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106 citation(s) found for "Muñoz, María del Mar".

Sexuality Challenges, Intimacy, and MPN Symptom Burden: An Analysis By The MPN Quality Of Life International Study Group (MPN-QOL ISG)
Geyer, Holly L. , Emanuel, Robyn M., Cannon, Keith, Slot, Stephanie, Boekhorst, Peter A.W. te , Commandeur, Suzan, Schouten, Harry C. , Sackmann, Federico, Fuentes, Ana Kerguelen, Pahl, Heike L. , Stegelmann, Frank , Döhner, Konstanze , Ranta, Dana, Reiter, Andreas , Boyer, Françoise, Étienne, Gabriel , Roy, Lydia , Cahn, Jean‐Yves , Harrison, Claire , Radia, Deepti , Muxí, Pablo , Maldonado, Norman I, Besses, Carlos , Cervantes, Francisco , Johansson, Peter , Barbui, Tiziano , Andréasson, Björn , Ferrari, Maria Luisa, Samuelsson, Jan , Birgegård, Gunnar , Xiao, Zhijian , Xu, Junqing , Zhang, Peihong , Dueck, Amylou C. , Kiladjian, Jean‐Jacques , Zweegman, Sonja , Hernández‐Maraver, Dolores , Grießhammer, Martin , Lehmann, Thomas , Ianotto, Jean‐Christophe , Barosi, Giovanni , Vannucchi, Alessandro M. , Passamonti, Francesco , Rambaldi, Alessandro , Xu, Zefeng , Sun, Xiujuan , Gale, Robert Peter , Mesa, Ruben A.

Blood | October 10, 2019 | Volume: 122 | Issue: 21 | Pages: 4088-4088

10.1182/blood.v122.21.4088.4088 Get It

Abstract Background We have previously reported on the high prevalence and severity of challenges with intimacy and sexuality amongst a large international cohort of MPN patients (Emanuel JCO 2012). We sought to further analyze the relationships between issues of intimacy (sexual desire and function), their relationships to MPN disease features, individual MPN symptom prevalence and severity, language, and overall quality of life. Methods Data was collected among an international cohort of patients with MPNs. Subjects completed the BFI, MPN-SAF, and EORTC QLQ-C30 instruments. Surveyed symptoms on the MPN-SAF included the patient’s perceptions of common MPN-related symptoms and overall quality of life (QOL) on a 0 (absent) to 10 (worst imaginable) scale. Specifically, the MPN-SAF sexuality item asked about “problems with sexual desire or function”. Total symptom score (TSS) was computed based on 10 symptom items using the published scoring algorithm on a 0 (all reported symptoms absent) to 100 (all reported symptoms worst imaginable) scale. Pairwise associations between the MPN-SAF sexuality item and continuous and categorical covariates were investigated using Pearson correlations and analysis of variance/t-tests, respectively. Multivariate regression models were used to investigate impact of groups of covariates on the sexuality item with the final multivariate model selected using forward regression. Results Demographics A total of 1908 MPN patients (essential thrombocythemia=799, polycythemia vera=671, myelofibrosis=432, missing=6) completed the sexuality item. Participants were of typical age (median=60, range 15-94) and gender (female=53%). Overall, 1218 subjects described sexuality related complaints (score >0) with an overall mean symptom score of 3.5 (median=2.0, SD=3.7, range 0-10); 725/1908 (38%) patients had severe sexuality related complaints (score >4). Univariate Analysis Among the QLQ-C30 functioning scales, all domains had similar statistically significant correlations (r=-.26 to -.32, all p<0.001). Among QLQ-C30 symptom scales, all QLQ-C30 symptoms displayed correlations ranging between .08 and .29 (all p<0.001). Among MPN-SAF items, the MPN-SAF sexuality item correlated most significantly with the TSS (r=.41, p<0.001), along with MPN-SAF symptoms (r=.16 to .39; all p<0.001). MPN-SAF sexuality measure significantly differed by anemia (means: absent 3.3, present 4.5; p<0.001), leukopenia (means: absent 3.4, present 