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Chien SH, Huang HY, Chen YJ, Tsai YC, Lu SH, Lee LH, Liu HM, Chen WC, Liu YC, Lin TA, Liu CY. Comparing transfusion reactions between pre-storage and post-storage leukoreduced apheresis platelets: an analysis using propensity score matching. Ann Hematol 2024; 103:1389-1396. [PMID: 38393657 PMCID: PMC10940477 DOI: 10.1007/s00277-024-05652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Transfusion reactions induced by platelet transfusions may be reduced and alleviated by leukocyte reduction of platelets. Although leukoreduction of apheresis platelets can be performed either pre-storage or post-storage, seldom studies directly compare the incidence of transfusion reaction in these two different blood products. We conducted a retrospective study to compare the transfusion reactions between pre-storage and post-storage leukoreduced apheresis platelets. We reviewed the general characteristics and the transfusion reactions, symptoms, and categories for inpatients who received pre-storage or post-storage leukoreduced apheresis platelets. Propensity-score matching was performed to adjust for baseline differences between groups. A total of 40,837 leukoreduction apheresis platelet orders were reviewed. 116 (0.53%) transfusion reactions were reported in 21,884 transfusions with pre-storage leukoreduction, and 174 (0.91%) reactions were reported in 18,953 transfusions with post-storage leukoreduction. Before propensity-score matching, the odds ratio for transfusion reactions in the pre-storage group relative to the post-storage group was 0.57 (95% confidence interval [CI] 0.45-0.72, P < 0.01); the odds ratio after matching was 0.63 (95% CI 0.49-0.80, P < 0.01). A two-proportion z-test revealed pre-storage leukoreduction significantly decreases the symptoms of chills, fever, itching, urticaria, dyspnea, and hypertension as compared with those in post-storage leukoreduction. Pre-storage leukoreduced apheresis platelet significantly decreased febrile non-hemolytic transfusion reaction as compared with post-storage groups. This study suggests pre-storage leukoreduction apheresis platelet significantly decreases the transfusion reaction as compared with those in post-storage leukoreduction.
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Affiliation(s)
- Sheng-Hsuan Chien
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, 112, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Hsin-Yi Huang
- Biostatistics Task Force, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Ying-Ju Chen
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Yu-Chen Tsai
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Shu-Hua Lu
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Li-Hsuan Lee
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Hsueng-Mei Liu
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Wen-Chun Chen
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, 112, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Yao-Chung Liu
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, 112, Taiwan
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Ting-An Lin
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, 112, Taiwan
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Chun-Yu Liu
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, 112, Taiwan.
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, 112, Taiwan.
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Hsu TL, Tsai CK, Liu CY, Yeh CM, Lin FL, Hsiao LT, Liu YC, Chien SH, Wang HY, Ko PS, Lin TA, Chen WC, Chen PM, Liu JH, Gau JP, Liu CJ. Risk factors of early disease progression and decreased survival for multiple myeloma patients after upfront autologous stem cell transplantation. Ann Hematol 2024:10.1007/s00277-024-05641-y. [PMID: 38472362 DOI: 10.1007/s00277-024-05641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/19/2024] [Indexed: 03/14/2024]
Abstract
Multiple myeloma (MM) stands as the second most prevalent hematological malignancy, constituting approximately 10% of all hematological malignancies. Current guidelines recommend upfront autologous stem cell transplantation (ASCT) for transplant-eligible MM patients. This study seeks to delineate factors influencing post-ASCT outcomes in MM patients. Our cohort comprised 150 MM patients from Taipei Veterans General Hospital, with progression-free survival (PFS) as the primary endpoint and overall survival (OS) as the secondary endpoint. A Cox proportional hazards model was employed to discern potential predictive factors for survival. ASCT age ≥ 65 (hazard ratio [HR] 1.94, 95% confidence interval [CI] 1.08-3.47) and the presence of extramedullary disease (HR 2.53, 95% CI 1.53-4.19) negatively impacted PFS. Conversely, treatment response ≥ VGPR before ASCT (HR 0.52, 95% CI 0.31-0.87) and total CD34+ cells collected ≥ 4 × 106 cells/kg on the first stem cell harvesting (HR 0.52, 95% CI 0.32-0.87) were positively associated with PFS. For OS, patients with ISS stage III (HR 2.06, 95% CI 1.05-4.04), the presence of extramedullary disease (HR 3.92, 95% CI 2.03-7.58), light chain ratio ≥ 100 before ASCT (HR 7.08, 95% CI 1.45-34.59), post-ASCT cytomegalovirus infection (HR 9.43, 95% CI 3.09-28.84), and a lower conditioning melphalan dose (< 140 mg/m2; HR 2.75, 95% CI 1.23-6.17) experienced shorter OS. In contrast, post-ASCT day + 15 absolute monocyte counts (D15 AMC) > 500/µl (HR 0.36, 95% CI 0.17-0.79) and post-ASCT day + 15 platelet counts (D15 PLT) > 80,000/µl (HR 0.48, 95% CI 0.24-0.94) were correlated with improved OS. Significantly, early PLT and AMC recovery on day + 15 predicting longer OS represents a novel finding not previously reported. Other factors also align with previous studies. Our study provides real-world insights for post-ASCT outcome prediction beyond clinical trials.
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Affiliation(s)
- Te-Lin Hsu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Kuang Tsai
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Yu Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fen-Lan Lin
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Hsuan Chien
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Yuan Wang
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Shen Ko
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-An Lin
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chun Chen
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Min Chen
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Section of Hematology and Oncology, Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
- Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Aldoss I, Khaled SK, Wang X, Palmer J, Wang Y, Wagner JR, Clark MC, Simpson J, Paul J, Vyas V, Chien SH, Stein A, Pullarkat V, Salhotra A, Al Malki MM, Aribi A, Sandhu K, Thomas SH, Budde LE, Marcucci G, Brown CE, Forman SJ. Favorable Activity and Safety Profile of Memory-Enriched CD19-Targeted Chimeric Antigen Receptor T-Cell Therapy in Adults with High-Risk Relapsed/Refractory ALL. Clin Cancer Res 2023; 29:742-753. [PMID: 36255386 PMCID: PMC10544259 DOI: 10.1158/1078-0432.ccr-22-2038] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 06/27/2022] [Revised: 08/25/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE A phase I/II study evaluating the safety and activity of memory-enriched CD19-directed chimeric antigen receptor (CD19-CAR) T cells in adults with relapsed/refractory B-cell acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS In phase I, we tested sequentially two cell populations for CAR transduction: (i) central memory (Tcm) or (ii) naïve, stem, and central memory (Tn/mem) T cells. The study employed an activity constrained for toxicity design to determine the recommended phase II dose (RP2D), which was tested in phase II. RESULTS The Tcm cohort was closed early due to lack of activity. The 200 ×106 Tn/mem-derived CD19-CAR T-cell dose was found to be safe and active, and was declared the RP2D. At RP2D, 58 participants underwent leukapheresis and 46 received CD19-CAR T cells. Median age for treated participants was 38 years (range, 22-72). Twenty-nine (63%) participants had relapsed post-allogeneic hematopoietic cell transplantation (alloHCT), 18 (39%) had Philadelphia-like (Ph-like) genotype, and 16 (35%) had extramedullary disease (EMD) at lymphodepletion (LD). Three (7%) participants had grade 3 cytokine release syndrome (CRS), and none had grade ≥ 4 CRS. Eight (17%) participants had grade ≥ 3 neurotoxicity, including one fatal cerebral edema. Forty (87%) patients achieved complete remission (CR)/CR with incomplete hematologic recovery, 2 (4%) progressed, and 4 (9%) were unevaluable for response. Among 42 response-evaluable participants, 16/17 with Ph-like ALL and 13/15 with EMD at LD responded. Twenty-one (53%) responders underwent alloHCT consolidation, which was associated with improved relapse-free survival (adjusted HR = 0.16; 95% confidence interval, 0.05-0.48; P = 0.001). CONCLUSIONS Tn/mem-derived CD19-CAR T cells were safe and active, including in Ph-like ALL and EMD. See related commentary by El Marabti and Abdel-Wahab, p. 694.
