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Yu X, Jia H, Yang J, Masteghin MG, Beere H, Mtunzi M, Deng H, Huo S, Chen C, Chen S, Tang M, Sweeney SJ, Ritchie D, Seeds A, Liu H. Effects of phosphorous and antimony doping on thin Ge layers grown on Si. Sci Rep 2024; 14:7969. [PMID: 38575676 PMCID: PMC10995153 DOI: 10.1038/s41598-024-57937-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024] Open
Abstract
Suppression of threading dislocations (TDs) in thin germanium (Ge) layers grown on silicon (Si) substrates has been critical for realizing high-performance Si-based optoelectronic and electronic devices. An advanced growth strategy is desired to minimize the TD density within a thin Ge buffer layer in Ge-on-Si systems. In this work, we investigate the impact of P dopants in 500-nm thin Ge layers, with doping concentrations from 1 to 50 × 1018 cm-3. The introduction of P dopants has efficiently promoted TD reduction, whose potential mechanism has been explored by comparing it to the well-established Sb-doped Ge-on-Si system. P and Sb dopants reveal different defect-suppression mechanisms in Ge-on-Si samples, inspiring a novel co-doping technique by exploiting the advantages of both dopants. The surface TDD of the Ge buffer has been further reduced by the co-doping technique to the order of 107 cm-2 with a thin Ge layer (of only 500 nm), which could provide a high-quality platform for high-performance Si-based semiconductor devices.
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Affiliation(s)
- Xueying Yu
- Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Hui Jia
- Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
| | - Junjie Yang
- Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Mateus G Masteghin
- Advanced Technology Institute, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Harvey Beere
- Cavendish Laboratory, University of Cambridge, Cambridge, CB3 0HE, UK
| | - Makhayeni Mtunzi
- Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Huiwen Deng
- Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Suguo Huo
- London Centre for Nanotechnology, 17-19 Gordon Street, London, WC1H 0AH, UK
| | - Chong Chen
- Cavendish Laboratory, University of Cambridge, Cambridge, CB3 0HE, UK
| | - Siming Chen
- Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Mingchu Tang
- Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
| | - Stephen J Sweeney
- James Watt School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK
| | - David Ritchie
- Cavendish Laboratory, University of Cambridge, Cambridge, CB3 0HE, UK
| | - Alwyn Seeds
- Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Huiyun Liu
- Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
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Blombery P, Fox L, Ryland GL, Thompson ER, Lickiss J, McBean M, Yerneni S, Trainer A, Hughes D, Greenway A, Mechinaud F, Wood EM, Lieschke GJ, Szer J, Barbaro P, Roy J, Wight J, Lynch E, Martyn M, Gaff C, Ritchie D. Erratum to: Utility of clinical comprehensive genomic characterization for diagnostic categorization in patients presenting with hypocellular bone marrow failure syndromes. Haematologica 2024; 109:1311. [PMID: 38562077 PMCID: PMC10985447 DOI: 10.3324/haematol.2023.284760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 11/27/2023] [Indexed: 04/04/2024] Open
Affiliation(s)
| | - Lucy Fox
- Clinical Haematology, Peter MacCallum Cancer Centre
| | | | | | | | | | | | - Alison Trainer
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne; University of Melbourne, Peter MacCallum Cancer Centre
| | | | | | | | | | - Graham J Lieschke
- Clinical Haematology, Peter MacCallum Cancer Centre/Royal Melbourne Hospital
| | - Jeff Szer
- Clinical Haematology, Peter MacCallum Cancer Centre/Royal Melbourne Hospital
| | - Pasquale Barbaro
- Children Health Queensland and University of Queensland, South Brisbane
| | - John Roy
- Children Health Queensland and University of Queensland, South Brisbane
| | - Joel Wight
- Department of Haematology, Austin Health
| | - Elly Lynch
- Melbourne Genomics Health Alliance, Parkville
| | | | - Clara Gaff
- Melbourne Genomics Health Alliance, Parkville
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre/Royal Melbourne Hospital, Melbourne, Australia
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3
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Gong JY, Chiang C, Wark JD, Ritchie D, Panek-Hudson Y, Le MV, Limbri L, Fabila N, Fourlanos S, Yates CJ. Bone Density and Trabecular Bone Score Decline Rapidly in the First Year After Bone Marrow Transplantation with a Marked Increase in 10-Year Fracture Risk. Calcif Tissue Int 2024; 114:377-385. [PMID: 38376757 PMCID: PMC10957585 DOI: 10.1007/s00223-024-01189-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
As outcomes from allogeneic bone marrow transplantation (BMT) have improved, prevention of long-term complications, such as fragility fractures, has gained importance. We aimed to assess areal bone mineral density (aBMD) and trabecular bone score (TBS) changes post BMT, and determine their relationship with fracture prevalence. Patients who attended the Royal Melbourne Hospital (RMH) BMT clinic between 2005-2021 were included. Patient characteristics and dual-energy X-ray absorptiometry (DXA) values were collected from the electronic medical record and a survey. TBS iNsight™ was used to calculate TBS for DXA scans performed from 2019 onwards. 337 patients with sequential DXAs were eligible for inclusion. Patients were primarily male (60%) and mean age ± SD was 45.7 ± 13.4 years. The annualised decline in aBMD was greater at the femoral neck (0.066g/cm2 (0.0038-0.17)) and total hip (0.094g/cm2 (0.013-0.19)), compared to the lumbar spine (0.049g/cm2 (- 0.0032-0.16)), p < 0.0001. TBS declined independently of aBMD T-scores at all sites. Eighteen patients (5.3%) sustained 19 fractures over 3884 person-years of follow-up post-transplant (median follow-up 11 years (8.2-15)). This 5.3% fracture prevalence over the median 11-year follow-up period is higher than what would be predicted with FRAX® estimates. Twenty-two patients (6.5%) received antiresorptive therapy, and 9 of 18 (50%) who fractured received or were on antiresorptive therapy. In BMT patients, aBMD and TBS decline rapidly and independently in the first year post BMT. However, FRAX® fracture probability estimates incorporating these values significantly underestimate fracture rates, and antiresorptive treatment rates remain relatively low.
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Affiliation(s)
- Joanna Y Gong
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC, 3052, Australia
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Australia
| | - Cherie Chiang
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Australia
- Endocrinology Department, Austin Health, Melbourne, Australia
- Department of Medicine (RMH), University of Melbourne, Melbourne, Australia
| | - John D Wark
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC, 3052, Australia
- Department of Medicine (RMH), University of Melbourne, Melbourne, Australia
| | - David Ritchie
- Department of Medicine (RMH), University of Melbourne, Melbourne, Australia
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Yvonne Panek-Hudson
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Minh V Le
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC, 3052, Australia
| | - Lydia Limbri
- Department of Medicine (RMH), University of Melbourne, Melbourne, Australia
- Northeast Health Wangaratta, Victoria, Australia
| | - Nicolo Fabila
- Department of Medicine (RMH), University of Melbourne, Melbourne, Australia
| | - Spiros Fourlanos
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC, 3052, Australia
- Department of Medicine (RMH), University of Melbourne, Melbourne, Australia
| | - Christopher J Yates
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC, 3052, Australia.
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Australia.
- Department of Medicine (RMH), University of Melbourne, Melbourne, Australia.
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Minson A, Hamad N, Cheah CY, Tam C, Blombery P, Westerman D, Ritchie D, Morgan H, Holzwart N, Lade S, Anderson MA, Khot A, Seymour JF, Robertson M, Caldwell I, Ryland G, Saghebi J, Sabahi Z, Xie J, Koldej R, Dickinson M. CAR T cells and time-limited ibrutinib as treatment for relapsed/refractory mantle cell lymphoma: the phase 2 TARMAC study. Blood 2024; 143:673-684. [PMID: 37883795 DOI: 10.1182/blood.2023021306] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
ABSTRACT CD19-directed chimeric antigen receptor T cells (CAR-T) achieve high response rates in patients with relapsed/refractory mantle cell lymphoma (MCL). However, their use is associated with significant toxicity, relapse concern, and unclear broad tractability. Preclinical and clinical data support a beneficial synergistic effect of ibrutinib on apheresis product fitness, CAR-T expansion, and toxicity. We evaluated the combination of time-limited ibrutinib and CTL019 CAR-T in 20 patients with MCL in the phase 2 TARMAC study. Ibrutinib commenced before leukapheresis and continued through CAR-T manufacture for a minimum of 6 months after CAR-T administration. The median prior lines of therapy was 2; 50% of patients were previously exposed to a Bruton tyrosine kinase inhibitor (BTKi). The primary end point was 4-month postinfusion complete response (CR) rate, and secondary end points included safety and subgroup analysis based on TP53 aberrancy. The primary end point was met; 80% of patients demonstrated CR, with 70% and 40% demonstrating measurable residual disease negativity by flow cytometry and molecular methods, respectively. At 13-month median follow-up, the estimated 12-month progression-free survival was 75% and overall survival 100%. Fifteen patients (75%) developed cytokine release syndrome; 12 (55%) with grade 1 to 2 and 3 (20%) with grade 3. Reversible grade 1 to 2 neurotoxicity was observed in 2 patients (10%). Efficacy was preserved irrespective of prior BTKi exposure or TP53 mutation. Deep responses correlated with robust CAR-T expansion and a less exhausted baseline T-cell phenotype. Overall, the safety and efficacy of the combination of BTKi and T-cell redirecting immunotherapy appears promising and merits further exploration. This trial was registered at www.ClinicalTrials.gov as #NCT04234061.
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Affiliation(s)
- Adrian Minson
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, Sydney, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
| | | | - Piers Blombery
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - David Westerman
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Huw Morgan
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Nicholas Holzwart
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Stephen Lade
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mary Ann Anderson
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Amit Khot
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - John F Seymour
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Molly Robertson
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Imogen Caldwell
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Georgina Ryland
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Javad Saghebi
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Zahra Sabahi
- Department of Haematology, St Vincent's Hospital, Sydney, Australia
| | - Jing Xie
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rachel Koldej
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Michael Dickinson
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
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5
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Rees MJ, Rivalland A, Tan S, Xie M, Yong MK, Ritchie D. Non-viral pathogens of infectious diarrhoea post-allogeneic stem cell transplantation are associated with graft-versus-host disease. Ann Hematol 2024; 103:593-602. [PMID: 37926752 DOI: 10.1007/s00277-023-05526-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
Infectious diarrhoea is common post-allogeneic haematopoietic stem-cell transplantation (alloHSCT). While the epidemiology of Clostridioides difficile infection (CDI) post-alloHSCT has been described, the impact of other diarrhoeal pathogens is uncertain. We reviewed all alloHSCT between 2017 and 2022 at a single large transplant centre; 374 patients were identified and included. The 1-year incidence of infectious diarrhoea was 23%, divided into viral (13/374, 3%), CDI (65/374, 17%) and other bacterial infections (16/374, 4%). There was a significant association between infectious diarrhoea within 1 year post-transplant and the occurrence of severe acute lower gastrointestinal graft-versus-host disease (GVHD, OR = 4.64, 95% CI 2.57-8.38, p < 0.001) and inferior GVHD-free, relapse-free survival on analysis adjusted for age, donor type, stem cell source and T-cell depletion (aHR = 1.64, 95% CI = 1.18-2.27, p = 0.003). When the classes of infectious diarrhoea were compared to no infection, bacterial (OR = 6.38, 95% CI 1.90-21.40, p = 0.003), CDI (OR = 3.80, 95% CI 1.91-7.53, p < 0.001) and multiple infections (OR = 11.16, 95% CI 2.84-43.92, p < 0.001) were all independently associated with a higher risk of severe GI GVHD. Conversely, viral infections were not (OR = 2.98, 95% CI 0.57-15.43, p = 0.20). Non-viral infectious diarrhoea is significantly associated with the development of GVHD. Research to examine whether the prevention of infectious diarrhoea via infection control measures or modulation of the microbiome reduces the incidence of GVHD is needed.
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Affiliation(s)
- Matthew J Rees
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia.
| | - Alexandra Rivalland
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Sarah Tan
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Mingdi Xie
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Michelle K Yong
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Victorian Infectious Diseases Service, Melbourne Health, Melbourne, Australia
- Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Melbourne, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia
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Pillay B, Ritchie D, Panek-Hudson Y, Jefford M, Garcia T, Shields C, Gniel J, Phipps-Nelson J, Drosdowsky A, Ellen S, Ftanou M. Evaluating the Feasibility and Acceptability of a Psychosexual Intervention for Couples Post-allogeneic Hematopoietic Stem Cell Transplantation. Integr Cancer Ther 2024; 23:15347354241230956. [PMID: 38426395 PMCID: PMC10908224 DOI: 10.1177/15347354241230956] [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: 08/05/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Allogeneic hematopoietic stem cell transplantation (HSCT) can have a long-term impact on patients' sexual functioning and consequently, their relationship satisfaction. This study aimed to examine the feasibility and acceptability of a 5-session psychosexual intervention for HSCT survivors and their partners. METHODS To be eligible patients were required to be more than 3 months post-allogeneic HSCT. The intervention comprised 2 components: (1) A psychosexual education session exploring medical/behavioral treatment options for sexual dysfunction, delivered by a specialist nurse; (2) A 4-session Emotionally-Focused Therapy-based relationship education program for couples delivered by a clinical psychologist. Measures assessing relationship quality, sexual functioning, anxiety, and depression were administered pre- and post-intervention. Feasibility was measured via participation rate, adherence and compliance with completing main measures. Acceptability of the intervention was assessed via patient/partner satisfaction surveys. RESULTS Eight of 85 (9.4%) eligible patients and their partners participated in the study. Reasons for declining participation included: feeling uncomfortable due to sensitive nature of intervention; did not have any relationship/sexual function issues; and experiencing ongoing medical issues. Six of 8 couples (75%) attended at least 4 intervention sessions and 5 of 8 (62.5%) completed the main study measures post-intervention. Four couples reported that sexual satisfaction and relationship satisfaction was somewhat or much better post-intervention; 1 reported no change. CONCLUSION Feasibility criteria were not met, with low enrolment rate, however the intervention was deemed acceptable. Couples who participated adhered to the intervention and considered it beneficial. Further strategies to identify and manage sexual concerns are required.