4.4; p=0.01), thrombocytopenia (means: absent 3.3, present 4.5; p<0.001), red cell transfusion (means: no 3.5, yes 5.0; p<0.001), MPN subtype (ET mean 3.1, PV mean=3.6, MF mean=4.4; p<0.001) and language (means ranged from 2.4 [Swedish] to 4.6 [Chinese]; p<0.001). MPN-SAF sexuality did not significantly differ by age, gender, prior thrombosis or prior hemorrhage. Multivariate Analysis In a multivariate model of MPN-SAF sexuality containing all QLQ-C30 functioning scales, physical (p=0.001), emotional (p=0.01), cognitive (p=0.005) and social (p=0.002) functioning were all statistically significant. Numerous symptoms were also significant in a multivariate model of MPN-SAF sexuality containing all other MPN-SAF symptoms (all p<0.05; abdominal pain, inactivity, dizziness/vertigo/lightheadedness, insomnia, depression/sad mood, cough, night sweats and overall QOL). The final multivariate model based on forward regression starting with all demographics, clinical variables, and patient-reported QLQ-C30 scales and MPN-SAF items found age, language, QLQ-C30 role functioning and MPN-SAF items (insomnia, depression/sad mood, night sweats and QOL) to be significant (p<0.05). Conclusions Sexuality related complaints have been linked to both physiologic and psychologic origins and are highly prevalent within the MPN population. The results of this study congruently identified close associations between sexuality and function within emotional, cognitive and social domains. Additionally, the correlations of sexuality issues with MPN symptoms and disease features further suggest this item is a key correlate of overall functionality and quality of life. Future investigations into the causative factors and biological correlates of this complaint may assist in addressing this ongoing challenge. Disclosures: Etienne: novartis: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Bristol Myers Squibb: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Pfizer: Membership on an entity’s Board of Directors or advisory committees; Ariad: Membership on an entity’s Board of Directors or advisory committees. Roy:Novartis, BMS: Honoraria. Harrison:Novartis: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; YM Bioscience: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Celgene: Honoraria; Shire: Speakers Bureau; S Bio: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity’s Board of Directors or advisory committees. Birgegard:Vifor Pharma: Honoraria. Mesa:Eli Lilly and Co: Research Funding; Genetech: Research Funding; Gilead: Research Funding; Incyte: Research Funding; Sanofi: Research Funding; NS pharma: Research Funding; Celgene: Research Funding.
Insomnia, Quality Of Life and MPN Symptom Burden: An Analysis By The MPN Quality Of Life International Study Group (MPN-QOL ISG)
Geyer, Holly L. , Emanuel, Robyn M., Cannon, Keith, Slot, Stephanie, Boekhorst, Peter A.W. te , Commandeur, Suzan, Schouten, Harry C. , Sackmann, Federico, Fuentes, Ana Kerguelen, Pahl, Heike L. , Stegelmann, Frank , Döhner, Konstanze , Bonatz, Karin, Reiter, Andreas , Boyer, Françoise, Étienne, Gabriel , Ranta, Dana, Roy, Lydia , Cahn, Jean‐Yves , Harrison, Claire , Radia, Deepti , Muxí, Pablo , Maldonado, Norman I, Besses, Carlos , Cervantes, Francisco , Johansson, Peter , Barbui, Tiziano , Andréasson, Björn , Ferrari, Maria Luisa, Samuelsson, Jan , Birgegård, Gunnar , Xiao, Zhijian , Xu, Junqing , Zhang, Peihong , Dueck, Amylou C. , Kiladjian, Jean‐Jacques , Zweegman, Sonja , Hernández‐Maraver, Dolores , Grießhammer, Martin , Lehmann, Thomas , Ianotto, Jean‐Christophe , Barosi, Giovanni , Vannucchi, Alessandro M. , Passamonti, Francesco , Rambaldi, Alessandro , Xu, Zefeng , Zhang, Yue , Sun, Xiujuan , Gale, Robert Peter , Mesa, Ruben A.

