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Schuler T, Passos Chaves L, Kamble S, Bland E, Feinberg BA. Prevalence of historical medical conditions or comorbidities with potential role in clinical decision making related to suitability of immuno-oncologic plus IV antiangiogenic therapy in newly diagnosed first-line unresectable hepatocellular carcinoma in the United States. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
511 Background: Treatment landscape in advanced/unresectable hepatocellular carcinoma (uHCC) has been rapidly changing. In June 2020, the first immuno-oncologic (I/O) + IV anti-angiogenic regimen for uHCC was approved as first line (1L) treatment in the US. As with any new therapy, it is key to understand the prevalence of medical conditions listed in patient medical history/comorbidities that could potentially influence physician choice of 1L therapy in uHCC patients. Methods: We conducted a retrospective chart review study using Cardinal Health's Oncology Provider Extended Network (OPEN). US medical oncologists identified newly diagnosed adult uHCC patients initiating 1L systemic therapy from June 2020 to April 2022. Based on the warnings and precautions section of the US FDA labels, medical conditions reported as part of patient medical history or comorbidities [including gastrointestinal (GI) bleeding risk, chronic kidney disease, autoimmune disorders, thromboembolic events] were identified from patient medical records. Less suitable was defined as the occurrence of ≥ 1 medical condition/comorbidity reported in the medical record. All patient data were deidentified. Proportions of patients with the above medical conditions or with physician-reported record of an esophagogastroduodenoscopy (EGD) procedure to assess risk of bleeding were calculated. Results: In the cohort of 433 uHCC patients initiating 1L systemic therapy, majority were male 287 (66%), Caucasian 244 (56%) with average age of 64 years. At 1L initiation, majority of the patients were 333 BCLC Stage C (77%) and 316 (73%) had ECOG performance status of 0 or 1. Approximately 160 (37%) were Child-Pugh B, 99 (23%) had non-alcoholic steatohepatitis (NASH), 176 (41%) had Hep-C etiology (among those tested), and 294 (68%) had liver cirrhosis. Prior to therapy initiation, 254 (59%) received EGD within 3 months. In the overall cohort, 221 (51%) patients were reported to have at least one condition listed as medical history/comorbidity that could make them less suitable to receive I/O + IV anti-angiogenic regimen. Upper/lower GI bleeding risk and chronic kidney disease were reported in 164 (38%) and 64 (15%) patients, respectively. History of thromboembolic events and autoimmune disorders were reported in 50 (12%) and 22 (5%) of patients, respectively. Conclusions: A significant proportion of the newly diagnosed uHCC patients were found to have at least one condition listed as medical history/comorbidity that would make them potentially less suitable for I/O + IV anti-angiogenic regimen. Our findings reinforce the importance of medical history and co-morbidity assessment in uHCC patients prior to therapy selection to optimize benefit-risk ratio for each patient.