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Affiliation(s)
- Ibrahim Aldoss
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Samer K. Khaled
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Xiuli Wang
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
- T Cell Therapeutics Research Laboratories, City of Hope, Duarte, California
| | - Joycelynne Palmer
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Computational and Quantitative Sciences, Division of Biostatistics, Beckman Research Institute, City of Hope, Duarte, California
| | - Yan Wang
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Computational and Quantitative Sciences, Division of Biostatistics, Beckman Research Institute, City of Hope, Duarte, California
| | - Jamie R. Wagner
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
- T Cell Therapeutics Research Laboratories, City of Hope, Duarte, California
| | - Mary C. Clark
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Clinical and Translational Project Development, City of Hope, Duarte, California
| | - Jennifer Simpson
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Jinny Paul
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
- T Cell Therapeutics Research Laboratories, City of Hope, Duarte, California
| | - Vibhuti Vyas
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
- T Cell Therapeutics Research Laboratories, City of Hope, Duarte, California
| | - Sheng-Hsuan Chien
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
- T Cell Therapeutics Research Laboratories, City of Hope, Duarte, California
| | - Anthony Stein
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Vinod Pullarkat
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Amandeep Salhotra
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Monzr M. Al Malki
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ahmed Aribi
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Karamjeet Sandhu
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Sandra H. Thomas
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Clinical and Translational Project Development, City of Hope, Duarte, California
| | - Lihua E. Budde
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
- T Cell Therapeutics Research Laboratories, City of Hope, Duarte, California
| | - Guido Marcucci
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Christine E. Brown
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
- T Cell Therapeutics Research Laboratories, City of Hope, Duarte, California
| | - Stephen J. Forman
- Hematological Malignancies Research Institute, City of Hope, Duarte, California
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
- T Cell Therapeutics Research Laboratories, City of Hope, Duarte, California
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Wang X, Urak R, Walter M, Guan M, Han T, Vyas V, Chien SH, Gittins B, Clark MC, Mokhtari S, Cardoso A, Diamond DJ, Zaia J, Forman SJ, Nakamura R. Large-scale manufacturing and characterization of CMV-CD19CAR T cells. J Immunother Cancer 2022; 10:jitc-2021-003461. [PMID: 35027426 PMCID: PMC8762141 DOI: 10.1136/jitc-2021-003461] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Accepted: 12/04/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Adoptive transfer of CD19-specific chimeric antigen receptor (CD19CAR) T cells can induce dramatic disease regression in patients with B cell malignancies. CD19CAR T cell therapy may be limited by insufficient engraftment and persistence, resulting in tumor relapse. We previously demonstrated a proof of principle that cytomegalovirus (CMV)-specific T cells can be isolated and enriched prior to CD19CAR transduction to produce CMV-CD19CAR T cells, and that these CMV-CD19CAR T cells can be expanded in vivo through CMV vaccination, resulting in better tumor control in a murine model. Here we developed a clinical platform for generating CMV-CD19CAR T cells. METHODS Peripheral blood mononuclear cells (PBMCs) collected from CMV-seropositive healthy donors were stimulated with a good manufacturing practices-grade PepTivator overlapping CMVpp65 peptide pool and enriched for CMV-responsive interferon γ (IFNγ)+T cells using IFNγ Catchmatrix, within the CliniMACS Prodigy Cytokine Capture System (Miltenyi Biotec). Resulting CMV-specific T cells were transduced with a lentiviral vector encoding a second generation CD19R:CD28:ζ/EGFRt CAR and expanded with interleukin 2 (IL-2) and IL-15 for 15 days before characterization. RESULTS CMV-specific T cells were enriched from 0.8%±0.5 of input PBMC to 76.3%±11.6 in nine full-scale qualification runs (absolute yield of 4.2±3.3×106 IFNγ+T cells from an input of 1×109 PBMCs). Average CD19CAR transduction efficiency of CMV-specific T cells was 27.0%±14.2 in the final products, which underwent rapid expansion, resulting in a total cell dose of 6.2±0.9 × 106 CD19CAR-tranduced T cells with CMV specificity (ie, functionally bispecific). CMV-CD19CAR T cells were polyclonal, expressed memory markers but had low expression of exhaustion markers, responded to both CD19 and CMVpp65 stimulation with rapid proliferation and exhibited antigen-specific effector functions against both CD19-expressing tumors and CMVpp65 antigen. The final products passed release criteria for clinical use. CONCLUSIONS We demonstrated the feasibility of our large-scale platform for generating CMV-CD19CAR T cells for clinical application. We plan to initiate a clinical trial at City of Hope using CMV-CD19CAR T cells for patients with intermediate/high-grade B cell non-Hodgkin's lymphoma immediately after autologous hematopoietic cell transplantation followed by vaccination with a novel CMV vaccine based on Modified Vaccinia Ankara (Triplex) 28 days and 56 days post-T cell infusion.
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Affiliation(s)
- Xiuli Wang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Ryan Urak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Miriam Walter
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Min Guan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Tianxu Han
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Vibhuti Vyas
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Sheng-Hsuan Chien
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Brenna Gittins
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Mary C Clark
- Department of Clinical Translational Project Development, City of Hope, Duarte, California, USA
| | - Sally Mokhtari
- Department of Clinical Translational Project Development, City of Hope, Duarte, California, USA
| | - Angelo Cardoso
- Center for Gene Therapy, Hematological Malignancy and Stem Cell Transplantation Institute, City of Hope, Duarte, California, USA
| | - Don J Diamond
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - John Zaia
- Center for Gene Therapy, Hematological Malignancy and Stem Cell Transplantation Institute, City of Hope, Duarte, California, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
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5
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Fu YK, Liu HM, Lee LH, Chen YJ, Chien SH, Lin JS, Chen WC, Cheng MH, Lin PH, Lai JY, Chen CM, Liu CY. The TVGH-NYCU Thal-Classifier: Development of a Machine-Learning Classifier for Differentiating Thalassemia and Non-Thalassemia Patients. Diagnostics (Basel) 2021; 11:diagnostics11091725. [PMID: 34574066 PMCID: PMC8467438 DOI: 10.3390/diagnostics11091725] [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: 07/25/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022] Open
Abstract
Thalassemia and iron deficiency are the most common etiologies for microcytic anemia and there are indices discriminating both from common laboratory simple automatic counters. In this study a new classifier for discriminating thalassemia and non-thalassemia microcytic anemia was generated via combination of exciting indices with machine-learning techniques. A total of 350 Taiwanese adult patients whose anemia diagnosis, complete blood cell counts, and hemoglobin gene profiles were retrospectively reviewed. Thirteen prior established indices were applied to current cohort and the sensitivity, specificity, positive and negative predictive values were calculated. A support vector machine (SVM) with Monte-Carlo cross-validation procedure was adopted to generate the classifier. The performance of our classifier was compared with original indices by calculating the average classification error rate and area under the curve (AUC) for the sampled datasets. The performance of this SVM model showed average AUC of 0.76 and average error rate of 0.26, which surpassed all other indices. In conclusion, we developed a convenient tool for primary-care physicians when deferential diagnosis contains thalassemia for the Taiwanese adult population. This approach needs to be validated in other studies or bigger database.
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Affiliation(s)
- Yi-Kai Fu
- School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-K.F.); (S.-H.C.); (J.-S.L.); (M.-H.C.); (P.-H.L.)
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Hsueng-Mei Liu
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-M.L.); (L.-H.L.); (Y.-J.C.); (W.-C.C.)
| | - Li-Hsuan Lee
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-M.L.); (L.-H.L.); (Y.-J.C.); (W.-C.C.)
| | - Ying-Ju Chen
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-M.L.); (L.-H.L.); (Y.-J.C.); (W.-C.C.)
| | - Sheng-Hsuan Chien
- School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-K.F.); (S.-H.C.); (J.-S.L.); (M.-H.C.); (P.-H.L.)
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-M.L.); (L.-H.L.); (Y.-J.C.); (W.-C.C.)
- Institute of Clinical Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Jeong-Shi Lin
- School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-K.F.); (S.-H.C.); (J.-S.L.); (M.-H.C.); (P.-H.L.)
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-M.L.); (L.-H.L.); (Y.-J.C.); (W.-C.C.)
| | - Wen-Chun Chen
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-M.L.); (L.-H.L.); (Y.-J.C.); (W.-C.C.)