Blood | October 10, 2019 | Volume: 122 | Issue: 21 | Pages: 4087-4087

10.1182/blood.v122.21.4087.4087 Get It

Abstract Background We have previously reported on the high prevalence and severity of insomnia amongst a large international cohort of MPN patients (Emanuel JCO 2012). We sought to further analyze the relationships between insomnia and the MPN disease features (in particular splenomegaly, status of blood counts), individual MPN symptom prevalence and severity, language, and overall quality of life. Methods Data was collected among an international cohort of patients with MPNs. Subjects completed the BFI, MPN-SAF, and EORTC QLQ-C30 instruments. Surveyed symptoms on the MPN-SAF included the patient’s perceptions of common MPN-related symptoms and overall quality of life (QOL) on a 0 (absent) to 10 (worst imaginable) scale. Specifically, the MPN-SAF insomnia item asked about “difficulty sleeping”. Total symptom score (TSS) was computed based on 10 symptom items using the published scoring algorithm on a 0 (all reported symptoms absent) to 100 (all reported symptoms worst imaginable) scale. Pairwise associations between the MPN-SAF insomnia item and continuous and categorical covariates were investigated using Pearson correlations and analysis of variance/t-tests, respectively. Multivariate regression models were used to investigate impact of groups of covariates on the insomnia item with the final multivariate model selected using forward regression. Results Demographics A total of 1992 MPN patients (essential thrombocythemia=834, polycythemia vera=703, myelofibrosis=449, unknown=6) completed the insomnia item. Participants were of typical age (median=61, range-15-94) and gender (female=54%). Overall, 1307 subjects endorsed the MPN insomnia item (score >0) with an overall mean symptom score of 3.0 (median=2.0, SD=3.1. range=0-10); 603/1992 (30%) of patients had severe insomnia related complaints (score >4). Univariate Analysis Among QLQ-C30 functioning scales, emotional functioning most highly correlated with the MPN-SAF insomnia item (r=-.47, p<0.001) with all other domains also having statistically significant but slightly weaker correlation (all p<0.001). Among QLQ-C30 symptom scales, insomnia (r=.79, p<0.001) and fatigue (r=.45, p<0.001) most highly correlated with the MPN-SAF insomnia item with all other QLQ-C30 symptoms having correlations between .13 and .37 (all p<.001). Among MPN-SAF items, the MPN-SAF insomnia item correlated with all MPN-SAF items (all p<0.001) including the TSS (r=0.55, p<0.001) and most highly with depression (r=.52, p<0.001), concentration problems (r=.43, p<0.001), overall QOL (r=.41, p<0.001), night sweats (r=.41, p<0.001), and extremity tingling (r=.40, p<0.001). MPN-SAF insomnia significantly differed by gender (means: M 2.4, F 3.4; p<0.001), language (means ranged from 2.6 [Italian] to 3.6 [German]; p=0.01), anemia (means: absent 2.8, present 3.5; p<0.001), prior hemorrhage (means: no 2.9, yes 3.7; p=0.01), and requiring red blood cell transfusion (means: no 2.9, yes 3.6; p=0.03), with a trend for a difference by MPN type (ET mean=2.7, PV mean=3.0, MF mean=3.2; p=0.06). Multivariate Analysis In a multivariate model of MPN-SAF insomnia containing all QLQ-C30 functioning scales, physical, emotional, and cognitive functioning along with global health status/QOL were all significant (all p<0.001). Numerous symptoms were also significant in a multivariate model of MPN-SAF insomnia containing all other MPN-SAF symptoms (all p<0.05: headaches, extremity tingling, depression, sexual problems, night sweats, pruritus, fever, and QOL). The final multivariate model based on forward regression starting with all demographics, clinical variables, and patient-reported QLQ-C30 scales and MPN-SAF items found age, gender, QLQ-C30 emotional functioning and MPN-SAF items to be significant. Conclusions Insomnia is highly prevalent and severe in MPN patients and closely correlates with most other MPN-related symptoms and functional domains bearing a multi-faceted impact on overall quality of life. Correlations between insomnia and emotional, cognitive, and physical complaints including depression/sad mood, concentration problems, night sweats, and numbness/tingling in the extremities suggest that the cause of MPN-related sleep complaints is likely complex. Future studies should evaluate the impact of interventions on MPN associated insomnia as well as its biological underpinnings. Disclosures: Etienne: novartis: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Bristol Myers Squibb: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Pfizer: Membership on an entity’s Board of Directors or advisory committees; Ariad: Membership on an entity’s Board of Directors or advisory committees. Roy:Novartis, BMS: Honoraria. Harrison:Novartis: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; YM Bioscience: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Celgene: Honoraria; Shire: Speakers Bureau; S Bio: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity’s Board of Directors or advisory committees. Birgegard:Vifor Pharma: Honoraria.
Myeloproliferative (MPN) Symptom Burden Response Thresholds: Assessment Of MPN-SAF TSS Quartiles As Potential Markers Of Symptom Response
Emanuel, Robyn M., Geyer, Holly L. , Slot, Stephanie, Boekhorst, Peter A.W. te , Commandeur, Suzan, Schouten, Harry C. , Sackmann, Federico, Fuentes, Ana Kerguelen, Pahl, Heike L. , Stegelmann, Frank , Doehner, Konstanze, Bonatz, Karin, Reiter, Andreas , Boyer, Françoise, Étienne, Gabriel , Ranta, Dana, Roy, Lydia , Cahn, Jean‐Yves , Harrison, Claire , Radia, Deepti , Muxí, Pablo , Maldonado, Norman I, Besses, Carlos , Cervantes, Francisco , Johansson, Peter , Barbui, Tiziano , Andréasson, Björn , Ferrari, Maria Luisa, Samuelsson, Jan , Birgegård, Gunnar , Xiao, Zhijian , Xu, Junqing, Zhang, Peihong , Tefferi, Ayalew , Dueck, Amylou C. , Kiladjian, Jean‐Jacques , Zweegman, Sonja , Hernández‐Maraver, Dolores , Lehmann, Thomas , Ianotto, Jean‐Christophe , Barosi, Giovanni , Vannucchi, Alessandro M. , Passamonti, Francesco , Grießhammer, Martin , Rambaldi, Alessandro , Xu, Zefeng , Zhang, Yue , Sun, Xiujuan , Gale, Robert Peter , Mesa, Ruben A.