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Affiliation(s)
- Brindha Pillay
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yvonne Panek-Hudson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael Jefford
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Teresa Garcia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Cassandra Shields
- University of Queensland, Queensland, Australia
- The Australian Centre for Emotionally Focused Therapy, Queensland, Australia
| | - Jo Gniel
- Landscape of Life, Melbourne, Victoria, Australia
| | - Jo Phipps-Nelson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Steve Ellen
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
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7
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Tew M, Douglas AP, Szer J, Bajel A, Harrison SJ, Tio SY, Worth LJ, Hicks RJ, Ritchie D, Slavin MA, Thursky KA, Dalziel K. Evaluating the cost-effectiveness of [ 18F]FDG-PET/CT for investigation of persistent or recurrent neutropenic fever in high-risk haematology patients. Cancer Imaging 2023; 23:119. [PMID: 38102639 PMCID: PMC10724891 DOI: 10.1186/s40644-023-00647-7] [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: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND A recent randomised trial demonstrated [18F]fluorodeoxyglucose positron-emission tomography in combination with low-dose CT (FDG-PET/CT), compared to standard of care computed tomography (CT) imaging, positively impacted antimicrobial management and outcomes of acute leukaemia and haematopoietic stem cell transplant recipients with persistent and recurrent neutropenic fever. We conducted an economic evaluation from a healthcare perspective alongside the clinical trial. METHODS Unit costs in Australian dollars were applied to all resources used (antimicrobials, diagnostic tests, ICU and hospital bed days). Effectiveness was measured as number of patients with antimicrobial rationalisation, 6-month mortality and quality-adjusted life years (QALYs) derived from patient-reported trial-based health-related quality-of-life. Generalised linear models were used to analyse costs and outcomes. Incremental cost-effectiveness ratios (ICERs) for all outcomes and net monetary benefit (NMB) for QALYs were calculated. We performed bootstrapping with 1000 replications using the recycled predictions method. RESULTS The adjusted healthcare costs were lower for FDG-PET/CT (mean $49,563; 95%CI 36,867, 65,133) compared to CT (mean $57,574; 95% CI 44,837, 73,347). The difference in QALYs between the two groups was small (0.001; 95% CI -0.001, 0.004). When simulated 1000 times, FDG-PET/CT was the dominant strategy as it was cheaper with better outcomes than the standard CT group in 74% of simulations. The estimated NMBs at willingness-to-pay thresholds of $50,000 and $100,000 per QALY were positive, thus FDG-PET/CT remained cost-effective at these thresholds. CONCLUSIONS FDG-PET/CT is cost effective when compared to CT for investigation of persistent/recurrent neutropenic fever in high-risk patients, providing further support for incorporation of FDG-PET/CT into clinical guidelines and funding. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, NCT03429387.
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Affiliation(s)
- Michelle Tew
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Abby P Douglas
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Jeff Szer
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ashish Bajel
- Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Simon J Harrison
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Shio Yen Tio
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Leon J Worth
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Rodney J Hicks
- Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David Ritchie
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Karin A Thursky
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Nedumannil R, Batterham E, Harding E, Ritchie D, Wei A, Bajel A. Consecutive day dosing of high-dose cytarabine consolidation over 3 days is resource-efficient and safe in older adult patients with acute myeloid leukemia. Leuk Lymphoma 2023; 64:2123-2132. [PMID: 37656967 DOI: 10.1080/10428194.2023.2251071] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023]
Abstract
High-dose cytarabine (HDAC) is conventionally delivered on days 1, 3 and 5 (HDAC-135) as acute myeloid leukemia (AML) post-remission therapy. Limited data is available on alternative HDAC schedules such as HDAC-123 (given consecutively for 3 days). We retrospectively compared the tolerability and efficacy of HDAC-135 and HDAC-123 delivered in sequential cohorts of adult AML patients. Seventy-three patients were included with 33% aged ≥60 years. HDAC-123 was associated with faster hematological recovery, reduced bacteremia and shorter hospitalization. No differences in safety profile or hematological recovery were seen between patients ≥60 years and <60 years receiving HDAC-123 except a shorter median time to neutrophil count recovery after cycle 1 in the latter group. Three patients (8%) receiving HDAC-123, all aged <60 years, required a change in schedule to HDAC-135 due to transient cytarabine-related side effects. HDAC-123 consolidation was well-tolerated by AML patients, including those ≥60 years, and associated with tangible reductions in resource utilization.
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Affiliation(s)
- Rithin Nedumannil
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Emily Batterham
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Emily Harding
- Department of Pharmacy, The Royal Melbourne Hospital, Parkville, Australia
| | - David Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Andrew Wei
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- Division of Blood Cells and Blood Cancers, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Ashish Bajel
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
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9
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McEwan A, Greenwood M, Ward C, Ritchie D, Szer J, Gardiner E, Colic A, Sipavicius J, Panek-Hudson Y, Kerridge I. Diagnosis and management of endothelial disorders following haematopoietic stem cell transplantation. Intern Med J 2023; 53:2162-2174. [PMID: 37528613 DOI: 10.1111/imj.16188] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023]
Abstract
Haematopoietic stem cell transplantation is a mainstay of therapy for numerous malignant and nonmalignant diseases. Endothelial activation and dysfunction occur after stem cell transplantation, driven by various patient- and transplant-specific factors. This can manifest as one of the relatively uncommon endothelial injury syndromes, such as sinusoidal obstruction syndrome, transplant-associated thrombotic microangiopathy, idiopathic pneumonia syndrome, capillary leak syndrome, engraftment syndrome or posterior reversible encephalopathy syndrome. This review focuses on the pathogenesis, classification and diagnosis of these disorders, as well as provides guidance on risk mitigation and treatment.
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Affiliation(s)
- Ashley McEwan
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Haematology Department, Liverpool Hospital, Sydney, New South Wales, Australia
- South West Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Greenwood
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ward
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Haematology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeff Szer
- Peter MacCallum Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Haematology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Gardiner
- John Curtin School of Medical Research at the Australian National University, Canberra, Australian Capital Territory, Australia
| | - Andriana Colic
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Julija Sipavicius
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Yvonne Panek-Hudson
- Peter MacCallum Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Haematology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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10
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Mallafré-Larrosa M, Papi G, Trilla A, Ritchie D. Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study. JMIR Cancer 2023; 9:e48040. [PMID: 38015612 DOI: 10.2196/48040] [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: 04/09/2023] [Revised: 09/09/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe. OBJECTIVE This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement. METHODS The WASABY app's content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app's 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app's user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion, app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics. RESULTS After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7%). Most app users identified themselves as nonsmokers (689/748, 92.1%), reported either no or infrequent alcohol consumption (432/748, 57.8% and 250/748, 33.4%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5%). In aggregate, the app's content garnered substantial interest, as evidenced by 40.8% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app's content (odds ratio 0.878, 95% CI 0.809-0.954 and odds ratio 0.835, 95% CI 0.735-0.949, respectively). CONCLUSIONS The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe's Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention.
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Affiliation(s)
- Meritxell Mallafré-Larrosa
- Association of European Cancer Leagues, Brussels, Belgium
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Ginevra Papi
- Association of European Cancer Leagues, Brussels, Belgium
| | - Antoni Trilla
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - David Ritchie
- Association of European Cancer Leagues, Brussels, Belgium
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11
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Lew TE, Cliff ERS, Dickinson M, Tam CS, Seymour JF, Blombery P, Bajel A, Ritchie D, Khot A. Allogeneic stem cell transplantation achieves long-term remissions in mantle cell lymphoma, including in TP53-mutated disease. Leuk Lymphoma 2023; 64:1792-1800. [PMID: 37531077 DOI: 10.1080/10428194.2023.2241095] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
Cytarabine-containing chemoimmunotherapy followed by autologous transplantation and rituximab maintenance achieves durable remissions for most patients with mantle cell lymphoma (MCL). However, patients with TP53-mutated disease have poor outcomes with standard approaches. We previously reported that allogeneic stem cell transplantation (alloSCT) achieved durable remissions in MCL, however follow-up among patients with TP53-mutated disease was limited. Here we report extended follow-up of the overall cohort (n = 36) and TP53-mutated subset (n = 13) (median follow-up 10.8 and 4.2 years, respectively). Estimated overall survival was 56% at 10 years for the overall cohort and 59% at 4 years for the TP53-mutated subset. Among patients with TP53-mutated disease, no relapses occurred beyond 6 months post-transplant. Survival after post-alloSCT disease relapse was poor (median 2.1 years). These data confirm that alloSCT can be curative in MCL, including patients with TP53-mutated disease, and should be considered for earlier utilization in this subgroup for whom conventional chemoimmunotherapy is ineffective.
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Affiliation(s)
- Thomas E Lew
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Edward R Scheffer Cliff
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Program on Regulation, Therapeutics and Law, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Dickinson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Constantine S Tam
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Alfred Hospital and Monash University, Melbourne, Australia
| | - John F Seymour
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Piers Blombery
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ashish Bajel
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - David Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Amit Khot
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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12
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Moore J, Hamad N, Gottlieb D, Bajel A, Ritchie D, Yeung D, Greenwood M, Purtill D, Tran S, Solterbeck A, Aarons D, Kwan J. Early cessation of calcineurin inhibitors is feasible post-haploidentical blood stem cell transplant: the ANZHIT 1 study. Blood Adv 2023; 7:5554-5565. [PMID: 37467011 PMCID: PMC10514140 DOI: 10.1182/bloodadvances.2023009840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/25/2023] [Accepted: 06/18/2023] [Indexed: 07/20/2023] Open
Abstract
Haploidentical hematopoietic stem cell transplant (haplo-HSCT) using posttransplant cyclophosphamide (PTCy) is appropriate for those who lack matched donors. Most studies using PTCy have been retrospective making conclusions difficult. ANZHIT-1 was a phase 2 study conducted at 6 Australian allogeneic HSCT centers. The primary end points were disease-free and overall survival at 2 years after HSCT. The reduced-intensity conditioning (RIC) included fludarabine, cyclophosphamide, and 200 cGy total body irradiation, and the myeloablative conditioning (MAC) was IV fludarabine and busulfan. PTCy, MMF and a calcineurin inhibitor (CNI) were used for graft-versus-host disease (GVHD) prophylaxis. CNIs were weaned and ceased by day +120 in eligible patients on day 60. Patients (n = 78) with hematological malignancies were included in the study, with a median follow-up of 732 days (range, 28-1728). HSCT was RIC in 46 patients and MAC in 32 patients. Disease-free survival probability at 2 years was 67.5% (95% [CI], 53.2-85.6) for MAC recipients and 68.3% (95% CI, 56.3-83.01) for RIC recipients. Transplant-related mortality (TRM) on day 100 and year 1 was 4.9% (95% CI, 1.6-15.3) and 17.9% (95% CI, 8.8-36.5), respectively, in the MAC group compared with 3.1% (95% CI, 0.8.1-12) and 11.6% (95% CI, 6-22.4), respectively, in the RIC group. The median time for elective cessation of CNI was day 142.5 days, with no excess chronic GVHD (cGVHD) or mortality. Of the evaluable patients, 71.6% discontinued immunosuppression 12 months after transplant. This prospective haplo-HSCT trial using PTCY demonstrated encouraging survival rates, indicating that early CNI withdrawal is feasible and safe.
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Affiliation(s)
- John Moore
- Haematology Department, St Vincent’s Hospital, Sydney, Australia
| | - Nada Hamad
- Haematology Department, St Vincent’s Hospital, Sydney, Australia
| | - David Gottlieb
- Haematology Department, Westmead Hospital, Sydney, Australia
| | - Ashish Bajel
- Haematology Department, Royal Melbourne Hospital, Melbourne, Australia
| | - David Ritchie
- Haematology Department, Royal Melbourne Hospital, Melbourne, Australia
| | - David Yeung
- Haematology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Matthew Greenwood
- Haematology Department, Royal North Shore Hospital Sydney, Sydney, Australia
| | - Duncan Purtill
- Haematology Department, Fiona Stanley Hospital, Perth, Australia
| | - Steven Tran
- Australasian Bone Marrow Transplant Recipients Registry, Sydney, Australia
| | | | - Donna Aarons
- Australasian Bone Marrow Transplant Recipients Registry, Sydney, Australia
| | - John Kwan
- Haematology Department, Westmead Hospital, Sydney, Australia
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13
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Mallafré-Larrosa M, Ritchie D, Papi G, Mosquera I, Mensah K, Lucas E, Bøje RB, Kirkegaard P, Andersen B, Basu P. Survey of current policies towards widening cervical screening coverage among vulnerable women in 22 European countries. Eur J Public Health 2023; 33:502-508. [PMID: 37043751 PMCID: PMC10234668 DOI: 10.1093/eurpub/ckad055] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND This study aimed to investigate the status of cervical cancer screening (CCS) implementation in Europe by investigating national or regional policies towards broadening coverage of CCS amongst vulnerable subgroups of the population at high risk for CC. METHODS A web-based survey was conducted between September 2021 and February 2022 with CCS programme managers and experts to identify and rank six population subgroups at high risk considered most vulnerable to CC and to map existing policies that addressed the coverage of CCS towards population sub-groups at risk. RESULTS A total of 31 responses were received from experts covering 22 European countries. The results of this survey suggest that whilst many countries identify lower coverage of CCS amongst population subgroups at high risk of CC as a public health problem, few countries have developed dedicated policies towards broadening coverage among these subgroups. The six countries who reported having done so were concentrated in the Northern or Western European regions, suggesting the existence of geographical disparities within the continent. A key challenge in this respect is the difficulty to categorize subgroups of the target population; many individuals are burdened by intersectionality thereby resting in multiple categories, which may hinder the effectiveness of interventions targeted to reach specific subgroups. CONCLUSION A greater clarity on the conceptualization of vulnerability can help countries to develop and subsequently implement strategies to increase coverage to subgroups of the target population currently underserved with regards to CCS.