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Ming-Hsuan Cheng
- School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-K.F.); (S.-H.C.); (J.-S.L.); (M.-H.C.); (P.-H.L.)
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Po-Heng Lin
- School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-K.F.); (S.-H.C.); (J.-S.L.); (M.-H.C.); (P.-H.L.)
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Jheng-You Lai
- Institute of Public Health, Yangming Campus, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Chyong-Mei Chen
- Institute of Public Health, Yangming Campus, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Correspondence: (C.-M.C.); (C.-Y.L.); Tel.: +886-2-28757522 (C.-Y.L.); Fax: +886-2-28757695 (C.-Y.L.)
| | - Chun-Yu Liu
- School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-K.F.); (S.-H.C.); (J.-S.L.); (M.-H.C.); (P.-H.L.)
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-M.L.); (L.-H.L.); (Y.-J.C.); (W.-C.C.)
- Correspondence: (C.-M.C.); (C.-Y.L.); Tel.: +886-2-28757522 (C.-Y.L.); Fax: +886-2-28757695 (C.-Y.L.)
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6
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Chien SH, Yao M, Li CC, Chang PY, Yu MS, Huang CE, Tan TD, Lin CH, Yeh SP, Li SS, Wang PN, Liu YC, Gau JP. Charlson comorbidity index predicts outcomes of elderly after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia and myelodysplastic syndrome. J Formos Med Assoc 2021; 120:2144-2152. [PMID: 33423899 DOI: 10.1016/j.jfma.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the curative therapy for acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS), but advanced age with multiple comorbidities limits the eligibility for allo-HSCT. We conducted a retrospective study to investigate the comorbidities assessments and prognostic factors that predict outcomes for these patients. METHODS Clinical data of patients older than 50 years who had received diagnoses of AML or MDS and underwent allo-HSCT were obtained. Information on patient characteristics, including age, gender, allogeneic transplant type, conditioning regimens, Charlson comorbidity index (CCI), and presence of acute graft-versus-host disease (GVHD) or chronic GVHD, were collected and analyzed. RESULTS Two hundred fifty-five elderly patients with a median age at allo-HSCT of 57 years were included. The significant prognostic factors associated with worse overall survival (OS) were CCI ≥3 (hazard ratio: 1.88) and grade III-IV acute GVHD (3.18). Similar findings were noted in the non-relapse mortality analysis. To investigate the effects of chronic GVHD on patient outcomes, OS analysis was performed for those with survival >100 days after transplantation. The results revealed CCI ≥3 (1.88) and grade III-IV acute GVHD (2.73) remained poor prognostic factors for OS, whereas mild chronic GVHD (0.43) was associated with better OS. CONCLUSION This cohort study suggests that CCI ≥3 predicts poor outcomes, primarily due to a higher NRM risk. Careful management of GVHD after transplantation could improve outcomes in elderly patients with AML or MDS after allo-HSCT.
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Affiliation(s)
- Sheng-Hsuan Chien
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming Yao
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Cheng Li
- Department of Hematology and Oncology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan; Tai Cheng Stem Cell Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Ying Chang
- Division of Hematology and Oncology, Department of Medicine, Tri-Service General Hospital, Taiwan; National Defense Medical Center, Taiwan
| | - Ming-Sun Yu
- Division of Hematology and Oncology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cih-En Huang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan
| | - Tran-Der Tan
- Koo Foundation Sun Yat-Sen Cancer Center, Taiwan
| | - Cheng-Hsien Lin
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Su-Peng Yeh
- Division of Hematology and Oncology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Sin-Syue Li
- Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Nan Wang
- Division of Hematology, Chang Gung Medical Foundation, Linkou Branch, Tao-Yuan, Taiwan
| | - Yi-Chang Liu
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jyh-Pyng Gau
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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7
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Liu YC, Wu CJ, Ko PS, Chien SH, Fan NW, Wang HY, Gau JP, Liu CJ, Hsiao LT, Chiou TJ, Liu CY, Liu JH. Mycobacterial infections in adult recipients of allogeneic hematopoietic stem cell transplantation: A cohort study in a high endemic area. Journal of Microbiology, Immunology and Infection 2020; 53:274-282. [DOI: 10.1016/j.jmii.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 12/19/2022]
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8
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Chien SH, Liu YC, Liu CJ, Ko PS, Wang HY, Hsiao LT, Lin JS, Chiou TJ, Liu CY, Gau JP. European Group for Blood and Marrow Transplantation score correlates with outcomes of older patients undergoing allogeneic hematopoietic stem cell transplantation. J Chin Med Assoc 2020; 83:238-244. [PMID: 31904659 DOI: 10.1097/jcma.0000000000000255] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) are hematological diseases predominantly occurring in older patients. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the curative therapy for refractory AML or high-risk MDS, old age is often a hurdle to the procedure. We conducted a retrospective study to analyze the prognostic factors predicting outcomes of older patients undergoing allo-HSCT for acute leukemia and MDS. METHODS We collected data from patients diagnosed with acute leukemia or MDS, who underwent allo-HSCT at >50 years of age and reviewed clinical characteristics, including age, sex, underlying disease, European Group for Blood and Bone Marrow Transplantation (EBMT) risk score, and presence of acute graft-versus-host disease (aGVHD) or chronic GVHD (cGVHD). The Cox proportional hazard model was adopted to explore the independent prognostic factors for overall survival (OS), progression-free survival (PFS), and non-relapse mortality (NRM). RESULTS A total of 85 older patients were included, with the median age at allo-HSCT being 55 years. The significant prognostic factors for worse OS or PFS were an EBMT risk score > 3 and grade III-IV aGVHD, while patients with moderate to severe cGVHD would have better OS or PFS. Interestingly, it is not cGVHD but grade III-IV aGVHD that significantly correlated with NRM. CONCLUSION This cohort study suggests that an EBMT risk score >3 and grade III-IV aGVHD predict poor outcomes, and careful management of GVHD may allow better survival for older patients undergoing allo-HSCT.
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Affiliation(s)
- Sheng-Hsuan Chien
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yao-Chung Liu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Jen Liu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Shen Ko
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Yuan Wang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Liang-Tsai Hsiao
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jeong-Shi Lin
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzeon-Jye Chiou
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chun-Yu Liu
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Jyh-Pyng Gau
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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9
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Chien SH, Liu HM, Chen PM, Ko PS, Lin JS, Chen YJ, Lee LH, Hsiao LT, Chiou TJ, Gau JP, Yang MH, Liu CY. The landscape of BCR-ABL mutations in patients with Philadelphia chromosome-positive leukaemias in the era of second-generation tyrosine kinase inhibitors. Hematol Oncol 2020; 38:390-398. [PMID: 32011024 DOI: 10.1002/hon.2721] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/24/2019] [Accepted: 01/12/2020] [Indexed: 11/09/2022]
Abstract
BCR-ABL mutations are associated with resistance to tyrosine kinase inhibitors (TKIs) in Philadelphia chromosome-positive leukaemia. The emergence of these mutations in the era of second-generation TKIs, such as dasatinib and nilotinib, remains an evolving field. We conducted a retrospective study to quantitatively characterize the BCR-ABL transcript and mutation status during treatment with first-generation and second-generation TKI therapies. BCR-ABL mutations were detected by direct sequencing for patients with Philadelphia chromosome-positive leukaemia receiving TKI therapies. The efficacy of TKI therapy was quantitatively assessed by calculating the log reduction of BCR-ABL transcripts, which was measured using real-time quantitative polymerase chain reaction. Fisher's exact test was performed to analyse the associations of log reduction <3 and mutation status. We found 35 patients harbouring 55 mutations of 43 different types, of which 30% occurred in patients receiving imatinib, 27% in nilotinib, and 43% in dasatinib. We found a novel germline mutation, N336 N (AAC➔AAT), and two novel frameshift mutations, Asn358Thr fs*14 and Gly251Ala fs*16. T315I was the most common missense mutation, followed by V299L and F317L. Intron 8 35-bp insertion was the most frequent frameshift mutation. Both missense and multiple BCR-ABL mutations were significantly associated with worse molecular response compared with the molecular response of patients without mutation. Missense mutations, rather than frameshift, were associated with less log reduction, while the T315I, F317L, and T315A mutations were significantly correlated with poor log reduction. Collectively, amino acid substitutions at T315I, F317L, and T315A accounted for the majority of missense mutations and the loss of major molecular response. Mutation analysis is essential for patients receiving TKI therapy who exhibit an unfavourable response. The present study provided a landscape of BCR-ABL mutations in the era of second-generation TKIs.