Blood | October 10, 2019 | Volume: 122 | Issue: 21 | Pages: 4067-4067

10.1182/blood.v122.21.4067.4067 Get It

Abstract Background We have previously reported on the significant, but heterogeneous baseline MPN symptom burden among an international sample of MPN patients (including essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF)) utilizing the MPN Symptom Assessment Form (MPN-SAF) and the derivative Total Symptom Score (MPN-SAF TSS). Recent clinical trials have sought to determine optimal MPN symptom response criteria, such as absolute 10 point improvement in MPN SAF TSS for ET/PV (ELN Criteria, Barosi et. al. Blood 2013) and 50% reduction in MPN-SAF TSS for MF (IWG-MRT, Tefferi et. al. Blood 2013). We sought to determine the role of improvement in MPN-SAF TSS quartiles as potential thresholds to assess symptomatic response to therapy. Methods Utilizing prospectively gathered MPN-SAF TSS (Emanuel et. al. JCO 2012) in patients we assessed potential thresholds of response by evaluating quartile thresholds for severity of symptom burden. The MPN-SAF TSS was scored as the average of 10 symptoms (individual symptoms scores of 0-10, with a total score of 0 (best) to 100 (worst)). MPN-SAF TSS quartiles were identified by the percentage of scores between 0-24% (quartile 1 (Q1)), 25-49% (quartile 2 (Q2)), 50-74% (quartile 3 (Q3)), 75-100% (quartile 4 (Q4)). Results MPN-SAF TSS Quartiles: MPN-SAF TSS quartiles were identified among 1858 MPN patients (ET N=775, PV N=654, and MF N=423). Overall MPN-SAF TSS scores of 0 - 7 were designated as Q1, 8 - 17 as Q2, 18 - 31 as Q3, and ≥ 32 was as Q4. MPN-SAF TSS scores were significantly different between clusters (p<0.001). Associations Between Quartiles and Demographic/ Disease Factors: As quartiles increased, the proportion of PV and ET patients diminished and MF increased (Table 1, p<0.001). Cytopenias and transfusion dependence increased in prevalence in the higher quartiles (p<0.001). A history of prior thrombosis was also significantly more prevalent in the quartiles with highest symptom burden (p<0.001). The prevalence of women was significantly higher among the more symptomatic quartiles females 48.9% Q1, 49.4% Q2, 58.4% Q3, and 60.1% Q4; p<0.001). Associations Between Individual Symptoms and MPN-SAF TSS Quartiles: All individual symptoms measured in the MPN-SAF TSS were significantly worse in quartiles as they increased (p<0.0001). Evaluation of Prognostic Scoring and MPN-SAF TSS Quartiles: Comparison of each patients individual risk score (IPSET, PV, DIPSS for MF) and worsening symptom quartile showed the highest correlation with MF patients (DIPSS) (Table 1). However, ET and PV risk scores were not surrogates for symptom burden by quartile. Conclusions Distribution of MPN patient symptomatic burden by MPN-SAF TSS quartiles provides an easy-to-calculate method to cluster and analyze MPN patients of similar burden. Although MF patients are most prevalent in the most severe quartile of MPN symptomatology it is notable that Q4 has many patients with PV and ET. Future prospective efforts are ongoing to assess the potential of using changes in quartile (i.e. improving from Q3 to Q1) as potential symptomatic response thresholds. Disclosures: Etienne: novartis: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Bristol Myers Squibb: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Pfizer: Membership on an entity’s Board of Directors or advisory committees; Ariad: Membership on an entity’s Board of Directors or advisory committees. Roy:Novartis, BMS: Honoraria. Harrison:Gilead: Honoraria, Membership on an entity’s Board of Directors or advisory committees; S Bio: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Shire: Speakers Bureau; Celgene: Honoraria; YM Bioscience: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Novartis: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau. Vannucchi:Novartis: Honoraria, Membership on an entity’s Board of Directors or advisory committees. Birgegard:Vifor Pharma: Honoraria.
Mean muscle attenuation correlates with severe acute pancreatitis unlike visceral adipose tissue and subcutaneous adipose tissue
Sternby, Hanna , Mahle, Mariella, Linder, Nicolas , Erichson-Kirst, Laureen, Dimova, Alexandra , Ignatavičius, Povilas , Ilzarbe, Lucas , Koiva, Peeter, Penttilä, Anne , Regnér, Sara , Bollen, Thomas L., Brill, Richard , Stangl, Franz , Wohlgemuth, Walter A. , Singh, Vijay , Busse, Harald , Beer, Sebastian , Singh, Vijay P , Verdonk, Robert C , Michl, Patrick , Rosendahl, Jonas , Regnér, Sara

United European Gastroenterology Journal | October 10, 2019 | Volume: 7 | Issue: 10 | Pages: 1312-1320

10.1177/2050640619882520 | PMID 31839956 Get It

Background Acute pancreatitis (AP) is a frequent disorder with considerable morbidity and mortality. Obesity has previously been reported to influence disease severity. Objective The aim of this study was to investigate the association of adipose and muscle parameters with the severity grade of AP. Methods In total 454 patients were recruited. The first contrast‐enhanced computed tomography of each patient was reviewed for adipose and muscle tissue parameters at L3 level. Associations with disease severity were analysed through logistic regression analysis. The predictive capacity of the parameters was investigated using receiver operating characteristic (ROC) curves. Results No distinct variation was found between the AP severity groups in either adipose tissue parameters (visceral adipose tissue and subcutaneous adipose tissue) or visceral muscle ratio. However, muscle mass and mean muscle attenuation differed significantly with p ‐values of 0.037 and 0.003 respectively. In multivariate analysis, low muscle attenuation was associated with severe AP with an odds ratio of 4.09 (95% confidence intervals: 1.61–10.36, p ‐value 0.003). No body parameter presented sufficient predictive capability in ROC‐curve analysis. Conclusions Our results demonstrate that a low muscle attenuation level is associated with an increased risk of severe AP. Future prospective studies will help identify the underlying mechanisms and characterise the influence of body composition parameters on AP.
Symptom Severity and Clinical Variables of Polycythemia Vera Patients with Splenomegaly, Phlebotomy Requirements and/or Hydroxyurea Use: a Retrospective Evaluation of 1334 Patients
Geyer, Holly L. , Scherber, Robyn M. , Xiao, Zhijian , Slot, Stephanie, Fuentes, Ana Kerguelen, Döhner, Konstanze , Harrison, Claire , Radia, Deepti , Muxí, Pablo , Sackman, Federico, Besses, Carlos , Cervantes, Francisco , Johansson, Peter , Andréasson, Björn , Rambaldi, Alessandro , Barbui, Tiziano , Samuelsson, Jan , Birgegård, Gunnar , Bonatz, Karin, Reiter, Andreas , Boyer, Françoise, Étienne, Gabriel , Ranta, Dana, Roy, Lydia , Cahn, Jean‐Yves , Maldonado, Norman I, Ferrari, Maria Luisa, Cannon, Keith, Boekhorst, Peter A.W. te , Schouten, Harry C. , Pahl, Heike L. , Stegelmann, Frank , Xu, Junqing , Zhang, Peihong , Rambaldi, Alessandro , Dueck, Amylou C. , Kiladjian, Jean‐Jacques , Zweegman, Sonja , Hernández‐Maraver, Dolores , Vannucchi, Alessandro M. , Passamonti, Francesco , Ianotto, Jean‐Christophe , Barosi, Giovanni , Grießhammer, Martin , Lehmann, Thomas , Xu, Zefeng , Zhang, Yue , Sun, Xiujuan , Mesa, Ruben A.

