent racial composition. Non-spatial and spatial regression analyses with tract-level SMR as the outcome were conducted. RESULTS County-level SMR estimates were shown to mask much of the variance within counties across their tracts. Liver cancer mortality was strongly correlated with the percent of Black residents in a census tract and moderately associated with SEA. In the multivariate spatially-adjusted regression analysis, only Percent Black composition remained significantly associated with an increased liver cancer SMR. CONCLUSIONS Using ASF, we developed a high-resolution map of liver cancer mortality in Wisconsin. This map provided details on the distribution of liver cancer that were inaccessible in the county-level map. These tract-level estimates were associated with several racial and socioeconomic variables.
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Affiliation(s)
- Amin Bemanian
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
- Medical Scientist Training Program, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Laura D Cassidy
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Raphael Fraser
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Purushottam W Laud
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Kia Saeian
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Kirsten M M Beyer
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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24
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Vyas P, O'kane AA, Ager E, Crooks S, Elliott C, Eriksson S, Fraser R, Hallstrom M, Hayes J, Indyk H, Jozwiak S, Kong K, McMahon A, Meneely J, Ming WW, Mitchell B, Sullivan D, Thompson C, Vuyani M, Vyas S, Wilson P. Determination of Vitamin B12 in Fortified Bovine Milk- Based Infant Formula Powder, Fortified Soya-Based Infant Formula Powder, Vitamin Premix, and Dietary Supplements by Surface Plasmon Resonance: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/94.4.1217] [Citation(s) in RCA: 11] [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: 11/14/2022]
Abstract
Abstract
A collaborative study was conducted on an inhibition-based protein-binding assay using the Biacore Q™ biosensor instrument and the Biacore Qflex™ Kit Vitamin B12 PI. The samples studied included infant formula, cereals, premixes, vitamin tablets, dietary supplements, and baby food. The collaborative study, which involved 11 laboratories, demonstrated that the assay showed an RSDr of 1.59–27.8 and HorRat values for reproducibility of 0.34–1.89 in samples with levels ranging from ppm to ppb. The assay studied is a label-free protein binding-based assay that uses the principle of surface plasmon resonance (SPR) to measure the interaction between vitamin B12 and a specifc binding protein. A Biacore Q biosensor uses this principle to detect binding directly at the surface of a sensor chip with a hydrophilic gold-dextran surface. The instrument passes a mixture of prepared sample extract and binding protein solution across a covalently immobilized vitamin B12 chip surface, and the response is given as free-binding protein as the mixture binds to the immobilized surface. This technique uses the specifcity and robustness of the protein-ligand interaction to allow minimal sample preparation and a wide range of matrixes to be analyzed rapidly. The reagents and accessories needed to perform this assay are provided as the ready-to-use format “Qflex Kit Vitamin B12 PI.” The method is intended for routine use in the quantitative determination of vitamin B12 (as cyanocobalamin) in a wide range of food products, dietary vitamin supplements, and multivitamin premixes.
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Affiliation(s)
- Pathik Vyas
- AsureQuality Auckland Laboratory, 131 Boundary Rd, Blockhouse Bay, Auckland, New Zealand
| | - Anthony A O'kane
- Queen’s University Belfast—Institute for Agri-Food and Land Use (IAFLU), David Keir Bldg, Stranmillis Rd, Belfast, BT9 5AG, United Kingdom
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25
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Cacciottolo TM, Perikari A, van der Klaauw A, Henning E, Stadler LKJ, Keogh J, Farooqi IS, Tenin G, Keavney B, Ryan E, Budd R, Bewley M, Coelho P, Rumsey W, Sanchez Y, McCafferty J, Dockrell D, Walmsley S, Whyte M, Liu Y, Choy MK, Tenin G, Abraham S, Black G, Keavney B, Ford T, Stanley B, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Sidik N, McCartney P, Corcoran D, Collison D, Rush C, McConnachie A, Touyz R, Oldroyd K, Berry C, Gazdagh G, Diver L, Marshall J, McGowan R, Ahmed F, Tobias E, Curtis E, Parsons C, Maslin K, D'Angelo S, Moon R, Crozier S, Gossiel F, Bishop N, Kennedy S, Papageorghiou A, Fraser R, Gandhi S, Prentice A, Inskip H, Godfrey K, Schoenmakers I, Javaid MK, Eastell R, Cooper C, Harvey N, Watt ER, Howden A, Mirchandani A, Coelho P, Hukelmann JL, Sadiku P, Plant TM, Cantrell DA, Whyte MKB, Walmsley SR, Mordi I, Forteath C, Wong A, Mohan M, Palmer C, Doney A, Rena G, Lang C, Gray EH, Azarian S, Riva A, Edwards H, McPhail MJW, Williams R, Chokshi S, Patel VC, Edwards LA, Page D, Miossec M, Williams S, Monaghan R, Fotiou E, Santibanez-Koref M, Keavney B, Badat M, Mettananda S, Hua P, Schwessinger R, Hughes J, Higgs D, Davies J. Scientific Business Abstracts of the 113th Annual Meeting of the Association of Physicians of Great Britain and Ireland. QJM 2019; 112:724-729. [PMID: 31505685 DOI: 10.1093/qjmed/hcz175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Perikari
- University of Cambridge Metabolic Research Laboratories
| | | | - E Henning
- University of Cambridge Metabolic Research Laboratories
| | - L K J Stadler
- University of Cambridge Metabolic Research Laboratories
| | - J Keogh
- University of Cambridge Metabolic Research Laboratories
| | - I S Farooqi
- University of Cambridge Metabolic Research Laboratories
| | - G Tenin
- From University of Manchester
| | | | - E Ryan
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - R Budd
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - M Bewley
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - P Coelho
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - W Rumsey
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - Y Sanchez
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - J McCafferty
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - D Dockrell
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - S Walmsley
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - M Whyte
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - Y Liu
- From the University of Manchester
| | - M-K Choy
- From the University of Manchester
| | - G Tenin
- From the University of Manchester
| | | | - G Black
- From the University of Manchester
| | | | - T Ford
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Good
- Golden Jubilee National Hospital
| | - P Rocchiccioli
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - M McEntegart
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - H Eteiba
- Golden Jubilee National Hospital
| | | | | | | | - S Hood
- Golden Jubilee National Hospital
| | | | - R McDade
- Golden Jubilee National Hospital
| | - N Sidik
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - P McCartney
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Corcoran
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Collison
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - C Rush
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Touyz
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
| | - K Oldroyd
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - Colin Berry
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - G Gazdagh
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - L Diver
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - J Marshall
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - R McGowan
