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Ribrag V, Chavez JC, Boccomini C, Kaplan J, Chandler JC, Santoro A, Corradini P, Flinn IW, Advani R, Cassier PA, Sangha R, Kenkre VP, Isufi I, Uttamsingh S, Hagner PR, Gandhi AK, Shen F, Michelliza S, Haeske H, Hege K, Pourdehnad M, Kuruvilla J. Phase Ib study of combinations of avadomide (CC-122), CC-223, CC-292, and rituximab in patients with relapsed/refractory diffuse large B-cell lymphoma. EJHaem 2022; 3:139-153. [PMID: 35846221 PMCID: PMC9176062 DOI: 10.1002/jha2.375] [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] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 01/13/2023]
Abstract
There is a need for additional treatment options for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) who do not benefit from available therapies. We examined combinations of the cereblon E3 ligase modulator (CELMoD) agent avadomide (CC-122), the selective, ATP-competitive mammalian target of rapamycin kinase inhibitor CC-223, and the potent, selective, covalent Bruton tyrosine kinase inhibitor CC-292 in patients with relapsed/refractory (R/R) DLBCL. In the multicenter, phase Ib CC-122-DLBCL-001 study (NCT02031419), the dose-escalation portion explored combinations of CC-122, CC-223, and CC-292 administered as doublets or triplets with rituximab in patients with chemorefractory DLBCL. Primary endpoints were safety, tolerability, and dose-limiting toxicities; additional endpoints included pharmacokinetics, pharmacodynamics, biomarkers, and preliminary efficacy. As of December 1, 2017, 106 patients were enrolled across four cohorts. The median age was 65 years (range 24-84 years), and patients had a median of 3 (range 1-10) prior to regimens. A total of 101 patients (95.3%) discontinued, most commonly due to disease progression (49.1%). The most common any-grade adverse events (AEs) across treatment arms were gastrointestinal and hematologic; the most common grade 3/4 AEs were hematologic. CC-122 was well tolerated, with no unexpected safety concerns. Preliminary efficacy was observed in three of four treatment arms. CC-122 plus rituximab was considered suitable for dose expansion, whereas CC-223 and CC-292 combinations were associated with enhanced toxicity and/or insufficient improvement in responses. CC-122 plus rituximab was well tolerated, with preliminary antitumor activity in patients with R/R DLBCL. This innovative study demonstrates the feasibility of assessing the tolerability and preliminary efficacy of novel combinations utilizing a multi-arm dose-finding design.
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Affiliation(s)
| | - Julio C. Chavez
- H. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | | | - Jason Kaplan
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | | | - Armando Santoro
- Humanitas Clinical and Research Center IRCCSHumanitas UniversityRozzano‐MilanoItaly
| | - Paolo Corradini
- IRCCS Istituto Nazionale dei TumoriUniversity of MilanoMilanoItaly
| | - Ian W. Flinn
- Sarah Cannon Research InstituteNashvilleTennesseeUSA
| | | | | | | | | | - Iris Isufi
- Yale Cancer CenterNew HavenConnecticutUSA
| | | | | | | | - Frank Shen
- Bristol Myers SquibbPrincetonNew JerseyUSA
| | | | | | | | | | - John Kuruvilla
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreUniversity of TorontoTorontoCanada
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2
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Sharman JP, Brander DM, Mato AR, Ghosh N, Schuster SJ, Kambhampati S, Burke JM, Lansigan F, Schreeder MT, Lunin SD, Zweibach A, Shtivelband M, Travis PM, Chandler JC, Kolibaba KS, Sportelli P, Miskin HP, Weiss MS, Flinn IW. Ublituximab plus ibrutinib versus ibrutinib alone for patients with relapsed or refractory high-risk chronic lymphocytic leukaemia (GENUINE): a phase 3, multicentre, open-label, randomised trial. Lancet Haematol 2021; 8:e254-e266. [PMID: 33631112 DOI: 10.1016/s2352-3026(20)30433-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients with chronic lymphocytic leukaemia and high-risk features have poorer outcomes on ibrutinib than those without high-risk features. The aim of this study was to assess the benefit of adding ublituximab, an anti-CD20 monoclonal antibody, to ibrutinib therapy in this population. METHODS We did a randomised, phase 3, multicentre study (GENUINE) of patients aged 18 years or older with relapsed or refractory chronic lymphocytic leukaemia with at least one of 17p deletion, 11q deletion, or TP53 mutation, at 119 clinics in the USA and Israel. Eligible patients had received at least one previous chronic lymphocytic leukaemia therapy and had an Eastern Cooperative Oncology Group performance status of 2 or lower. We randomised patients (1:1) using permuted block randomisation with a block size of four and stratified by previous lines of therapy (one vs two or more) to receive ibrutinib alone or ibrutinib in combination with ublituximab. Treatment allocation was not masked to patients or investigators. Ibrutinib was given orally daily at 420 mg for all cycles. Ublituximab was given intravenously in 28-day cycles, with increasing doses during cycle 1 (≤150 mg on day 1, 750 mg on day 2, and 900 mg on days 8 and 15) and continuing at 900 mg on day 1 of cycles 2-6. After cycle 6, ublituximab was given at 900 mg every three cycles. The study was initially designed with co-primary endpoints of progression-free survival and overall response rate but due to protracted patient accrual, the protocol was amended to have a single primary endpoint of independent review committee-assessed overall response rate (defined as the proportion of patients who had a partial response, complete response, or complete response with incomplete marrow recovery according to the 2008 International Workshop on CLL criteria) in the intention-to-treat population. Safety was evaluated in the population of patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, NCT02301156, and the final analysis is presented. FINDINGS 224 patients were assessed for eligibility, of whom 126 patients were enrolled and randomly assigned to receive ublituximab plus ibrutinib (n=64) or ibrutinib alone (n=62) between Feb 6, 2015, and Dec 19, 2016. After a median follow-up of 41·6 months (IQR 36·7-47·3), the overall response rate was 53 (83%) of 64 patients in the ublituximab plus ibrutinib group and 40 (65%) of 62 patients in the ibrutinib group (p=0·020). 117 patients, including 59 in the ublituximab plus ibrutinib group and 58 in the ibrutinib group, received at least one dose of treatment and were included in safety analyses. Most adverse events were grade 1 or 2. The most common grade 3 and 4 adverse events were neutropenia (11 [19%] patients in the ublituximab plus ibrutinib group and seven [12%] in the ibrutinib group), anaemia (five [8%] and five [9%]), and diarrhoea (six [10%] and three [5%]). The most common serious adverse events were pneumonia (six [10%] in the ublituximab plus ibrutinib group and four [7%] in the ibrutinib group), atrial fibrillation (four [7%] and one [2%]), sepsis (four [7%] and one [2%]), and febrile neutropenia (three [5%] and one [2%]). Two patients in the ublituximab plus ibrutinib group died due to adverse events (one cardiac arrest and one failure to thrive), neither of which were treatment-related. Five patients in the ibrutinib group died due to adverse events, including one cardiac arrest, one cerebral infarction, one intracranial haemorrhage, one Pneumocystis jirovecii pneumonia infection, and one unexplained death; the death due to cardiac arrest was considered to be treatment-related. INTERPRETATION The addition of ublituximab to ibrutinib resulted in a statistically higher overall response rate without affecting the safety profile of ibrutinib monotherapy in patients with relapsed or refractory high-risk chronic lymphocytic leukaemia. These findings provide support for the addition of ublituximab to Bruton tyrosine kinase inhibitors for the treatment of these patients. FUNDING TG Therapeutics.