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Affiliation(s)
| | | | | | - Emily Bland
- Cardinal Health Specialty Solutions, Dublin, OH
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Pavlick AC, Amin A, Moser JC, Poretta T, Sakkal LA, Moshyk A, Klink AJ, Schuler T, Feinberg BA. Outcomes in patients with resected stage IIIA melanoma treated with adjuvant nivolumab or monitored with observation: A real-world study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21534 Background: Nivolumab is approved in the United States and other countries as an adjuvant treatment for patients with completely resected stage III–IV melanoma based on results of the phase 3 CheckMate 238 trial, though the trial enrolled a limited number of patients with stage IIIA disease (AJCC-8). The objective of this real-world study is to describe characteristics, treatment patterns, and outcomes of patients with resected stage IIIA melanoma (AJCC-8) treated with adjuvant nivolumab or monitored with observation. Methods: In this retrospective, chart-review study, physicians from Cardinal Health’s proprietary Oncology Provider Extended Network (OPEN) extracted data from electronic health records of patients who had undergone complete surgical resection of stage IIIA melanoma between Jan. 1, 2018, and Dec. 31, 2019. Recurrence-free survival (RFS) and overall survival (OS) were evaluated from the date of resection and compared between the adjuvant nivolumab and observation cohorts using log-rank tests and adjusted Cox proportional hazards models (covariates included age, sex, race, region, payer type, ECOG PS, and Charlson Comorbidity Index). Discontinuations and deaths due to adjuvant nivolumab toxicity were assessed. Results: This study included 171 patients treated with adjuvant nivolumab and 38 patients monitored with observation. In the adjuvant nivolumab and observation cohorts, respectively, mean age was 57.4 and 68.1 years; most patients were male (59% and 68%) and white (90% and 87%); and median follow-up from resection was 20.7 and 25.0 months. Sentinel lymph node tumor burden of < 1 mm was reported in 12% (n = 20) and 16% (n = 6) of patients in the adjuvant nivolumab and observation cohorts, respectively. The scheduled treatment course with adjuvant nivolumab was completed by 91% of patients (n = 155). RFS and OS rates were numerically higher with adjuvant nivolumab than with observation (Table). There was a trend toward RFS and OS benefit with adjuvant nivolumab versus observation (unadjusted RFS HR 0.53, 95% CI 0.26–1.09; adjusted RFS HR 0.62, 95% CI 0.28–1.40; unadjusted OS HR 0.55, 95% CI 0.19–1.57; adjusted OS HR 0.81, 95% CI 0.25–2.61). Discontinuation of adjuvant nivolumab due to toxicity occurred in 2% of patients (n = 4); no treatment-related deaths were reported. Conclusions: These real-world results confirm that patients with resected stage IIIA melanoma (AJCC-8) have a good prognosis. Treatment with adjuvant nivolumab may provide modest survival benefit over observation in this population, though increased sample size and additional follow-up are warranted.[Table: see text]
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Affiliation(s)
| | - Asim Amin
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Justin C Moser
- HonorHealth Research and Innovation Institute, Scottsdale, AZ
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Kejda A, Wong S, Eade T, Booth J, Schuler T, Roderick S. PO-1565 Evaluation of online AI-driven adaption for palliative radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rosenberg MJ, Thorn DB, Izumi N, Williams D, Rowland M, Torres G, Haugh M, Hillyard P, Adelman N, Schuler T, Barrios MA, Holder JP, Schneider MB, Fournier KB, Bradley DK, Regan SP. Erratum: "Image-plate sensitivity to x rays at 2 to 60 keV" [Rev. Sci. Instrum. 90, 013506 (2019)]. Rev Sci Instrum 2019; 90:029902. [PMID: 30831772 DOI: 10.1063/1.5092602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 06/09/2023]
Affiliation(s)
- M J Rosenberg
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - D B Thorn
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Izumi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Williams
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - M Rowland
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - G Torres
- Mission Support and Test Services, LLC, Livermore, California 94551, USA
| | - M Haugh
- Mission Support and Test Services, LLC, Livermore, California 94551, USA
| | - P Hillyard
- Mission Support and Test Services, LLC, Livermore, California 94551, USA
| | - N Adelman
- California Polytechnic State University, San Luis Obispo, California 93407, USA
| | - T Schuler
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - M A Barrios
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J P Holder
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M B Schneider
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K B Fournier
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D K Bradley
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S P Regan
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
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Rosenberg MJ, Thorn DB, Izumi N, Williams D, Rowland M, Torres G, Haugh M, Hillyard P, Adelman N, Schuler T, Barrios MA, Holder JP, Schneider MB, Fournier KB, Bradley DK, Regan SP. Image-plate sensitivity to x rays at 2 to 60 keV. Rev Sci Instrum 2019; 90:013506. [PMID: 30709229 DOI: 10.1063/1.5053592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
The sensitivity of Fuji SR and MS image plates (IPs) used in x-ray spectrometers on OMEGA and the National Ignition Facility has been measured using two techniques. A set of radioisotopes has been used to constrain image-plate sensitivity between 6 and 60 keV, while a Manson source has been used to expose image plates to x rays at energies between 1.5 and 8 keV. These data have shown variation in sensitivity on the order of 5% for a given IP type and scanner settings. The radioisotope technique has also been used to assess IP fading properties for MS-type plates over long times. IP sensitivity as a function of scanner settings and pixel size has been systematically examined, showing variations of up to a factor of 2 depending on the IP type. Cross-calibration of IP scanners at different facilities is necessary to produce a consistent absolute sensitivity curve spanning the energy range of 2-60 keV.