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - F Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow
| | - E Tobias
- Academic Unit of Medical Genetics and Clinical Pathology, Laboratory Medicine Building, Queen Elizabeth University Hospital, University of Glasgow
| | - E Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - C Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Maslin
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - R Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - F Gossiel
- Academic Unit of Bone Metabolism, University of Sheffield
| | - N Bishop
- Academic Unit of Child Health, University of Sheffield
| | - S Kennedy
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - A Papageorghiou
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - R Fraser
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | - S Gandhi
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | | | - H Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - I Schoenmakers
- Department of Medicine, Faculty of Medicine and Health Sciences, University of East Anglia
| | - M K Javaid
- NIHR Oxford Biomedical Research Centre, University of Oxford
| | - R Eastell
- Academic Unit of Bone Metabolism, University of Sheffield
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - N Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | | | - A Howden
- School of Life Sciences, University of Dundee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E H Gray
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Azarian
- Institute of Hepatology, Foundation for Liver Research
| | - A Riva
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - H Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - M J W McPhail
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - R Williams
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Chokshi
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - V C Patel
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - L A Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - D Page
- University of Manchester
- Manchester Metropolitan University
| | - M Miossec
- Manchester Metropolitan University
- University of Newcastle
| | | | | | | | | | | | - M Badat
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - S Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya
| | - P Hua
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - R Schwessinger
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Hughes
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - D Higgs
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Davies
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
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26
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Bolaños-Meade J, Reshef R, Fraser R, Fei M, Abhyankar S, Al-Kadhimi Z, Alousi AM, Antin JH, Arai S, Bickett K, Chen YB, Damon LE, Efebera YA, Geller NL, Giralt SA, Hari P, Holtan SG, Horowitz MM, Jacobsohn DA, Jones RJ, Liesveld JL, Logan BR, MacMillan ML, Mielcarek M, Noel P, Pidala J, Porter DL, Pusic I, Sobecks R, Solomon SR, Weisdorf DJ, Wu J, Pasquini MC, Koreth J. Three prophylaxis regimens (tacrolimus, mycophenolate mofetil, and cyclophosphamide; tacrolimus, methotrexate, and bortezomib; or tacrolimus, methotrexate, and maraviroc) versus tacrolimus and methotrexate for prevention of graft-versus-host disease with haemopoietic cell transplantation with reduced-intensity conditioning: a randomised phase 2 trial with a non-randomised contemporaneous control group (BMT CTN 1203). Lancet Haematol 2019; 6:e132-e143. [PMID: 30824040 PMCID: PMC6503965 DOI: 10.1016/s2352-3026(18)30221-7] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prevention of graft-versus-host disease (GvHD) without malignant relapse is the overall goal of allogeneic haemopoietic cell transplantation (HCT). We aimed to evaluate regimens using either maraviroc, bortezomib, or post-transplantation cyclophosphamide for GvHD prophylaxis compared with controls receiving the combination of tacrolimus and methotrexate using a novel composite primary endpoint to identify the most promising intervention to be further tested in a phase 3 trial. METHODS In this prospective multicentre phase 2 trial, adult patients aged 18-75 years who received reduced-intensity conditioning HCT were randomly assigned (1:1:1) by random block sizes to tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide (cyclophosphamide 50 mg/kg on days 3 and 4, followed by tacrolimus starting on day 5 and mycophenolate mofetil starting on day 5 at 15 mg/kg three times daily not to exceed 1 g from day 5 to day 35); tacrolimus, methotrexate, and bortezomib (bortezomib 1·3 mg/m2 intravenously on days 1, 4, and 7 after HCT); or tacrolimus, methotrexate, and maraviroc (maraviroc 300 mg orally twice daily from day -3 to day 30 after HCT). Methotrexate was administered as a 15 mg/m2 intravenous bolus on day 1 and 10 mg/m2 intravenous bolus on days 3, 6, and 11 after HCT; tacrolimus was given intravenously at a dose of 0·05 mg/kg twice daily (or oral equivalent) starting on day -3 (except the post-transplantation cyclophosphamide, as indicated), with a target level of 5-15 ng/mL. Tacrolimus was continued at least until day 90 and was tapered off by day 180. Each study group was compared separately to a contemporary non-randomised prospective cohort of patients (control group) who fulfilled the same eligibility criteria as the trial, but who were treated with tacrolimus and methotrexate at centres not participating in the trial. The primary endpoint (GvHD-free, relapse-free survival [GRFS]) was defined as the time from HCT to onset of grade 3-4 acute GvHD, chronic GvHD requiring systemic immunosuppression, disease relapse, or death. The study was analysed by modified intention to treat. The study is closed to accrual and this is the planned analysis. This trial is registered with ClinicalTrials.gov, number NCT02208037. FINDINGS Between Nov 17, 2014, and May 18, 2016, 273 patients from 31 US centres were randomly assigned to the three study arms: 89 to tacrolimus, methotrexate, and bortezomib; 92 to tacrolimus, methotrexate, and maraviroc; 92 to tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; and six were excluded. Between Aug 1, 2014, and Sept 14, 2016, 224 controls received tacrolimus and methotrexate. Controls were generally well matched except for more frequent comorbidities than the intervention groups and a different distribution of types of conditioning regimens used. Compared with controls, the hazard ratio for GRFS was 0·72 (90% CI 0·54-0·94; p=0·044) for tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide, 0·98 (0·76-1·27; p=0·92) for tacrolimus, methotrexate, and bortezomib, and 1·10 (0·86-1·41; p=0·49) for tacrolimus, methotrexate, and maraviroc. 238 patients experienced grade 3 or 4 toxicities: 12 (13%) had grade 3 and 67 (73%) grade 4 events with tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; ten (11%) had grade 3 and 68 (76%) had grade 4 events with tacrolimus, methotrexate, and bortezomib; and 18 (20%) had grade 3 and 63 (68%) had grade 4 events with tacrolimus, methotrexate, and maraviroc. The most common toxicities were haematological (77 [84%] for tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; 73 [82%] for tacrolimus, methotrexate, and bortezomib; and 78 [85%] for tacrolimus, methotrexate, and maraviroc) and cardiac (43 [47%], 44 [49%], and 43 [47%], respectively). INTERPRETATION Tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide was the most promising intervention, yielding the best GRFS; this regimen is thus being prospectively compared with tacrolimus and methotrexate in a phase 3 randomised trial. FUNDING US National Health, Lung, and Blood Institute; National Cancer Institute; National Institute of Allergy and Infectious Disease; and Millennium Pharmaceuticals.
