Propensity Score Analysis of Conditioning Intensity in Peripheral Blood Haploidentical Hematopoietic Cell Transplantation.

T cell replete HLA-haploidentical hematopoietic cell transplantation (haplo-HCT) with post-transplant cyclophosphamide was originally described using a reduced-intensity conditioning (RIC) regimen. Given that myeloablative conditioning (MAC) is more effective at preventing disease relapse, we compared outcomes of patients receiving MAC and RIC regimens. We evaluated overall survival (OS), disease-free survival (DFS), relapse, nonrelapse mortality (NRM), and graft-versus-host disease (GVHD) of 148 patients that underwent haplo-HCT with either MAC (n = 61) or RIC (n = 87).

Severe Cytokine-Release Syndrome after T Cell-Replete Peripheral Blood Haploidentical Donor Transplantation Is Associated with Poor Survival and Anti-IL-6 Therapy Is Safe and Well Tolerated.

Use of high-dose post-transplantation cyclophosphamide for graft-versus-host disease prophylaxis has expanded the use of unmanipulated haploidentical hematopoietic cell transplantation. The immediate post-transplantation course in T cell-replete peripheral blood haploidentical hematopoietic cell transplantation (haplo-HCT) is often complicated by symptoms resembling cytokine-release syndrome (CRS), previously described in recipients of targeted cellular therapeutics. However, we know little about the incidence and impact of CRS on outcomes in these patients.

Targeting bone marrow lymphoid niches in acute lymphoblastic leukemia.

In acute lymphoblastic leukemia (ALL) the bone marrow microenvironment provides growth and survival signals that may confer resistance to chemotherapy. Granulocyte colony-stimulating factor (G-CSF) potently inhibits lymphopoiesis by targeting stromal cells that comprise the lymphoid niche in the bone marrow. To determine whether lymphoid niche disruption by G-CSF sensitizes ALL cells to chemotherapy, we conducted a pilot study of G-CSF in combination with chemotherapy in patients with relapsed or refractory ALL.

Primary care visits for asthma monitoring over time and association with acute asthma visits for urban Medicaid-insured children.

Objectives: To examine the association between numbers of primary care provider (PCP) visits for asthma monitoring (AM) over time and acute asthma visits in the emergency department (ED) and at the PCP for Medicaid-insured children.

Methods: We prospectively enrolled 2-10 years old children during ED asthma visits. We audited hospital and PCP records for each subject for three consecutive years.

Regional lymphadenectomy is indicated in the surgical treatment of pancreatic neuroendocrine tumors (PNETs).

Objective: To explore the prognostic importance and preoperative predictors of lymph node metastasis in an effort to guide surgical decision making in patients with pancreatic neuroendocrine tumors (PNETs).

Background: PNETs are uncommon, and the natural history of the disease is not well described. As a result, there remains controversy regarding the optimal management of regional lymph nodes during resection of the primary tumor.

Glycogen synthase kinase 3β inhibition as a therapeutic approach in the treatment of endometrial cancer.

Alternative strategies beyond current chemotherapy and radiation therapy regimens are needed in the treatment of advanced stage and recurrent endometrial cancers. There is considerable promise for biologic agents targeting the extracellular signal-regulated kinase (ERK) pathway for treatment of these cancers. Many downstream substrates of the ERK signaling pathway, such as glycogen synthase kinase 3β (GSK3β), and their roles in endometrial carcinogenesis have not yet been investigated.

IL-12p70-producing patient DC vaccine elicits Tc1-polarized immunity.

Background: Systemic administration of IL-12p70 has demonstrated clinical activity in cancer patients, but dose-limiting toxicities have hindered its incorporation in vaccine formulations. Here, we report on the immunological and clinical outcomes upon vaccination with CD40L/IFN-γ-matured, IL-12p70-producing DCs.

Methods: 7 HLA-A*0201+ newly diagnosed stage IV melanoma patients were immunized against the gp100 melanoma antigen using autologous peptide-pulsed, CD40L/IFN-γ-matured DCs.

Appraisal of emerging symptoms of colorectal cancer: associations with dispositional, demographic, and tumor characteristics.

The time it takes for individuals to realize that their emerging colorectal cancer (CRC) symptoms are serious is often an impediment to expeditious help-seeking. Tailored educational efforts to hasten symptom appraisal time would benefit from knowledge of the characteristics of individuals who tend to neglect their symptoms as well as the nature of symptoms that are most often neglected. In a sample of 112 CRC patients, we investigated associations between duration of symptom appraisal and: (1) trait anxiety, and (2) tumor location, which affects symptomatology.

The characteristics and outcomes of patients with multiple myeloma dual refractory or intolerant to bortezomib and lenalidomide in the era of carfilzomib and pomalidomide.

Patients with multiple myeloma who are refractory or intolerant to both bortezomib and lenalidomide have a poor prognosis. Next-generation therapies carfilzomib and pomalidomide have shown promising activity in this dual refractory population. Here we describe the clinical characteristics and ascertain the effects of carfilzomib and pomalidomide on survival in this patient cohort.

A phase 1/2 study of chemosensitization with the CXCR4 antagonist plerixafor in relapsed or refractory acute myeloid leukemia.

The interaction of acute myeloid leukemia (AML) blasts with the leukemic microenvironment is postulated to be an important mediator of resistance to chemotherapy and disease relapse. We hypothesized that inhibition of the CXCR4/CXCL12 axis by the small molecule inhibitor, plerixafor, would disrupt the interaction of leukemic blasts with the environment and increase the sensitivity of AML blasts to chemotherapy. In this phase 1/2 study, 52 patients with relapsed or refractory AML were treated with plerixafor in combination with mitoxantrone, etoposide, and cytarabine.