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Affiliation(s)
- Sheng-Hsuan Chien
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsueng-Mei Liu
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Ming Chen
- Department of Food and Science and biotechnology, National Chung Hsing University, Taichung, Taiwan
| | - Po-Shen Ko
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jeong-Shi Lin
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Ju Chen
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Hsuan Lee
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Muh-Hwa Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Yu Liu
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
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10
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Chien SH, Liu YC, Liu CJ, Ko PS, Wang HY, Hsiao LT, Chiou TJ, Liu JH, Gau JP. Invasive mold infections in acute leukemia patients undergoing allogeneic hematopoietic stem cell transplantation. Journal of Microbiology, Immunology and Infection 2019; 52:973-982. [DOI: 10.1016/j.jmii.2018.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
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11
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Liu YC, Chou YH, Ko PS, Wang HY, Fan NW, Liu CJ, Hsiao LT, Chien SH, Chiou TJ, Liu JH, Gau JP. Risk factors and clinical features for post-transplant thoracic air-leak syndrome in adult patients receiving allogeneic haematopoietic stem cell transplantation. Sci Rep 2019; 9:11795. [PMID: 31409884 PMCID: PMC6692350 DOI: 10.1038/s41598-019-48308-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/22/2019] [Indexed: 12/26/2022] Open
Abstract
Post-transplant thoracic air-leak syndrome (ALS) is rare but potentially life-threatening in patients receiving allogeneic haematopoietic stem cell transplantation (HSCT). Nevertheless, papers on thoracic ALS are limited, and this complication remains largely unknown. We reviewed 423 adult patients undergoing allogeneic HSCT from 2003 to 2014. Risk factors, clinical features and survival for thoracic ALS were collected and analysed. Thirteen out of 423 patients (3.1%) developed post-transplant thoracic ALS, including two ALS patients in the early phase. The median age at HSCT was 33 years among 13 patients with thoracic ALS. Male patients were predominant (69%). The median onset time was 253 days (range: 40–2680) after HSCT. Multivariate analysis revealed that grade III–IV acute graft-versus-host disease (GVHD) (p = 0.017), extensive chronic GVHD (cGVHD) (p = 0.019) and prior history of pulmonary invasive fungal infection (p = 0.007) were significant risk factors for thoracic ALS. In patients with cGVHD, those with thoracic ALS had a significantly worse survival than those without thoracic ALS (p = 0.04). Currently, published data analysing and exploring post-transplant thoracic ALS are limited. Our study employed a large patient cohort and determined the risk factors and clinical features for post-transplant thoracic ALS.
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Affiliation(s)
- Yao-Chung Liu
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yi-Hsin Chou
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Shen Ko
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Yuan Wang
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Wen Fan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Hsuan Chien
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Hwang Liu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Haematology and Oncology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jyh-Pyng Gau
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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12
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Lin TA, Gau JP, Liu YC, Ko PS, Wang HY, Chien SH, Liu CJ, Hsiao LT, Chiou TJ, Liu JH. Cerebrovascular disease after allogeneic hematopoietic stem cell transplantation: incidence, risk, and clinical outcome. Int J Hematol 2019; 109:584-592. [PMID: 30864116 DOI: 10.1007/s12185-019-02624-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/22/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/30/2022]
Abstract
Cerebrovascular complications after hematopoietic stem cell transplantation (HSCT) cause serious morbidity and often contribute to mortality. The incidence, risk factors, and outcome of cerebrovascular disease (CVD) after allogeneic HSCT remain poorly defined. We retrospectively evaluated 459 adult patients who underwent allogeneic HSCT at a tertiary medical center between January 2003 and December 2015. A total of 20 patients (4.4%) developed post-transplant CVD. All cerebrovascular accidents occurred in the first two years post-transplant. The two-year incidences of post-transplant CVD, intracranial hemorrhage, and cerebrovascular infarction were 6.1%, 3.2%, and 3.2%, respectively. The incidence rate of CVD within two years after HSCT was 34.7 (95% CI 22.3 to - 53.7) per 1000 person-years, which was about tenfold higher than the general Taiwanese population. The only significant risk factor associated with post-transplant CVD is prior exposure to three or more courses of high-dose cytarabine. Post-transplant CVD is associated with dismal outcome and early mortality. The median overall survival of patients with post-transplant CVD was markedly reduced compared with those without CVD (8.0 vs. 60.6 months). Most patients with post-transplant CVD died within two months after the CVD events. Our study demonstrates that CVD remains a devastating complication after allogeneic HSCT in the modern era.
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Affiliation(s)
- Ting-An Lin
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan. .,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Po-Shen Ko
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Yuan Wang
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Hsuan Chien
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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13
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Chiu HY, Lin LY, Chou WC, Fang WL, Shyr YM, Yeh YC, Mu-Hsin Chang P, Chen MH, Hung YP, Chao Y, Chien SH, Chen MH. Toxicities, safeties and clinical response of dacarbazine-based chemotherapy on neuroendocrine tumors in Taiwan population. J Chin Med Assoc 2018; 81:423-428. [PMID: 29287706 DOI: 10.1016/j.jcma.2017.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/07/2017] [Accepted: 08/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Currently, the role of dacarbazine (DTIC) based chemotherapy in neuroendocrine tumors (NETs) in Asia is unclear. Here, we report the outcomes of dacarbazine (DTIC)-based chemotherapy in Taiwan population. METHODS DTIC alone (250 mg/m2/day), or 5-fluorouracil (5-FU, 500 mg/m2/day) and DTIC (200 mg/m2/day) with or without epirubicin (200 mg/m2/day), for 3 days, every 3-4 weeks. Subgroups were analyzed by grading, and by Ki-67 index. RESULTS 48 patients were reviewed in this study, including 3 had grade 1 tumors, 23 had grade 2, while 22 were grade 3. In grade 3 NEC patients, the tumor Ki-67 index of 21-55% were noted in 8 patients, and >55% in 14 patients. Progression-free survival (PFS) was 5.1 months, and overall survival (OS) was 31.6 months. The PFS (in months) were 12.5 and 1.8 for patients with NETs and neuroendocrine carcinomas (NECs), respectively (p < 0.001). The OS were not reached and 5.9 months for patients with NETs and NECs, respectively (p = 0.001). Patients with NECs were divided into two groups, according to their Ki-67 index. In patients with a tumor Ki-67 index of 21-55%, PFS was 4.1 months, and OS was not reached; in those with a tumor Ki-67 index of >55%, they were 1.5 and 1.8 months, respectively (p < 0.001 and p = 0.013). CONCLUSION NETs, and grade 3 NECs, with Ki-67 indices of 20-55% had good responses to DTIC-based chemotherapy, with acceptable side effects. Ki-67 index could predict prognosis for grade 3 NEC patients, and guide further chemotherapy choices.