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Affiliation(s)
- Javier Bolaños-Meade
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
| | - Ran Reshef
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Raphael Fraser
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mingwei Fei
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sunil Abhyankar
- Department of Internal Medicine, University of Kansas Medical Center, Westwood, KS, USA
| | - Zaid Al-Kadhimi
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Amin M Alousi
- Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph H Antin
- Department of Medicial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sally Arai
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | | | - Yi-Bin Chen
- Department of Medicine, Massachusetts General, Hospital, Boston, MA, USA
| | - Lloyd E Damon
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yvonne A Efebera
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Nancy L Geller
- Office of Biostatistics Research, National Institutes of Health, Bethesda, MD, USA
| | - Sergio A Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Parameswaran Hari
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shernan G Holtan
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Mary M Horowitz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David A Jacobsohn
- Department of Pediatrics at George Washington University, Children's National Medical Center, Washington, DC, USA
| | - Richard J Jones
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Jane L Liesveld
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Brent R Logan
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Marco Mielcarek
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Pierre Noel
- Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Joseph Pidala
- Blood and Marrow Transplantation and Cellular Immunotherapy, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David L Porter
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Iskra Pusic
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ronald Sobecks
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Solomon
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Daniel J Weisdorf
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Juan Wu
- The Emmes Corporation, Rockville, MD, USA
| | - Marcelo C Pasquini
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Koreth
- Department of Medicial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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27
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Kilari D, D'Souza A, Fraser R, Qayed M, Davila O, Agrawal V, Diaz MA, Chhabra S, Cerny J, Copelan E, Farhadfar N, Freytes CO, Gale RP, Ganguly S, Hildebrandt GC, Holmberg L, Kamble RT, Kapoor P, Lazarus H, Lee C, Murthy HS, Naik S, Nishihori T, Saad A, Savani BN, Seo S, Warwick A, Wirk B, Yared JA, Nieto Y, Hari P. Autologous Hematopoietic Stem Cell Transplantation for Male Germ Cell Tumors: Improved Outcomes Over 3 Decades. Biol Blood Marrow Transplant 2019; 25:1099-1106. [PMID: 30794931 DOI: 10.1016/j.bbmt.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
The curative potential of autologous hematopoietic cell transplantation (autoHCT) for male germ cell tumors (GCTs) is well established. The optimal timing and number (single transplant [ST] versus tandem transplants [TT] versus triple transplants) of autoHCT are controversial, with wide practice variations. We examined survival trends among 2395 recipients of autoHCT for male GCTs between 1990 and 2015 reported to the Center for International Blood and Marrow Transplant Research. Trends and outcomes were analyzed by year of transplantation for intervals 1990 to 1994 (N = 288), 1995 to 1999 (N = 351), 2000 to 2004 (N = 376), 2005 to 2009 (N = 509), and 2010 to 2015 (N = 871). Multivariate analysis was restricted to the subset from 2000 to 2015 with research-level data (n = 267). The median duration of follow-up was 51 months. The median age at autoHCT was 31 years; 633 patients (26%) had primary extragonadal GCT, and 1167 (49%) underwent TT. The 3-year progression-free (PFS) and overall survival (OS) improved from 24% (95% confidence interval [CI], 18% to 31%) and 35% (95% CI, 29% to 40%), respectively, in 1990 to 1994 to 47% (95% CI, 43% to 50%) and 54% (95% CI, 50% to 57%), respectively, in 2010 to 2015 (P < .0001). TT recipients were more likely than ST recipients to undergo autoHCT as first salvage treatment. The proportion of TTs increased from 38% of all autoHCTs in 2000 to 2004 to 77% in 2010 to 2015. Nonseminoma histology, residual disease at autoHCT, >1 line of pretransplantation chemotherapy, and ST versus TT were associated with inferior PFS and OS. Post-transplantation survival has improved significantly over time for relapsed/refractory male GCT and is associated with the increased use of TTs (compared with STs) and performance of autoHCT earlier in the disease course.
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Affiliation(s)
| | - Anita D'Souza
- Center for International Blood and Marrow Transplantation, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Raphael Fraser
- Center for International Blood and Marrow Transplantation, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Muna Qayed
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Omar Davila
- Center for International Blood and Marrow Transplantation, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vaibhav Agrawal
- Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | | | - Jan Cerny
- UMass Memorial Medical Center, Worcester, Massachusetts
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | | | | | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | | | - Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | | | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Cindy Lee
- Royal Adelaide Hospita, Adelaide, South Australia, Australia
| | | | - Seema Naik
- Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sachiko Seo
- Department of Hematology and Oncology, National Cancer Research Center East, Chiba, Japan
| | - Anne Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean A Yared
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Addesso LC, Nimmer M, Visotcky A, Fraser R, Brousseau DC. Impact of Medical Scribes on Provider Efficiency in the Pediatric Emergency Department. Acad Emerg Med 2019; 26:174-182. [PMID: 30069952 DOI: 10.1111/acem.13544] [Citation(s) in RCA: 3] [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] [Received: 06/01/2018] [Revised: 07/13/2018] [Accepted: 07/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Today's emergency department (ED) providers spend a significant amount of time on medical record documentation, decreasing clinical productivity. One proposed solution is to utilize medical scribes who assist with documentation. We hypothesized that scribes would increase provider productivity and increase provider satisfaction without affecting patient experience or nursing satisfaction. METHODS We conducted an observational pre-post study comparing ED prescribe and postscribe clinical productivity metrics for 18 pediatric emergency medicine physicians, two general pediatricians, and two nurse practitioners working in the 12-bed nonurgent area of the pediatric ED. Productivity metrics included patients per hour (pts/hr), work relative value units per hour (wRVUs/hr), and visit duration measured for 1 year pre- and postscribe implementation. Cross-sectional satisfaction surveys were administered to patient families, providers, and nurses during the initial scribe rollout. RESULTS Overall, 24,518 prescribe and 27,062 postscribe visits were analyzed. Following scribe implementation, overall provider efficiency increased by 0.24 pts/hr (11.98%, p < 0.001) and 0.72 wRVUs/hr (20.14%, p < 0.001). The largest efficiency increase (0.36 pts/hr, 0.96 wRVUs/hr) occurred in January-March, when ED census peaked. Patient visit duration was 53 minutes in both the prescribe and the postscribe periods. During initial scribe implementation, 80% of parents of patients without a scribe rated the visit as very good/great compared to 84% with a scribe (p = 0.218). Of the 34 providers surveyed, 88% preferred working with a scribe. A majority of providers (82%) felt that their skills were used more effectively when working with a scribe, decreasing their likelihood of experiencing burnout. Of the 43 nurses surveyed, 51% preferred scribes and 47% were indifferent. CONCLUSIONS Medical scribes increased ED efficiency without decreasing patient satisfaction. Providers strongly favored the use of scribes, while nurses were indifferent. The next steps include a cost analysis of the scribe program.