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Affiliation(s)
- Jeff P Sharman
- Willamette Valley Cancer Institute, US Oncology Research, Eugene, OR, USA.
| | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Anthony R Mato
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Suman Kambhampati
- Sarah Cannon Cancer Center at Research Medical Center, Kansas City, MO, USA
| | - John M Burke
- Rocky Mountain Cancer Centers, US Oncology Research, Aurora, CO, USA
| | - Frederick Lansigan
- Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | - Alexander Zweibach
- Cancer Care Centers of South Texas, US Oncology Research, New Braunfels, TX, USA
| | | | | | | | | | | | | | | | - Ian W Flinn
- Sarah Cannon Research Institute, Nashville, TN, USA
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3
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Kumar SK, Callander NS, Adekola K, Anderson L, Baljevic M, Campagnaro E, Castillo JJ, Chandler JC, Costello C, Efebera Y, Faiman M, Garfall A, Godby K, Hillengass J, Holmberg L, Htut M, Huff CA, Kang Y, Hultcrantz M, Larson S, Liedtke M, Martin T, Omel J, Shain K, Sborov D, Stockerl-Goldstein K, Weber D, Keller J, Kumar R. Multiple Myeloma, Version 3.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:1685-1717. [PMID: 33285522 DOI: 10.6004/jnccn.2020.0057] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Multiple myeloma is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. This manuscript discusses the management of patients with solitary plasmacytoma, smoldering multiple myeloma, and newly diagnosed multiple myeloma.
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Affiliation(s)
| | | | - Kehinde Adekola
- 3Robert H. Lurie Comprehensive Cancer of Center Northwestern University
| | | | | | | | - Jorge J Castillo
- 7Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Jason C Chandler
- 8St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Yvonne Efebera
- 10The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Matthew Faiman
- 11Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Alfred Garfall
- 12Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Leona Holmberg
- 15Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Myo Htut
- 16City of Hope National Medical Center
| | - Carol Ann Huff
- 17The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Thomas Martin
- 22UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Donna Weber
- 27The University of Texas MD Anderson Cancer Center; and
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Kumar SK, Callander NS, Hillengass J, Liedtke M, Baljevic M, Campagnaro E, Castillo JJ, Chandler JC, Cornell RF, Costello C, Efebera Y, Faiman M, Garfall A, Godby K, Holmberg L, Htut M, Huff CA, Kang Y, Landgren O, Malek E, Martin T, Omel J, Raje N, Sborov D, Singhal S, Stockerl-Goldstein K, Tan C, Weber D, Johnson-Chilla A, Keller J, Kumar R. NCCN Guidelines Insights: Multiple Myeloma, Version 1.2020. J Natl Compr Canc Netw 2020; 17:1154-1165. [PMID: 31590151 DOI: 10.6004/jnccn.2019.0049] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The NCCN Guidelines for Multiple Myeloma provide recommendations for diagnosis, workup, treatment, follow-up, and supportive care for patients with monoclonal gammopathy of renal significance, solitary plasmacytoma, smoldering myeloma, and multiple myeloma. These NCCN Guidelines Insights highlight some of the important updates and changes in the 1.2020 version of the NCCN Guidelines for Multiple Myeloma.
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Affiliation(s)
| | | | | | | | | | | | | | - Jason C Chandler
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Yvonne Efebera
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Matthew Faiman
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Alfred Garfall
- Abramson Cancer Center at the University of Pennsylvania
| | | | - Leona Holmberg
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Myo Htut
- City of Hope National Medical Center
| | - Carol Ann Huff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Ehsan Malek
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Martin
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Noopur Raje
- Massachusetts General Hospital Cancer Center
| | | | - Seema Singhal
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Donna Weber
- The University of Texas MD Anderson Cancer Center; and
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5
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Spigel DR, McCleod M, Jotte RM, Einhorn L, Horn L, Waterhouse DM, Creelan B, Babu S, Leighl NB, Chandler JC, Couture F, Keogh G, Goss G, Daniel DB, Garon EB, Schwartzberg LS, Sen R, Korytowsky B, Li A, Aanur N, Hussein MA. Safety, Efficacy, and Patient-Reported Health-Related Quality of Life and Symptom Burden with Nivolumab in Patients with Advanced Non-Small Cell Lung Cancer, Including Patients Aged 70 Years or Older or with Poor Performance Status (CheckMate 153). J Thorac Oncol 2019; 14:1628-1639. [PMID: 31121324 DOI: 10.1016/j.jtho.2019.05.010] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [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: 02/14/2019] [Revised: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION CheckMate 153 (NCT02066636) is a phase 3B/4 study assessing nivolumab in previously treated patients with advanced NSCLC. Eligibility criteria allowed enrollment of patients with poor prognostic features of advanced age or diminished Eastern Cooperative Oncology Group performance status (ECOG PS), which are typically underrepresented in or excluded from randomized controlled trials. METHODS Patients with stage IIIB or IV NSCLC and an ECOG PS of 0 to 2 with disease progression after at least one systemic therapy received nivolumab (3 mg/kg every 2 weeks) until progression, unacceptable toxicity, or consent withdrawal. The primary end point was the incidence of grade 3 to 5 select treatment-related adverse events (TRAEs). RESULTS Among 1426 treated patients, 556 (39%) were aged 70 years or older and 128 (9%) had an ECOG PS of 2. The median treatment duration was 3.2 months. Across subgroups and the overall population, the incidences of select grade 3 to 5 TRAEs (6%-9%) and grade 3 or 4 TRAEs (12%-14%) were similar. One grade 5 TRAE was documented. The median overall survival time was comparable in the overall population (9.1 months) and patients aged 70 years or older (10.3 months) but shorter in patients with an ECOG PS of 2 (4.0 months). Patient-reported outcomes generally improved. CONCLUSIONS Data from this large predominantly community-based study, which included patients aged 70 years or older and with an ECOG PS of 2, are consistent with registrational studies. As expected, the median overall survival for patients with an ECOG PS of 2 was lower than for the overall population but comparable with historical data.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, Tennessee.
| | - Michael McCleod
- Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, Florida
| | - Robert M Jotte
- Rocky Mountain Cancer Centers, Denver, Colorado; US Oncology Research, Houston, Texas
| | | | - Leora Horn
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Sunil Babu
- Fort Wayne Medical Oncology and Hematology, Fort Wayne, Indiana
| | - Natasha B Leighl
- The Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | | | - George Keogh
- Charleston Hematology Oncology Associates, Charleston, South Carolina
| | - Glenwood Goss
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Edward B Garon
- Translational Research In Oncology-US, Inc. (TRIO-US), Los Angeles, California
| | | | | | | | - Ang Li
- Bristol-Myers Squibb, Princeton, New Jersey
| | | | - Maen A Hussein
- Sarah Cannon Research Institute/Florida Cancer Specialists, Leesburg, Florida
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McCullar B, Pandey M, Yaghmour G, Hare F, Patel K, Stein MK, Feldman R, Chandler JC, Martin MG. Correction to: Genomic landscape of small cell carcinoma of the breast contrasted to small cell carcinoma of the lung. Breast Cancer Res Treat 2018; 173:243. [PMID: 30306431 DOI: 10.1007/s10549-018-4974-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the original publication, the sixth author name was published incorrectly as Matthew Stein. The correct author name should read as Matthew K Stein.