Blood | October 9, 2019 | Volume: 124 | Issue: 21 | Pages: 1848-1848

10.1182/blood.v124.21.1848.1848 Get It

Abstract Background Polycythemia vera (PV) is a clonal myeloproliferative disorder characterized by erythrocytosis, splenomegaly and a frequently burdensome symptom profile. Despite current guidelines of aspirin, phlebotomy, and selective cytoreduction, many patients have inadequately controlled PV-related symptoms and/or disease features. We performed a comparison of PV symptom burden/disease feature phenotypes to understand unmet needs in current medical management. Methods Data was collected prospectively amongst an international cohort of PV patients including symptom burden, demographics, and disease features. Subgroups were identified who had previously failed hydroxyurea (PV-HU), required ongoing phlebotomy (PV-P), had palpable splenomegaly (PV-S), or had all 3 features (PV-HUPS). Control groups were derived from the remaining PV patients lacking the specified subgroup trait; patients in whom the trait status was unknown were excluded from each respective control group. All participants completed the MPN specific symptom burden questionnaire (MPN-SAF TSS (MPN-10 – Table 1)) and had no prior history of splenectomy. Surveyed symptoms on the MPN-10 included the patient's perceptions of common MPN-related symptoms and overall quality of life (QOL) on a 0 (absent) to 10 (worst imaginable) scale. PV risk scores were calculated using the 2013 criteria (Leukemia 2013). Comparison of symptoms between groups employed t-tests. Results Patient Demographics and Disease Features Between Phenotypic Groups A total of 1334 PV patients completed the MPN-10, and were assigned to categories of PV-HU (499 [37%]), PV-P (646 [48%]), PV-S (369, [28%]), and PV-HUPS (148 [12%]). The demographics between these groups were similar (comparable age (median range 60-63), PV risk scores (mean risk range: Low 16.4-23.7%; Intermediate 31.4%-36.6%; High 42.8%-47%). Mean hemoglobin was similar among PV subgroups (range 14.4-14.9); PV-HUPS had a higher mean WBC count (20.3 g/dL vs. 8.8-11.8 g/dL) and platelet count (703.5 x 10(9)/L vs. 327.5-462.8 x 10(9)/L), and disease duration (11.5 years vs. 6.4-8.8 years). Prior thrombosis was most common in PV-S patients (28.5% vs. 21.8-25.2%) and prior hemorrhage was most common in PV-HUPS patients (23.8% vs. 13.7-15.8%). Symptom Burden The MPN-10 scores of each problematic PV phenotype (HU, P, S, HUPS) were compared to the remainder of the PV cohort lacking the trait (PV-control; Table 1). Both individual symptom scores and TSS were highest for PV-HUPS patients (mean TSS 32.5 vs. 27.7-29.2). All problematic PV subgroups demonstrated significant differences for individual symptoms and TSS compared to PV-control. Comparing "problematic" subgroup responses, PV-HU patients described more inactivity whereas PV-S patients described more early satiety and pruritus. No statistical differences were noted in PV-HU, PV-P and PV-HUPS patient responses to MPN-10 items of "fever" and "weight loss". Discussion PV patients who have either failed HU, are undergoing phlebotomy and/or have splenomegaly exhibit moderate to severe symptomatology and demonstrate unmet medical need for management. As evidenced in this study, considerable overlap in symptomatology exists in PV-HU, PV-P, PV-S and PV-HUPS. Current randomized trials of JAK inhibitors have demonstrated benefits in a PV-HUPS phenotype. This data suggests that PV patients with any evidence of inadequate control (PV-HU, P, or S) have similarly unmet needs and may be candidates for clinical trials, intensification of medical therapy or perhaps JAK inhibitor therapy. Disclosures Kiladjian: Shire Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees. Zweegman:Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Millennium: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees, Research Funding. Besses:Shire Pharmaceuticals: honoraria for educational lectures Other. Birgegard:Shire Pharmaceuticals: Consultancy, Honoraria, Research Funding. Etienne:Novartis, BMS, Pfizer, Ariad: Honoraria. Roy:Merck: Peg-Interferon provided for academic clinical trial in CML Other. te Boekhorst:Novartis: Consultancy. Griesshammer:Novartis: Honoraria; Shire: Honoraria; Sanofi: Honoraria; Amgen: Honoraria; Roche: Honoraria. Mesa:Incyte Corporation, CTI, NPS Pharma, Inc., Gilead Science Inc., Celgene: Research Funding.
Genome-wide association study of cerebral small vessel disease reveals established and novel loci
Chung, Jaeyoon , Marini, Sandro , Pera, Joanna, Norrving, Bo, Jiménez-Conde, Jordi , Roquer, Jaume, Tirschwell, David L, Brown, Devin L. , Silliman, Scott, Worrall, Bradford B. , Demel, Stacie L , Greenberg, Steven M. , Słowik, Agnieszka , Lindgren, Arne, Schmidt, Reinhold , Sargurupremraj, Muralidharan , Tiedt, Steffen, Malik, Rainer, Debette, Stéphanie , Dichgans, Martin , Langefeld, Carl D. , Woo, Daniel , Anderson, Christopher D. , Tirschwell, David , Marini, Sandro , Dichgans, Martin , Debette, Stephanie , Fernández‐Cadenas, Israel , Selim, Magdy H. , Meschia, James F. , Lindgren, Arne, Traylor, Matthew , Tiedt, Steffen , Rosand, Jonathan M.