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Affiliation(s)
- Luke C. Addesso
- Department of Pediatrics Medical College of Wisconsin Milwaukee WI
| | - Mark Nimmer
- Department of Pediatrics Medical College of Wisconsin Milwaukee WI
| | - Alexis Visotcky
- Department of Biostatistics Medical College of Wisconsin Milwaukee WI
| | - Raphael Fraser
- Department of Biostatistics Medical College of Wisconsin Milwaukee WI
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Abstract
BACKGROUND In the era of global surgery, there are limited data regarding the available surgical workforce in South Africa. METHODS This aim of this study was to determine the orthopaedic surgeon density in South Africa. This involved a quantitative descriptive analysis of all registered specialist orthopaedic surgeons in South Africa, using data collected from various professional societal national databases. RESULTS The results showed 1.63 orthopaedic surgeons per 100,000 population. The vast majority were male (95%) with under two-thirds (65%) being under the age of 55 years. The majority of the orthopaedic surgeons were found in Gauteng, followed by the Western Cape and Kwa-Zulu Natal. The majority of specialists reportedly worked either full time or part time in the private sector (95%), and the orthopaedic surgeon density per uninsured population (0.36) was far below that of the private sector (8.3). CONCLUSION Interprovincial differences as well as intersectoral differences were marked indicating geographic and socio-economic maldistribution of orthopaedic surgeons. This parallels previous studies which looked at other surgical sub-disciplines in South Africa. Addressing this maldistribution requires concerted efforts to expand public sector specialist posts as well as quantifying the burden of orthopaedic disease in both private and public sectors before recommendations can be made regarding workforce allocation in the future. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A J Dell
- Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| | - S Gray
- Medical Intern, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - R Fraser
- Busamed Hillcrest Private Hospital, Durban, South Africa
| | - M Held
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - R Dunn
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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Gopalakrishnan S, D'Souza A, Scott E, Fraser R, Davila O, Shah N, Gale RP, Kamble R, Diaz MA, Lazarus HM, Savani BN, Hildebrandt GC, Solh M, Freytes CO, Lee C, Kyle RA, Usmani SZ, Ganguly S, Assal A, Berdeja J, Kanate AS, Dhakal B, Meehan K, Kindwall-Keller T, Saad A, Locke F, Seo S, Nishihori T, Gergis U, Gasparetto C, Mark T, Nieto Y, Kumar S, Hari P. Revised International Staging System Is Predictive and Prognostic for Early Relapse (<24 months) after Autologous Transplantation for Newly Diagnosed Multiple Myeloma. Biol Blood Marrow Transplant 2018; 25:683-688. [PMID: 30579965 DOI: 10.1016/j.bbmt.2018.12.141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/12/2018] [Indexed: 11/15/2022]
Abstract
The revised International Staging System (R-ISS) combines ISS with genetic markers and lactate dehydrogenase and can prognosticate newly diagnosed multiple myeloma (MM). Early relapse (<24 months) after upfront autologous hematopoietic cell transplantation (AHCT) strongly predicts inferior overall survival (OS). We examined the ability of R-ISS in predicting early relapse and its independent prognostic effect on postrelapse survival after an early relapse. Using the Center for International Blood and Marrow Transplant Research database we identified MM patients receiving first AHCT within 18 months after diagnosis with available R-ISS stage at diagnosis (n = 628). Relative risks of relapse/progression, progression-free survival (PFS), and OS were calculated with the R-ISS group as a predictor in multivariate analysis. Among early relapsers, postrelapse survival was tested to identify factors affecting postrelapse OS. The cumulative incidence of early relapse was 23%, 39%, and 50% for R-ISS I, R-ISS II, and R-ISS III, respectively (P < .001). Shorter PFS and OS were seen with higher stage R-ISS. R-ISS was independently predictive for inferior postrelapse OS among early relapsers, as was the presence of ≥3 comorbidities and the use of ≥2 induction chemotherapy lines. R-ISS stage at diagnosis predicts early post-AHCT relapse and independently affects postrelapse survival among early relapsers.
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Affiliation(s)
| | - Anita D'Souza
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Emma Scott
- Center for Hematologic Malignancies, The Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Raphael Fraser
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Omar Davila
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nina Shah
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Rammurti Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Hillard M Lazarus
- Seidman Cancer Center, Division of Hematology Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | | | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Saad Z Usmani
- Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - Amer Assal
- Columbia University Medical Center, New York, New York
| | | | - Abraham S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Binod Dhakal
- Medical College of Wisconsin, Division of Hematology Oncology; Milwaukee, Wisconsin
| | - Kenneth Meehan
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Frederick Locke
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Sachiko Seo
- Department of Hematology & Oncology, National Cancer Research Center East, Chiba, Japan
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | | | - Tomer Mark
- University of Colorado Hospital, Division of Hematology Oncology; Aurora, Colorado
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Parameswaran Hari
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Scott EC, Hari P, Kumar S, Fraser R, Davila O, Shah N, Gale RP, Diaz MA, Agrawal V, Cornell RF, Ganguly S, Akpek G, Freytes C, Hashmi S, Malek E, Kamble RT, Lazarus H, Solh M, Usmani SZ, Kanate AS, Saad A, Chhabra S, Gergis U, Cerny J, Kyle RA, Lee C, Kindwall-Keller T, Assal A, Hildebrandt GC, Holmberg L, Maziarz RT, Nishihori T, Seo S, Kumar S, Mark T, D'Souza A. Staging Systems for Newly Diagnosed Myeloma Patients Undergoing Autologous Hematopoietic Cell Transplantation: The Revised International Staging System Shows the Most Differentiation between Groups. Biol Blood Marrow Transplant 2018; 24:2443-2449. [PMID: 30142419 PMCID: PMC6293469 DOI: 10.1016/j.bbmt.2018.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 12/30/2022]
Abstract
The Revised International Staging System (R-ISS) and the International Myeloma Working Group 2014 (IMWG 2014) are newer staging systems used to prognosticate multiple myeloma (MM) outcomes. We hypothesized that these would provide better prognostic differentiation for newly diagnosed multiple myeloma (MM) compared with ISS. We analyzed the Center for International Blood and Marrow Transplant Research database from 2008 to 2014 to compare the 3 systems (N = 628) among newly diagnosed MM patients undergoing upfront autologous hematopoietic cell transplantation (AHCT). The median follow-up of survivors was 48 (range, 3 to 99) months. The R-ISS provided the greatest differentiation between survival curves for each stage (for overall survival [OS], the differentiation was 1.74 using the R-ISS, 1.58 using ISS, and 1.60 using the IMWG 2014) . Univariate analyses at 3 years for OS showed R-ISS I at 88% (95% confidence interval [CI], 83% to 93%), II at 75% (95% CI, 70% to 80%), and III at 56% (95% CI, 3% to 69%; P < .001). An integrated Brier score function demonstrated the R-ISS had the best prediction for PFS, though all systems had similar prediction for OS. Among available systems, the R-ISS is the most optimal among available prognostic tools for newly diagnosed MM undergoing AHCT. We recommend that serum lactate dehydrogenase and cytogenetic data be performed on every MM patient at diagnosis to allow accurate prognostication.