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Affiliation(s)
- M J Rosenberg
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - D B Thorn
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Izumi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Williams
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - M Rowland
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - G Torres
- Mission Support and Test Services, LLC, Livermore, California 94551, USA
| | - M Haugh
- Mission Support and Test Services, LLC, Livermore, California 94551, USA
| | - P Hillyard
- Mission Support and Test Services, LLC, Livermore, California 94551, USA
| | - N Adelman
- California Polytechnic State University, San Luis Obispo, California 93407, USA
| | - T Schuler
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - M A Barrios
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J P Holder
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M B Schneider
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K B Fournier
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D K Bradley
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S P Regan
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
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Keller S, Sedlacik J, Schuler T, Buchert R, Avanesov M, Zenouzi R, Lohse AW, Kooijman H, Fiehler J, Schramm C, Yamamura J. Prospective comparison of diffusion-weighted MRI and dynamic Gd-EOB-DTPA-enhanced MRI for detection and staging of hepatic fibrosis in primary sclerosing cholangitis. Eur Radiol 2018; 29:818-828. [PMID: 30014204 DOI: 10.1007/s00330-018-5614-9] [Citation(s) in RCA: 8] [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: 04/09/2018] [Revised: 05/26/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the diagnostic value of multiparametric magnetic resonance imaging (MRI) including dynamic Gd-EOB-DTPA-enhanced (DCE) and diffusion-weighted (DW) imaging for diagnosis and staging of hepatic fibrosis in primary sclerosing cholangitis (PSC) using transient elastography as a standard reference. MATERIAL AND METHODS Multiparametric MRI was prospectively performed on a 3.0-Tesla scanner in 47 patients (age 43.9±14.3 years). Transient elastography derived liver stiffness measurements (LSM), DCE-MRI derived parameters (hepatocellular uptake rate (Ki), arterial (Fa), portal venous (Fv) and total (Ft) blood flow, mean transit time (MTT), and extracellular volume (Ve)) and the apparent diffusion coefficient (ADC) were calculated. Correlation and univariate analysis of variance with post hoc pairwise comparison were applied to test for differences between LSM derived fibrosis stages (F0/F1, F2/3, F4). ROC curve analysis was used as a performance measure. RESULTS Both ADC and Ki correlated significantly with LSM (r= -0.614; p<0.001 and r= -0.368; p=0.01). The ADC significantly discriminated fibrosis stages F0/1 from F2/3 and F4 (p<0.001). Discrimination of F0/1 from F2/3 and F4 reached a sensitivity/specificity of 0.917/0.821 and 0.8/0.929, respectively. Despite significant inter-subject effect for classification of fibrosis stages, post hoc pairwise comparison was not significant for Ki (p>0.096 for F0/1 from F2/3 and F4). LSM, ADC and Ki were significantly associated with serum-based liver functional tests, disease duration and spleen volume. CONCLUSION DW-MRI provides a higher diagnostic performance for detection of hepatic fibrosis and cirrhosis in PSC patients in comparison to Gd-EOB-DTPA-enhanced DCE-MRI. KEY POINTS • Both ADC and hepatocellular uptake rate (Ki) correlate significantly with liver stiffness (r= -0.614; p<0.001 and r= -0.368; p=0.01). • The DCE-imaging derived quantitative parameter hepatocellular uptake rate (Ki) fails to discriminate pairwise intergroup differences of hepatic fibrosis (p>0.09). • DWI is preferable to DCE-imaging for discrimination of fibrosis stages F0/1 to F2/3 (p<0.001) and F4 (p<0.001).