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Affiliation(s)
- Hwa-Yen Chiu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Liang-Yu Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital-Linkou, Taoyaun, Taiwan, ROC
| | - Wen-Liang Fang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ming Shyr
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Chen Yeh
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Peter Mu-Hsin Chang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Han Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ping Hung
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yee Chao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Sheng-Hsuan Chien
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Ming-Huang Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Teng CJ, Huon LK, Hu YW, Yeh CM, Chien SH, Chen SC, Liu CJ. Correction: Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan. PLoS One 2016; 11:e0162225. [PMID: 27560694 PMCID: PMC4999230 DOI: 10.1371/journal.pone.0162225] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Liu YC, Chien SH, Fan NW, Hu MH, Gau JP, Liu CJ, Yu YB, Liu CY, Hsiao LT, Liu JH, Chiou TJ, Chen PM, Tzeng CH. Incidence and risk factors of probable and proven invasive fungal infection in adult patients receiving allogeneic hematopoietic stem cell transplantation. Journal of Microbiology, Immunology and Infection 2016; 49:567-74. [DOI: 10.1016/j.jmii.2015.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/19/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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16
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Teng CJ, Huon LK, Hu YW, Yeh CM, Chien SH, Chen SC, Liu CJ. Secondary Solid Organ Neoplasm in Patients with Acute Lymphoblastic Leukemia: A Nationwide Population-Based Study in Taiwan. PLoS One 2016; 11:e0152909. [PMID: 27035574 PMCID: PMC4817987 DOI: 10.1371/journal.pone.0152909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 03/21/2016] [Indexed: 11/23/2022] Open
Abstract
Background Acute lymphoblastic leukemia (ALL) is more common in children than in adults. Secondary neoplasms (SNs) in childhood ALL have been widely reported. However, only one study has demonstrated SNs in adult ALL. Because of the poorer survival of adult ALL, the incidence might be underestimated. Objective To evaluate the incidence and risk factors of secondary solid organ neoplasms among adult and child ALL patients. Methods Newly diagnosed ALL patients between 1997 and 2011 were recruited from the Taiwan National Health Insurance database. Those who had antecedent or combined malignancies were excluded. Standardized incidence ratios (SIRs) were analyzed to compare the risk of our cohort to general population in the same age, sex and calendar year. Risk factors for SN development were analyzed by Cox proportional hazards models. Effects of treatments were treated as time-dependent variables. Results The 15-year cumulative incidence of SN was 1.9% and 8.4% in 1,381 child and 2,154 adult ALL patients, respectively. The SIR was significantly increased in child ALL (SIR 6.06), but not in adult ALL (SIR 1.16). The SIRs of follow-up periods were 5.14, 2.24, .87 and .71 at ≥ 10 years, 5–10 years, 1–5 years and 0–1, respectively. Overall, 15 SNs developed, and CNS tumors (SIR 11.56) were the most common type. Multivariate analysis showed that age ≥ 20 years (hazard ratio [HR] 5.04), end-stage renal disease (HR 18.98) and cranial irradiation (HR 8.12) were independent risk factors for cancer development. Conclusions When compared with the general population, child ALL shows a increased risk of developing SNs. CNS tumors are the most common type, and cranial irradiation is an independent risk factor. With longer follow-up, the risk of SNs increases. Hence, physicians need to pay more attention on the risk of developing SNs in long-term ALL survivors with risk factors.
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Affiliation(s)
- Chung-Jen Teng
- Division of Hematology and Oncology, Department of Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Leh-Kiong Huon
- Department of Otolaryngology-Head & Neck Surgery, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Yu-Wen Hu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Hsuan Chien
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - San-Chi Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail: (SC); (CL)
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- * E-mail: (SC); (CL)
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Chien SH, Tzeng CH, Chiou TJ, Chen PM, Yen CC, Hsiao LT. Anemia is an important prognostic factor for very elderly patients with diffuse large B-cell lymphoma treated with rituximab and attenuated chemotherapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sheng-Hsuan Chien
- Division of Hematology and Oncology, Department of Medicine,Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Min Chen
- Division of Hematology and Oncology Department of Medicine Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Liang-Tsai Hsiao
- Division of Hematology and Oncology, Department of Medicine,Taipei Veterans General Hospital, Taipei, Taiwan
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Chien SH, Liu CJ, Hong YC, Teng CJ, Hu YW, Ku FC, Yeh CM, Chiou TJ, Gau JP, Tzeng CH. Development of second primary malignancy in patients with non-Hodgkin lymphoma: a nationwide population-based study. J Cancer Res Clin Oncol 2015; 141:1995-2004. [PMID: 25971624 DOI: 10.1007/s00432-015-1979-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 04/23/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND With the improved survival of non-Hodgkin lymphoma (NHL) patients, development of second primary malignancy (SPM) has become an increasingly important issue in these long-term survivors. METHODS We conducted a retrospective study to analyze NHL patients diagnosed between January 1997 and December 2010 in Taiwan. Standardized incidence ratios (SIRs) were applied to compare the risk of SPMs in NHL patients and the general population. Multivariate analysis was performed to determine the independent predictors of SPM. RESULT NHL patients have a significantly greater risk of developing SPM [SIR 1.43; 95 % confidence interval (CI) 1.32-1.55; p < 0.001). A significantly high SIR was noted for leukemia, myeloma, and neoplasms of the bone and soft tissue, thyroid, central nervous system, skin, stomach, head and neck, liver and biliary tract, and the lungs and mediastinum. Multivariate analysis revealed that age ≥60 years [hazard ratios (HR) 2.04], being male (HR 1.22), comorbidities of chronic obstructive pulmonary disease (HR 1.34), liver cirrhosis (HR 1.50), hepatitis C infection (HR 1.94) and therapy containing radiotherapy (HR 1.38) were the significant predictors for SPM occurrence. The median follow-up time and survival time were 3.37 and 9.45 years, respectively. CONCLUSION This Taiwanese population-based study provides updated data about the risk of SPM in NHL patients, demonstrating an approximately 1.5 time greater risk of SPM compared to the general population. A high risk of SPM for myeloma and hepatocellular carcinoma is unique to Asian patients.
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Affiliation(s)
- Sheng-Hsuan Chien
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chung Hong
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Hematology and Oncology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chung-Jen Teng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Yu-Wen Hu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fan-Chen Ku
- Department of Hematology and Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chiu-Mei Yeh
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Cheng-Hwai Tzeng
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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19
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Liu YC, Chien SH, Fan NW, Hu MH, Gau JP, Liu CJ, Yu YB, Liu CY, Hsiao LT, Liu JH, Chiou TJ, Tzeng CH. Risk factors for pericardial effusion in adult patients receiving allogeneic haematopoietic stem cell transplantation. Br J Haematol 2015; 169:737-45. [PMID: 25818840 DOI: 10.1111/bjh.13357] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 11/05/2014] [Accepted: 01/20/2015] [Indexed: 01/22/2023]
Abstract
Pericardial effusion (PE) is a rare but potentially life-threatening complication for allogeneic haematopoietic stem cell transplantation (HSCT) recipients. The risk factors, aetiology, incidence and therapy are largely unclear. To investigate this issue, we reviewed 391 adult patients undergoing allogeneic HSCT between January 2003 and December 2013. Twelve out of 391 patients (3·1%) developed PE of moderate to large amounts, including 9 out of 12 patients (75%) identified as late-onset PE. Two out of the nine patients with late-onset PE experienced recurrent effusion. The median age at HSCT was 44·5 years (range: 22-63 years) among the 12 patients with PE and 47 years in the late-onset patients. Multivariate analysis revealed that multiple transplant procedures was a significant risk factor for PE (P = 0·036) and a trend as risk factor in patients aged>50 years (P = 0·066). For late-onset PE, pre-transplant age>50 years (P = 0·032) and extensive chronic graft-versus-host disease (cGVHD) (P = 0·006) remained statistically significant on multivariate analysis. Currently, there are no published data exploring the risk factors for post-transplant PE in adult patients of allogeneic HSCT. Our study determined the risk factors and incidence for the post-transplant PE, especially in the late-onset group.