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Affiliation(s)
- Emma C Scott
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Parameswaran Hari
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sathish Kumar
- Hematology/Oncology, Singapore General Hospital, Singapore
| | - Raphael Fraser
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Omar Davila
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nina Shah
- Department of Stem Cell Transplantation, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Vaibhav Agrawal
- Division of Hematology/Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Robert F Cornell
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Gorgun Akpek
- Stem Cell Transplantation and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Cesar Freytes
- School of Medicine, Texas Transplant Institute, San Antonio, Texas
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ehsan Malek
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Melhem Solh
- Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Saad Z Usmani
- Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Abraham S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Jan Cerny
- Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Cindy Lee
- Department of Haematology, Royal Adelaide Hospital, Adelaide, Australia
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | - Amer Assal
- Division of Hematology/Oncology, Columbia University Medical Center, New York, New York
| | - Gerhard C Hildebrandt
- Markey Cancer Center, University of Kentucky Chandler Medical Center, Lexington, Kentucky
| | - Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Richard T Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Sachiko Seo
- Department of Hematology & Oncology, National Cancer Research Center East, Chiba, Japan
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Tomer Mark
- University of Colorado Hospital, Aurora, Colorado
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Dhakal B, Kreuziger LB, Rein L, Kleman A, Fraser R, Aster RH, Hari P, Padmanabhan A. Disease burden, complication rates, and health-care costs of heparin-induced thrombocytopenia in the USA: a population-based study. Lancet Haematol 2018; 5:e220-e231. [PMID: 29703336 DOI: 10.1016/s2352-3026(18)30046-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Heparin-induced thrombocytopenia can be a life-threatening and limb-threatening complication of heparin therapy. Incidence and complication rates of this condition have been extrapolated from studies with modest sample sizes, and despite the availability of therapeutic interventions the outcomes of heparin-induced thrombocytopenia are not well understood. We aimed to estimate disease burden, complication rates, and costs of heparin-induced thrombocytopenia in the USA. METHODS In this population-based study we analysed data from 2009 to 2013 from the Nationwide (National) Inpatient Sample (NIS), a large, all-payer inpatient health-care database in the USA. To validate the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for heparin-induced thrombocytopenia (289.84), we defined the sensitivity and specificity of this code using patient data from 2013 from a local hospital (Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA). The primary outcomes assessed were the incidence of hospital discharges with codes for heparin-induced thrombocytopenia and of discharges for heparin-induced thrombocytopenia associated with cardiopulmonary bypass, haemodialysis, hip or knee arthroplasty, trauma or injury (or both), and gingival or periodontal disease (or both). We also assessed the incidence of thrombosis, bleeding, limb or digit amputation, mortality, length of hospital stay, and associated hospital charges. FINDINGS Between 2009 and 2013, 97 566 discharges from the NIS assigned the ICD-9-CM code for heparin-induced thrombocytopenia, and 149 911 247 discharges coded for non-heparin-induced thrombocytopenia, were analysed. Overall, heparin-induced thrombocytopenia was identified in 97 566 (0·065%; SE 0·0012) of 150 008 813 discharges, corresponding to approximately one in 1500 hospital admissions. Patients undergoing cardiopulmonary bypass had the highest rates of heparin-induced thrombocytopenia (7702 [0·63%; SE 0·03] of 1 230 362), followed by those undergoing haemodialysis (23 012 [0·47%; 0·01] of 4 908 100), those with gingival or periodontal disease, or both (106 [0·12%; 0·03] of 88 621), and those with trauma or injury, or both (541 [0·09%; 0·01] of 602 944); patients with hip (845 [0·04%; 0·004] of 1 943 353) and knee (676 [0·02%; 0·002] of 3 022 602) arthroplasty had the lowest rates of heparin-induced thrombocytopenia. Thrombosis (29 079 [29·8%; SE 0·4] of 97 566) and bleeding (6044 [6·2%; 0·2] of 97 566) were common complications in heparin-induced thrombocytopenia, and 1446 (23·9%; 1·2) of 6044 patients with heparin-induced thrombocytopenia who had haemorrhage died. 742 (0·76%; SE 0·06) of 97 566 patients with heparin-induced thrombocytopenia discharges underwent amputations compared with 173 043 (0·12%; 0·001) of 149 911 247 with non-heparin-induced thrombocytopenia discharges (adjusted odds ratio 5·095 [95% CI 4·309-6·023]; p<0·0001). Overall, in-hospital mortality was 9842 (10·1%; SE 0·2) of 97 508 in discharge summaries coded for heparin-induced thrombocytopenia compared with 3 206 700 (2·1%; 0·01) of 149 811 891 in discharges for non-heparin-induced thrombocytopenia (adjusted odds ratio 4·075 [95% CI 3·846-4·317]; p<0·0001). The median length of stay among live discharges was 8·9 days (IQR 4·6-17·1) and total hospital charges were US$83 072 (IQR 37 240-188 419) for heparin-induced thrombocytopenia discharges compared with 2·6 days (1·4-4·8) and $21 360 (11 426-41 917) for non-heparin-induced thrombocytopenia discharges (p<0·0001 for both). 333 discharges from a local hospital were analysed to assess the diagnostic sensitivity and specificity of the heparin-induced thrombocytopenia ICD-9-CM code; sensitivity was 90·9% (95% CI 57·1-99·5) and specificity was 94·4% (91·1-96·6). INTERPRETATION Complication rates for heparin-induced thrombocytopenia remain high and more effective preventive and treatment interventions are needed. FUNDING None.
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Affiliation(s)
- Binod Dhakal
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lisa Baumann Kreuziger
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - Lisa Rein
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ariel Kleman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Raphael Fraser
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard H Aster
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - Parameswaran Hari
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anand Padmanabhan
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA; Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA.
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Kilari D, Hari P, Qayed M, Fraser R, Davila O, Kumar S, Mark TM, Nieto Y, D'Souza A. Tandem high-dose chemotherapy and autologous hematopoietic stem cell transplantation (SCT) compared to single SCT for relapsed/refractory germ cell tumors (GCT). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.572] [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
572 Background: Single-center observational studies have established the use of single or tandem SCT to salvage relapsed GCT but randomized trials are lacking. We analyzed outcomes and prognostic factors in 2,395 male SCT recipients for relapsed GCT between 1990 and 2015. Methods: Recipients of single or tandem SCT reported to the Center for International Blood and Marrow Transplant Research were identified. Outcomes were compared by SCT year: 1990-94 (N = 288), 1995-99 (N = 351), 2000-04 (N = 376), 2005-09 (N = 509) and 2010-15 (N = 871). A recent subset (n = 267, 2000-2015) with detailed disease- and transplant-related data was further analyzed with a multivariate (MVA) Cox proportional hazards model. Results: Median age at SCT was 31 (11-76) years and 49% received SCT within 12 months of diagnosis consistent with early relapse/primary refractory GCT. 26% had primary extragonadal GCT; 1,167 (49%) had intent to tandem transplant (TT). The median follow up was 51 (3-313) months. Day 100 non-relapse mortality was statistically similar at 8% in 1990-94 (vs. 4% in 2010-15) but 3-year progression-free survival (PFS) improved from 24 (18-31)% in 1990-94 to 47 (43-50)% in 2010-15 (p < 0.0001) and 3-year survival (OS) from 35 (29-40)% to 54 (50-57)% in 2010-15 (p < 0.0001). Compared with single SCT, TT recipients were younger 31 (16-62) vs 34 (13-76), with lower Hematopoietic Cell Transplantation-Comorbidity Index, more likely to undergo SCT after 1 line of chemotherapy (28% vs 9%), and within 1 year of diagnosis (51% vs 38%). TT was preferred over single SCT over time (48% of SCT were TT in 2000-04 vs. 81% in 2010-15). In MVA, non-seminoma histology, residual tumor at SCT, receipt of > 1 line of pre-SCT chemotherapy and single SCT (vs. TT), were associated with worse PFS and OS. Year of SCT was not significant when adjusted for these covariates. Conclusions: In this large longitudinal cohort, improvements in PFS and OS were observed in recent years. SCT earlier in disease course and tandem SCT were associated with superior outcomes. These data involving a large cohort reported from 225 centers confirm specialized centers’ date in a real-world setting.