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Affiliation(s)
- S Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany. .,Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany.
| | - J Sedlacik
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - T Schuler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - R Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - M Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - R Zenouzi
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A W Lohse
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - H Kooijman
- Philips Medical Systems, MR Clinical Science, Hamburg, Germany
| | - J Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - J Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
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Kissane DW, Zaider TI, Li Y, Hichenberg S, Schuler T, Lederberg M, Lavelle L, Loeb R, Del Gaudio F. Reply to K. Kusaka et al. J Clin Oncol 2017; 35:688-689. [PMID: 28045626 DOI: 10.1200/jco.2016.70.6424] [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)
- David W Kissane
- David W. Kissane, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; and Monash University, Clayton, Victoria, Australia; Talia I. Zaider and Yuelin Li, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Shira Hichenberg, Tammy Schuler, and Marguerite Lederberg, Memorial Sloan Kettering Cancer Center, New York, NY; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and Rebecca Loeb and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Talia I Zaider
- David W. Kissane, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; and Monash University, Clayton, Victoria, Australia; Talia I. Zaider and Yuelin Li, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Shira Hichenberg, Tammy Schuler, and Marguerite Lederberg, Memorial Sloan Kettering Cancer Center, New York, NY; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and Rebecca Loeb and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yuelin Li
- David W. Kissane, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; and Monash University, Clayton, Victoria, Australia; Talia I. Zaider and Yuelin Li, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Shira Hichenberg, Tammy Schuler, and Marguerite Lederberg, Memorial Sloan Kettering Cancer Center, New York, NY; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and Rebecca Loeb and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shira Hichenberg
- David W. Kissane, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; and Monash University, Clayton, Victoria, Australia; Talia I. Zaider and Yuelin Li, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Shira Hichenberg, Tammy Schuler, and Marguerite Lederberg, Memorial Sloan Kettering Cancer Center, New York, NY; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and Rebecca Loeb and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tammy Schuler
- David W. Kissane, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; and Monash University, Clayton, Victoria, Australia; Talia I. Zaider and Yuelin Li, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Shira Hichenberg, Tammy Schuler, and Marguerite Lederberg, Memorial Sloan Kettering Cancer Center, New York, NY; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and Rebecca Loeb and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marguerite Lederberg
- David W. Kissane, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; and Monash University, Clayton, Victoria, Australia; Talia I. Zaider and Yuelin Li, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Shira Hichenberg, Tammy Schuler, and Marguerite Lederberg, Memorial Sloan Kettering Cancer Center, New York, NY; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and Rebecca Loeb and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lisa Lavelle
- David W. Kissane, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; and Monash University, Clayton, Victoria, Australia; Talia I. Zaider and Yuelin Li, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Shira Hichenberg, Tammy Schuler, and Marguerite Lederberg, Memorial Sloan Kettering Cancer Center, New York, NY; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and Rebecca Loeb and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca Loeb
- David W. Kissane, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; and Monash University, Clayton, Victoria, Australia; Talia I. Zaider and Yuelin Li, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Shira Hichenberg, Tammy Schuler, and Marguerite Lederberg, Memorial Sloan Kettering Cancer Center, New York, NY; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and Rebecca Loeb and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Francesca Del Gaudio
- David W. Kissane, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; and Monash University, Clayton, Victoria, Australia; Talia I. Zaider and Yuelin Li, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Shira Hichenberg, Tammy Schuler, and Marguerite Lederberg, Memorial Sloan Kettering Cancer Center, New York, NY; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and Rebecca Loeb and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center, New York, NY