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Affiliation(s)
- Meritxell Mallafré-Larrosa
- Association of European Cancer Leagues (ECL), Brussels, Belgium
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - David Ritchie
- Association of European Cancer Leagues (ECL), Brussels, Belgium
| | - Ginevra Papi
- Association of European Cancer Leagues (ECL), Brussels, Belgium
| | - Isabel Mosquera
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
| | - Keitly Mensah
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
| | - Rikke Buus Bøje
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
| | - Pia Kirkegaard
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
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14
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Quintana TA, Johnson WL, Ritchie D, Smith V, Martin KA, McMahan K, Brewer MT, Jesudoss Chelladurai JRJ. Genetic characterization of the zoonotic parasite Ancylostoma caninum in the central and eastern United States. J Helminthol 2023; 97:e37. [PMID: 37070361 DOI: 10.1017/s0022149x23000159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Ancylostoma caninum is the most common nematode parasite of dogs in the United States. The present study aimed to describe the molecular epidemiology of A. caninum isolates from the central and eastern states of the United States using the partial mitochondrial cytochrome oxidase (cox1) gene and to compare them with those reported globally. We isolated eggs from faecal samples of dogs and characterized each isolate based on cox1 sequences. A total of 60 samples originating from Kansas, Iowa, New York, Florida and Massachusetts were included. 25 haplotypes were identified in the United States dataset with high haplotype diversity (0.904). Sequence data were compared to sequences from other world regions available in GenBank. Global haplotype analysis demonstrated 35 haplotypes with a haplotype diversity of 0.931. Phylogenetic and network analysis provide evidence for the existence of moderate geographical structuring of A. caninum haplotypes. Our results provide an updated summary of A. caninum haplotypes and data for neutral genetic markers with utility for tracking hookworm populations. Sequences have been deposited in GenBank (ON980650-ON980674). Further studies of isolates from other regions are essential to understand the genetic diversity of this parasite.
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Affiliation(s)
- T A Quintana
- Department of Diagnostic Medicine/Pathobiology, Kansas State University College of Veterinary Medicine, Manhattan, KS, USA
| | - W L Johnson
- Department of Diagnostic Medicine/Pathobiology, Kansas State University College of Veterinary Medicine, Manhattan, KS, USA
| | - D Ritchie
- Department of Diagnostic Medicine/Pathobiology, Kansas State University College of Veterinary Medicine, Manhattan, KS, USA
- Kansas State Veterinary Diagnostic Laboratory, Manhattan, KS, USA
| | - V Smith
- Department of Diagnostic Medicine/Pathobiology, Kansas State University College of Veterinary Medicine, Manhattan, KS, USA
- Kansas State Veterinary Diagnostic Laboratory, Manhattan, KS, USA
| | - K A Martin
- Department of Pathology, Iowa State University College of Veterinary Medicine, Ames, IA, USA
| | - K McMahan
- Department of Pathology, Iowa State University College of Veterinary Medicine, Ames, IA, USA
| | - M T Brewer
- Department of Pathology, Iowa State University College of Veterinary Medicine, Ames, IA, USA
| | - J R J Jesudoss Chelladurai
- Department of Diagnostic Medicine/Pathobiology, Kansas State University College of Veterinary Medicine, Manhattan, KS, USA
- Kansas State Veterinary Diagnostic Laboratory, Manhattan, KS, USA
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15
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Tan L, Tran B, Tie J, Markman B, Ananda S, Tebbutt NC, Michael M, Link E, Wong SQ, Chandrashekar S, Guinto J, Ritchie D, Koldej R, Solomon BJ, McArthur GA, Hicks RJ, Gibbs P, Dawson SJ, Desai J. A Phase Ib/II Trial of Combined BRAF and EGFR Inhibition in BRAF V600E Positive Metastatic Colorectal Cancer and Other Cancers: The EVICT (Erlotinib and Vemurafenib In Combination Trial) Study. Clin Cancer Res 2023; 29:1017-1030. [PMID: 36638198 PMCID: PMC10011885 DOI: 10.1158/1078-0432.ccr-22-3094] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/02/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
PURPOSE BRAF V600E mutant metastatic colorectal cancer represents a significant clinical problem, with combination approaches being developed clinically with oral BRAF inhibitors combined with EGFR-targeting antibodies. While compelling preclinical data have highlighted the effectiveness of combination therapy with vemurafenib and small-molecule EGFR inhibitors, gefitinib or erlotinib, in colorectal cancer, this therapeutic strategy has not been investigated in clinical studies. PATIENTS AND METHODS We conducted a phase Ib/II dose-escalation/expansion trial investigating the safety/efficacy of the BRAF inhibitor vemurafenib and EGFR inhibitor erlotinib. RESULTS Thirty-two patients with BRAF V600E positive metastatic colorectal cancer (mCRC) and 7 patients with other cancers were enrolled. No dose-limiting toxicities were observed in escalation, with vemurafenib 960 mg twice daily with erlotinib 150 mg daily selected as the recommended phase II dose. Among 31 evaluable patients with mCRC and 7 with other cancers, overall response rates were 32% [10/31, 16% (5/31) confirmed] and 43% (3/7), respectively, with clinical benefit rates of 65% and 100%. Early ctDNA dynamics were predictive of treatment efficacy, and serial ctDNA monitoring revealed distinct patterns of convergent genomic evolution associated with acquired treatment resistance, with frequent emergence of MAPK pathway alterations, including polyclonal KRAS, NRAS, and MAP2K1 mutations, and MET amplification. CONCLUSIONS The Erlotinib and Vemurafenib In Combination Trial study demonstrated a safe and novel combination of two oral inhibitors targeting BRAF and EGFR. The dynamic assessment of serial ctDNA was a useful measure of underlying genomic changes in response to this combination and in understanding potential mechanisms of resistance.
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Affiliation(s)
- Lavinia Tan
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Division of Personalized Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Jeanne Tie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Division of Personalized Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ben Markman
- Monash Health, Melbourne, Victoria, Australia
| | - Sumi Ananda
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Niall C Tebbutt
- Olivia Newton John Cancer Wellness and Research Centre, Melbourne, Victoria, Australia
| | - Michael Michael
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Link
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephen Q Wong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jerick Guinto
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,ACRF Translational Research Laboratory, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rachel Koldej
- ACRF Translational Research Laboratory, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin J Solomon
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grant A McArthur
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rodney J Hicks
- The University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia.,Centre for Cancer Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter Gibbs
- Division of Personalized Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Sarah-Jane Dawson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Cancer Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Jayesh Desai
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Nedumannil R, Ritchie D, Bajel A, Ng AP, Harrison SJ, Westerman D. Real-world utility of early measurable residual disease assessments by multi-parametric flow cytometry in adult patients with B-lymphoblastic leukemia receiving Hyper-CVAD induction chemotherapy. Eur J Haematol Suppl 2023; 110:168-176. [PMID: 36321745 DOI: 10.1111/ejh.13890] [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: 08/24/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
Multi-parametric flow cytometry (MFC) has a well-established role in measurable residual disease (MRD) monitoring in patients with B-lymphoblastic leukemia (B-ALL). However, the optimal time-point (TP) for early MRD testing and associated prognostic impact remain undefined in adult B-ALL patients receiving Hyper-CVAD induction chemotherapy. To evaluate the utility of MRD analysis after one cycle (TP1) in comparison to MRD analysis after two cycles (TP2) of induction treatment with Hyper-CVAD chemotherapy, we studied 49 adult B-ALL patients over a 10-year period (2010-2020) who had available bone marrow samples for morphological and MFC MRD assessments at the two separate TPs. Median times to TP1 and TP2 relative to start of treatment were 21 and 45 days, respectively. When censored at transplant, achievement of MRD negativity at TP1 was not associated with a statistically significant improvement in either event-free survival (EFS) (p = .426) or overall survival (OS) (p = .335) when compared to patients with MRD positivity. In contrast, achieving MRD negativity at TP2 was associated with a statistically significant improvement in both EFS (p = ·005) and OS (p = .047) over patients who remained MRD positive. Multivariate analysis demonstrated that KMT2A-rearrangement and MRD positivity at TP2 were the only significant predictors of outcome, correlating with worse EFS and OS. Therefore, in the absence of residual morphologic disease, MRD analysis after one cycle of Hyper-CVAD induction chemotherapy did not provide additional benefit with regard to risk stratification or correlation with survival outcomes when compared to MRD testing after two cycles of Hyper-CVAD in adult B-ALL patients.
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Affiliation(s)
- Rithin Nedumannil
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Ashish Bajel
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Ashley P Ng
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Immunology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Simon J Harrison
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - David Westerman
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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17
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Lew TE, Minson A, Dickinson M, Handunnetti SM, Blombery P, Khot A, Anderson MA, Ritchie D, Tam CS, Seymour JF. Treatment approaches for patients with TP53-mutated mantle cell lymphoma. Lancet Haematol 2023; 10:e142-e154. [PMID: 36725119 DOI: 10.1016/s2352-3026(22)00355-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 02/01/2023]
Abstract
Mantle cell lymphoma is an uncommon subtype of lymphoma characterised by clinical and biological heterogeneity. Although most patients with mantle cell lymphoma have durable responses after chemoimmunotherapy, there is a need to prospectively identify high-risk subsets of patients for whom disease control with standard chemotherapy will be short lived. Among the available prognostic factors, TP53 mutations are uniquely informative owing to their strong association with early disease progression and death among patients receiving conventional chemoimmunotherapy, with the highest negative prognostic value compared with other established risk indicators, including the mantle cell lymphoma international prognostic index, histological features, elevated Ki-67, and other genetic lesions. The poor outcomes for patients with TP53-mutated mantle cell lymphoma receiving chemoimmunotherapy and second-line Bruton tyrosine kinase inhibitors represent an urgent need for alternative approaches. In this Review, we synthesise the available data to inform the management of this high-risk subset of patients and present a treatment strategy prioritising clinical trials and early use of cellular therapies.
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Affiliation(s)
- Thomas E Lew
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Adrian Minson
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Dickinson
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Sasanka M Handunnetti
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Piers Blombery
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Amit Khot
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Mary Ann Anderson
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Constantine S Tam
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Haematology, The Alfred Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - John F Seymour
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
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18
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Douglas G, Yong MK, Tio SY, Chau M, Prabahran A, Sasadeusz J, Slavin M, Ritchie D, Chee L. Effective CMV prophylaxis with high-dose valaciclovir in allogeneic hematopoietic stem-cell recipients at a high risk of CMV infection. Transpl Infect Dis 2023; 25:e13994. [PMID: 36413495 DOI: 10.1111/tid.13994] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/22/2022] [Revised: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection increases mortality and morbidity following allogeneic hematopoietic stem-cell transplantation (alloHSCT). Universal antiviral prophylaxis with letermovir is effective but unsubsidized in Australia. Valaciclovir demonstrates anti-CMV activity in high doses, but few current real-world studies explore its use as primary prophylaxis in high-risk patients post-alloHSCT. METHODS We performed a retrospective analysis of alloHSCT recipients at high risk of clinically significant CMV infection (cs-CMVi), defined as a plasma CMV DNA viral load of >400 IU/ml requiring preemptive therapy, or CMV disease. High-risk recipients were CMV seropositive and underwent T-cell depleted, haploidentical or umbilical cord stem-cell transplants. Consecutive patients transplanted from July 2018 to January 2020, treated with valaciclovir 2 g TDS from day +7 to +100 (HD-VALA), were compared to a historical cohort (July 2017-June 2018) who only received preemptive CMV therapy, and standard valaciclovir (SD-VALA) for varicella/herpes prophylaxis. We compared incidence of and time to cs-CMVi. RESULTS In the SD-VALA cohort (n = 27, median CMV follow-up duration 259 days), 23/27 (85%) developed cs-CMVi at a median of 39 days. For the HD-VALA cohort (n = 35, median CMV follow-up duration 216 days), 19/35 (54%) developed cs-CMVi, at a median of 68 days. Time to cs-CMVi was significantly longer in HD-VALA cohort (p < .0001). On multivariate analysis, HD VALA reduced the risk of cs-CMVi (HR 0.32, p = .0005). CONCLUSIONS In alloHSCT recipients at high risk for cs-CMVi, HD-VALA resulted in lower cumulative reactivation, and delayed reactivation, reducing requirement for preemptive CMV therapy in the early post-engraftment period.