Brain | July 10, 2019 | Volume: 142 | Issue: 10 | Pages: 3176-3189

10.1093/brain/awz233 | PMID 31430377 Get It

Intracerebral haemorrhage (ICH) and small vessel ischaemic stroke (SVS) are the most severe manifestations of cerebral small vessel disease. In a cross-phenotype genome-wide association analysis, Chung et al. identify two novel associations at 2q33 and 13q34 plus a previously identified locus at 1q22 for non-lobar ICH and SVS risk.
Big Data Approaches to Phenotyping Acute Ischemic Stroke Using Automated Lesion Segmentation of Multi-Center Magnetic Resonance Imaging Data
Wu, Ona , Winzeck, Stefan , Hancock, Brandon L., Etherton, Mark R. , Bouts, Mark J.R.J. , Donahue, Kathleen, Schirmer, Markus D. , Irie, Robert E., Mocking, Steven J. T. , McIntosh, Elissa C. , Bezerra, Raquel , Kamnitsas, Konstantinos , Frid, Petrea , Wassélius, Johan , Xu, Huichun , Jiménez-Conde, Jordi , Lorentzen, Eric, McArdle, Patrick F. , Schmidt, Reinhold , Sharma, Pankaj , Słowik, Agnieszka , Stanne, Tara M. , Thijs, Vincent , Woo, Daniel , Kittner, Steven J. , Worrall, Bradford B. , Maguire, Jane , Rost, Natalia S. , Investigators, on behalf of the MRI-GENIE and GISCOME, Wu, Ona , Giese, Anne‐Katrin , Cole, John W. , Holmegaard, Lukas , Lemmens, Robin , Meschia, James F. , Roquer, Jaume , Rundek, Tatjana , Sacco, Ralph L. , Vagal, Achala , Bevan, Steve , Mitchell, Braxton D. , Rosand, Jonathan M. , Jern, Christina , Lindgren, Arne G. , Investigators, on behalf of the MRI-GENIE and GISCOME