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Barnett M, McDonnell G, DeRosa A, Schuler T, Philip E, Peterson L, Touza K, Jhanwar S, Atkinson TM, Ford JS. Psychosocial outcomes and interventions among cancer survivors diagnosed during adolescence and young adulthood (AYA): a systematic review. J Cancer Surviv 2016; 10:814-31. [PMID: 26920873 PMCID: PMC5001943 DOI: 10.1007/s11764-016-0527-6] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/13/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE A cancer diagnosis during adolescence or young adulthood (AYA; defined as ages 15-39) generates unique medical and psychosocial needs as developmental milestones are simultaneously impacted. Past research highlights that AYAs' experiences and psychosocial outcomes are different, and more research and attention is needed. We aimed to identify and synthesize literature regarding psychosocial outcomes, unique needs, and existing psychosocial interventions pertaining to individuals diagnosed with cancer exclusively during AYA, and to highlight areas for future research. METHODS A systematic literature search was conducted using MEDLINE (via PubMed), EMBASE, Cochrane, Web of Science, and PsycINFO (via OVID). Grey literature was searched using key term variations and combinations. Overall, 15,301 records were assessed by two independent reviewers, with 38 studies meeting inclusion criteria. RESULTS Data synthesis of the 38 articles was organized by four main themes based on quality of life and survivorship: physical well-being (7 studies), psychological well-being (8 studies), social well-being (9 studies), and survivorship care (14 studies). The paucity of studies for such broad inclusion criteria highlights that this population is often combined or subsumed under other age groups, missing needs unique to these AYAs. CONCLUSIONS AYA cancer survivors' experiences are nuanced, with interacting variables contributing to post-treatment outcomes. AYAs require age-appropriate and flexible care, informational needs and treatment-related education that foster autonomy for long-term survivorship, as well as improved follow-up care and psychological outcomes. IMPLICATIONS FOR CANCER SURVIVORS By incorporating these findings into practice, the informational and unmet needs of AYAs can be addressed effectively. Education and programming is lacking specific and general subject matter specific to AYAs, incorporating ranging needs at different treatment stages.
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Affiliation(s)
- Marie Barnett
- Columbia University Medical Center, New York, NY, USA
| | - Glynnis McDonnell
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
- St. John's University Department of Psychology, Queens, NY, USA
| | - Antonio DeRosa
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Tammy Schuler
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
- Association for Behavioral and Cognitive Therapies, New York, NY, USA
| | - Errol Philip
- The Notre Dame Laboratory for Psycho-oncology Research, Notre Dame, IN, USA
| | - Lisa Peterson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Kaitlin Touza
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Sabrina Jhanwar
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Thomas M Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Jennifer S Ford
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
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DuHamel K, Schuler T, Nelson C, Philip E, Temple L, Schover L, Baser RE, Starr TD, Cannon K, Jennings S, Jandorf L, Carter J. The sexual health of female rectal and anal cancer survivors: results of a pilot randomized psycho-educational intervention trial. J Cancer Surviv 2016; 10:553-63. [PMID: 26667358 PMCID: PMC4864056 DOI: 10.1007/s11764-015-0501-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 11/17/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sexual dysfunction is a frequently reported consequence of rectal/anal cancer treatment for female patients. PURPOSE The purpose of this study was to conduct a small randomized controlled trial to assess the efficacy of a telephone-based, four-session Cancer Survivorship Intervention-Sexual Health (CSI-SH). METHODS Participants (N = 70) were stratified by chemotherapy, stoma, and menopause statuses before randomization to CSI-SH or assessment only (AO). Participants were assessed at baseline, 4 months (follow-up 1), and 8 months (follow-up 2). RESULTS The intervention had medium effect sizes from baseline to follow-up 1, which decreased by follow-up 2. Effect sizes were larger among the 41 sexually active women. Unadjusted means at the follow-ups were not significantly different between the treatment arms. Adjusting for baseline scores, demographics, and medical variables, the intervention arm had significantly better emotional functioning at follow-ups 1 and 2 and less cancer-specific stress at follow-up 1 compared to the AO arm. CONCLUSION The data supported the hypothesized effects on improved sexual and psychological functioning and quality of life in CSI-SH female rectal/anal cancer survivors compared to the AO condition. This pilot study (N = 70) of CSI-SH supported the impact of this intervention on sexual and psychological functioning and quality of life on rectal and anal cancer survivors compared with an AO condition. However, intervention effects were stronger at follow-up 1 as compared to follow-up 2 and were stronger for sexually active women. IMPLICATIONS FOR CANCER SURVIVORS Women may benefit from a brief, four-session, sexual health intervention after treatment from rectal and anal cancer.