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Affiliation(s)
- Genevieve Douglas
- Department of Clinical Haematology and Bone Marrow Transplantation, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Australia
| | - Michelle K Yong
- Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, Australia.,National Centre for Infections in Cancer, Parkville, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Shio Yen Tio
- Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, Australia.,National Centre for Infections in Cancer, Parkville, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Maggie Chau
- Department of Clinical Haematology and Bone Marrow Transplantation, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Australia.,Pharmacy Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ashvind Prabahran
- Department of Clinical Haematology and Bone Marrow Transplantation, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Australia
| | - Joe Sasadeusz
- Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, Australia.,National Centre for Infections in Cancer, Parkville, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - David Ritchie
- Department of Clinical Haematology and Bone Marrow Transplantation, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Lynette Chee
- Department of Clinical Haematology and Bone Marrow Transplantation, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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19
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Jake Shortt, Galettis P, Cheah CY, Davis J, Ludford-Menting M, Link EK, Martin JH, Koldej R, Ritchie D. A phase 1 clinical trial of the repurposable acetyllysine mimetic, n-methyl-2-pyrrolidone (NMP), in relapsed or refractory multiple myeloma. Clin Epigenetics 2023; 15:15. [PMID: 36709310 PMCID: PMC9884426 DOI: 10.1186/s13148-023-01427-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/13/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND N-methyl-2-pyrrolidone (NMP) is an epigenetically active chemical fragment and organic solvent with numerous applications including use as a drug-delivery vehicle. Previously considered biologically inert, NMP demonstrates immunomodulatory and anti-myeloma properties that are partly explained by acetyllysine mimetic properties and non-specific bromodomain inhibition. We therefore evaluated orally administered NMP in a phase 1 dose-escalation trial to establish its maximum tolerated dose (MTD) in patients with relapsed/refractory multiple myeloma (RR-MM). Secondary endpoints were safety, pharmacokinetics (PK), overall response rate and immunological biomarkers of activity. RESULTS Thirteen patients received NMP at starting doses between 50 and 400 mg daily. Intra-patient dose escalation occurred in five patients, with one attaining the ceiling protocolised dose of 1 g daily. Median number of monthly cycles commenced was three (range 1-20). Grade 3-4 adverse events (AEs) were reported in seven (54%; 95% CI 25-81%) patients. Most common AEs (> 30% of patients) of any grade were nausea and musculoskeletal pain. The only dose limiting toxicity (DLT) was diarrhoea in a patient receiving 200 mg NMP (overall DLT rate 8%; 95% CI 0-36%). Hence, the MTD was not defined. Median progression-free and overall survival were 57 (range 29-539) days and 33 (95% CI 9.7- > 44) months, respectively. The best response of stable disease (SD) was achieved in nine patients (69%; 95% CI 39-91%). PK analysis demonstrated proportional dose-concentrations up to 400 mg daily, with a more linear relationship above 500 mg. Maximum plasma concentrations (Cmax) of 16.7 mg/L at the 800 mg dose were below those predicted to inhibit BET-bromodomains. Peripheral blood immune-profiling demonstrated maintenance of natural killer (NK) cells, and a gene expression signature suggestive of enhanced T, B and NK cell functions; a subject with prolonged exposure manifested sustained recovery of B and NK cells at 12 months. CONCLUSIONS NMP demonstrated potential disease stabilising and immunomodulatory activity at sub-BET inhibitory plasma concentrations and was well tolerated in RR-MM; an MTD was not determined up to a maximum dose of 1 g daily. Further dose-finding studies are required to optimise NMP dosing strategies for therapeutic intervention.
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Affiliation(s)
- Jake Shortt
- grid.1002.30000 0004 1936 7857Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC Australia ,grid.419789.a0000 0000 9295 3933Monash Haematology, Monash Health, Clayton, VIC Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
| | - Peter Galettis
- grid.266842.c0000 0000 8831 109XCentre for Drug Repurposing and Medicines Research, University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW Australia
| | - Chan Y. Cheah
- grid.3521.50000 0004 0437 5942Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA Australia ,grid.1012.20000 0004 1936 7910Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA Australia
| | - Joanne Davis
- grid.416153.40000 0004 0624 1200ACRF Translational Research Laboratory, Royal Melbourne Hospital, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, Melbourne, VIC Australia
| | - Mandy Ludford-Menting
- grid.416153.40000 0004 0624 1200ACRF Translational Research Laboratory, Royal Melbourne Hospital, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, Melbourne, VIC Australia
| | - Emma K. Link
- grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia ,grid.1055.10000000403978434Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Jennifer H. Martin
- grid.266842.c0000 0000 8831 109XCentre for Drug Repurposing and Medicines Research, University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW Australia
| | - Rachel Koldej
- grid.416153.40000 0004 0624 1200ACRF Translational Research Laboratory, Royal Melbourne Hospital, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, Melbourne, VIC Australia
| | - David Ritchie
- grid.416153.40000 0004 0624 1200ACRF Translational Research Laboratory, Royal Melbourne Hospital, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, Melbourne, VIC Australia ,grid.1055.10000000403978434Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC Australia
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20
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Ball WP, Black C, Gordon S, Ostrovska B, Paranjothy S, Rasalam A, Ritchie D, Rowlands H, Rzewuska M, Thompson E, Wilde K, Butler JE. Inequalities in children's mental health care: analysis of routinely collected data on prescribing and referrals to secondary care. BMC Psychiatry 2023; 23:22. [PMID: 36627578 PMCID: PMC9831880 DOI: 10.1186/s12888-022-04438-5] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic has negatively impacted mental health and disrupted the delivery of care. Prevalence of poor mental health is not evenly distributed across age groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but detailed socio-demographic trends are relatively under-researched. METHODS We analysed records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation. RESULTS We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Mean age at first mental health prescription was almost 1 year younger in the most deprived areas than in the least. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17 to 30%. The proportion of accepted referrals that were for girls rose to 62% and the mean age increased 1.5 years. CONCLUSIONS The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need. Persistent inequities in mental health prescribing and referrals require urgent action.
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Affiliation(s)
- William P Ball
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland
| | - Corri Black
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland.,NHS Grampian, Aberdeen, Scotland
| | - Sharon Gordon
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland
| | - Bārbala Ostrovska
- Aberdeen Centre for Health Data Science PPIE Group, Aberdeen, Scotland
| | - Shantini Paranjothy
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland.,NHS Grampian, Aberdeen, Scotland
| | | | | | - Helen Rowlands
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland
| | - Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
| | | | - Katie Wilde
- Grampian Data Safe Haven (DaSH), University of Aberdeen, Aberdeen, Scotland
| | - Jessica E Butler
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland.
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21
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Loo S, Dillon R, Ivey A, Anstee NS, Othman J, Tiong IS, Potter N, Jovanovic J, Runglall M, Chong CC, Bajel A, Ritchie D, Gray K, Yeoh ZH, McBean M, Gilkes A, Thomas I, Johnson S, Russell NH, Wei AH. Pretransplant FLT3-ITD MRD assessed by high-sensitivity PCR-NGS determines posttransplant clinical outcome. Blood 2022; 140:2407-2411. [PMID: 35960851 PMCID: PMC10653044 DOI: 10.1182/blood.2022016567] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sun Loo
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
| | - Richard Dillon
- Guy’s and St Thomas Hospital, London, United Kingdom
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Adam Ivey
- Department of Pathology, The Alfred Hospital, Melbourne, Australia
| | - Natasha S. Anstee
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
| | - Jad Othman
- Guy’s and St Thomas Hospital, London, United Kingdom
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Ing Soo Tiong
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Manohursingh Runglall
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Chyn Chua Chong
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
| | - Ashish Bajel
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - David Ritchie
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Kelli Gray
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Zhi Han Yeoh
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Michelle McBean
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Amanda Gilkes
- Division of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sean Johnson
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | - Andrew H. Wei
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
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22
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Malone M, Ritchie D. Evaluation of Recurrent Right-Sided Pleural Effusion: Hepatic Hydrothorax vs. Silicone Breast Implant Rupture. Cureus 2022; 14:e30268. [PMID: 36381727 PMCID: PMC9653170 DOI: 10.7759/cureus.30268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
We report a case of a 55-year-old woman who presented to our hospital emergency department with a recurrent right-sided pleural effusion. Her presenting symptom was shortness of breath which first began two years prior after she experienced a blunt thoracic injury. This injury resulted in the rupture of her right silicone breast implant. Since the traumatic rupture of her right breast implant, she developed asthma-like symptoms and allergies that were adequately controlled with bronchodilators, antihistamines, and glucocorticoids. Laboratory investigation was significant for elevated immunoglobulin E (IgE) levels and eosinophilia consistent with an allergic hypersensitivity reaction. She denied a history of smoking, asthma, or allergies preceding the trauma to her right breast implant. Our differential diagnosis also included the possibility of an inflammatory reaction to the silicone breast rupture as a possible etiology for the recurrent pleural effusion. The patient underwent a right-sided diagnostic and therapeutic thoracentesis procedure on two separate occasions within a span of a month in an effort to improve her symptoms and arrive at a definitive diagnosis. Her worsening symptoms were believed to be triggered by the pleural effusion. Aspirated pleural fluid was sent to the laboratory for analysis. Both samples excluded infectious or malignant causes of the pleural effusion. Ultimately, the source of her pleural effusion was determined to be decompensated liver cirrhosis. The patient underwent a pleurodesis procedure in an effort to seal the pleural space.
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23
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Elliott J, Ahlawat S, Prince HM, Kennedy G, Wells J, Huang G, Collins J, Bardy P, Van Der Weyden C, Ritchie D, Khot A. Long-term outcomes for allogeneic bone marrow transplantation in Sezary syndrome and mycosis fungoides. Bone Marrow Transplant 2022; 57:1724-1726. [PMID: 36028756 DOI: 10.1038/s41409-022-01787-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Jessica Elliott
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Shalini Ahlawat
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - H Miles Prince
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | | | - Jenny Collins
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Peter Bardy
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Carrie Van Der Weyden
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Amit Khot
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
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24
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Ball W, Rowlands H, Black C, Paranjothy S, Rasalam A, Ritchie D, Rzewuska M, Thompson E, Wilde K, Butler J. Inequalities in children’s mental health prescribing and referrals for specialist mental health services. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Objective1 in 8 young people in the United Kingdom are estimated to have a diagnosable mental health condition. Prevalence is increasing over time, many are untreated, and need is not evenly distributed across the population. We aimed to investigate trends in children’s mental health prescribing and referrals to specialist outpatient services.
ApproachWe linked individual-level healthcare administrative records on community prescribing and referrals to outpatient Child and Adolescent Mental Health Services (CAMHS). The study cohort included all children aged 2 through 17 in the NHS Grampian Health Board region from 2015 to 2021 (average annual population circa 100,000) with a mental health prescription or CAMHS referral.
We measured prevalence of mental health prescribing and referrals to CAMHS over time. We investigated demographic and socioeconomic differences, including comparison of rates by age, sex, and residential area deprivation. We also investigated socioeconomic and demographic differences in referral acceptance and rejection.
ResultsPrescriptions for mental health drugs have risen 40%: from 5,000 per month in 2015 to 7,000 in 2021. 75% of prescriptions to primary schoolers are to boys, mostly for attention deficit hyperactivity disorder medications. Prescriptions to girls rise during secondary school, mostly for anti-depressants. Prescribing rates are 2.6-fold higher in the most versus least deprived areas.
Referrals to CAMHS have risen 20% over the study period, and the proportion of referrals rejected has increased from 18% to 31% – leaving the number of children accepted to specialist care stable. Boys are referred twice as often at younger ages, while girls’ referrals spike during puberty. Since 2015, boys have been referred less and rejected more, with girls now making up 61% of those treated. Referral rates are two-fold higher in the most versus least deprived areas.
ConclusionsBoth mental health prescribing and referrals to CAMHS have increased in this population, but the CAMHS service size remained fixed. Presentation and treatment patterns vary dramatically by age and sex, and socioeconomic inequalities are clear and persistent.
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25
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Douglas A, Thursky K, Spelman T, Szer J, Bajel A, Harrison S, Tio SY, Bupha-Intr O, Tew M, Worth L, Teh B, Chee L, Ng A, Carney D, Khot A, Haeusler G, Yong M, Trubiano J, Chen S, Hicks R, Ritchie D, Slavin M. [18F]FDG-PET-CT compared with CT for persistent or recurrent neutropenic fever in high-risk patients (PIPPIN): a multicentre, open-label, phase 3, randomised, controlled trial. The Lancet Haematology 2022; 9:e573-e584. [DOI: 10.1016/s2352-3026(22)00166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/15/2022]
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26
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Malone M, Ritchie D. The Mystery of a Unilateral Headache Ultimately Diagnosed as Moyamoya Disease. Cureus 2022; 14:e26816. [PMID: 35971361 PMCID: PMC9374177 DOI: 10.7759/cureus.26816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/05/2022] Open
Abstract
Moyamoya disease (MMD) is a rare chronic cerebrovascular occlusive disease characterized by progressive stenosis or occlusion of the intracranial internal carotid arteries and their proximal branches, with subsequent abnormally formed collateral vessels. Moyamoya disease is typically found in children of East Asian descent and is the most common pediatric cerebrovascular pathology in East Asian populations. However, moyamoya disease can be present without any predisposing factors, and this is what distinguishes the disease from the syndrome. Moyamoya syndrome is typically associated with other conditions such as sickle cell disease or neurofibromatosis. The syndrome can also be seen in patients who have had exposure to cervical or neck radiation. We present a rare case of an adult Peruvian woman who initially presented with a severe right hemispherical headache, which was ultimately diagnosed as MMD. This report and the discussion aim to provide more understanding of moyamoya disease and how it can be incidentally discovered in an unsuspected patient without any predisposing factors. The fact that the patient lacked any predisposing factors makes moyamoya disease, and not the syndrome, the diagnosis. Currently available treatments are limited. One specialized therapeutic approach is a procedure called encephaloduroarteriosynangiosis (EDAS), which aims to involve the transposition of a segment of a scalp artery onto the surface of the brain to permit the additional formation of collateral arteries. We aim to highlight the management and treatment of a case of moyamoya presenting as a severe right hemispherical headache in a patient without any predisposing factors.