Stroke | June 10, 2019 | Volume: 50 | Issue: 7 | Pages: 1734-1741

10.1161/strokeaha.119.025373 | PMID 31177973 Get It

Background and Purpose— We evaluated deep learning algorithms’ segmentation of acute ischemic lesions on heterogeneous multi-center clinical diffusion-weighted magnetic resonance imaging (MRI) data sets and explored the potential role of this tool for phenotyping acute ischemic stroke. Methods— Ischemic stroke data sets from the MRI-GENIE (MRI-Genetics Interface Exploration) repository consisting of 12 international genetic research centers were retrospectively analyzed using an automated deep learning segmentation algorithm consisting of an ensemble of 3-dimensional convolutional neural networks. Three ensembles were trained using data from the following: (1) 267 patients from an independent single-center cohort, (2) 267 patients from MRI-GENIE, and (3) mixture of (1) and (2). The algorithms’ performances were compared against manual outlines from a separate 383 patient subset from MRI-GENIE. Univariable and multivariable logistic regression with respect to demographics, stroke subtypes, and vascular risk factors were performed to identify phenotypes associated with large acute diffusion-weighted MRI volumes and greater stroke severity in 2770 MRI-GENIE patients. Stroke topography was investigated. Results— The ensemble consisting of a mixture of MRI-GENIE and single-center convolutional neural networks performed best. Subset analysis comparing automated and manual lesion volumes in 383 patients found excellent correlation (ρ=0.92; P <0.0001). Median (interquartile range) diffusion-weighted MRI lesion volumes from 2770 patients were 3.7 cm 3 (0.9–16.6 cm 3 ). Patients with small artery occlusion stroke subtype had smaller lesion volumes ( P <0.0001) and different topography compared with other stroke subtypes. Conclusions— Automated accurate clinical diffusion-weighted MRI lesion segmentation using deep learning algorithms trained with multi-center and diverse data is feasible. Both lesion volume and topography can provide insight into stroke subtypes with sufficient sample size from big heterogeneous multi-center clinical imaging phenotype data sets.
Association of Apolipoprotein E With Intracerebral Hemorrhage Risk by Race/Ethnicity
Marini, Sandro, Crawford, Katherine, Morotti, Andrea, Lee, Myung J., Pezzini, Alessandro, Moomaw, Charles J., Flaherty, Matthew L., Montaner, Joan, Roquer, Jaume, Jimenez-Conde, Jordi, Giralt-Steinhauer, Eva, Elosua, Roberto, Cuadrado-Godia, Elisa, Soriano-Tarraga, Carolina, Slowik, Agnieszka, Jagiella, Jeremiasz M., Pera, Joanna, Urbanik, Andrzej, Pichler, Alexander, Hansen, Björn M., McCauley, Jacob L., Tirschwell, David L., Selim, Magdy, Brown, Devin L., Silliman, Scott L., Worrall, Bradford B., Meschia, James F., Kidwell, Chelsea S., Testai, Fernando D., Kittner, Steven J., Schmidt, Helena, Enzinger, Christian, Deary, Ian J., Rannikmae, Kristiina, Samarasekera, Neshika, Salman, Rustam Al-Shahi, Sudlow, Catherine L., Klijn, Catharina J. M., Nieuwenhuizen, Koen M. van, Fernandez-Cadenas, Israel, Delgado, Pilar, Norrving, Bo, Lindgren, Arne, Goldstein, Joshua N., Viswanathan, Anand, Greenberg, Steven M., Falcone, Guido J., Biffi, Alessandro, Langefeld, Carl D., Woo, Daniel, Rosand, Jonathan, Anderson, Christopher D., Hardy, John , Benjamin, Emelia J. , Montaner, Joan , Rotter, Jerome I. , Seshadri, Sudha , Anderson, Christopher D. , Lubitz, Steven A. , Sudlow, Cathie , Rannikmäe, Kristiina , James, Michael L. , Testai, Fernando D. , Maguire, Jane , Brown, Devin L. , Tirschwell, David , Hansen, Björn M. , Elosúa, Roberto , Cuadrado‐Godia, Elisa , Soriano‐Tárraga, Carolina , Nieuwenhuizen, Koen M. van , Klijn, Catharina J.M. , Samarasekera, Neshika , Salman, Rustam Al‐Shahi , Pezzini, Alessandro , Delgado, Pilar , Lee, Chaeyoung , McCauley, Jacob L. , Marini, Sandro , Chen, Christopher , Bersano, Anna , van Nieuwenhuizen, Koen M , Seshadri, Sudha , Hardy, John , Montaner, Joan , Benjamin, Emelia J , Lubitz, Steven A , Rotter, Jerome I , Pezzini, Alessandro , Crawford, Katherine, Morotti, Andrea, Lee, Myung J., Moomaw, Charles J., Flaherty, Matthew L., Roquer, Jaume, Jimenez-Conde, Jordi, Giralt-Steinhauer, Eva, Slowik, Agnieszka, Jagiella, Jeremiasz M., Pera, Joanna, Urbanik, Andrzej, Pichler, Alexander, Hansen, Björn M., Selim, Magdy, Brown, Devin L., Silliman, Scott L., Worrall, Bradford B., Meschia, James F., Kidwell, Chelsea S., Kittner, Steven J., Schmidt, Helena, Enzinger, Christian, Deary, Ian J., Salman, Rustam Al-Shahi, Fernandez-Cadenas, Israel, Delgado, Pilar, Norrving, Bo, Lindgren, Arne, Goldstein, Joshua N., Viswanathan, Anand, Greenberg, Steven M., Falcone, Guido J., Biffi, Alessandro, Langefeld, Carl D., Woo, Daniel, Rosand, Jonathan, Anderson, Christopher D., Al-Shahi Salman, Rustam , Bersano, Anna , Testai, Fernando D , McCauley, Jacob L

JAMA Neurology | February 6, 2019 | Volume: 76 | Issue: 4 | Pages: 480

10.1001/jamaneurol.2018.4519 | PMID 30726504 Get It

Abstract 17: Apolipoprotein E and Intracerebral Hemorrhage: A Trans-Ethnic Meta-Analysis
Morotti, Andrea , Moomaw, Charles J. , Flaherty, Matthew L. , Jiménez-Conde, Jordi , Słowik, Agnieszka , Pichler, Alexander , Tirschwell, David L, Brown, Devin L. , Silliman, Scott, Worrall, Bradford B. , Kidwell, Chelsea S., Kittner, Steven J. , Sudlow, Catherine L, Viswanathan, Anand , Greenberg, Steven M. , Falcone, Guido J. , Langefeld, Carl D. , Woo, Daniel , Marini, Sandro , Pezzini, Alessandro , Montaner, Joan , Cuadrado‐Godia, Elisa , Tirschwell, David L, Selim, Magdy H. , Meschia, James F. , Testai, Fernando D. , Deary, Ian J. , Salman, Rustam Al‐Shahi , Sudlow, Catherine L, Klijn, Catharina J.M. , Fernández‐Cadenas, Israel , Lindgren, Arne G. , Goldstein, Joshua Norkin , Rosand, Jonathan M. , Anderson, Christopher D.