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Affiliation(s)
- Brennan McCullar
- University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Manjari Pandey
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - George Yaghmour
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Felicia Hare
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kruti Patel
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Matthew K Stein
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca Feldman
- University of Tennessee Health Science Center, Memphis, TN, USA
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7
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Nebot N, Arkenau HT, Infante JR, Chandler JC, Weickhardt A, Lickliter JD, Sarantopoulos J, Gordon MS, Mak G, St-Pierre A, Tang L, Mookerjee B, Carson SW, Hayes S, Grossmann KF. Evaluation of the effect of dabrafenib and metabolites on QTc interval in patients with BRAF V600-mutant tumours. Br J Clin Pharmacol 2018; 84:764-775. [PMID: 29243287 DOI: 10.1111/bcp.13488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/01/2017] [Accepted: 11/28/2017] [Indexed: 01/01/2023] Open
Abstract
AIMS The effect of repeat oral supratherapeutic dosing of the BRAF inhibitor dabrafenib on QTc interval was assessed in patients with BRAF V600-mutant tumours. METHODS Part 1 of this phase 1, multicentre, 2-part study (BRF113773/NCT01738451) assessed safety/tolerability of dabrafenib 225 or 300 mg twice daily (BID) to inform part 2 dosing. Patients in part 2 received dabrafenib-matched placebo on day -1, single-dose dabrafenib 300 mg on day 1, 300 mg BID on days 2 to 7, and 300 mg on day 8 (morning), followed by 24-h Holter electrocardiographic monitoring and pharmacokinetics sample collection each dose day. Pharmacokinetics/pharmacodynamics analysis assessed combined dabrafenib and metabolite effects on QTc interval. RESULTS Part 1 (n = 12) determined supratherapeutic dosing, 300 mg BID, for part 2. Thirty-one patients completed part 2. Mean maximum ΔΔQTcF occurred on day 8, 10 h postdose (2.86 msec; 90% CI, -1.36 to 7.07). Categorical analysis showed no placebo and dabrafenib outliers (increase >60 msec; QTcF >500 msec). Day 1 dabrafenib 300 mg Cmax and AUC(0-∞) were ≈ 2-fold higher than with single-dose 150 mg. Day 8 AUC(0-τ) with 300 mg BID was ≈ 2.7-fold higher than with 150 mg BID. Dabrafenib metabolites showed similar trends. Pharmacokinetics/pharmacodynamics modelling/simulation showed that median QTc increase was <5 msec (upper 90% CI, <10 msec). No unexpected toxicities occurred with supratherapeutic dosing. CONCLUSION Repeat oral supratherapeutic dabrafenib 300 mg BID dosing had no clinically relevant effect on QTc interval, with no new safety signals seen.
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Affiliation(s)
- Noelia Nebot
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936, USA
| | | | | | | | - Andrew Weickhardt
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Australia
| | | | - John Sarantopoulos
- Institute for Drug Development, Cancer Therapy and Research Center at The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Michael S Gordon
- Pinnacle Oncology Hematology/HonorHealth Research Institute, Scottsdale, AZ, 85258, USA
| | - Gabriel Mak
- Sarah Cannon Research Institute UK, London, W1G 6AD, UK
| | | | - Lihua Tang
- Novartis Pharmaceuticals Corporation, Morrisville, NC, USA
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8
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Kumar SK, Callander NS, Alsina M, Atanackovic D, Biermann JS, Castillo J, Chandler JC, Costello C, Faiman M, Fung HC, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kang Y, Kassim A, Liedtke M, Malek E, Martin T, Neppalli VT, Omel J, Raje N, Singhal S, Somlo G, Stockerl-Goldstein K, Weber D, Yahalom J, Kumar R, Shead DA. NCCN Guidelines Insights: Multiple Myeloma, Version 3.2018. J Natl Compr Canc Netw 2018; 16:11-20. [DOI: 10.6004/jnccn.2018.0002] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Kumar SK, Callander NS, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Faiman M, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Liedtke M, Martin T, Omel J, Raje N, Reu FJ, Singhal S, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R. Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 15:230-269. [PMID: 28188192 DOI: 10.6004/jnccn.2017.0023] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multiple myeloma (MM) is caused by the neoplastic proliferation of plasma cells. These neoplastic plasma cells proliferate and produce monoclonal immunoglobulin in the bone marrow causing skeletal damage, a hallmark of multiple myeloma. Other MM-related complications include hypercalcemia, renal insufficiency, anemia, and infections. The NCCN Multiple Myeloma Panel members have developed guidelines for the management of patients with various plasma cell dyscrasias, including solitary plasmacytoma, smoldering myeloma, multiple myeloma, systemic light chain amyloidosis, and Waldenström's macroglobulinemia. The recommendations specific to the diagnosis and treatment of patients with newly diagnosed MM are discussed in this article.
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Chandler JC, Schaeffer JW, Davidson M, Magzamen SL, Pérez-Méndez A, Reynolds SJ, Goodridge LD, Volckens J, Franklin AB, Shriner SA, Bisha B. A method for the improved detection of aerosolized influenza viruses and the male-specific (F+) RNA coliphage MS2. J Virol Methods 2017; 246:38-41. [PMID: 28450173 PMCID: PMC7113747 DOI: 10.1016/j.jviromet.2017.04.004] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/12/2017] [Accepted: 04/14/2017] [Indexed: 01/06/2023]
Abstract
Developed a method for viral bioaerosol sampling using anion exchange resin. MS2 and influenza viruses (A/B) detection improved by 8.26×, 6.77× and 3.33×. The anion exchange resin method can adapt to existing bioaerosol samplers.
The detection of aerosolized viruses can serve as an important surveillance and control tool in agriculture, human health, and environmental settings. Here, we adapted an anion exchange resin-based method, initially developed to concentrate negatively charged viruses from water, to liquid impingement-based bioaerosol sampling. In this method, aerosolized viruses are collected in a 20 ml liquid sample contained within widely used impingers, BioSamplers (SKC Inc., Eighty Four, PA), and further concentrated via adsorption to an anion exchange resin that is suspended within this liquid. Viral nucleic acids are then extracted from the resin to facilitate molecular analyses through a reduction in the effective sample volume. For this study, various quantities of two negatively charged viruses, type A and type B influenza viruses (FluMist Quadrivalent vaccine) and the male-specific (F+) RNA coliphage MS2 (MS2), were nebulized into a custom-built bioaerosolization chamber, and sampled using BioSamplers with and without anion exchange resin. Compared to direct testing of the BioSampler liquid, detection was improved by 6.77× and 3.33× for type A and type B influenza viruses, respectively, by using the anion exchange resin. For MS2, the anion exchange resin method allowed for an average improvement in detection of 8.26×.