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Affiliation(s)
- Yao-Chung Liu
- Department of Medicine of Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan.,Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Hsuan Chien
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Wen Fan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hung Hu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, Cardinal Tien Hospital, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Bin Yu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yu Liu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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20
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Chien SH, Liu CJ, Hu YW, Hong YC, Teng CJ, Yeh CM, Chiou TJ, Gau JP, Tzeng CH. Frequency of surveillance computed tomography in non-Hodgkin lymphoma and the risk of secondary primary malignancies: A nationwide population-based study. Int J Cancer 2015; 137:658-65. [DOI: 10.1002/ijc.29433] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/19/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Sheng-Hsuan Chien
- Division of Hematology and Oncology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Public Health, National Yang-Ming University; Taipei Taiwan
| | - Yu-Wen Hu
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Public Health, National Yang-Ming University; Taipei Taiwan
- Cancer Center, Taipei Veterans General Hospital; Taipei Taiwan
| | - Ying-Chung Hong
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Hematology and Oncology, Department of Medicine; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Chung-Jen Teng
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Oncology and Hematology, Department of Medicine; Far Eastern Memorial Hospital; Taipei Taiwan
| | - Chiu-Mei Yeh
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Tzeon-Jye Chiou
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Transfusion Medicine, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Cheng-Hwai Tzeng
- Division of Hematology and Oncology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
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21
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Liu CJ, Hong YC, Teng CJ, Hung MH, Hu YW, Ku FC, Chen YT, Chien SH, Yeh CM, Chen TJ, Chiou TJ, Gau JP, Tzeng CH. Risk and impact of tuberculosis in patients with chronic myeloid leukemia: A nationwide population-based study in Taiwan. Int J Cancer 2014; 136:1881-7. [DOI: 10.1002/ijc.29201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/27/2014] [Accepted: 08/20/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Public Health; National Yang-Ming University; Taipei Taiwan
| | - Ying-Chung Hong
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Chung-Jen Teng
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Public Health; National Yang-Ming University; Taipei Taiwan
- Division of Oncology and Hematology, Department of Medicine; Far Eastern Memorial Hospital; New Taipei City Taiwan
| | - Man-Hsin Hung
- Division of Hematology and Oncology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Program in Molecular Medicine; School of Life Sciences, National Yang-Ming University; Taipei Taiwan
| | - Yu-Wen Hu
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Cancer Center; Taipei Veterans General Hospital; Taipei Taiwan
| | - Fan-Chen Ku
- Department of Hematology and Oncology; Show Chwan Memorial Hospital; Changhua Taiwan
| | - Yung-Tai Chen
- Division of Hematology and Oncology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Medicine; Taipei City Hospital Heping Fuyou Branch; Taipei Taiwan
| | | | - Chiu-Mei Yeh
- Department of Family Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Tzeng-Ji Chen
- Institute of Public Health; National Yang-Ming University; Taipei Taiwan
- Department of Family Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Tzeon-Jye Chiou
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Transfusion Medicine, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Cheng-Hwai Tzeng
- Division of Hematology and Oncology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
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Kuan AS, Teng CJ, Wu HH, Su VYF, Chen YT, Chien SH, Yeh CM, Hu LY, Chen TJ, Tzeng CH, Liu CJ. Risk of ischemic stroke in patients with ovarian cancer: a nationwide population-based study. BMC Med 2014; 12:53. [PMID: 24661584 PMCID: PMC4022213 DOI: 10.1186/1741-7015-12-53] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/25/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer patients are at risk of thromboembolism. However, studies investigating the relationship between ovarian cancer and ischemic stroke are lacking. The objectives of this study were to assess the association between ovarian cancer and ischemic stroke, and to determine the predictive risk factors. METHODS Ovarian cancer patients aged 20 years and older without antecedent cerebrovascular events and who were followed up for more than 1 year between 1 January 2003 and 31 December 2011 were recruited from the Taiwan National Health Insurance database. Hazard ratios (HRs) of stroke risk for ovarian cancer patients compared with an age- and comorbidity-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative ischemic stroke incidence between ovarian cancer patients and the matched cohort was analyzed with the Kaplan-Meier method and tested with the log-rank test. RESULTS Each cohort (ovarian cancer and matched cohort) consisted of 8,810 individuals, with a median age of 49 years. After a median follow-up of 2.68 and 3.85 years, respectively, the ischemic stroke incidence was 1.38-fold higher in the ovarian cancer cohort than in the comparison cohort (9.4 versus 6.8 per 1,000 person-years), with an age- and comorbidity-adjusted HR of 1.49 (P <0.001). The ischemic stroke risk imposed by ovarian cancer was more prominent in patients under 50 years old (HR 2.28; P <0.001) compared with patients 50 years and older (HR 1.33; P = 0.005). Significant risk factors predicting stroke development were age 50 years and older (HR 2.21; P <0.001), hypertension (HR 1.84; P <0.001), diabetes mellitus (HR 1.71; P <0.001), and treatment with chemotherapy (HR 1.45; P = 0.017), especially platinum-based regimens. CONCLUSIONS Ovarian cancer patients were at an increased risk of developing ischemic stroke. Age, hypertension, diabetes, and chemotherapy treatment were independent risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Chia-Jen Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Chien SH, Hsieh MK, Li H, Monnell J, Dzombak D, Vidic R. Pilot-scale cooling tower to evaluate corrosion, scaling, and biofouling control strategies for cooling system makeup water. Rev Sci Instrum 2012; 83:024101. [PMID: 22380105 DOI: 10.1063/1.3680563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pilot-scale cooling towers can be used to evaluate corrosion, scaling, and biofouling control strategies when using particular cooling system makeup water and particular operating conditions. To study the potential for using a number of different impaired waters as makeup water, a pilot-scale system capable of generating 27,000 kJ∕h heat load and maintaining recirculating water flow with a Reynolds number of 1.92 × 10(4) was designed to study these critical processes under conditions that are similar to full-scale systems. The pilot-scale cooling tower was equipped with an automatic makeup water control system, automatic blowdown control system, semi-automatic biocide feeding system, and corrosion, scaling, and biofouling monitoring systems. Observed operational data revealed that the major operating parameters, including temperature change (6.6 °C), cycles of concentration (N = 4.6), water flow velocity (0.66 m∕s), and air mass velocity (3660 kg∕h m(2)), were controlled quite well for an extended period of time (up to 2 months). Overall, the performance of the pilot-scale cooling towers using treated municipal wastewater was shown to be suitable to study critical processes (corrosion, scaling, biofouling) and evaluate cooling water management strategies for makeup waters of complex quality.
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Affiliation(s)
- S H Chien
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
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Chien SH, Carmona G, Prochnow LI, Austin ER. Cadmium availability from granulated and bulk-blended phosphate-potassium fertilizers. J Environ Qual 2003; 32:1911-4. [PMID: 14535337 DOI: 10.2134/jeq2003.1911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2002] [Indexed: 05/24/2023]
Abstract
Recent field experiments have shown that high chloride (Cl) in irrigation waters can increase soil cadmium (Cd) uptake by crops because of the formation of soluble ion-pair complexes of Cd with Cl in soil solution. The present study was aimed at testing a hypothesis that KCl in granulated PK fertilizers may enhance Cd uptake by crops from Cd-containing P fertilizers because of close contact between Cd and Cl in the same granules. Less effect would be expected if the same granular PK fertilizers were bulk-blended because of separation of Cd and Cl in different granules. A single superphosphate (SSP) containing 32 mg Cd kg(-1) was granulated by the compaction process with KCl at a P to K ratio = 1:1. Granular KCl was also bulk-blended with granular SSP or Cd-free monocalcium phosphate (MCP) at the same P to K ratio. An acid Ultisol (pH 5.2) was treated with PK fertilizers at 400 mg kg(-1) each for P and K. Upland rice (Oryza sativa L.) and soybean [Glycine max (L.) Merr.] were grown to maturity, and signalgrass (Brachiaria decumbens Stapf.) was cut four times during the study. The results showed that the agronomic effectiveness in increasing crop yield was the same with SSP and MCP whether granulated or bulk-blended with KCl. Concentrations of Cd in plant tissue samples of all crops were much lower for MCP than for SSP. In all the plant tissue samples, except grain samples of upland rice, Cd concentrations obtained with granulated (SSP + KCl) were significantly higher than that with bulk-blended (SSP) + (KCl).
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Affiliation(s)
- S H Chien
- Resource Development Division, IFDC, P.O. Box 2040, Muscle Shoals, AL 35662, USA.
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Chien SH, Teller DY, Palmer J. The transition from scotopic to photopic vision in 3-month-old infants and adults: an evaluation of the rod dominance hypothesis. Vision Res 2001; 40:3853-71. [PMID: 11090677 DOI: 10.1016/s0042-6989(00)00200-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The scotopic to photopic transition was tested in adults and 12-week-old infants using a large field motion nulling technique at a series of luminances between -3.57 and 2.70 log cd m(-2). The stimuli were composed of 0.25 cyc deg(-1), 5.6 Hz blue/black and yellow/black sinusoidal grating components, superimposed and moving in opposite directions. The contrasts of the two components were traded off to determine motion nulls at each luminance level. An eye movement based response measure was used for infant subjects, whereas self-report was used in adults. In both age groups, the motion null values approached a scotopic asymptote consistent with V'(lambda) at the lowest luminance levels, and a photopic asymptote consistent with V(10)(lambda) at the highest luminance levels. The scotopic to photopic transition was gradual and occurred over about 3 log units between about -2 and 1 log cd m(-2) in both groups. The null values for infants and adults were highly similar at each luminance level, and the shapes of the transition curves were virtually identical at the two ages. These data suggest that at each different luminance level, the balance between rod-initiated and cone-initiated signals in the extrafoveal luminance channel is similar or identical in 12-week-old infants and adults.