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Affiliation(s)
| | - Tammy Schuler
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Association for Behavioral and Cognitive Therapies, New York, NY, USA
| | | | - Errol Philip
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larissa Temple
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leslie Schover
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | - Lina Jandorf
- Icahn School of Medicine at Mount Sinai School, New York, NY, USA
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kissane DW, Zaider TI, Li Y, Hichenberg S, Schuler T, Lederberg M, Lavelle L, Loeb R, Del Gaudio F. Randomized Controlled Trial of Family Therapy in Advanced Cancer Continued Into Bereavement. J Clin Oncol 2016; 34:1921-7. [PMID: 27069071 DOI: 10.1200/jco.2015.63.0582] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Systematic family-centered cancer care is needed. We conducted a randomized controlled trial of family therapy, delivered to families identified by screening to be at risk from dysfunctional relationships when one of their relatives has advanced cancer. PATIENTS AND METHODS Eligible patients with advanced cancer and their family members screened above the cut-off on the Family Relationships Index. After screening 1,488 patients or relatives at Memorial Sloan Kettering Cancer Center or three related community hospice programs, 620 patients (42%) were recruited, which represented 170 families. Families were stratified by three levels of family dysfunction (low communicating, low involvement, and high conflict) and randomly assigned to one of three arms: standard care or 6 or 10 sessions of a manualized family intervention. Primary outcomes were the Complicated Grief Inventory-Abbreviated (CGI) and Beck Depression Inventory-II (BDI-II). Generalized estimating equations allowed for clustered data in an intention-to-treat analysis. RESULTS On the CGI, a significant treatment effect (Wald χ(2) = 6.88; df = 2; P = .032) and treatment by family-type interaction was found (Wald χ(2) = 20.64; df = 4; P < .001), and better outcomes resulted from 10 sessions compared with standard care for low-communicating and high-conflict groups compared with low-involvement families. Low-communicating families improved by 6 months of bereavement. In the standard care arm, 15.5% of the bereaved developed a prolonged grief disorder at 13 months of bereavement compared with 3.3% of those who received 10 sessions of intervention (Wald χ(2) = 8.31; df = 2; P =.048). No significant treatment effects were found on the BDI-II. CONCLUSION Family-focused therapy delivered to high-risk families during palliative care and continued into bereavement reduced the severity of complicated grief and the development of prolonged grief disorder.
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Affiliation(s)
- David W Kissane
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Talia I Zaider
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Yuelin Li
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Shira Hichenberg
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Tammy Schuler
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Marguerite Lederberg
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Lisa Lavelle
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Rebecca Loeb
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Francesca Del Gaudio
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
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Schuler T, Nahar K, Chan D, Stevens M, Schembri G, Guminski A, Eade T. 2828 Towards predicting tumour response in patients with locally advanced head and neck cancer treated with neoadjuvant chemotherapy. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31570-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Masterson MP, Hurley KE, Zaider T, Corner G, Schuler T, Kissane DW. Psychosocial Health Outcomes for Family Caregivers Following the First Year of Bereavement. Death Stud 2015; 39:573-578. [PMID: 25651502 DOI: 10.1080/07481187.2014.985406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The authors examined psychosocial outcomes following the first year of bereavement, for 51 family caregivers, including both spouses and offspring. Researchers assessed caregivers during palliative care and again during the second year of bereavement, for social functioning, depression, and distress. For all family caregivers, only depression scores declined significantly between T1 and T2 (p < 0.05). Caregiver relationship and gender did not make a difference in recovery. Results demonstrate that poor psychosocial health outcomes exist beyond the first year of bereavement. Early identification of these caregivers is necessary to provide mental health professionals the opportunity to intervene proactively.