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Affiliation(s)
- J C Chandler
- National Wildlife Research Center, Wildlife Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, CO, USA
| | - J W Schaeffer
- High Plains Intermountain Center for Agricultural Health and Safety, Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - M Davidson
- High Plains Intermountain Center for Agricultural Health and Safety, Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Western Sydney University, Richmond, NSW, Australia
| | - S L Magzamen
- High Plains Intermountain Center for Agricultural Health and Safety, Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - S J Reynolds
- High Plains Intermountain Center for Agricultural Health and Safety, Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - L D Goodridge
- Department of Food Science and Agricultural Chemistry, McGill University, Ste. Anne de Bellevue, QC, Canada
| | - J Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - A B Franklin
- National Wildlife Research Center, Wildlife Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, CO, USA
| | - S A Shriner
- National Wildlife Research Center, Wildlife Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, CO, USA
| | - B Bisha
- Department of Animal Science, University of Wyoming, Laramie, WY, USA.
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Yaghmour G, Prouet P, Wiedower E, Jamy OH, Feldman R, Chandler JC, Pandey M, Martin MG. Genomic alterations in neuroendocrine cancers of the ovary. J Ovarian Res 2016; 9:52. [PMID: 27566252 PMCID: PMC5002197 DOI: 10.1186/s13048-016-0259-2] [Citation(s) in RCA: 8] [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: 06/01/2016] [Accepted: 08/11/2016] [Indexed: 12/18/2022] Open
Abstract
Background As we have previously reported, small cell carcinoma of the ovary (SCCO) is a rare, aggressive form of ovarian cancer associated with poor outcomes. In an effort to identify new treatment options, we utilized comprehensive genomic profiling to assess the potential for novel therapies in SCCO. Methods Patients with SCCO, SCCO-HT (hypercalcemic type), neuroendocrine tumors of the ovary (NET-O), and small cell carcinoma of the lung (SCLC) profiled by Caris Life Sciences between 2007–2015 were identified. Tumors were assessed with up to 21 IHC stains, in situ hybridization of cMET, EGFR, HER2 and PIK3CA, and next-generation sequencing (NGS) as well as Sanger sequencing of selected genes. Results Forty-six patients with SCCO (10 SCCO, 18 SCCO-HT, 18 NET-O) were identified as well as 58 patients with SCLC for comparison. Patients with SCCO and SCCO-HT were younger (median 42 years [range 12–75] and 26 years [range 8–40], respectively) than patients with NET-O 62 [range 13–76] or SCLC 66 [range 36–86]. SCCO patients were more likely to be metastatic (70 %) than SCCO-HT (50 %) or NET-O (33 %) patients, but at a similar rate to SCLC patients (65 %). PD1 expression varied across tumor type with SCCO (100 %), SCCO-HT (60 %), NET-O (33 %) vs SCLC (42 %). PDL1 expression also varied with SCCO (50 %), SCCO-HT (20 %), NET-O (33 %) and SCLC (0 %). No amplifications were identified in cMET, EGFR, or HER2 and only 1 was found in PIK3CA (NET-O). Actionable mutations were rare with 1 patient with SCCO having a BRCA2 mutation and 1 patient with NET-O having a PIK3CA mutation. No other actionable mutations were identified. Conclusions No recurrent actionable mutations or rearrangements were identified using this platform in SCCO. IHC patterns may help guide the use of chemotherapy in these rare tumors.
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Affiliation(s)
- George Yaghmour
- The West Cancer Center, 1588 Union Ave., Memphis, TN, 38104, USA.,Department of Hematology & Oncology, The University of Tennessee Health Science Center, 956 Court Ave., Suite H310A, Memphis, TN, 38163, USA
| | - Philippe Prouet
- Department of Internal Medicine, The University of Tennessee Health Science Center, 956 Court Ave., Suite H314, Memphis, TN, 38163, USA.
| | - Eric Wiedower
- The West Cancer Center, 1588 Union Ave., Memphis, TN, 38104, USA.,Department of Hematology & Oncology, The University of Tennessee Health Science Center, 956 Court Ave., Suite H310A, Memphis, TN, 38163, USA
| | - Omer Hassan Jamy
- Department of Internal Medicine, The University of Tennessee Health Science Center, 956 Court Ave., Suite H314, Memphis, TN, 38163, USA
| | - Rebecca Feldman
- Caris Life Sciences, 4750 S. 44th Place, Phoenix, AZ, 85040, USA
| | - Jason C Chandler
- The West Cancer Center, 1588 Union Ave., Memphis, TN, 38104, USA.,Department of Hematology & Oncology, The University of Tennessee Health Science Center, 956 Court Ave., Suite H310A, Memphis, TN, 38163, USA
| | - Manjari Pandey
- The West Cancer Center, 1588 Union Ave., Memphis, TN, 38104, USA.,Department of Hematology & Oncology, The University of Tennessee Health Science Center, 956 Court Ave., Suite H310A, Memphis, TN, 38163, USA
| | - Mike G Martin
- The West Cancer Center, 1588 Union Ave., Memphis, TN, 38104, USA.,Department of Hematology & Oncology, The University of Tennessee Health Science Center, 956 Court Ave., Suite H310A, Memphis, TN, 38163, USA
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McCullar B, Pandey M, Yaghmour G, Hare F, Patel K, Stein M, Feldman R, Chandler JC, Martin MG. Genomic landscape of small cell carcinoma of the breast contrasted to small cell carcinoma of the lung. Breast Cancer Res Treat 2016; 158:195-202. [DOI: 10.1007/s10549-016-3867-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/11/2016] [Indexed: 12/14/2022]
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13
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Nunnery SE, Fintel AE, Jackson WC, Chandler JC, Ugwueke MO, Martin MG. Treatment Disparities Faced by Undocumented Workers From Low- and Middle-Income Countries in the United States With Hematologic Malignancies. J Natl Compr Canc Netw 2016; 14:483-6. [DOI: 10.6004/jnccn.2016.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Johnson B, Giri S, Nunnery SE, Wiedower E, Jamy O, Yaghmour G, Chandler JC, Martin MG. Comorbidities Drive Outcomes for Both Malignancy-Associated and Non–Malignancy-Associated Hemophagocytic Syndrome. Clinical Lymphoma Myeloma and Leukemia 2016; 16:230-6. [DOI: 10.1016/j.clml.2016.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 12/13/2022]
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15
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Anderson KC, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Djulbegovic B, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Krishnan AY, Kumar SK, Liedtke M, Lunning M, Raje N, Reu FJ, Singhal S, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R. NCCN Guidelines Insights: Multiple Myeloma, Version 3.2016. J Natl Compr Canc Netw 2016; 14:389-400. [PMID: 27059188 PMCID: PMC6016087 DOI: 10.6004/jnccn.2016.0046] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 12/17/2022]
Abstract
These NCCN Guidelines Insights highlight the important updates/changes specific to the 2016 version of the NCCN Clinical Practice Guidelines in Oncology for Multiple Myeloma. These changes include updated recommendations to the overall management of multiple myeloma from diagnosis and staging to new treatment options.