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27
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Tam CS, Gregory GP, Ku M, Fleming S, Handunnetti SM, Lee D, Walker P, Perkins A, Lew TE, Sirdesai S, Chua CC, Gilbertson M, Lasica M, Anderson MA, Renwick W, Grigg A, Patil S, Opat S, Friebe A, Cooke R, De Boer J, Spencer A, Ritchie D, Agarwal R, Blombery P. Recommendation for TP53 mutation testing in newly diagnosed mantle cell lymphoma: a statement from working groups sponsored by the Victorian Comprehensive Cancer Centre. Intern Med J 2022; 52:1286-1287. [PMID: 35879233 DOI: 10.1111/imj.15851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Constantine S Tam
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,VCCC Alliance, Melbourne, Victoria, Australia
| | - Gareth P Gregory
- Monash University, Melbourne, Victoria, Australia.,Monash Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Shaun Fleming
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Sasanka M Handunnetti
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Denise Lee
- Department of Haematology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Patricia Walker
- Alfred Hospital, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peninsula Health, Melbourne, Victoria, Australia.,Peninsula Private Hospital, Melbourne, Victoria, Australia
| | - Andrew Perkins
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Thomas E Lew
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Shreerang Sirdesai
- Department of Haematology, University Hospital Geelong, Geelong, Victoria, Australia
| | - Chong Chyn Chua
- Alfred Hospital, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Northern Health, Melbourne, Victoria, Australia
| | - Michael Gilbertson
- Monash University, Melbourne, Victoria, Australia.,Monash Haematology, Monash Health, Melbourne, Victoria, Australia.,Department of Haematology and Oncology, Western Health, Melbourne, Victoria, Australia
| | - Masa Lasica
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - William Renwick
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology and Oncology, Western Health, Melbourne, Victoria, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Hospital, Melbourne, Victoria, Australia
| | - Sush Patil
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Stephen Opat
- Monash University, Melbourne, Victoria, Australia.,Monash Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Adam Friebe
- Department of Haematology, University Hospital Geelong, Geelong, Victoria, Australia
| | - Rachel Cooke
- Department of Clinical Haematology, Northern Health, Melbourne, Victoria, Australia
| | | | - Andrew Spencer
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - David Ritchie
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rishu Agarwal
- Department of Clinical Haematology, Austin Hospital, Melbourne, Victoria, Australia
| | - Piers Blombery
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
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28
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Ramanan R, Lim ABM, Tan JLC, Barmanray RD, Mason K, Collins J, Hillman M, Szer J, Bajel A, Ritchie D. Predictors and Outcomes of Dose Reduction of Methotrexate and Cyclosporin Graft-Versus-Host-Disease Prophylaxis Following Allogeneic Haematopoietic Cell Transplantation. Intern Med J 2022. [PMID: 35666197 DOI: 10.1111/imj.15829] [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] [Received: 09/22/2021] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Concern regarding dose-related toxicities of methotrexate (MTX) and cyclosporin (CYA) GVHD prophylaxis occasionally lead to dose alterations post allogeneic haematopoietic cell transplant (alloHCT). AIM To clarify causes of MTX and CYA dose alteration and assess impact on patient outcomes including GVHD, relapse, non-relapse mortality (NRM), and overall survival (OS). METHOD Analysis of retrospective data was performed in a single tertiary centre of patients who underwent alloHCT for any indication and who received GVHD prophylaxis with CYA and MTX between the years 2011 and 2015. Univariate analysis was conducted using the log-rank test for OS and using competing risk regression for NRM, relapse and GVHD. Fisher exact tests were used to determine if an association existed between each of the pre-transplant variables and MTX alteration. Multivariate models for OS and NRM were constructed using Cox proportional hazards modelling and competing risk regression respectively. RESULTS 54/196 (28%) had MTX alterations and 61/187 (33%) had CYA alterations. Reasons for MTX alteration included mucositis, renal or liver impairment, fluid overload and sepsis. Causes of CYA alteration were numerous but most commonly due to acute kidney impairment. MTX alteration was associated with inferior OS (HR 2.4, P=<0.001) and higher NRM (OR 4.6, P<0.001) at 6 years(y) post-landmark. CYA alteration was associated with greater NRM (OR 2.7, P= 0.0137) at 6y. GVHD rates were unaffected by dose alteration. CONCLUSIONS Our findings suggest dose alteration in MTX and CYA GVHD prophylaxis is associated with adverse survival outcomes in alloHCT, without a significant impact on GVHD rates. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Radha Ramanan
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Andrew B M Lim
- Department of Clinical Haematology and Olivia Newton John Cancer Research Institute, Austin Health, Heidelberg, Vic., Australia
| | - Joanne L C Tan
- Department of Haematology, Alfred Health, Melbourne, Vic., Australia
| | - Rahul D Barmanray
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic., Australia
| | - Kate Mason
- Department of Clinical Haematology and Olivia Newton John Cancer Research Institute, Austin Health, Heidelberg, Vic., Australia
| | - Jenny Collins
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Matthew Hillman
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Jeff Szer
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic., Australia
| | - Ashish Bajel
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Vic., Australia.,Sir Peter MacCallum Dept of Oncology, University of Melbourne, Parkville, Vic., Australia
| | - David Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic., Australia
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29
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Ritchie D, Van Hal G, Van den Broucke S. Factors affecting intention to screen after being informed of benefits and harms of breast cancer screening: a study in 5 European countries in 2021. Arch Public Health 2022; 80:143. [PMID: 35599312 PMCID: PMC9125943 DOI: 10.1186/s13690-022-00902-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participation in mammography screening comes with harms alongside benefits. Information about screening provided to women should convey this information yet concerns persist about its effect on participation. This study addressed factors that may influence the intention to screen once a woman has been informed about benefits and harms of participation. METHODS A cross-sectional survey of women from five countries (Belgium, France, Italy, Spain, and the United Kingdom) was performed in January 2021. The survey contained a statement regarding the benefits and harms of mammography screening along with items to measure cognitive variables from the theory of planned behaviour and health belief model and the 6-item version of the European Health Literacy Survey Questionnaire (HLS-EU-Q6). Logistic regression and mediation analysis were performed to investigate the effect of cognitive and sociodemographic variables. RESULTS A total of 1180 participants responded to the survey. 19.5% of participants (n = 230) were able to correctly identify that mammography screening carries both benefits and harms. 56.9% of participants (n = 672) responded that they would be more likely to participate in screening in the future after being informed about the benefits and harms of mammography screening. Perceived behavioural control and social norms demonstrated were significant in predicting intention, whereas, the effect of health literacy was limited. CONCLUSIONS Informing women about the presence of benefits and harms of in mammography screening participation did not negatively impact upon intention to be screened. Information should also address perception on implementation factors alongside messages on benefits and harms. Overall, screening programme managers should not be discouraged by the assumption of decreased participation through increasing efforts to address the lack of knowledge on benefits and harms.
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Affiliation(s)
- David Ritchie
- Faculty of Medicine and Health Sciences, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Guido Van Hal
- Faculty of Medicine and Health Sciences, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
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30
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Roux A, Cholerton R, Sicsic J, Moumjid N, French DP, Giorgi Rossi P, Balleyguier C, Guindy M, Gilbert FJ, Burrion JB, Castells X, Ritchie D, Keatley D, Baron C, Delaloge S, de Montgolfier S. Study protocol comparing the ethical, psychological and socio-economic impact of personalised breast cancer screening to that of standard screening in the "My Personal Breast Screening" (MyPeBS) randomised clinical trial. BMC Cancer 2022; 22:507. [PMID: 35524202 PMCID: PMC9073478 DOI: 10.1186/s12885-022-09484-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/02/2022] [Indexed: 12/11/2022] Open
Abstract
Background The MyPeBS study is an ongoing randomised controlled trial testing whether a risk-stratified breast cancer screening strategy is non-inferior, or eventually superior, to standard age-based screening at reducing incidence of stage 2 or more cancers. This large European Commission-funded initiative aims to include 85,000 women aged 40 to 70 years, without prior breast cancer and not previously identified at high risk in six countries (Belgium, France, Italy, Israel, Spain, UK). A specific work package within MyPeBS examines psychological, socio-economic and ethical aspects of this new screening strategy. It compares women’s reported data and outcomes in both trial arms on the following issues: general anxiety, cancer-related worry, understanding of breast cancer screening strategy and information-seeking behaviour, socio-demographic and economic characteristics, quality of life, risk perception, intention to change health-related behaviours, satisfaction with the trial. Methods At inclusion, 3-months, 1-year and 4-years, each woman participating in MyPeBS is asked to fill online questionnaires. Descriptive statistics, bivariate analyses, subgroup comparisons and analysis of variations over time will be performed with appropriate tests to assess differences between arms. Multivariate regression models will allow modelling of different patient reported data and outcomes such as comprehension of the information provided, general anxiety or cancer worry, and information seeking behaviour. In addition, a qualitative study (48 semi-structured interviews conducted in France and in the UK with women randomised in the risk-stratified arm), will help further understand participants’ acceptability and comprehension of the trial, and their experience of risk assessment. Discussion Beyond the scientific and medical objectives of this clinical study, it is critical to acknowledge the consequences of such a paradigm shift for women. Indeed, introducing a risk-based screening relying on individual biological differences also implies addressing non-biological differences (e.g. social status or health literacy) from an ethical perspective, to ensure equal access to healthcare. The results of the present study will facilitate making recommendations on implementation at the end of the trial to accompany any potential change in screening strategy. Trial registration Study sponsor: UNICANCER. My personalised breast screening (MyPeBS). Clinicaltrials.gov (2018) available at: https://clinicaltrials.gov/ct2/show/NCT03672331 Contact: Cécile VISSAC SABATIER, PhD, + 33 (0)1 73 79 77 58 ext + 330,142,114,293, contact@mypebs.eu. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09484-6.
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Affiliation(s)
- Alexandra Roux
- IRIS (UMR8156 CNRS & U997 INSERM), Paris 13 University, Aubervilliers, France
| | | | | | - Nora Moumjid
- Université Lyon 1, P2S EA 4129, Centre Léon Bérard, F-69373, Lyon, France
| | | | | | | | - Michal Guindy
- Assuta Medical Centers, Tel Aviv, Israel.,Ben Gurion University, Beersheba, Israel
| | | | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | | | - Suzette Delaloge
- Institut Gustave Roussy, Villejuif, France.,Unicancer, Paris, France
| | - Sandrine de Montgolfier
- IRIS (UMR8156 CNRS & U997 INSERM), Paris 13 University, Aubervilliers, France. .,Paris Est Creteil University, Créteil, France.
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31
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Kliman D, Tran S, Kennedy G, Curley C, McLean A, Gottlieb D, Kwan J, Ritchie D, Chee L, Spencer A, Purtill D, Bardy P, Larsen S, Chien N, Perera T, Greenwood M, Hamad N, Moore J. The improvement in overall survival from unrelated donor transplantation in Australia and New Zealand is driven by a reduction in non-relapse mortality: A study from the ABMTRR. Bone Marrow Transplant 2022; 57:982-989. [PMID: 35440804 DOI: 10.1038/s41409-022-01683-w] [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] [Received: 11/11/2021] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022]
Abstract
Unrelated donors (UDs) are the commonest source for allogeneic transplantation (alloSCT), with higher non-relapse mortality (NRM) than siblings. We analyzed data from the Australasian Bone Marrow Transplant Recipient Registry from adults receiving a first UD alloSCT during 2001-2015, to determine whether and how NRM has changed. Predictors of outcome were determined using cox regression, accounting for time-interactions and competing risks. A total of 2308 patients met inclusion criteria. Changes over time included increasing age, utilization of peripheral blood cells, reduced intensity conditioning, and T-cell depletion. Three-year OS increased significantly from 44% in 2001-2005 to 58% in 2011-2015 (p < 0.001). This was attributed to a reduction in NRM from 35% to 24% (p < 0.001) with no change in relapse. Factors associated with increased NRM included age, male sex, CMV seropositivity, HLA mismatch, transplant more than 6 months from diagnosis, and T-cell depletion when administered during 2001-2005. Survival following UD SCT has improved by almost 15% over the past decade, driven by improvements in NRM. This has occurred despite increasing recipient age and appears to be due to better donor selection, reduced delays to transplantation, and improved prevention and management of GVHD.