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Affiliation(s)
| | | | | | - Raphael Fraser
- Center for International Blood and Marrow Transplant Research/ Medical College of Wisconsin, Milwaukee, WI
| | - Omar Davila
- Center for International Blood and Marrow Transplant Research/ Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Yago Nieto
- UT MD Anderson Cancer Center, Houston, TX
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research/ Medical College of Wisconsin, Milwaukee, WI
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Dhakal B, Nelson A, Guru Murthy GS, Fraser R, Eastwood D, Hamadani M, Pasquini M, D'Souza A, Hari P. Autologous Hematopoietic Cell Transplantation in Patients With Multiple Myeloma: Effect of Age. Clinical Lymphoma Myeloma and Leukemia 2017; 17:165-172. [DOI: 10.1016/j.clml.2016.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 01/23/2023]
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Dispenzieri A, Kumar S, Zhang MJ, Krishnan A, Gasparetto C, Nieto Y, Fraser R, Huang J, Hari P, D'Souza A. Trends in Survival Outcomes Among Patients (pts) Relapsing Early after Autologous Stem Cell Transplantation (ASCT) for Multiple Myeloma (MM) (CIBMTR Study # MM14-03). Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Underwood TJ, Noble F, Madhusudan N, Sharland D, Fraser R, Owsley J, Grant M, Kelly JJ, Byrne JP. The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection. J Gastrointest Surg 2017; 21:614-621. [PMID: 28120276 PMCID: PMC5359364 DOI: 10.1007/s11605-017-3363-8] [Citation(s) in RCA: 13] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/04/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Enhanced recovery programmes improve outcomes in surgery, but their implementation after upper gastrointestinal resection has been limited. The aim of this study was to compare short-term outcomes for patients undergoing oesophagogastric surgery in an enhanced recovery programme (EROS). METHODS EROS was developed after a multidisciplinary meeting by multiple rounds of revision. EROS was applied to all patients undergoing major upper GI resection at a university teaching hospital in the UK from 20/9/13, with data reviewed at 18/09/15. EROS was assessed to identify predictors for compliance. RESULTS One hundred six patients underwent major upper GI resection including 81 oesophagectomies, 24 gastrectomies and 1 colonic interposition graft. Major complications (Clavien Dindo ≥3) occurred in 12 patients with 1 in-hospital death. Thirty-five patients (44%) were discharged on target day 8 of the EROS programme. Age and complications were independently associated with missing this discharge target. CONCLUSION Enhanced recovery is feasible and safe after major upper gastrointestinal surgery.
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Affiliation(s)
- Timothy J. Underwood
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK ,Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building, MP824, Southampton General Hospital, Southampton, Hampshire SO16 6YD UK
| | - F. Noble
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK ,Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building, MP824, Southampton General Hospital, Southampton, Hampshire SO16 6YD UK
| | - N. Madhusudan
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - D. Sharland
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - R. Fraser
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - J. Owsley
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - M. Grant
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - J. J. Kelly
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - James P. Byrne
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
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Affiliation(s)
- R J Weir
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - D B Paintin
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - J I S Robertson
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - M Tree
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - R Fraser
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - J Young
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
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Brown JJ, Chinn RH, Düsterdieck GO, Fraser R, Gleadle RH, Lever AF, Robertson JIS, Tree M. Renin, Angiotensin and Aldosterone in Relation to Electrolyte Metabolism [Abridged]. Proc R Soc Med 2016. [DOI: 10.1177/003591576906201227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J J Brown
- MRC Blood Pressure Research Unit, Western Infirmary, Glasgow
| | - R H Chinn
- MRC Blood Pressure Research Unit, Western Infirmary, Glasgow
| | - G O Düsterdieck
- MRC Blood Pressure Research Unit, Western Infirmary, Glasgow
| | - R Fraser
- MRC Blood Pressure Research Unit, Western Infirmary, Glasgow
| | - R H Gleadle
- MRC Blood Pressure Research Unit, Western Infirmary, Glasgow
| | - A F Lever
- MRC Blood Pressure Research Unit, Western Infirmary, Glasgow
| | - J I S Robertson
- MRC Blood Pressure Research Unit, Western Infirmary, Glasgow
| | - M Tree
- MRC Blood Pressure Research Unit, Western Infirmary, Glasgow
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Abstract
Objectives: The aim of this study was to evaluate the existing newborn sickle haemoglobinopathy screening programme in Jamaica. Methods: A retrospective analysis of infants screened during the period 8 November 1995 to 22 July 2006 was performed. Patient data for analyses was restricted to patients with homozygous (Hb SS) sickle cell disease. Published data from the Jamaican Sickle Cell Cohort Study was used to make comparisons with the study sample. Results: The study sample consisted of 435 patients with Hb SS disease. Acute chest syndrome was the most common clinical (non-death) event accounting for ∼50% of all events. Acute splenic sequestration, no longer a significant cause of mortality, was responsible for ∼32% of clinical events. Seven deaths (1.8%) occurred during the study period compared with 17.6% to the same age in the Jamaican Sickle Cell Cohort Study. There was a lower proportion of hospital admissions and episodes of serious illness in the study group compared with controls. Conclusions: Survival estimates for the study sample showed improvement compared with the Jamaican Sickle Cell Cohort Study. This study continues to demonstrate the benefits of, and as such shows support for, newborn screening and early interventions in sickle cell disease. In addition, it highlights some of the areas for continued focus and research development. Although the current system is providing an essential and beneficial service, the study emphasizes the need for newborn screening programmes to be comprehensive care systems to be fully effective.