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Affiliation(s)
- Melissa P Masterson
- a Department of Psychiatry & Behavioral Sciences , Memorial Sloan-Kettering Cancer Center , New York , New York , USA
| | - Karen E Hurley
- a Department of Psychiatry & Behavioral Sciences , Memorial Sloan-Kettering Cancer Center , New York , New York , USA
- b Teachers College , Columbia University , New York , New York , USA
| | - Talia Zaider
- a Department of Psychiatry & Behavioral Sciences , Memorial Sloan-Kettering Cancer Center , New York , New York , USA
| | - Geoffrey Corner
- a Department of Psychiatry & Behavioral Sciences , Memorial Sloan-Kettering Cancer Center , New York , New York , USA
| | - Tammy Schuler
- a Department of Psychiatry & Behavioral Sciences , Memorial Sloan-Kettering Cancer Center , New York , New York , USA
| | - David W Kissane
- c School of Psychology & Psychiatry, Faculty of Medicine, Nursing and Health Sciences , Monash University, Monash Medical Centre , Clayton , Australia
- d Department of Psychiatry , Weill Medical College of Cornell University , New York , New York , USA
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Jennings S, Philip EJ, Nelson C, Schuler T, Starr T, Jandorf L, Temple L, Garcia E, Carter J, DuHamel K. Barriers to recruitment in psycho-oncology: unique challenges in conducting research focusing on sexual health in female survivorship. Psychooncology 2014; 23:1192-5. [PMID: 24664909 DOI: 10.1002/pon.3520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Sabrina Jennings
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Jiménez-Mier J, Ederer D, Schuler T. X-ray Raman scattering at the edge of manganese compounds: Characteristic behaviour of and. Radiat Phys Chem Oxf Engl 1993 2006. [DOI: 10.1016/j.radphyschem.2005.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- T. Schuler
- Laboratory of Hydraulics, Hydrology and Glaciology; Swiss Federal Institute of Technology; Zurich Switzerland
| | - U. H. Fischer
- Laboratory of Hydraulics, Hydrology and Glaciology; Swiss Federal Institute of Technology; Zurich Switzerland
| | - G. H. Gudmundsson
- Laboratory of Hydraulics, Hydrology and Glaciology; Swiss Federal Institute of Technology; Zurich Switzerland
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Li K, Schuler T, Chen Z, Glass GE, Childs JE, Plagemann PG. Isolation of lactate dehydrogenase-elevating viruses from wild house mice and their biological and molecular characterization. Virus Res 2000; 67:153-62. [PMID: 10867194 DOI: 10.1016/s0168-1702(00)00142-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Lactate dehydrogenase-elevating virus (LDV) was first identified as a contaminant of transplantable mouse tumors that were passaged in laboratory mice. It has been assumed that these LDVs originated from LDVs endemic in wild house mouse populations. In order to test this hypothesis and to explore the relationships between LDVs from wild house mice among each other and to those isolated from laboratory mice, we have isolated LDVs from wild house mice and determined their biological and molecular properties. We have screened for LDV tissues of 243 wild house mice that had been caught in various regions of North, Central and South America between 1985 and 1994. We were able to isolate LDVs from the tissues of four mice, three had been caught in Baltimore, MD and one in Montana. We demonstrate that the phenotypic properties (ability to establish a long-term viremic infection, low immunogenicity of the neutralization epitope, high resistance to antibody neutralization and lack of neuropathogenicity) of the four wild house mouse LDVs are identical to those of the primary LDVs isolated from transplantable tumors (LDV-P and LDV-vx), which are distinct from those of the neuropathogenic LDV-C. Furthermore, ORF 5 and ORF 2 and their protein products (the primary envelope glycoprotein VP-3P, and the minor envelope glycoprotein, respectively) of the wild house mouse LDVs were found to be closely related to those of LDV-P and LDV-vx. The LDVs caught in Baltimore, MD were especially closely related to each other, whereas the LDV isolated in Montana was more distantly related, indicating that it had evolved independently. The ectodomain of VP-3P of all four wild house mouse LDVs, like those of LDV-P and LDV-vx, possess the same three polylactosaminoglycan chains, two of which are lacking in the VP-3P ectodomain of LDV-C. These results further strengthen the conclusion that the three polylactosaminoglycan chains are the primary determinants of the phenotypic properties of LDV-P/vx.