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Affiliation(s)
- David Kliman
- Department of Haematology and Stem Cell Transplantation, St Vincent's Hospital, Sydney, NSW, Australia.
| | - Steven Tran
- Australasian Bone Marrow Transplant Recipient Registry, Sydney, NSW, Australia
| | - Glen Kennedy
- Haematology and Bone Marrow Transplant Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Cameron Curley
- Haematology and Bone Marrow Transplant Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Angela McLean
- Haematology and Bone Marrow Transplant Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - David Gottlieb
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, NSW, Australia
| | - John Kwan
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, NSW, Australia
| | - David Ritchie
- Department of Haematology and BMT, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Lynette Chee
- Department of Haematology and BMT, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Andrew Spencer
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Hospital, Melbourne, VIC, Australia
| | - Duncan Purtill
- Blood and Marrow Transplant Program, Fiona Stanley Hospital, Perth, WA, Australia
| | - Peter Bardy
- Haematology and Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stephen Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicole Chien
- Clinical Haematology Service and Stem Cell Transplant Program, Auckland City Hospital, Auckland, New Zealand
| | - Travis Perera
- Wellington Blood and Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - Matthew Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nada Hamad
- Department of Haematology and Stem Cell Transplantation, St Vincent's Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology and Stem Cell Transplantation, St Vincent's Hospital, Sydney, NSW, Australia
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32
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Zantomio D, Bayly E, Wong K, Spencer A, Ritchie D, Morgan S, Kelsey G, Dennington PM. A Centre-Based Comparison of Double vs Single Prevention Strategy on Transfusion Transmitted-Cytomegalovirus in At-Risk Haemopoietic stem cell transplant Patients and a State Survey on CMV-Seronegative Ordering Practices. Intern Med J 2022; 53:717-722. [PMID: 35319139 DOI: 10.1111/imj.15751] [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: 08/01/2021] [Revised: 02/07/2022] [Accepted: 03/13/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Universal leucocyte depletion reduces the risk of transfusion transmitted Cytomegalovirus; however, many clinicians still prescribe Cytomegalovirus seronegative units. Our retrospective study aims to confirm the low risk of transfusion transmitted Cytomegalovirus with leucocyte depletion alone and demonstrate the ongoing variability in Cytomegalovirus seronegative transfusion prescribing. MATERIALS AND METHODS Over a 9 year period (7/2009-7/2018), occurrences of transfusion transmitted Cytomegalovirus in Cytomegalovirus seronegative donor/recipient haemopoietic stem cell transplant pairs were compared at one allogeneic haemopoietic stem cell transplant centre providing Cytomegalovirus seronegative blood products and leucocyte depletion (double prevention) versus another providing leucocyte depletion only (single prevention). Retrospective chart audit identified patient demographics, blood product exposure and Cytomegalovirus infection by polymerase chain reaction. A separate audit examined Cytomegalovirus seronegative blood product ordering in a broader range of hospital types. RESULTS We identified 122 and 66 Cytomegalovirus negative donor/recipient haemopoietic stem cell transplant pairs using double and single transfusion prevention strategy respectively. Transfusion exposure to red cells and pooled platelets was similar, though more apheresis platelets were used in the double prevention group. Cytomegalovirus infection rate was 3 (2.4%) and zero in the double and single prevention groups respectively. Cytomegalovirus seronegative unit ordering was not limited to hospitals with obstetric or neonatal populations, suggesting ongoing reliance of Cytomegalovirus seronegative units outside this population. CONCLUSION The analysis suggests a double prevention strategy does not provide additional protection against transfusion transmitted Cytomegalovirus. There is ongoing variability in the acceptance of leucocyte depletion alone despite the low risk of Cytomegalovirus infection This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daniela Zantomio
- Pathology Services, Australian Red Cross Lifeblood, Australia.,Department of Haematology, Austin Health, Heidelberg, Victoria, Australia
| | - Emma Bayly
- Pathology Services, Australian Red Cross Lifeblood, Australia.,Laboratory Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kimberly Wong
- Pathology Services, Australian Red Cross Lifeblood, Australia.,Laboratory Haematology, Alfred Hospital, Melbourne, Australia
| | - Andrew Spencer
- Department of Haematology and Bone Marrow Transplant, Alfred Health, Melbourne, Victoria, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Susan Morgan
- Laboratory Haematology, Alfred Hospital, Melbourne, Australia
| | - Giles Kelsey
- Laboratory Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Laboratory Haematology, Alfred Hospital, Melbourne, Australia
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33
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Ashoka A, Tamming RR, Girija AV, Bretscher H, Verma SD, Yang SD, Lu CH, Hodgkiss JM, Ritchie D, Chen C, Smith CG, Schnedermann C, Price MB, Chen K, Rao A. Extracting quantitative dielectric properties from pump-probe spectroscopy. Nat Commun 2022; 13:1437. [PMID: 35301311 PMCID: PMC8931171 DOI: 10.1038/s41467-022-29112-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/08/2021] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Optical pump-probe spectroscopy is a powerful tool for the study of non-equilibrium electronic dynamics and finds wide applications across a range of fields, from physics and chemistry to material science and biology. However, a shortcoming of conventional pump-probe spectroscopy is that photoinduced changes in transmission, reflection and scattering can simultaneously contribute to the measured differential spectra, leading to ambiguities in assigning the origin of spectral signatures and ruling out quantitative interpretation of the spectra. Ideally, these methods would measure the underlying dielectric function (or the complex refractive index) which would then directly provide quantitative information on the transient excited state dynamics free of these ambiguities. Here we present and test a model independent route to transform differential transmission or reflection spectra, measured via conventional optical pump-probe spectroscopy, to changes in the quantitative transient dielectric function. We benchmark this method against changes in the real refractive index measured using time-resolved Frequency Domain Interferometry in prototypical inorganic and organic semiconductor films. Our methodology can be applied to existing and future pump-probe data sets, allowing for an unambiguous and quantitative characterisation of the transient photoexcited spectra of materials. This in turn will accelerate the adoption of pump-probe spectroscopy as a facile and robust materials characterisation and screening tool. Photoinduced changes in transmission, reflection and scattering prevent conventional pump-probe spectroscopy to unambiguously assign the origin of spectral signatures. Ashoka et al. have developed an optical modelling technique to extract quantitative and unambiguous changes in the dielectric function from standard pump-probe measurements.
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Affiliation(s)
- Arjun Ashoka
- Cavendish Laboratory, University of Cambridge, J.J. Thomson Avenue, CB3 0HE, Cambridge, UK
| | - Ronnie R Tamming
- Robinson Research Institute, Faculty of Engineering, Victoria University of Wellington, Wellington, 6012, New Zealand.,School of Chemical and Physical Sciences, Victoria University of Wellington, Wellington, 6012, New Zealand.,MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington, 6012, New Zealand
| | - Aswathy V Girija
- Cavendish Laboratory, University of Cambridge, J.J. Thomson Avenue, CB3 0HE, Cambridge, UK
| | - Hope Bretscher
- Cavendish Laboratory, University of Cambridge, J.J. Thomson Avenue, CB3 0HE, Cambridge, UK
| | - Sachin Dev Verma
- Cavendish Laboratory, University of Cambridge, J.J. Thomson Avenue, CB3 0HE, Cambridge, UK.,Department of Chemistry, Indian Institute of Science Education and Research Bhopal, Bhopal Bypass Road, Bhopal, 462066, Madhya Pradesh, India
| | - Shang-Da Yang
- Institute of Photonics Technologies, National Tsing Hua University, Hsinchu, 30013, Taiwan
| | - Chih-Hsuan Lu
- Institute of Photonics Technologies, National Tsing Hua University, Hsinchu, 30013, Taiwan
| | - Justin M Hodgkiss
- School of Chemical and Physical Sciences, Victoria University of Wellington, Wellington, 6012, New Zealand.,MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington, 6012, New Zealand
| | - David Ritchie
- Cavendish Laboratory, University of Cambridge, J.J. Thomson Avenue, CB3 0HE, Cambridge, UK
| | - Chong Chen
- Cavendish Laboratory, University of Cambridge, J.J. Thomson Avenue, CB3 0HE, Cambridge, UK
| | - Charles G Smith
- Cavendish Laboratory, University of Cambridge, J.J. Thomson Avenue, CB3 0HE, Cambridge, UK
| | - Christoph Schnedermann
- Cavendish Laboratory, University of Cambridge, J.J. Thomson Avenue, CB3 0HE, Cambridge, UK
| | - Michael B Price
- School of Chemical and Physical Sciences, Victoria University of Wellington, Wellington, 6012, New Zealand.,MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington, 6012, New Zealand
| | - Kai Chen
- Robinson Research Institute, Faculty of Engineering, Victoria University of Wellington, Wellington, 6012, New Zealand.,MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington, 6012, New Zealand.,The Dodd-Walls Centre for Photonic and Quantum Technologies, Dunedin, 9016, New Zealand
| | - Akshay Rao
- Cavendish Laboratory, University of Cambridge, J.J. Thomson Avenue, CB3 0HE, Cambridge, UK.
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Abo S, Parry SM, Ritchie D, Sgro G, Truong D, Denehy L, Granger CL. Exercise in allogeneic bone marrow transplantation: a qualitative representation of the patient perspective. Support Care Cancer 2022; 30:5389-5399. [PMID: 35292849 PMCID: PMC9046308 DOI: 10.1007/s00520-022-06931-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/19/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Exercise is emerging as a vital aspect of care to alleviate the physical and psychosocial symptom burden associated with allogeneic bone marrow transplantation (BMT). Understanding the patient perspective regarding exercise is important to move towards implementation. This study aimed to characterise experiences and views regarding participation in an exercise program in adults receiving treatment for haematological disease with allogeneic BMT. METHODS Individual semi-structured interviews were conducted with 35 participants from either an early- or late-commencing supervised group-based exercise program. Using an inductive, conventional approach to qualitative content analysis data were independently analysed by two researchers. RESULTS Six major themes and 33 sub-themes were identified: this encompassed motivation, physical opportunity and capability to exercise; psychosocial effects of group-based exercise; experienced impact of participation in an exercise program; and intervention design considerations. Key barriers to exercise included symptom severity and fluctuating health and distance or difficult access to an exercise facility or equipment, whilst facilitators included encouragement from staff; peer support in the group-based setting; flexibility; education; and ability to measure change. CONCLUSION This study highlights the importance of a flexible approach to exercise with consideration of individual symptoms and preferences. The perceived psychological impact of exercise should not be underestimated; future exercise programs should be designed in partnership with patients, with consideration of group-based activities to reduce social isolation if this is feasible in the treatment context. Intervention design should also acknowledge the individual's physical and psychological capability, opportunity and automatic and reflective motivation to direct and sustain exercise behaviours following BMT.
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Affiliation(s)
- Shaza Abo
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010 Australia ,Department of Physiotherapy, Royal Melbourne Hospital, Parkville, VIC 3052 Australia
| | - Selina M. Parry
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010 Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC 3052 Australia
| | - Gabriella Sgro
- Department of Physiotherapy, Royal Melbourne Hospital, Parkville, VIC 3052 Australia
| | - Dominic Truong
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010 Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010 Australia ,Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, VIC 3000 Australia
| | - Catherine L. Granger
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010 Australia ,Department of Physiotherapy, Royal Melbourne Hospital, Parkville, VIC 3052 Australia
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35
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Chee L, Ritchie D, Ludford-Menting M, Ripley J, Chung J, Park D, Norton S, Kenealy M, Koldej R. Dysregulation of immune cell and cytokine signaling correlates with clinical outcomes in myelodysplastic syndrome (MDS). Eur J Haematol 2021; 108:342-353. [PMID: 34963023 DOI: 10.1111/ejh.13742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis. Although hypomethylating agents (HMA) have improved survival in higher-risk MDS, most patients eventually succumb to progressive disease. Utilizing samples collected prospectively from three MDS clinical trials, we analyzed genetic and immunological biomarkers and correlated them with clinical outcomes. METHODS 154 samples were analyzed from 133 de novo MDS patients for T-cell and myeloid cell immunophenotyping and gene expression analysis. Treatments were with HMA or immunomodulatory drug (IMiD) alone or in combination. RESULTS We observed differences in immune cell subsets between lower and higher risk IPSS groups with NKT cells, MDSCs, intermediate-proinflammatory and non-classical monocytes being higher in the latter group while naïve CD4+ T-cells were reduced. Intermediate-proinflammatory monocytes were increased in non-responders and those failing to achieve at least a hematological improvement. Pro-inflammatory NKT cells were increased at diagnosis for patients failing to derive clinical benefit after 12 months of treatment. Gene expression analysis of paired bone marrow (BM) colony-forming units (CFUs) from diagnosis and 4 cycles post-treatment confirmed that genes involved in cytokine signaling were downregulated in C4 normal colonies. CONCLUSIONS These findings support the central roles of dysregulation in innate immunity and inflammatory signaling in the pathogenesis of MDS which correlated with clinical outcomes post-treatment.