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Affiliation(s)
- S H Chien
- Department of Psychology, University of Washington, Box 351525, 98195-1525, Seattle, WA, USA.
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Qi F, Sorkhabi O, Suits AG, Chien SH, Li WK. Photodissociation of ethylene sulfide at 193 nm: a photofragment translational spectroscopy study with VUV synchrotron radiation and ab initio calculations. J Am Chem Soc 2001; 123:148-61. [PMID: 11273612 DOI: 10.1021/ja003314v] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Photodissociation of ethylene sulfide at 193 nm has been studied using photofragment translational spectroscopy and ab initio theoretical calculations. Tunable synchrotron radiation was used as a universal but selective probe of the reaction products to reveal new aspects of the photodissociation dynamics. The channel giving S + C2H4 was found to be dominated by production of ground-state sulfur atoms (S(3P):S(1D) = 1.44:1), mostly through a spin-forbidden process. The results also suggest the presence of a channel giving S(3P) in conjunction with triplet ethylene C2H4 (3B(1u)) and allow insight into the energy of the latter species near its equilibrium geometry, in which the two methylene groups occupy perpendicular planes. In addition, a channel leading to the production of H2S with C2H2 also has been observed. Our experimental results are supported and elaborated by theoretical calculations.
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Affiliation(s)
- F Qi
- Chemical Sciences Division, Ernest Orlando Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA.
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27
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Abstract
Considered to have immunostimulating activity, echinacea is a widely used phytomedicinal for treatment of the common cold and upper respiratory tract infections (URTIs). We reviewed the literature from the MEDLINE database (January 1966-July 1999), International Pharmaceutical Abstracts (IPA) online database, Cambridge Scientific Abstracts Biological Sciences online database, Alt-Health Watch online database, EMBase CD-ROM database, and references from published articles, reviews, and letters to evaluate evidence from clinical trials of echinacea's purported efficacy for treating or preventing URTIs. Twelve clinical studies published from 1961-1997 concluded that echinacea was efficacious for treating the common cold, but the results are unclear due to inherent flaws in study design. Five trials were published since 1997; two showed that echinacea lacked efficacy for treating and preventing URTI symptoms, and three concluded that it was effective in reducing the frequency, duration, and severity of common cold symptoms. Again, these results are unclear because of methodologic uncertainties, such as small populations and use of noncommercially available, nonstandardized dosage forms. Although evidence for echinacea's efficacy is inconclusive, it appears to be safe. Patients without contraindications to it may not be dissuaded from using an appropriate preparation to treat the common cold.
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Affiliation(s)
- J T Giles
- School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond 23298-0533, USA
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28
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Abstract
We compared the mechanical properties of normal and reconstructed heel pads in seven patients. Four had latissimus dorsi flaps and one each an anterior thigh flap, a local dorsalis pedis flap and a sural arterial flap. The thickness of the heel pad was measured under serial incremental loads of 0.5 kg to a maximum of 3 kg and then relaxed sequentially. The load-displacement curve of the heel pad during a loading-unloading cycle was plotted and from this the unloaded heel-pad thickness (UHPT), compressibility index (CI), elastic modulus (Ep), and energy dissipation ratio (EDR) were calculated. The EDR was significantly increased in the reconstructed heels (53.7 +/- 18% v 23.4 +/- 6.5%, p = 0.003) indicating that in them more energy is dissipated as heat. Insufficient functional capacity in the reconstructed heel pad can lead to the development of shock-induced discomfort and ulceration.
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Affiliation(s)
- C L Wang
- National Taiwan University, Taipei
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29
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Chien SH, Hung SH, Cheng YM, Lin GT, Lin SY, Ko CY, Chen LH, Chiang HC. Surgical treatment of pathologic fracture of the femur. Kaohsiung J Med Sci 1997; 13:556-61. [PMID: 9348733] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A retrospective study of the surgical treatment of 32 metastatic lesions of the femur in 30 patients at the Kaohsiung Medical College Hospital was performed from 1987 to 1994. There were 16 women and 14 men with an average age of 61 years. A surgical technique combining internal fixation or prosthesis and methylmethacrylate cement was used in all cases. Adequate pain relief was achieved in thirty-one cases (97 %). Of the entire group, 20 cases (62%) remained ambulatory, 10 cases (31%) were confined to a wheelchair, only two cases had implant failure and one suffered from infection.
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Affiliation(s)
- S H Chien
- Department of Orthopedic Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical College, Taiwan, Republic of China
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30
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Pan TM, Chien SH, Wang TK, Tsai JL, Horng CB. [Diagnosis of Yersinia pestis]. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi 1997; 30:43-50. [PMID: 10592809] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
There is no plaque case report in Taiwan since 1952. However, it is necessary to set up a laboratory system to investigate the distribution of Yersinia pestis in the natural environment to implement the public policy for preventing plague. Besides the traditional methods; e.g. culture, microscopic observation, biochemical characteristics, anti-F1 antigen detection by slide agglutination, immunofluorescence, and phage lytic assay, PCR was used as rapid screening test in our study. These laboratory methods were used to examine whether the flea samples harvested in King-Men island carry Y. pestis. The results showed that the flea index per mouse was high but no Y. pestis was detected in the fleas.
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Affiliation(s)
- T M Pan
- National Institute of Preventive Medicine, Department of Health, Taipei, Taiwan, ROC
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31
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Abstract
Association studies between the A1 allele of the dopamine D2 receptor (DRD2) gene TaqI A polymorphism and alcoholism remain controversial. A recent study from Japan demonstrated that the A1 allele is associated with severe alcoholism in the Japanese population. We were interested in knowing if this association also exists in the Atayals of Taiwan, who were found to have a higher prevalence of alcohol-use disorders than the Han Chinese in Taiwan. Genotype and allele frequencies were determined in alcohol-abusing, alcohol-dependent, and nonalcoholic control Atayal natives in Taiwan. A1 allele frequencies in alcohol-dependent, alcohol-abusing, and normal control Atayals were 0.39, 0.42, and 0.39, respectively. No difference in A1 allele frequency was found among these three groups. Our data do not support the hypothesis that the A1 allele of the TaqI A polymorphism of the DRD2 gene increases susceptibility to alcohol-use disorders in the Atayals of Taiwan.
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Affiliation(s)
- C H Chen
- Division of Psychiatry, Cheng Hsin Rehabilitation and Medical Center, Taipei, Taiwan
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32
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Abstract
A serine-to-cysteine mutation of dopamine D2 receptor at codon 311 (Cys311) was found to have higher frequency in schizophrenic patients than in normal controls in Japanese by Arinami et al. [1994: Lancet 343: 703-704]. The Cys311 allele was found to be associated with patients with younger age-of-onset, positive family history, and more positive symptoms. To investigate the possible involvement of Cys311 in schizophrenia in the Chinese population, 114 unrelated Taiwanese Chinese schizophrenic patients with positive family history and 88 normal controls were genotyped for Cys311. Four patients and 5 normal controls were heterozygotes of Ser311/Cys311; no homozygotes of Cys311 were identified in either group. The allele frequencies of Cys311 in Chinese schizophrenic patients and normal controls were 2% and 3%, respectively. No significant difference was detected between the two groups. Our results do not support the argument that the Cys311 allele of DRD2 poses a genetic risk for certain types of schizophrenia in Chinese populations.