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Affiliation(s)
| | | | | | | | - Jason C Chandler
- St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | - Kelly Godby
- University of Alabama at Birmingham Comprehensive Cancer Center
| | - Craig Hofmeister
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Leona Holmberg
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Carol Ann Huff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | - Noopur Raje
- Massachusetts General Hospital Cancer Center
| | - Frederic J Reu
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Seema Singhal
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Donna Weber
- The University of Texas MD Anderson Cancer Center
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16
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Anderson KC, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Djulbegovic B, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Krishnan AY, Kumar SK, Liedtke M, Lunning M, Raje N, Singhal S, Smith C, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R. Multiple Myeloma, Version 2.2016: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2015; 13:1398-435. [PMID: 26553768 PMCID: PMC4891187 DOI: 10.6004/jnccn.2015.0167] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Recent statistics from the American Cancer Society indicate that the incidence of MM is increasing. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) included in this issue address management of patients with solitary plasmacytoma and newly diagnosed MM.
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Pérez-Méndez A, Chandler JC, Bisha B, Goodridge LD. Concentration of enteric viruses from tap water using an anion exchange resin-based method. J Virol Methods 2014; 206:95-8. [PMID: 24911889 DOI: 10.1016/j.jviromet.2014.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 11/29/2022]
Abstract
Detecting low concentrations of enteric viruses in water is needed for public health-related monitoring and control purposes. Thus, there is a need for sensitive, rapid and cost effective enteric viral concentration methods compatible with downstream molecular detection. Here, a virus concentration method based on adsorption of the virus to an anion exchange resin and direct isolation of nucleic acids is presented. Ten liter samples of tap water spiked with different concentrations (10-10,000 TCID50/10 L) of human adenovirus 40 (HAdV-40), hepatitis A virus (HAV) or rotavirus (RV) were concentrated and detected by real time PCR or real time RT-PCR. This method improved viral detection compared to direct testing of spiked water samples where the ΔCt was 12.1 for AdV-40 and 4.3 for HAV. Direct detection of RV in water was only possible for one of the three replicates tested (Ct of 37), but RV detection was improved using the resin method (all replicates tested positive with an average Ct of 30, n=3). The limit of detection of the method was 10 TCID50/10 L for HAdV-40 and HAV, and 100 TCID50/10 L of water for RV. These results compare favorably with detection limits reported for more expensive and laborious methods.
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Affiliation(s)
- A Pérez-Méndez
- Department of Animal Sciences, Colorado State University, Fort Collins, CO, USA.
| | - J C Chandler
- Department of Animal Science, University of Wyoming, Laramie, WY, USA.
| | - B Bisha
- Department of Animal Science, University of Wyoming, Laramie, WY, USA.
| | - L D Goodridge
- Department of Food Science and Agricultural Chemistry, McGill University, Ste. Anne de Bellevue, Quebec, Canada.
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18
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Traina TA, Hudis C, Seidman A, Gajria D, Gonzalez J, Anthony SP, Smith DA, Chandler JC, Jac J, Youssoufian H, Korth CC, Barrett JA, Sun L, Norton L. Abstract P6-11-10: IBL2001: Phase I/II study of a novel dose-dense schedule of oral indibulin for the treatment of metastastic breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-11-10] [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: Indibulin (ZI0-301) is a novel, oral, synthetic small molecule microtubule inhibitor which binds tubulin at a different site than taxanes and vinca alkaloids. Preclinical data demonstrate indibulin does not interact with acetylated (neuronal) tubulins and in clinical studies has not exhibited the neurotoxicity associated with other tubulin binders. Indibulin has potent antitumor activity in human cancer cell lines, including multidrug-, taxane-, and vinblastine-resistant. Norton-Simon modeling based on cell line data suggested that dose dense (dd) administration could optimize efficacy while limiting toxicity.
Methods: Eligible patients (pts) have metastatic or unresectable locally advanced breast cancer, ECOG performance status ≤ 2, adequate organ function, measurable or nonmeasurable disease and any number of prior therapies. Uncontrolled gastrointestinal malabsorption syndrome and grade 2 or higher peripheral neuropathy are the principal exclusions. Adverse events (AEs) are graded by CTCAE v. 4.0. Objective disease status is evaluated according to RECIST 1.1. The primary objective of the phase (Ph) I portion of the study is to determine the maximum tolerated dose (MTD) of indibulin when given in dd fashion 5 days treatment, 9 days rest using standard 3+3 dose escalation schema.
The secondary objectives are to evaluate safety profile at various dosing levels, pharmacokinetics (PK) and preliminary activity of indibulin. Once the MTD is defined, a food effect cross- over group (N = 12) will be enrolled. Two groups of 6 pts each will be treated in either the fed or fasted state during the first cycle. A subgroup of 13 pts consisting of 12 pts from the food effect group plus the last pt from the MTD cohort will be evaluated for PFS at 4 months and will serve as the population for the first stage of a Simon two-stage design. If 4 or more out of 13 pts do not progress at 4 months, the Ph II portion of the study will be opened.
Results: Twenty one pts (20 F, 1 M) have been enrolled to cohorts 1 through 6 and the dose escalation is ongoing. Preliminary safety and efficacy data have been analyzed for 18 pts treated in cohorts 1 through 5 and are presented henceforth. No DLT has been observed and no MTD has been reached. Median age 58 years (32–81). PS 0=4, 1=12, 2=2. Median number of prior therapies 5 (1–12). Most frequent treatment-emergent AEs were: anorexia, constipation, cough, nausea (each in 39% pts); dyspnea (33%); fatigue, vomiting (each 28%). There were no related grade 3–4 AEs. PK analysis revealed that indibulin plasma exposures increased approximately dose proportionally from 25 to 200 mg with Cmax of 165 ± 89 ng/mL and AUC0-24 of 1411 ± 111 ng·h/mL at 200 mg. There were no objective responses. Stable disease was seen in 1 pt in the 150 mg cohort. Longest duration on-study was 4 months.
Conclusions: Oral indibulin was well tolerated in the doses up to 200 mg and the dose-proportional PK with lack of DLTs allows for further dose-escalation. Stable disease observed at sub-MTD dose may be a sign of activity in this heavily pre-treated population.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-11-10.