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Affiliation(s)
- L Chee
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia.,Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC, 3050, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, 3050, Australia.,The Australasian Leukaemia and Lymphoma Group, Richmond, VIC, 3121, Australia
| | - D Ritchie
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia.,Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC, 3050, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, 3050, Australia.,The Australasian Leukaemia and Lymphoma Group, Richmond, VIC, 3121, Australia
| | - M Ludford-Menting
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia
| | - J Ripley
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia.,Liverpool Hospital, Liverpool, NSW, 2170, Australia
| | - J Chung
- Melbourne Bioinformatics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - D Park
- Melbourne Bioinformatics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - S Norton
- Nanix Limited, Dunedin, New Zealand
| | - M Kenealy
- The Australasian Leukaemia and Lymphoma Group, Richmond, VIC, 3121, Australia.,Cabrini Hospital, Malvern, VIC, 3144, Australia.,Monash University, Clayton, VIC, 3800, Australia
| | - R Koldej
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, 3050, Australia
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Keighley C, Cooley L, Morris AJ, Ritchie D, Clark JE, Boan P, Worth LJ. Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021. Intern Med J 2021; 51 Suppl 7:89-117. [DOI: 10.1111/imj.15589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Caitlin Keighley
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney Camperdown New South Wales Australia
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology Westmead New South Wales Australia
- Southern IML Pathology, Sonic Healthcare Coniston New South Wales Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases Royal Hobart Hospital Hobart Tasmania Australia
- University of Tasmania Hobart Tasmania Australia
| | - Arthur J. Morris
- LabPLUS, Clinical Microbiology Laboratory Auckland City Hospital Auckland New Zealand
| | - David Ritchie
- Department of Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
| | - Julia E. Clark
- Department of Infection Management Queensland Children's Hospital, Children's Health Queensland Brisbane Queensland Australia
- Child Health Research Centre The University of Queensland Brisbane Queensland Australia
| | - Peter Boan
- PathWest Laboratory Medicine WA, Department of Microbiology Fiona Stanley Fremantle Hospitals Group Murdoch Western Australia Australia
- Department of Infectious Diseases Fiona Stanley Fremantle Hospitals Group Murdoch Western Australia Australia
| | - Leon J. Worth
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
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37
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Beer H, Routledge D, Joyce T, Furphy EJ, Combe N, Ritchie D, Khot A, Lim SM, Montalto M, Harrison SJ. The development of a home-based therapeutic platform for multiple myeloma. Expert Rev Hematol 2021; 14:1129-1135. [PMID: 34936527 DOI: 10.1080/17474086.2021.2022471] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND Multiple Myeloma (MM) accounts for 1-2% of all malignancies but is the second commonest haematological malignancy. It is characterized by a proliferation of malignant plasma cells. The treatment paradigm of MM in Australia is traditionally hospital-based, complex and costly. While MM comprises 1-2% of cancer diagnoses, it appears in the top ten cancer diagnoses requiring hospital admission. The cumulative time spent receiving treatment is a significant burden for patients. The ability to receive treatment at home and maximize time away from hospital-based settings is a key preference for patients receiving anticancer therapies over a prolonged period of time. METHODS The Peter MacCallum Cancer Centre and Royal Melbourne Hospital's combined Clinical Hematology Unit has collaborated with their Hospital in the Home departments to develop several innovative programs to address this. RESULTS We describe our current active programs and potential developments in home-based MM therapy. CONCLUSION We have enabled large numbers of patients to receive complex therapies in their own home and the COVID-19 pandemic has increased the pace of the roll out without any compromise in safety. We anticipate that the next raft of immunotherapies will be able to transition into the @Home treatment setting in the coming years.
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Affiliation(s)
- Hayley Beer
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - David Routledge
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Australia
| | - Trish Joyce
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Emma-Jane Furphy
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Nella Combe
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Australia
| | - Amit Khot
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Australia
| | - Seok Ming Lim
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | | | - Simon J Harrison
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Australia
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Ritchie D, Arbyn M, Basu P, Corbex M, Fidarova E, Ivanuš U, Papi G, Torode J, Zacharopoulou C. Europe's Path to Eliminating Cervical Cancer as a Public Health Problem. Lancet Reg Health Eur 2021; 12:100276. [PMID: 34901914 PMCID: PMC8639459 DOI: 10.1016/j.lanepe.2021.100276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- David Ritchie
- Association of European Cancer Leagues (ECL), Brussels, Belgium
| | - Marc Arbyn
- Unit Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Partha Basu
- International Agency for Research on Cancer/World Health Organization (IARC), Lyon, France
| | - Marilys Corbex
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Elena Fidarova
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Urska Ivanuš
- Cervical Cancer Screening and Registry ZORA, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ginevra Papi
- Association of European Cancer Leagues (ECL), Brussels, Belgium
| | - Julie Torode
- Institute of Cancer Policy, King's College, London, United Kingdom
| | - Chrysoula Zacharopoulou
- Department of Gynaecology and Obstetrics. Military hospital Bégin, Saint-Mandé, France.,Member of the European Parliament, La République en marche (France), Brussels, Belgium
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39
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Joshi P, Kiers L, Evans A, Ritchie D, Szer J, Cruse B. Oromandibular parafunction in chronic graft-versus-host disease: novel association and treatment approach. Intern Med J 2021; 51:1950-1953. [PMID: 34796632 DOI: 10.1111/imj.15569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) complicating allogeneic haemopoietic stem cell transplantation rarely involves the nervous system; oromandibular parafunction has not been previously reported. We describe five patients with cGVHD, presenting with bruxism, limitation of mouth opening, jaw locking, pain and masseter hypertrophy. Pathophysiological mechanisms are discussed. Targeted botulinum toxin injections were an effective treatment with minimal side-effects.
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Affiliation(s)
- Purwa Joshi
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Lynette Kiers
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (Royal Melbourne Hospital), Faculty of Medicine, Health and Dentistry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (Royal Melbourne Hospital), Faculty of Medicine, Health and Dentistry, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Ritchie
- Department of Medicine (Royal Melbourne Hospital), Faculty of Medicine, Health and Dentistry, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jeff Szer
- Department of Medicine (Royal Melbourne Hospital), Faculty of Medicine, Health and Dentistry, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Belinda Cruse
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (Royal Melbourne Hospital), Faculty of Medicine, Health and Dentistry, The University of Melbourne, Melbourne, Victoria, Australia
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40
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Koo RM, Ritchie D. Self-reliance or the generosity of others?: autologous versus allogeneic stem cell transplantation in high-risk Hodgkin lymphoma. Leuk Lymphoma 2021; 62:2303-2305. [PMID: 34678112 DOI: 10.1080/10428194.2021.1988593] [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: 10/20/2022]
Affiliation(s)
- Ray Mun Koo
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - David Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
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41
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Ritchie D. Evaluation of the impact of the European Code against Cancer on awareness and attitudes towards cancer prevention at the population and health promoters’ levels. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.231] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
The European Code against Cancer (ECAC) informs the public on steps to take to reduce their cancer risk. Despite over three decades of promotion, no systematic evaluation of its impact has yet been carried out. This study aimed to address the gap in knowledge regarding the impact of the ECAC.
Methods
An online survey targeting adults in the general population was conducted and analysed by age, gender, and country, both descriptive and mutually adjusted in logistic regression analyses. Additionally, semi-structured interviews with health promotion professionals from not-for-profit organisations in Europe were conducted and a qualitative thematic analysis was carried out for each interview.
Results
8171 people from eight European countries responded to the survey. Although 70 % of respondents were aware of cancer prevention guidance, a low percentage of participants had previously heard about the ECAC (2% in UK to 21 % in Hungary and Poland). Females were more likely to make lifestyle changes to reduce their risk of cancer (odds ratio = 1.17; 95 % confidence interval: 1.05-1.29). Twenty-eight online semi-structured interviews with professionals were conducted covering 25 countries. Regional variation in the methods and target groups of the promotion and dissemination of the ECAC was reported.
Conclusions
Whilst familiarity with the ECAC in the general public is low, professionals frequently use it as a basis for informing population-level actions. Future editions should be accompanied by a systematic evaluation of the ECAC investigating the impact upon society.
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Affiliation(s)
- D Ritchie
- Prevention, ECL, Brussels, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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42
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Lindsay J, Othman J, Yong MK, Ritchie D, Chee L, Tay K, Tio SY, Kerridge I, Fay K, Stevenson W, Arthur C, Chen SCA, Kong DCM, Greenwood M, Pergam SA, Liu C, Slavin MA. Dynamics of Epstein-Barr virus on post-transplant lymphoproliferative disorders after antithymocyte globulin-conditioned allogeneic hematopoietic cell transplant. Transpl Infect Dis 2021; 23:e13719. [PMID: 34453768 DOI: 10.1111/tid.13719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of antithymocyte globulin (ATG) in allogeneic hematopoietic cell transplant (HCT) is associated with an increased risk of Epstein-Barr virus (EBV) reactivation and post-transplant lymphoproliferative disorders (PTLD). The dynamics and outcomes of EBV-DNAemia are not well described in this population. METHODS We retrospectively assessed the kinetics of EBV-DNAemia after ATG conditioning of HCT recipients. Receiver operating characteristic (ROC) curves were used to assess EBV-DNAemia to predict EBV-PTLD in this group. RESULTS A total of 174/405 (43%) consecutive HCT recipients from two centers met inclusion criteria of ATG conditioned, non-B-cell lymphoma patients. Of these with EBV-DNA measured using standardized IU/ml, 78.6% (92/117) developed EBV-DNAemia: 62% spontaneously resolved; 19% cleared after preemptive rituximab, and 13% developed EBV-PTLD. ROC curve analysis using maximum pre-EBV-PTLD EBV-DNAemia, demonstrated an AUC of 0.912 with EBV-DNAemia of 9782 IU/ml, associated with 82.6% sensitivity and 94.4% specificity for development of EBV-PTLD. Median time for EBV-DNAemia to increase from initial detection to >1000 IU/ml was 7 days; to >10 000 IU/ml, 12 days; and to >100 000 IU/ml, 18 days. Median EBV-DNAemia level prior to administration of rituximab was significantly lower in patients with successful preemptive treatment, compared with those who developed EBV-PTLD (3.41 log10 IU/ml [3.30-3.67] vs. 4.34 log10 IU/ml [3.85-5.13], p = .002; i.e., 2628 IU/ml vs. 21 965 IU/ml, respectively). CONCLUSIONS EBV-DNAemia >10 000 IU/ml was the strongest predictor of the development of EBV-PTLD, and progression to this level was rapid in ATG-conditioned HCT recipients. This information may guide EBV-PTLD management strategies in these high-risk patients.
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Affiliation(s)
- Julian Lindsay
- National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Vaccine and Infectious Disease and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jad Othman
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michelle K Yong
- National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - David Ritchie
- Clinical Hematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Lynette Chee
- Clinical Hematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - KimHeng Tay
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shio Yen Tio
- National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Blood Research Centre, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Keith Fay
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - William Stevenson
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Blood Research Centre, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Chris Arthur
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sharon C-A Chen
- National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, The University of Sydney, and the Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia
| | - David C M Kong
- NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, Parkville, Victoria, Australia.,Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,Pharmacy Department, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Matthew Greenwood
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Blood Research Centre, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Steven A Pergam
- Vaccine and Infectious Disease and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Division of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Catherine Liu
- Vaccine and Infectious Disease and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Division of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Monica A Slavin
- National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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43
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Hamad N, Ananda-Rajah M, Gilroy N, MacIntyre R, Gottlieb D, Ritchie D, Harrison S, Kennedy G, Watson AM, Greenwood M, Doocey R, Perera T, Spencer A, Wong E, O'Brien T, Shaw P, Conyers R, Milliken S, Bardy P, Larsen S, Ho PJ, Lai H, Bajel A, Butler J, Tiley C, D'Rozario J, Johnston A, Cochrane T, Mills T, Irving I, Pullon H, Purtill D. Australia and New Zealand Transplant and Cellular Therapies COVID-19 vaccination consensus position statement. Intern Med J 2021; 51:1321-1323. [PMID: 34423546 PMCID: PMC8652893 DOI: 10.1111/imj.15263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
Australia and New Zealand have achieved excellent community control of COVID‐19 infection. In light of the imminent COVID‐19 vaccination roll out in both countries, representatives of all adult and paediatric allogeneic bone marrow transplant and cellular therapy (TCT) centres as well as representatives from autologous transplant only centres in Australia and New Zealand collaborated with infectious diseases specialists with expertise in TCT on this consensus position statement regarding COVID‐19 vaccination in TCT patients in Australia and New Zealand. It is our recommendation that TCT patients, should have expedited access to high‐efficacy COVID‐19 vaccines given that these patients are at high risk of morbidity and mortality from COVID‐19 infection. We also recommend prioritising vaccination of TCT healthcare workers and household members of TCT patients. Vaccination should not replace other public health measures in TCT patients given the effectiveness of COVID‐19 vaccination in TCT patients is unknown. Furthermore, given the limited available data, prospective collection of safety and efficacy data of COVID‐19 vaccination in this patient group is a priority.