A gene expression signature that predicts the therapeutic response of the basal-like breast cancer to neoadjuvant chemotherapy.

Several gene expression profiles have been reported to predict breast cancer response to neoadjuvant chemotherapy. These studies often consider breast cancer as a homogeneous entity, although higher rates of pathologic complete response (pCR) are known to occur within the basal-like subclass. We postulated that profiles with higher predictive accuracy could be derived from a subset analysis of basal-like tumors in isolation.

Sex differences in responding to rectal cancer symptoms.

Many people who develop cancer symptoms wait inordinate amounts of time before seeking medical attention. Studies have found that symptom appraisal time--the time that passes before the individual concludes that their symptoms could be serious--accounts for most of the total delay time across subjects. It is thus important to understand the individual characteristics associated with slow recognition of dangerous symptoms.

The Cancer Pain Inventory: preliminary development and validation.

Objective: The purpose of this study was to develop a Cancer Pain Inventory (CPI) that measures cancer patients' beliefs and concerns about pain. This paper describes development and pilot testing of a preliminary version of the CPI and describes its psychometric properties including its reliability and validity relative to established pain measures.

Methods: Subjects were recruited from inpatient and outpatient oncology services of an NCI-designated comprehensive cancer center.

Trait anxiety as an independent predictor of poor health-related quality of life and post-traumatic stress symptoms in rectal cancer.

Objectives: To determine the influence of trait anxiety on patient reports of health-related quality of life (HRQoL) and post-traumatic stress symptoms (PTSS) in a sample of rectal cancer survivors.

Design: Eighty patients who had been diagnosed with rectal cancer were assessed at two points in time in a longitudinal study.

Methods: At Time 1, soon after initial treatment, participants completed the State-Trait Anxiety Inventory and the Temperament and Character Inventory Harm Avoidance scale, which were combined into a composite measure of trait anxiety.

Isolation and molecular profiling of bone marrow micrometastases identifies TWIST1 as a marker of early tumor relapse in breast cancer patients.

Purpose: Micrometastatic cells detected in the bone marrow have prognostic significance in breast cancer. These cells are heterogeneous and likely do not exhibit uniform biological behavior. To understand the molecular diversity of disseminated cancer cells that reside in bone marrow, we enriched this cell population and did global gene expression profiling in the context of a prospective clinical trial involving women with clinical stage II/III breast cancer undergoing neoadjuvant chemotherapy.

Porous implant exposure: Incidence, management, and morbidity.

Purpose: To identify what factors may predispose patients to exposure of porous anophthalmic implants and to determine the outcome of exposed porous implants.

Methods: Examination of pooled data obtained through a PubMed literature search of English-language publications from 1989 through 2004 using the key words enucleation, evisceration, and socket reconstruction.

Results: Porous implants were inserted in 80% (3012 of 3777) of the cases identified from 49 publications.

Angiogenic cells can be rapidly mobilized and efficiently harvested from the blood following treatment with AMD3100.

Circulating endothelial progenitor cells (EPCs) are thought to contribute to angiogenesis following vascular injury, stimulating interest in their ability to mediate therapeutic angiogenesis. However, the number of EPCs in the blood is low, limiting endogenous repair, and a method to rapidly mobilize EPCs has not been reported. In this study, healthy donors were mobilized sequentially with the CXCR4 antagonist, AMD3100, and G-CSF.

Asthma coaching in the pediatric emergency department.

Objectives: Coaching and monetary incentives have been used to modify medical behavior of individuals with several chronic diseases, including asthma. The authors performed a randomized, controlled trial of an intervention combining asthma coaching during an emergency department (ED) visit for asthma, and monetary incentive to improve follow-up with primary care providers (PCP).

Methods: Subjects were parents of children 2-12 years of age, with Medicaid or no medical insurance, receiving treatment for asthma in the ED.

Relation of age, severity of illness, and hemodynamics with brain natriuretic peptide levels in patients <20 years of age with heart disease.

Brain natriuretic peptide (BNP) levels were obtained before cardiac catheterization in 193 pediatric patients with a variety of cardiac lesions. Age and functional status had strong relations to BNP values, with elevations of BNP levels associated with increasing functional disability and decreasing age. Mild but statistically significant correlations were found between BNP levels and right-sided cardiac pressures.

Human papillomavirus type and tobacco use as predictors of survival in early stage cervical carcinoma.

Objective: Molecular and environmental co-factors are known risk factors for cervical cancer. The aim of this study was to define the prognostic significance of HPV 18 and its phylogenetically related viruses and smoking on survival in patients with early stage cervical cancer.

Methods: HPV typing was performed on stage IB-IIB cervical tumors.

Improving follow-up for children with asthma after an acute Emergency Department visit.

Objective: To improve follow-up with primary care providers after acute Emergency Department (ED) asthma visits for children from low-income urban families.

Study Design: A prospective, randomized, controlled trial evaluated combined telephone asthma coaching and monetary incentive. The primary outcome was asthma-planning visits with primary care providers within 15 days of index ED visits.

Cervical carcinoma in the elderly: an analysis of patterns of care and outcome.

Background: Advanced age often is considered a poor prognostic factor for cervical carcinoma. The authors investigated the patterns of care and treatment outcomes of elderly women with cervical carcinoma.

Methods: A hospital-based tumor registry was used to identify patients with invasive cervical carcinoma who were treated between 1986 and 2003.

Psychological factors related to delay in consultation for cancer symptoms.

This research investigated psychological characteristics associated with delay in seeking help for symptoms of rectal cancer. Sixty nine subjects reconstructed pivotal events beginning with symptom onset and ending with medical consultation, and completed the Temperament and Character Inventory (TCI) and the State-Trait Anxiety Inventory (STAI). The mean delay time was around 6 months, with about 1 out of 6 subjects waiting one year or more.