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Affiliation(s)
- TA Traina
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - C Hudis
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - A Seidman
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - D Gajria
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - J Gonzalez
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - SP Anthony
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - DA Smith
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - JC Chandler
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - J Jac
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - H Youssoufian
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - CC Korth
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - JA Barrett
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - L Sun
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
| | - L Norton
- Memorial Sloan-Kettering Cancer Center, New York, NY; Evergreen Hematology and Oncology, Spokane, WA; Compass Oncology, Vancouver, WA; The West Clinic, Memphis, TN; US Oncology Research, Woodlands, TX; ZIOPHARM Oncology, Inc., Boston, MA; Harmon Hill Consulting, New York, NY
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Mishra A, Liu S, Sams GH, Curphey DP, Santhanam R, Rush LJ, Schaefer D, Falkenberg LG, Sullivan L, Jaroncyk L, Yang X, Fisk H, Wu LC, Chandler JC, Wu YZ, Heerema NA, Chan KK, Perrotti D, Zhang J, Porcu P, Racke FK, Garzon R, Lee RJ, Marcucci G, Caligiuri MA. Aberrant overexpression of IL-15 initiates large granular lymphocyte leukemia through chromosomal instability and DNA hypermethylation. Cancer Cell 2012; 22:645-55. [PMID: 23153537 PMCID: PMC3627362 DOI: 10.1016/j.ccr.2012.09.009] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 07/02/2012] [Accepted: 09/14/2012] [Indexed: 12/12/2022]
Abstract
How inflammation causes cancer is unclear. Interleukin-15 (IL-15) is a pro-inflammatory cytokine elevated in human large granular lymphocyte (LGL) leukemia. Mice overexpressing IL-15 develop LGL leukemia. Here, we show that prolonged in vitro exposure of wild-type (WT) LGL to IL-15 results in Myc-mediated upregulation of aurora kinases, centrosome aberrancies, and aneuploidy. Simultaneously, IL-15 represses miR-29b via induction of Myc/NF-κBp65/Hdac-1, resulting in Dnmt3b overexpression and DNA hypermethylation. All this is validated in human LGL leukemia. Adoptive transfer of WT LGL cultured with IL-15 led to malignant transformation in vivo. Drug targeting that reverses miR-29b repression cures otherwise fatal LGL leukemia. We show how excessive IL-15 initiates cancer and demonstrate effective drug targeting for potential therapy of human LGL leukemia.
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Affiliation(s)
- Anjali Mishra
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Shujun Liu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Gregory H. Sams
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Douglas P. Curphey
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Ramasamy Santhanam
- Department of Molecular & Cellular Biochemistry, The Ohio State University, Columbus OH, 43210 USA
| | - Laura J. Rush
- College of Veterinary Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Deanna Schaefer
- College of Veterinary Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Lauren G. Falkenberg
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Laura Sullivan
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Laura Jaroncyk
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Xiaojuan Yang
- College of Pharmacy, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Harold Fisk
- Department of Molecular Genetics, The Ohio State University, Columbus OH, 43210 USA
| | - Lai-Chu Wu
- Department of Molecular & Cellular Biochemistry, The Ohio State University, Columbus OH, 43210 USA
| | - Jason C. Chandler
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Yue-Zhong Wu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Nyla A. Heerema
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Department of Pathology, The Ohio State University, Columbus OH, 43210 USA
| | - Kenneth K. Chan
- College of Pharmacy, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Danilo Perrotti
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Jianying Zhang
- Center for Biostatistics, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Pierluigi Porcu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Frederick K. Racke
- Department of Pathology, The Ohio State University, Columbus OH, 43210 USA
| | - Ramiro Garzon
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Robert J. Lee
- College of Pharmacy, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Guido Marcucci
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Michael A. Caligiuri
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
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Blum W, Klisovic RB, Becker H, Yang X, Rozewski DM, Phelps MA, Garzon R, Walker A, Chandler JC, Whitman SP, Curfman J, Liu S, Schaaf L, Mickle J, Kefauver C, Devine SM, Grever MR, Marcucci G, Byrd JC. Dose escalation of lenalidomide in relapsed or refractory acute leukemias. J Clin Oncol 2010; 28:4919-25. [PMID: 20956622 DOI: 10.1200/jco.2010.30.3339] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Lenalidomide is effective in myeloma and low-risk myelodysplastic syndromes with deletion 5q. We report results of a phase I dose-escalation trial of lenalidomide in relapsed or refractory acute leukemia. PATIENTS AND METHODS Thirty-one adults with acute myeloid leukemia (AML) and four adults with acute lymphoblastic leukemia (ALL) were enrolled. Lenalidomide was given orally at escalating doses of 25 to 75 mg daily on days 1 through 21 of 28-day cycles to determine the dose-limiting toxicity (DLT) and maximum-tolerated dose (MTD), as well as to provide pharmacokinetic and preliminary efficacy data. RESULTS Patients had a median age of 63 years (range, 22 to 79 years) and a median of two prior therapies (range, one to four therapies). The DLT was fatigue; 50 mg/d was the MTD. Infectious complications were frequent. Plasma lenalidomide concentration increased proportionally with dose. In AML, five (16%) of 31 patients achieved complete remission (CR); three of three patients with cytogenetic abnormalities achieved cytogenetic CR (none with deletion 5q). Response duration ranged from 5.6 to 14 months. All responses occurred in AML with low presenting WBC count. No patient with ALL responded. Two of four patients who received lenalidomide as initial therapy for AML relapse after allogeneic transplantation achieved durable CR after development of cutaneous graft-versus-host disease, without donor leukocyte infusion. CONCLUSION Lenalidomide was safely escalated to 50 mg daily for 21 days, every 4 weeks, and was active with relatively low toxicity in patients with relapsed/refractory AML. Remissions achieved after transplantation suggest a possible immunomodulatory effect of lenalidomide, and results provide enthusiasm for further studies in AML, either alone or in combination with conventional agents or other immunotherapies.
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Affiliation(s)
- William Blum
- Division of Hematology, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA.
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Eiring AM, Harb J, Neviani P, Oaks JJ, Liu S, Spizzo R, Schwind S, Santhanam R, Hickey C, Becker H, Chandler JC, Andino R, Cortes J, Hokland P, Huettner CS, Bhatia R, Roy DC, Liebhaber S, Caligiuri MA, Marcucci G, Garzon R, Croce CM, Calin GA, Perrotti D. Abstract 1950: Suppression of RISC-independent decoy and RISC-mediated RNA-pairing activities of microRNA-328 is required for maturation-arrest and enhanced survival of blast crisis CML progenitors. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-1950] [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
MicroRNAs (miRs) and heterogeneous ribonucleoproteins (hnRNPs) are post-transcriptional gene regulators that bind to mRNA in a sequence-specific manner. We showed that hnRNP-E2 inhibits myeloid maturation of bone marrow (BM) progenitors from chronic myelogenous leukemia patients in myeloid blast crisis (CML-BC) by suppressing CEBPA mRNA translation. We report here that loss of miR-328 is induced by BCR/ABL and specifically occurs in CML-BC, and its restored expression rescues differentiation and impairs clonogenic potential of BCR/ABL+ BM progenitors. Accordingly, miR-328 increases during granulocytic differentiation of human CD34+ and mouse LSK BM stem/progenitor cells. Mechanistically, BCR/ABL uses the MAPK-hnRNP-E2 pathway to suppress C/EBPα and miR-328 expression as pharmacologic inhibition of and/or shRNAs against these molecules efficiently restore miR-328 expression. Interestingly, two functional C/EBPα binding sites are present in the miR-328 promoter and positively regulate its transcription.