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Affiliation(s)
- L King
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - R Fraser
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - M Forbes
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - M Grindley
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - S Ali
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - M Reid
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, West Indies
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Kelly D, Theodoratou E, Farrington SM, Fraser R, Campbell H, Dunlop MG, Zgaga L. The contributions of adjusted ambient ultraviolet B radiation at place of residence and other determinants to serum 25-hydroxyvitamin D concentrations. Br J Dermatol 2016; 174:1068-78. [PMID: 26581342 DOI: 10.1111/bjd.14296] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Solar ultraviolet B (UVB) radiation is the major source of vitamin D (vitD) for humans. OBJECTIVES To describe ambient UVB radiation at wavelengths that induce vitD synthesis (vitD-UVB) in Scotland, and to examine the relationship to serum 25-hydroxyvitamin D (25OHD). METHODS We estimated the average vitD-UVB dose for each day of the year and for each postcode area in Scotland, using the Tropospheric Emission Monitoring Internet Service database. Cumulative and weighted vitD-UVB (CW-vitD-UVB) exposure at place of residence was calculated for each participant. Plasma 25OHD was assayed in 1964 healthy participants. RESULTS Significant seasonal and geographical variation in vitD-UVB was observed. Ambient vitD-UVB exposure at place of residence was significantly associated with plasma 25OHD (P < 0·01). An average increase in 25OHD of 1 ng mL(-1) was observed for every 1000 mJ cm(-2) higher CW-vitD-UVB dose or for every 2·5 μg of daily supplement taken. Adequate 25OHD concentration (> 16 ng mL(-1)) was observed in the majority when CW-vitD-UVB dose was > 6000 mJ cm(-2), a level of ambient radiation achieved only in summer months in Scotland. When predicting vitD deficiency, dramatic improvement in the area under the curve was observed (from 0·55 to 0·70) after CW-vitD-UVB dose was added to the model, in addition to a range of other covariates. CONCLUSIONS Ambient vitD-UVB can be a useful predictor of vitD status. Geotemporally mapped measurements of vitD-UVB can be used as a proxy for vitD status or as a covariate in epidemiological research, particularly if 25OHD is unavailable.
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Affiliation(s)
- D Kelly
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - E Theodoratou
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, U.K
| | - S M Farrington
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, U.K
- MRC Human Genetics Unit, Western General Hospital Edinburgh, Edinburgh, EH4 2XU, U.K
| | - R Fraser
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, U.K
| | - H Campbell
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, U.K
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, U.K
- MRC Human Genetics Unit, Western General Hospital Edinburgh, Edinburgh, EH4 2XU, U.K
| | - M G Dunlop
- Colon Cancer Genetics Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, U.K
- MRC Human Genetics Unit, Western General Hospital Edinburgh, Edinburgh, EH4 2XU, U.K
| | - L Zgaga
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, U.K
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Guilmette J, Semionov A, Dennie C, Gahide G, Pressacco J, Fraser R, Cordeau MP, Chartrand-Lefebvre C. Hemorrhagic infiltration of the aortopulmonary adventitia: A complication of acute aortic dissection. Eur J Radiol 2016; 85:239-247. [DOI: 10.1016/j.ejrad.2015.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/15/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
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Arslan A, Flax L, Nunez P, Kanter M, Fraser R, Caputo N, Simon R. 347 Detecting Occult Shock in Trauma Patients: A Comparison of Serum Lactate versus Shock Index. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.383] [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: 10/23/2022]
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Badiei A, Chambers ST, Gaddam RR, Fraser R, Bhatia M. Cystathionine-gamma-lyase gene silencing with siRNA in monocytes/macrophages protects mice against acute pancreatitis. Appl Microbiol Biotechnol 2015; 100:337-46. [PMID: 26411454 DOI: 10.1007/s00253-015-6989-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/24/2015] [Accepted: 09/04/2015] [Indexed: 12/29/2022]
Abstract
Hydrogen sulphide (H2S) is an endogenous inflammatory mediator produced by cystathionine-γ-lyase (CSE) in monocytes/macrophages. To determine the role of H2S and macrophages in inflammation, we used small interference RNA (siRNA) to target the CSE gene and investigated its effect in a mouse model of acute pancreatitis. Acute pancreatitis is characterised by increased levels of plasma amylase, myeloperoxidase (MPO) activity and pro-inflammatory cytokines and chemokines in the pancreas and lung. SiRNA treatment attenuated inflammation in the pancreas and lungs of mice following caerulein-induced acute pancreatitis. MPO activity increased in caerulein-induced acute pancreatitis (16.21 ± 3.571 SD fold increase over control) and treatment with siRNA significantly reduced this (mean 3.555 ± 2.522 SD fold increase over control) (p < 0.0001). Similarly, lung MPO activity increased following treatment with caerulein (3.56 ± 0.941 SD fold increase over control) while siRNA treatment significantly reduced MPO activity (0.8243 ± 0.4353 SD fold increase over control) (p < 0.0001). Caerulein treatment increased plasma amylase activity (7094 ± 207 U/l) and this significantly decreased following siRNA administration (5895 ± 115 U/l) (p < 0.0001). Cytokine and chemokine levels in caerulein-induced acute pancreatitis reduced following treatment with siRNA. For example, siRNA treatment significantly decreased pancreatic and lung monocyte chemoattractant protein (MCP)-1 (169.8 ± 59.75 SD; 90.01 ± 46.97 SD pg/ml, respectively) compared to caerulein-treated mice (324.7 ± 103.9 SD; 222.8 ± 85.37 SD pg/ml, pancreas and lun,g respectively) (p < 0.0001). These findings show a crucial pro-inflammatory role for H2S synthesised by CSE in macrophages in acute pancreatitis and suggest CSE gene silencing with siRNA as a potential therapeutic approach for this condition.
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Affiliation(s)
- A Badiei
- Inflammation Research Group, Department of Pathology, University of Otago, 2 Riccarton Avenue, P.O. Box 4345, Christchurch, 8140, New Zealand
| | - S T Chambers
- Infection Research Group, Department of Pathology, University of Otago, Christchurch, New Zealand
| | - R R Gaddam
- Inflammation Research Group, Department of Pathology, University of Otago, 2 Riccarton Avenue, P.O. Box 4345, Christchurch, 8140, New Zealand
| | - R Fraser
- Inflammation Research Group, Department of Pathology, University of Otago, 2 Riccarton Avenue, P.O. Box 4345, Christchurch, 8140, New Zealand
| | - M Bhatia
- Inflammation Research Group, Department of Pathology, University of Otago, 2 Riccarton Avenue, P.O. Box 4345, Christchurch, 8140, New Zealand.
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Padfield PL, Brown JJ, Fraser R, Lever AF, Morton JJ, Robertson JI, Tree M. Measurement of plasma renin concentration and angiotensin II in peripheral and renal venous plasma in the management of renovascular hypertension. Contrib Nephrol 2015; 3:45-51. [PMID: 1026369 DOI: 10.1159/000399380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Athough in general, measurement of renal vein renin appears to give a good prediction as to the subsequent response to surgery, its main value lies in its ability to reflect changes in renal plasma flow; true changes in renin secretion rate being much more difficult to detect. Although it is a little early to say how much information can be derived from saralasin infusions, caution must be exercised in necessarily assuming that the test accurately reflects subsequent surgical response.