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Affiliation(s)
- C H Chen
- Division of Psychiatry, Cheng Hsin Rehabilitation and Medical Center, Taipei, Taiwan, Republic of China
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33
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Cheng YM, Chien SH, Chou PH, Lin SY. A fixational method of tendon transfer in foot surgery. Gaoxiong Yi Xue Ke Xue Za Zhi 1994; 10:97-9. [PMID: 8176777] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Tendon transfer has been used for correcting foot deformities and improving foot function in paralytic and spastic foot problems. The traditional fixational method by Cole's pull-out button often induces pressure sores which make the button sink and loosens the transferred tendon, leading to poor surgical results. By using a metal eye cover and pull-out wire instead of button and suture material, the transferred tendon can be firmly fixed. Moreover, the concavity of the metal eye cover is suitable for the arch of the foot that provides a large contact surface & even pressure distribution to prevent the most common complications of the pull-out button method, the pressure sore.
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Affiliation(s)
- Y M Cheng
- Department of Orthopaedic Surgery, Kaohsiung Medical College, Taiwan, Republic of China
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34
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Chien SH, Chen SK, Lin SY, Chen SS, Wu HS. [Repair method and healing of skeletal muscle injury]. Gaoxiong Yi Xue Ke Xue Za Zhi 1991; 7:481-8. [PMID: 1779442] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study used m.anterior tibialis of rabbits to document recovery after laceration and repair after a healing period of 12 weeks. Postoperation care were divided into three groups: cast immobilization one or four weeks, and free activity. There were three different methods used to repair muscles including simple suture with Dexon 2-0, modified Kessler with 1/4 width of mersiline 5-0 and simple suture with tendon graft. Physiologic recovery including tension force and muscle contracture length had been tested. Histologic recovery including H & E and ATPase stains had been examined. The recovery of tension force was influenced by immobilization time, not by suture method. The best recovery of tension force was resulted from postoperation care with free activity. The result of shortening length of muscle was according to different suture methods and had no relation with immobilization time. Modified Kessler suture resulted in the best muscle contracture length. The method of modified Kessler suture without immobilization was recommended for management of lacerated muscle.
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Affiliation(s)
- S H Chien
- Department of Orthopaedic Surgery, Kaohsiung Medical College, Taiwan, Republic of China
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Tien HF, Wang CH, Su IJ, Wu HS, Chien SH, Chen YC, Lin DT, Lin KH, Shen MC. Immunoglobulin and T-cell receptor gene rearrangements in acute lymphoblastic leukemia--a higher incidence of double rearrangements in patients with myeloid antigen expression. Leuk Res 1991; 15:91-8. [PMID: 1850056 DOI: 10.1016/0145-2126(91)90088-b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Among 160 patients who were diagnosed as having acute lymphoblastic leukemia (ALL) by French American British (FAB) criteria, 32 patients (20%) expressed myeloid-associated antigens on leukemic blasts (My+ALL). Correlation of immunophenotype with rearrangement of immunoglobulin (Ig) heavy chain and T-cell receptor (TCR) beta chain genes was performed on 73 of these patients (21 were My+ALL). Rearrangements of both Ig and TCR genes (double rearrangements) were detected in 24 patients, including three (19%) of 16 T-lineage ALL. 17 (33%) of 52 B-lineage ALL, and four of five ALL expressing both B and T-cell surface markers. Also a higher incidence of double rearrangements in My+ALL was found as compared with My-ALL (43% vs 29%). This difference was more evident when only B-lineage ALL was considered (50% in My+ patients vs 24% in My- patients). However the difference is not statistically significant yet possibly due to the small number of patients in the study. Further studies on more patients are needed to confirm this. In My-B-lineage ALL, rearrangements of TCR beta chain gene were restricted to certain subgroups (Groups III & IV) of patients who expressed CD10 surface antigens but lacked cytoplasmic Ig. In My+ B-lineage ALL, rearrangements of TCR beta chain gene could be found in various subgroups studied (Groups II through V). Cross-lineage gene rearrangement in My+ALL may involve mechanisms different from those in My-ALL.
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Affiliation(s)
- H F Tien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, R.O.C
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36
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Lin SY, Wu HJ, Chien SH. Correction osteotomy of flexion deformity of cervical spine in ankylosing spondylitis--a case report. Gaoxiong Yi Xue Ke Xue Za Zhi 1990; 6:454-60. [PMID: 2213966] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
It is well known that severe flexion deformities of the spine may occur in patients suffering from ankylosing spondylitis. The prevention of these deformities by early recognition of the disease process should be the main aim of the medical profession in handling patients with specific spinal involvements. Yet, we still see all too often patients with advanced kyphotic deformities of the trunk who are very grossly disabled and thus present a major problem to definitive surgical correction of their deformities. Correction of rigid kyphosis by establishing a compensatory lordosis can be carried out in the lumbar or cervical area. Surgical intervention in the cervical region enables the chin to be lifted off the sternum, but great care has to be taken of the relatively bulky spinal cord, which practically fills the spinal canal. Excessive correction runs the risks of fatally damaging the nerves and vertebral vessels. Therefore, most centers perform correction osteotomies of the cervical spine progressively, with day-by-day adjustment of the external fixators. We present a case of cervical osteotomy in which, under local anesthesia and with the aid of S.S.E.P., cervical kyphosis was corrected by a one-stage procedure. The results and difficulties are described here-in.
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Affiliation(s)
- S Y Lin
- Department of Orthopedic Surgery, Kaohsiung Medical College, Taiwan, Republic of China
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37
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Chien SH, Hu HT, Chen SK, Lin SY. [Treatment of elbow contracture]. Gaoxiong Yi Xue Ke Xue Za Zhi 1989; 5:465-70. [PMID: 2593214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The most common sequela of the elbow joint after injury is decreased range of motion, i.e. elbow contracture. From January 1986 to July 1987, the Orthopaedic department of Kaohsiung Medical College collected data of 10 elbow contracture on 9 cases. Treatment included capsulotomy and joint debridement with immediate postoperative rehabilitation. This paper reports the clinical follow up results with an average time of 7 months after the operation. Range of motion increased 50 degrees on the average. No residual pain was complained. Activity of daily living was improved and the results were satisfied.
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Tien HF, Chuang SM, Wang CH, Lee FY, Chien SH, Chen YC, Shen MC, Liu CH. Chromosomal characteristics of Ph-positive chronic myelogenous leukemia in transformation. A study of 23 Chinese patients in Taiwan. Cancer Genet Cytogenet 1989; 39:89-97. [PMID: 2731152 DOI: 10.1016/0165-4608(89)90234-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Cytogenetic study was performed in the past 3 years on 23 Chinese patients with Philadelphia chromosome (Ph) positive chronic myelogenous leukemia (CML) in transformation; seven were in accelerated phase and 16 in acute blast crisis. Chromosomal abnormalities in addition to Ph were found in three (43%) of the patients at accelerated phase and 14 (88%) of the patients at blast crisis. The common nonrandom chromosomal aberrations were double Ph, trisomy 8, trisomy 19, and trisomy 21, which occurred in 47%, 41%, 35%, and 29%, respectively, of the total patients with extra chromosomal abnormalities. Isochromosome for the long arm of chromosome 17 was found in only one patient. In patients with blast crisis, the type of blast cell was characterized through morphologic, cytochemical, and immunocytochemical studies. Eleven cases were classified as myeloid and five as lymphoid transformation. Trisomy 8, 19, and 21 were detected only in patients with myeloid blast crisis. This study also revealed a high incidence of trisomy 21 and a low incidence of i(17q) in Chinese patients with transformation of CML.
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MESH Headings
- Adult
- Blast Crisis/genetics
- Blast Crisis/pathology
- Bone Marrow/pathology
- Bone Marrow/ultrastructure
- Child
- Chromosome Aberrations
- Female
- Humans
- Karyotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid, Accelerated Phase/genetics
- Leukemia, Myeloid, Accelerated Phase/pathology
- Male
- Middle Aged
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Affiliation(s)
- H F Tien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China
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39
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Abstract
Simple models are used to calculate the inelastic light scattering spectrum of motile bacteria when wiggling motions are included in addition to translational displacement. Computations of spectra lead to the conclusion that nontranslational motions can be neglected when swimming speeds are deduced from light-scattering data for normal vigorously motile strains. On the other hand, for slowly translating bacteria, or for strains exhibiting noticeable wiggling motion when viewed in a microscope, additional spectral components may be significant. Such components are best distinguished when measurements are made at small and intermediate scattering angles; at large angles the spectra have approximately the same scaling properties (functionals of Qt, Q being the Bragg wave vector) as those associated with simple translational motility.
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