We also show that maturation of differentiation-arrested BCR/ABL+ blasts requires direct interaction of hnRNP-E2 with the miR-328 C-rich regions. Moreover, imatinib treatment restores miR-328 expression, thus allowing its direct binding to hnRNP E2 independent from the RISC complex. Importantly, physiological miR-328 expression decreased hnRNP E2 binding to the uORF/spacer region of endogenous CEBPA mRNA (decoy activity). This, in turn, releases CEBPA mRNA from hnRNP E2 translation inhibition and allows in vitro and in vivo BCR/ABL+ cell differentiation.
Although hnRNP E2 was not found in complex with the basic RISC components in BCR/ABL+ cells, miR-328 was found associated to Dicer and Ago2, suggesting that miR-328 also acts through base-pairing with the 3′UTR of mRNA targets in a RISC-dependent manner. In fact, miR-328 suppresses PIM1 protein but not mRNA expression and this effect requires the integrity of the PIM1 3′UTR. Indeed, forced expression of a wild type, but not a kinase-deficient, PIM1 lacking the 3′UTR into miR-328-expressing cells fully rescues BCR/ABL clonogenicity, suggesting that miR-328-induced inhibition of PIM1 accounts for reduced survival of miR-328-infected CML-BCCD34+ blasts. To demonstrate that miR-328 acts on PIM1 in a RISC-dependent manner, we mutated the miR-328 in the seed sequence (miR-328-Mut) while retaining its C-rich character. As expected, miR-328-Mut interacted with hnRNP-E2 and rescued C/EBPα-mediated differentiation, but did not silence PIM1 expression. Thus, the discovery of dual activities for miR-328 which affect myeloid differentiation and survival not only adds a layer to the complexity of mechanisms regulating CML-BC but also highlights the ability of miRNAs to alter mRNA metabolism by acting as molecular decoys for RNA binding proteins.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1950.
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Affiliation(s)
| | - Jason Harb
- 1Ohio State Univ. Medical Ctr., Columbus, OH
| | | | | | - Shujun Liu
- 1Ohio State Univ. Medical Ctr., Columbus, OH
| | | | | | | | | | | | | | | | | | | | | | - Ravi Bhatia
- 6City of Hope National Medical Ctr, Duarte, CA
| | - Denis C. Roy
- 7Maissoneuve-Rosemont Hospital, Montreal, Quebec, Canada
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22
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Eiring AM, Harb JG, Neviani P, Garton C, Oaks JJ, Spizzo R, Liu S, Schwind S, Santhanam R, Hickey CJ, Becker H, Chandler JC, Andino R, Cortes J, Hokland P, Huettner CS, Bhatia R, Roy DC, Liebhaber SA, Caligiuri MA, Marcucci G, Garzon R, Croce CM, Calin GA, Perrotti D. miR-328 functions as an RNA decoy to modulate hnRNP E2 regulation of mRNA translation in leukemic blasts. Cell 2010; 140:652-65. [PMID: 20211135 DOI: 10.1016/j.cell.2010.01.007] [Citation(s) in RCA: 382] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 09/25/2009] [Accepted: 01/05/2010] [Indexed: 12/23/2022]
Abstract
MicroRNAs and heterogeneous ribonucleoproteins (hnRNPs) are posttranscriptional gene regulators that bind mRNA in a sequence-specific manner. Here, we report that loss of miR-328 occurs in blast crisis chronic myelogenous leukemia (CML-BC) in a BCR/ABL dose- and kinase-dependent manner through the MAPK-hnRNP E2 pathway. Restoration of miR-328 expression rescues differentiation and impairs survival of leukemic blasts by simultaneously interacting with the translational regulator poly(rC)-binding protein hnRNP E2 and with the mRNA encoding the survival factor PIM1, respectively. The interaction with hnRNP E2 is independent of the microRNA's seed sequence and it leads to release of CEBPA mRNA from hnRNP E2-mediated translational inhibition. Altogether, these data reveal the dual ability of a microRNA to control cell fate both through base pairing with mRNA targets and through a decoy activity that interferes with the function of regulatory proteins.
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Affiliation(s)
- Anna M Eiring
- Human Cancer Genetics Program, Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, Columbus, OH 43210, USA
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Stevenson RE, Rogers RC, Chandler JC, Gauderer MWL, Hunter AGW. Escape of the yolk sac: a hypothesis to explain the embryogenesis of gastroschisis. Clin Genet 2009; 75:326-33. [DOI: 10.1111/j.1399-0004.2008.01142.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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Hendrick JM, Kaste SC, Tamburro RF, Hoffer FA, Onciu M, Sandlund JT, Ribeiro RC, Chandler JC, Howard SC. Abdominal compartment syndrome in a newly diagnosed patient with Burkitt lymphoma. Pediatr Radiol 2006; 36:254-7. [PMID: 16395547 DOI: 10.1007/s00247-005-0046-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 09/19/2005] [Accepted: 10/03/2005] [Indexed: 11/25/2022]
Abstract
We present the radiological and clinical aspects of a patient with advanced-stage Burkitt lymphoma who presented with an acute abdomen complicated by abdominal compartment syndrome.
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Affiliation(s)
- Jennifer M Hendrick
- Department of Radiological Sciences, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA
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25
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Mehall JR, Ennis JS, Saltzman DA, Chandler JC, Grewal H, Wagner CW, Jackson RJ, Smith SD. Prospective results of a standardized algorithm based on hemodynamic status for managing pediatric solid organ injury. J Am Coll Surg 2001; 193:347-53. [PMID: 11584961 DOI: 10.1016/s1072-7515(01)01027-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Controversy surrounds the need for ICU admission, prolonged bed rest, and the duration of activity restrictions for children sustaining blunt trauma. Adult literature supports management based on hemodynamic status, not CT grade. STUDY DESIGN A 3-year prospective study of a standardized management algorithm for hemodynamically normal pediatric patients with blunt liver or spleen injury was performed. Patient selection was based on vital signs, irrespective of injury grade on CT. Patients requiring ICU admission for nonliver or nonspleen injury were excluded. Patients were admitted to a surgical ward with serial hematocrit levels. Discharge occurred 48 hours postinjury if patients had no abdominal tenderness, tolerated a regular diet, and had a stable hematocrit. Patients were allowed noncontact activity, including school, after discharge. Patients were followed up at 1 month with ultrasonographic imaging. RESULTS Eighty-nine patients sustained blunt liver or spleen injury. Forty-five patients were excluded for other injuries (Glasgow Coma Scale < 13, 32 of 45); the remaining 44 patients had a mean age of 8.9 years (range 2 to 17 years), Injury Severity Score 10.6 (range 4 to 33), liver grade 2.1, and splenic injury grade 2.3. Mechanisms of injury were predominately motor vehicle collisions (59%). All patients were managed nonoperatively without transfusion; 43 of 44 patients completed the algorithm. Mean observation was 55.2 +/- 12.3 hours. One-month followup occurred in 33 of 44 patients, with one complication detected and no delayed bleeding. CONCLUSION Management of pediatric solid organ injury should be guided by hemodynamic status and not injury grade on CT. Hemodynamically normal children can be safely managed without intensive care monitoring, do not need prolonged hospitalization, and can resume school on discharge.