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Affiliation(s)
- Nada Hamad
- St Vincent's Hospital Sydney and University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Ananda-Rajah
- Monash Institute of Medical Engineering and Alfred Health, Melbourne, Victoria, Australia
| | - Nicole Gilroy
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Raina MacIntyre
- Kirby Institute and University of New South Wales, Sydney, New South Wales, Australia
| | - David Gottlieb
- University of Sydney and Westmead Hospital, Sydney, New South Wales, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Simon Harrison
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Anne M Watson
- Liverpool Hospital, Sydney, New South Wales, Australia
| | | | | | - Travis Perera
- Wellington Blood and Cancer Centre, Wellington, New Zealand
| | - Andrew Spencer
- The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Eric Wong
- Austin Hospital, Melbourne, Victoria, Australia
| | - Tracey O'Brien
- Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Peter Shaw
- University of Sydney and Westmead Hospital, Sydney, New South Wales, Australia
| | - Rachel Conyers
- The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Samuel Milliken
- St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Peter Bardy
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Larsen
- Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - Phoebe J Ho
- Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - Hock Lai
- Townsville Hospital, Townsville, Queensland, Australia
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jason Butler
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Campbell Tiley
- Gosford Hospital and University of Newcastle, Newcastle, New South Wales, Australia
| | - James D'Rozario
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | | | - Tara Cochrane
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Tony Mills
- Princess Alexandria Hospital, Brisbane, Queensland, Australia
| | - Ian Irving
- ICON Cancer Centre, Brisbane, Queensland, Australia
| | | | - Duncan Purtill
- Fiona Stanley Hospital, Perth, Western Australia, Australia
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44
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Abo S, Denehy L, Ritchie D, Lin KY, Edbrooke L, McDonald C, Granger CL. People With Hematological Malignancies Treated With Bone Marrow Transplantation Have Improved Function, Quality of Life, and Fatigue Following Exercise Intervention: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6275370. [PMID: 33989413 DOI: 10.1093/ptj/pzab130] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 03/23/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE For people with hematological malignancies treated with bone marrow transplantation (BMT), this systematic review aimed to identify, evaluate, and synthesize the evidence examining the effect of exercise training on the outcomes of exercise capacity, health-related quality of life (HRQoL), and hospital length of stay (LOS) and to identify any difference in the effect on people treated with allogeneic versus autologous transplantation. METHODS Five electronic databases were systematically searched from inception to December 5, 2020. Prospective studies with a comparator group, with or without randomization, were included if they investigated the effects of an exercise intervention compared with usual care or another intervention in adults who had a hematological malignancy and were undergoing BMT. Primary outcomes of interest were functional exercise capacity and HRQoL; secondary outcomes included strength, fatigue, hospital LOS, and feasibility. Only randomized controlled trials were included in the meta-analyses. Risk of bias was evaluated using the Physiotherapy Evidence Database or Newcastle-Ottawa Scale; the quality of evidence for meta-analyses was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Twenty-four randomized controlled trials and 3 prospective nonrandomized experimental trials were included (n = 2432). There was moderate-quality evidence that exercise improves functional exercise capacity (mean difference [MD] = 29 m; 95% CI = 12.59 to 45.4), global HRQoL (MD = 3.38 points; 95% CI = 0.37 to 6.39), and fatigue (MD = 2.52 points; 95% CI = 0.42 to 4.63) and low-quality evidence for reduced hospital LOS (MD = 2.07 days; 95% CI = 0.43 to 3.72). These effects were more pronounced in recipients of allogeneic transplantation. No serious adverse events were associated directly with exercise in the included studies. CONCLUSION Exercise is safe and improves outcomes, including functional exercise capacity, HRQoL, and hospital LOS in adults undergoing BMT. IMPACT The results of this systematic review support the implementation of exercise programs in adults undergoing BMT, particularly recipients of allogeneic transplantation.
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Affiliation(s)
- Shaza Abo
- Department of Physiotherapy, The University of Melbourne, Victoria 3010, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Victoria 3010, Australia.,Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Ritchie
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kuan-Yin Lin
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Victoria 3010, Australia.,Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Cassie McDonald
- Department of Physiotherapy, The University of Melbourne, Victoria 3010, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Victoria 3010, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
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45
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Lew TE, Cliff ERS, Dickinson M, Tam CS, Seymour JF, Blombery P, Bajel A, Ritchie D, Khot A. T-cell replete allogeneic stem cell transplant for mantle cell lymphoma achieves durable disease control, including against TP53-mutated disease. Bone Marrow Transplant 2021; 56:2857-2859. [PMID: 34285380 DOI: 10.1038/s41409-021-01418-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Thomas E Lew
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia. .,Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
| | - Edward R S Cliff
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Michael Dickinson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Constantine S Tam
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - John F Seymour
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Piers Blombery
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ashish Bajel
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - David Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Amit Khot
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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46
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Abo S, Ritchie D, Denehy L, Panek-Hudson Y, Irving L, Granger CL. Feasibility of early-commencing group-based exercise in allogeneic bone marrow transplantation: the BOOST study. Bone Marrow Transplant 2021; 56:2788-2796. [PMID: 34272484 DOI: 10.1038/s41409-021-01411-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/27/2021] [Accepted: 07/05/2021] [Indexed: 01/06/2023]
Abstract
Increasing evidence supports that individualised exercise is safe and beneficial for adults treated with allogeneic bone marrow transplantation (alloBMT), although this is not part of standard care and no research has investigated group-based interventions. This study aimed to determine safety, feasibility and exploratory effects of a supervised group-based inpatient and subsequent home-based exercise programme in alloBMT. This single-site prospective cohort study included consecutive adults treated with alloBMT for haematological disease. All participants received usual care in addition to the protocolised exercise programme pre-transplant until 60 days post transplant. The primary outcome was feasibility; secondary outcomes included exercise capacity, frailty, health-related quality of life and strength. Consent rate was 100% (n = 42); 83% (n = 35) completed all aspects of the intervention and outcome testing; of those, 83% (n = 29) attended ≥2 group-exercise sessions per week; no adverse events occurred. Emotional well-being significantly improved over time, which may highlight benefits of group-based intervention. Other outcomes significantly declined from pre-BMT to hospital discharge, with some improvement at 60 days post-BMT. Participants with early signs of frailty demonstrated the greatest decline in outcomes. Group-based exercise was safe and feasible; observations from this study highlight the importance of baseline identification of frailty to target intervention at those who need it most.
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Affiliation(s)
- Shaza Abo
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia. .,Department of Physiotherapy, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.,Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Yvonne Panek-Hudson
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Parkville, VIC, Australia
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47
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Manos K, Khor R, Chong G, Palmer J, MacManus M, Keane C, Scott AM, Shortt J, Ritchie D, Churilov L, Johnston L, Witkowski T, Barraclough A, Lee ST, Lin W, Koldej R, Hawkes E. Abstract CT208: Phase I Dose Escalation Study of Radiotherapy and Durvalumab (MEDI4736) in Relapsed or Refractory Diffuse Large B-cell Lymphoma (DLBCL): The RaDD Study. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Most DLBCL & FL responds well to first line treatment, yet relapsed disease outcomes are poor. Immune checkpoint inhibition (ICI) with PD/PD1 inhibitors (PD1i) yield high response rates in some lymphomas; though single agent PD1i yields a disappointing ORR of 10% in heavily pre-treated DLBCL, some responses are durable. RT stimulates anti-tumour immunity through several mechanisms and may enhance response to ICI. Concurrent ICI & RT is synergistic in preclinical studies & solid tumours, improving local & distant (abscopal) response. RT to multiple disease sites may broaden the spectrum of tumour antigen release and overcome clonal variation between disease sites to further augment the immune response. A dose-response relationship between RT and antigen release has yet to be established. This phase I dose escalation study aims to determine the safety profile of RT in combination with durvalumab, an anti-PD-L1 monoclonal antibody, in relapsed/refractory DLBCL and FL.
Study Design and Methods: RaDD (NCT03610061) is a phase I dose escalation study to determine the safety profile of escalating dose and number of sites of RT in combination with durvalumab in relapsed/refractory (RR) DLBCL & FL. Eligible patients (pts) have received ≥ 1 prior line of therapy and are ineligible for or relapsed after autologous stem cell transplant (auto-SCT). Pts with active autoimmune disease, CNS involvement, prior allogeneic-SCT or chronic steroid use are excluded. RT dose and site escalation proceeds according to a 3+3 design with 6 dose levels (cohorts 1-6). Treatment comprises external beam RT to target site(s) daily for 5 days (Cohorts 1-5); Cohort 6 receives a further 5 daily fractions (max 30Gy). Durvalumab 1500mg IV commences day 2 of RT and continues 4-weekly until disease progression. Pts can continue until a second radiological progression if clinical benefit is ongoing. The dose limiting toxicity period is 28 days from start of RT.
The primary endpoint is the toxicity, drug pharmacokinetics, maximum tolerated dose (MTD) and recommended phase two dose (RP2D) of simultaneous RT and durvalumab. Secondary endpoints include response rates, progression-free survival and overall survival.
Correlative studies will examine the tumour-immune system interaction; an exploratory PET substudy with novel tracers for durvalumab (89Zr-Durvalumab) & CD8+ T cells (89Zr -Df-IAB22M2C) will also be performed.
Projected enrolment for determination of the MTD and RP2D is 6-30 pts pending toxicity. Recruitment will continue to 36 pts for secondary endpoint analysis. 22 pts are enrolled to date in the main study, with 2 patients enrolled in the PET-substudy.
Acknowledgements: Victorian Cancer Agency (grant funding - TRP16006), Astra Zeneca (durvalumab and funding), Celgene (funding), Imaginab (89Zr -Df-IAB22M2C).
Citation Format: Kate Manos, Richard Khor, Geoffrey Chong, Jodie Palmer, Michael MacManus, Colm Keane, Andrew M. Scott, Jake Shortt, David Ritchie, Leonid Churilov, Laura Johnston, Tom Witkowski, Allison Barraclough, Sze Ting Lee, Wendi Lin, Rachel Koldej, Eliza Hawkes. Phase I Dose Escalation Study of Radiotherapy and Durvalumab (MEDI4736) in Relapsed or Refractory Diffuse Large B-cell Lymphoma (DLBCL): The RaDD Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT208.
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Affiliation(s)
| | | | - Geoffrey Chong
- 2Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Australia
| | - Jodie Palmer
- 3Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | | | - Colm Keane
- 5Princess Alexandra Hospital, Woolloongabba, Australia
| | - Andrew M. Scott
- 2Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Australia
| | | | - David Ritchie
- 7Australian Cancer Research Foundation at Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Tom Witkowski
- 3Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | | | - Sze Ting Lee
- 2Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Australia
| | - Wendi Lin
- 1Austin Health, Heidelberg, Australia
| | - Rachel Koldej
- 7Australian Cancer Research Foundation at Royal Melbourne Hospital, Melbourne, Australia
| | - Eliza Hawkes
- 2Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Australia
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48
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Elliott J, Avdic S, Selim AG, Clancy L, Atkins E, Blyth E, Ritchie D, Gottlieb D, Bajel A. An atypical case of Epstein-Barr virus-positive plasma cell post-transplant lymphoproliferative disorder successfully treated with adoptive cell therapy. Br J Haematol 2021; 195:140-143. [PMID: 34180535 DOI: 10.1111/bjh.17633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Jessica Elliott
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Selmir Avdic
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia
| | - Adrian G Selim
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Leighton Clancy
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia
| | - Elissa Atkins
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia
| | - Emily Blyth
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.,Blood Transplant and Cell Therapies Program, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Ritchie
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Gottlieb
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.,Blood Transplant and Cell Therapies Program, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ashish Bajel
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
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49
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Ritchie D, Elkbuli A, McKenney M, Renda M. A rare case of low voltage electrical injury leading to bilateral femur fractures and vertebral body fractures: A case report and review of the literature. Int J Surg Case Rep 2021; 84:106066. [PMID: 34119943 PMCID: PMC8196053 DOI: 10.1016/j.ijscr.2021.106066] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction and importance Low voltage electrical injuries (less than 1000 V) can produce enough tetany to cause fractures, usually of the upper extremities. Simultaneous bilateral fractures of the femoral neck are an extremely rare occurrence. It is even more uncommon for a young healthy male to suffer significant fractures from a low voltage injury. Case presentation A 25-year-old male attempted suicide by filling a bathtub with water and getting into it prior to dropping a blender into the water. He experienced full body convulsions but remained awake throughout the entire event. In the trauma bay his primary complaints were bilateral hip pain and back pain, without neurologic deficit. Radiological studies confirmed bilateral sub-capital femur fractures and thoracic vertebral fractures (compression fractures of T3, T4, T5, T6, T7, T9, and T11). The patient underwent bilateral open reduction and internal fixation (ORIF) of the femurs, while the spine fractures were treated with a thoracic-lumbar-sacral orthosis TLSO brace. Clinical discussion Low voltage electrical injury is more likely to lead to fractures in patients with chronic renal failure and metabolic conditions such as hypocalcemia, osetomalacia, and osteoporosis. Fractures after low voltage electrical injury are extremely uncommon and a high suspicion for these injuries should be maintained because if missed there is a high risk of morbidity and mortality. Conclusion We present a rare case of low voltage electrical injury by 120 V from a domestic US power supply, amplified by water conduction resulting in bilateral femoral neck fractures and vertebral body fractures. Fractures resulting from low voltage electrical injury are usually related to chronic renal failure, and metabolic conditions such as hypocalcemia, osetomalacia, and osteoporosis. Electrical injuries require a thorough assessment including voltage, duration of injury, environment (wet skin or humid environment), and any existing comorbidities. Bilateral femure and vertebral fractures are rare injuries following low-voltage electrical injury.
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Affiliation(s)
- David Ritchie
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
| | - Michael Renda
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
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50
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Wieduwilt MJ, Stock W, Advani A, Luger S, Larson RA, Tallman M, Appelbaum F, Zhang MJ, Bo-Subait K, Wang HL, Bhatt VR, Dholaria B, Eapen M, Hamadani M, Jamy O, Prestidge T, Pulsipher M, Ritchie D, Rizzieri D, Sharma A, Barba P, Sandmaier BM, de Lima M, Kebriaei P, Litzow M, Saber W, Weisdorf D. Correction: Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: analysis from CALGB 10403 and the CIBMTR. Leukemia 2021; 35:2140. [PMID: 34088982 DOI: 10.1038/s41375-021-01303-4] [Citation(s) in RCA: 3] [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] [Indexed: 11/10/2022]
Affiliation(s)
| | - Wendy Stock
- University of Chicago Medicine, Chicago, IL, USA
| | - Anjali Advani
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | | | - Martin Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Khalid Bo-Subait
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hai-Lin Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omer Jamy
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Michael Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - David Ritchie
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pere Barba
- Vall Hebron University Hospital-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcos de Lima
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic, Rochester, MN, USA
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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