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Brown JJ, Davies DL, Lever AF, Robertson JIS, Bianchi G, Imbs JL, Johnson VW, Lawrence M, Fraser R, James VHT. Renin and Blood Pressure. Physiology (Bethesda) 2015. [DOI: 10.1159/000391451] [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: 11/19/2022] Open
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46
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Hiwase D, Moore S, Kutyna M, Fraser R, Singhal D, Chhetri R, Lewis I, Bardy P, To LB, Scott H. 155 SNP-MICROARRAY OF PERIPHERAL BLOOD-GRANULOCYTES DNA CAN DETECT CLONAL EVOLUTION IN MYELODYSPLASTIC SYNDROMES (MDS). Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30156-9] [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: 10/23/2022]
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Hiwase D, Moore S, Hahn C, Kutyna M, Van Der Hoek M, Fraser R, Chhetri R, Singhal D, Lewis I, Bardy P, To LB, Scott H. 154 TARGETED MUTATION SEQUENCING AND SNP-MICRORRAY CAN IDENTIFY POOR PROGNOSTIC GROUP IN IPSS-LOWER RISK GROUP. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30155-7] [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: 11/27/2022]
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Abstract
The importance of corticosteroids in cardiovascular and other chronic disease is recognised. In addition, plasma steroid precursor-to-product ratios are useful and convenient indirect indicators of efficiency of key steroidogenic enzymes (aldosterone synthase, 11β-hydroxylase and 17α-hydroxylase). The use of liquid chromatography-tandem mass spectrometry (LC-MS/MS) has enabled measurement of numerous corticosteroid compounds simultaneously. However, normal responses to trophins and variation in salt intake are not well described. This study examined these parameters in a large group of healthy volunteers. Sixty normotensive volunteers were recruited and underwent infusion of angiotensin II (AngII) and ACTH, following low- and high-salt diet. Measurement of plasma steroids at baseline and 30 min after infusion of trophin was carried out by LC-MS. As expected, plasma mineralocorticoid levels increased in response to salt restriction and were suppressed with salt loading; ACTH infusion increased all corticosteroids, while AngII increased mineralocorticoids and suppressed glucocorticoid production. ACTH increased S:F but decreased DOC:B, thus the S:F ratio is a more appropriate index of 11β-hydroxylase efficiency. The B:F ratio increased following ACTH treatment and salt restriction. A larger proportion of plasma B than generally accepted may be derived from the zona glomerulosa and this ratio may be most informative of 17α-hydroxylase activity in salt-replete subjects. Although DOC:aldosterone, B:aldosterone and 18-hydroxyB:aldosterone should provide indices of aldosterone synthase efficiency, responses of individual compounds to trophins suggest that none of them accurately reflect this. Based on these data, aldosterone synthase activity is most accurately reflected by aldosterone concentration alone.
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Affiliation(s)
- F McManus
- Institute of Cardiovascular and Medical SciencesUniversity of Glasgow, Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UKCollege of MedicineDentistry and Nursing, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - R Fraser
- Institute of Cardiovascular and Medical SciencesUniversity of Glasgow, Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UKCollege of MedicineDentistry and Nursing, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - E Davies
- Institute of Cardiovascular and Medical SciencesUniversity of Glasgow, Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UKCollege of MedicineDentistry and Nursing, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - J M C Connell
- Institute of Cardiovascular and Medical SciencesUniversity of Glasgow, Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UKCollege of MedicineDentistry and Nursing, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - E M Freel
- Institute of Cardiovascular and Medical SciencesUniversity of Glasgow, Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UKCollege of MedicineDentistry and Nursing, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
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Gordon-Strachan G, Cunningham-Myrie C, Fox K, Kirton C, Fraser R, McLeod G, Forrester T. Richer but fatter: the unintended consequences of microcredit financing on household health and expenditure in Jamaica. Trop Med Int Health 2014; 20:67-76. [PMID: 25329229 DOI: 10.1111/tmi.12403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Kristin Fox
- Sir Arthur Lewis Institute of Social and Economic Studies; University of the West Indies; Mona Jamaica
| | - Claremont Kirton
- Department of Economics; University of the West Indies; Mona Jamaica
| | - Raphael Fraser
- Department of Statistics; Florida State University; Tallahassee FL USA
| | - Georgia McLeod
- Department of Economics; University of the West Indies; Mona Jamaica
| | - Terrence Forrester
- UWI Solutions for Developing Countries; University of the West Indies; Mona Jamaica
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Mattana E, Stuppy WH, Fraser R, Waller J, Pritchard HW. Dependency of seed dormancy types on embryo traits and environmental conditions in Ribes species. Plant Biol (Stuttg) 2014; 16:740-7. [PMID: 24138146 DOI: 10.1111/plb.12115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 09/11/2013] [Indexed: 05/26/2023]
Abstract
The hypothesis that seed dormancy may be dependent on environmental conditions and seed morphological traits was tested for six Ribes species, across an altitudinal gradient of 1300 m and a longitudinal separation of 120°. Embryo measurements and seed germination experiments were conducted for R. alpinum L., R. hudsonianum Richardson var. petiolare (Douglas) Jancz., R. nevadaense Kellogg, R. roezlii Regel var. cruentum (Greene) Rehder and R. speciosum Pursh, and data taken from the literature for R. multiflorum Kit. ex Schult. ssp. sandalioticum Arrigoni. Germination was compared with seed viability to reveal proportional seed dormancy, which was then correlated to seed/embryo morphological traits and these traits related to the seed provenance environment. The embryos of all the investigated species are linear underdeveloped and all had a morphological component of seed dormancy (MD). Seeds of R. roezlii, R. hudsonianum and R. nevadaense required a temperature and/or hormone pre-treatment in order to germinate, highlighting morphophysiological seed dormancy (MPD). Seed dormancy was found to be strongly negatively correlated with embryo length, but not with embryo to seed (E:S) ratio or seed mass. Initial embryo length was positively related to mean annual temperature. Seed dormancy in the investigated Ribes species could be quantified and predicted by the interaction of embryo traits and environmental conditions. This approach may be helpful in assessing and predicting seed dormancy in the Ribes genus and in other genera and families with underdeveloped embryos.
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Affiliation(s)
- E Mattana
- Centro Conservazione Biodiversità (CCB), Dipartimento di Scienze della Vita e dell'Ambiente, Università degli Studi di Cagliari, Cagliari, Italy; Seed Conservation Department, Wellcome Trust Millennium Building, Royal Botanic Gardens, Kew, Ardingly, West Sussex, UK
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