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Affiliation(s)
- J R Mehall
- Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock 72202, USA
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26
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Abstract
The usual complications after a definitive pull-through procedure for Hirschsprung's disease include stricture formation, enterocolitis, bowel obstruction, and, occasionally, wound infection. The authors report a case of mucinous adenocarcinoma arising 32 years later at a stricture site from a previous pull-through procedure.
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Affiliation(s)
- C M Finck
- Arkansas Children's Hospital, Little Rock, AR 72202, USA
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27
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Abstract
Congenital abdominal aortic aneurysms are a distinct entity from acquired aortic aneurysms. The authors present the case of a 6-week-old boy with a 6-cm aneurysm involving the abdominal aorta and common iliac arteries. Three other cases of congenital aortic aneurysms are reviewed, and an approach to these rare patients is discussed. J Pediatr Surg 36:657-658.
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Affiliation(s)
- J R Mehall
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 800 Marshall St., Little Rock, AR 72202, USA
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28
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Abstract
Necrotizing enterocolitis (NEC) is a disease in which the primary risk factor is prematurity. Despite, and partially as a result of, the tremendous strides neonatal care has taken, it is a major cause of morbidity and mortality of the newborn. The infant with very low birth weight is particularly susceptible, and the management of the condition in this group differs somewhat from other neonates. The outcomes continue to improve, but there are significant sequelae. Prevention, which would be the best "cure," is elusive, in no small part because of the multifactorial nature of the etiology of NEC.
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MESH Headings
- Enterocolitis, Necrotizing/complications
- Enterocolitis, Necrotizing/diagnosis
- Enterocolitis, Necrotizing/therapy
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/therapy
- Infant, Very Low Birth Weight/physiology
- Intestinal Perforation/etiology
- Laparotomy
- Treatment Outcome
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Affiliation(s)
- J C Chandler
- Division of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, USA
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Abstract
Laparoscopic cholecystectomy is being performed with increasing frequency in children. The authors discuss the presentation, surgical technique, overall results, and potential complications associated with pediatric laparoscopic biliary tract surgery, citing a large personal experience as well as that reported in the literature.
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Affiliation(s)
- E P Tagge
- Division of Pediatric Surgery, Medical University of South Carolina, Charleston 29425, USA
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Chandler JC, Frankel AE, Tagge EP. Genetic engineering of immunotoxins. Semin Pediatr Surg 1996; 5:206-11. [PMID: 8858768] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Immunotoxins, composed of both targeting mechanisms and toxins, hold great promise for the treatment of some cancers and other pathological conditions. Research and manufacture of these drugs use various techniques of molecular biology, some of which are described in this article. A considerable amount of research has focused on ricin, a plant toxin, and its immunoconjugates. Areas currently under evaluation by our laboratory include structure-function studies based on mutational analysis, enhancement of intracellular trafficking, genetic fusion of the targeting and toxic moieties, and the expression of toxin in plant cell culture.
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Affiliation(s)
- J C Chandler
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA
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Tagge EP, Tagge DU, Chandler JC, Pitre BR, Haddad G, Frankel AE, Willingham MC, Garvin AJ, Papas TS. Molecular biology and the pediatric surgeon: definitions and basic methodology. Semin Pediatr Surg 1996; 5:139-48. [PMID: 8858759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Molecular biology techniques and their application are becoming increasingly important to the practicing clinician. This article reviews the basics of DNA chemistry and highlights important molecular biology techniques. It will provide a guide for the pediatric surgeon as she/he attempts to integrate this field into everyday practice.
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Affiliation(s)
- E P Tagge
- Department of Surgery, Medical University of South Carolina, Charleston, USA
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32
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Tagge EP, Mulvihill D, Chandler JC, Richardson M, Uflacker R, Othersen HD. Childhood pleuropulmonary blastoma: caution against nonoperative management of congenital lung cysts. J Pediatr Surg 1996; 31:187-9; discussion 190. [PMID: 8632276 DOI: 10.1016/s0022-3468(96)90345-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pulmonary blastoma is a rare and aggressive malignant tumor that affects children and adults. Recently a 3-year-old boy with a 2-year history of bilateral unilocular pulmonary cysts was transferred for evaluation of a cough and high spiking fever. A chest radiogram showed left pulmonary consolidation with pleural effusion, but thoracentesis was unsuccessful. Computerized tomography (CT) was suggestive of a pulmonary abscess, but CT-guided drainage did not yield any purulent fluid. Percutaneous biopsies were performed, and the cytology showed malignant cells. During thoracotomy, a large tumor involving the left lower lobe and pleural space was found, and a biopsy was performed. A frozen section showed blastemal and mesenchymal components devoid of neoplastic epithelium, consistent with the pleural variant of pulmonary blastoma. A left lower lobectomy, with tumor decortication of the pleural space, achieved total gross tumor removal. The child received aggressive multiagent chemotherapy, and midway through it he underwent elective excision of the opposite lung cyst. It has been 17 months since the lobectomy; he is off chemotherapy and has no evidence of disease. A review of the literature showed that a large number of pediatric pulmonary blastomas are associated with cystic lung disease. Because total tumor removal offers the only chance of a good long-term outcome, surgical excision or close follow-up of pulmonary cysts in children is strongly recommended.
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Affiliation(s)
- E P Tagge
- Department of Surgery, Medical University of South Carolina, Charleston, S.C. 29425, USA
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Fleshner PR, Siegman MG, Slater GI, Brolin RE, Chandler JC, Aufses AH. A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction. Am J Surg 1995; 170:366-70. [PMID: 7573730 DOI: 10.1016/s0002-9610(99)80305-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many cases of acute adhesive small-bowel obstruction (SBO) can be successfully treated with intestinal tube decompression. There is considerable controversy, however, regarding whether a short nasogastric tube (NGT) or a long nasointestinal tube (LT) is the best method of intestinal tube decompression. PATIENTS AND METHODS A prospective, randomized trial was conducted to compare NGT and LT decompression with respect to the success of nonoperative treatment and morbidity of surgical intervention in 55 patients with acute adhesive SBO. RESULTS Twenty-eight patients were managed with NGT and 27 with LT. There were 44 cases of partial SBO (23 NGT, 21 LT) and 11 cases of complete SBO (5 NGT, 6 LT). Twenty-one patients ultimately required operation, including 13 managed with NGT (46%) and 8 with LT (30%) (P = 0.16). The mean period between admission and operation was 60 hours in the NGT group versus 65 hours in the LT group. At operation, 3 patients in the NGT group had ischemic bowel that required resection. Postoperative complications occurred in 23% of patients treated with NGT versus 38% of patients treated with LT (P = 0.89). Postoperative ileus averaged 6.1 days for NGT patients versus 4.6 days for LT patients (P = 0.44). There were no deaths. CONCLUSIONS Patients with adhesive SBO can safely be given a trial of tube decompression upon hospital admission. There was no advantage of one type of tube over the other in patients with adhesive SBO.
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Affiliation(s)
- P R Fleshner
- Department of Surgery, Mount Sinai Hospital, New York, New York, USA
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