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Affiliation(s)
- K Li
- Department of Microbiology, Medical School, University of Minnesota, Minneapolis 55455, USA
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Zhang Z, Schuler T, Zupancic M, Wietgrefe S, Staskus KA, Reimann KA, Reinhart TA, Rogan M, Cavert W, Miller CJ, Veazey RS, Notermans D, Little S, Danner SA, Richman DD, Havlir D, Wong J, Jordan HL, Schacker TW, Racz P, Tenner-Racz K, Letvin NL, Wolinsky S, Haase AT. Sexual transmission and propagation of SIV and HIV in resting and activated CD4+ T cells. Science 1999; 286:1353-7. [PMID: 10558989 DOI: 10.1126/science.286.5443.1353] [Citation(s) in RCA: 667] [Impact Index Per Article: 26.7] [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: 11/02/2022]
Abstract
In sexual transmission of simian immunodeficiency virus, and early and later stages of human immunodeficiency virus-type 1 (HIV-1) infection, both viruses were found to replicate predominantly in CD4(+) T cells at the portal of entry and in lymphoid tissues. Infection was propagated not only in activated and proliferating T cells but also, surprisingly, in resting T cells. The infected proliferating cells correspond to the short-lived population that produces the bulk of HIV-1. Most of the HIV-1-infected resting T cells persisted after antiretroviral therapy. Latently and chronically infected cells that may be derived from this population pose challenges to eradicating infection and developing an effective vaccine.
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Affiliation(s)
- Z Zhang
- Department of Microbiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Zhang ZQ, Schuler T, Cavert W, Notermans DW, Gebhard K, Henry K, Havlir DV, Günthard HF, Wong JK, Little S, Feinberg MB, Polis MA, Schrager LK, Schacker TW, Richman DD, Corey L, Danner SA, Haase AT. Reversibility of the pathological changes in the follicular dendritic cell network with treatment of HIV-1 infection. Proc Natl Acad Sci U S A 1999; 96:5169-72. [PMID: 10220437 PMCID: PMC21835 DOI: 10.1073/pnas.96.9.5169] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [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: 11/18/2022] Open
Abstract
Over the course of HIV-1 infection, the lymphoid follicles where the humoral immune response is generated initially increase in size and number and then progressively involute. In advanced disease, the network of the processes of follicular dendritic cells (FDCs) that serve as antigen repositories and anatomical substrate for B and T cells and antigen to interact is destroyed, contributing to the breakdown of the immune system. Because destruction of FDCs is associated with deposition of HIV-1, and much of the virus can be cleared from the network with antiretroviral therapy, we investigated the reversibility of damage. We measured the immunohistochemically stainable FDC compartment by quantitative image analysis, and we documented changes in this compartment at different stages of disease. We show that treatment, initiated even at advanced stages of HIV-1 disease, can slowly reverse pathological changes in the FDC network.
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Affiliation(s)
- Z Q Zhang
- Department of Microbiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Schuler T. [Sclerosing of varicose veins in von Willebrand-Jürgens syndrome]. Hautarzt 1989; 40:239-40. [PMID: 2786514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Schuler T. [Meat inspection with a garlic press]. SCHWEIZ ARCH TIERH 1987; 129:165-6. [PMID: 3576169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Arnold P, Gerber H, Schuler T, Gilmour J, von Tscharner C, Straub R. [Grass sickness in the horse]. SCHWEIZ ARCH TIERH 1981; 123:383-5. [PMID: 7323797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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