Stroke | January 30, 2019 | Volume: 50 | Issue: Suppl_1 | Pages: No page available

10.1161/str.50.suppl_1.17 Get It

Introduction: Risk of lobar and non-lobar intracerebral hemorrhage (ICH) varies among blacks, whites and Hispanics. We sought to determine whether these differences could be due to variability in the effects of Apolipoprotein E (APOE) epsilon (ε) alleles, the most potent genetic risk factor for ICH. Methods: Primary ICH cases and controls were collected from US and European sites contributing to the International Stroke Genetic Consortium (ISGC). We meta-analyzed the effects of APOE allele status on ICH risk applying a two-stage clustering approach based on race/ethnicity and the contributing study. Models were adjusted for age, sex, history of hypertension, hypercholesterolemia, warfarin, statin and antiplatelet use, smoking and alcohol use. A propensity score analysis was used to model the influence of APOE against the burden of hypertension across races/ethnicities. Results: 13,124 subjects (54.5% male, median age 66 years) were included. In whites, APOE ε2 (odds ratio (OR)=1.85, 95% confidence interval (CI)=1.27-2.69, p<0.001) and APOE ε4 (OR=1.94, 95% CI=1.58-2.38, p<0.001) were independently associated with lobar ICH risk, however within self-identified Hispanics and blacks, no associations were found (Figure). After propensity score-matching for hypertension burden, APOE ε4 was associated with lobar ICH risk among whites (OR=1.12, 95% CI=1.08-1.17) and Hispanics (OR=1.07, 95% CI=1.01-1.15, p=0.01), but not blacks (OR=1.02 95% CI=0.98-1.07, p=0.251). APOE ε2 and ε4 did not show an effect on non-lobar ICH risk in any race/ethnicity. Conclusion: APOE ε4 and ε2 alleles affect lobar ICH risk variably by race and ethnicity. Associations are confirmed in whites but can be shown in Hispanics only when the excess burden of hypertension is propensity score-matched. Further studies are needed to explore interactions between APOE alleles and environmental exposures that vary by race and ethnicity in representative populations at risk for ICH.
BEACON CRC study safety lead-in (SLI) in patients with BRAFV600E metastatic colorectal cancer (mCRC): Efficacy and tumor markers.
Cuyle, Pieter‐Jan , Yaeger, Rona , Schellens, Jan H.M. , Desai, Jayesh , Maharry, Kati , Christy‐Bittel, Janna, Gollerkeri, Ashwin , Cutsem, Eric Van , Huijberts, Sanne C.F.A. , Élez, Elena , Tabernero, Josep , Fakih, Marwan , Montagut, Clara O. , Peeters, Marc , Yoshino, Takayuki , Ciardiello, Fortunato , Wasan, Harpreet , Kopetz, Scott , Grothey, Axel , Desai, Jayesh

Journal of Clinical Oncology | January 2, 2019 | Volume: 36 | Issue: 4_suppl | Pages: 627-627

10.1200/jco.2018.36.4_suppl.627 Get It

627 Background: The SLI of the BEACON CRC phase 3 study assessed the safety and efficacy of the combination of the BRAF inhibitor encorafenib (ENCO) + MEK inhibitor binimetinib (BINI) + anti-EGFR antibody cetuximab (CETUX) in pts with BRAFV600E-mutant mCRC after 1 or 2 prior regimens. CEA and CA19-9 are tumor markers that are widely used to monitor the effectiveness of systemic therapies for mCRC; here we report on the association of CEA and CA19-9 changes while on treatment with clinical outcomes in pts from the SLI. Methods: Pts in the SLI received the triplet of ENCO 300 mg QD + BINI 45 mg BID + CETUX 400 mg/m2 (initial dose) then 250 mg/m2 QW in 28-day cycles. Pts were evaluated for safety, radiographic response, and change in tumor markers CEA and CA19-9. Results: 30 pts were treated. The triplet was generally well tolerated, and adverse events were consistent with known BRAF, MEK, and EGFR inhibitor toxicities. The rate of severe skin toxicities (grade 3/4) was lower than generally observed for CETUX in mCRC. Of the 29 pts with a BRAFV600E mutation, the median time on study treatment was 5.6 mo (range, 1.0–9.3 mo), and 22 (76%) remained on study treatment at the time of data cutoff. The confirmed overall response rate (ORR) was 41%, with 1 complete and 11 partial responses. In addition, 9 pts had prolonged stable disease (SD) up to 9.3 mo.CEA and CA19-9 were analyzed in 28 pts. CEA and CA19-9 decreased in 96% and 82% of these pts, respectively. Among 15 pts with treatment duration ≥5.6 mo, median/mean % decreases were 97%/79% for CEA and 92%/82% for CA19-9 in confirmed responders (n=6). Respective decreases in pts with prolonged SD (n=9) were similar: 84%/68% for CEA and 89%/68% for CA19-9. Updated safety, efficacy, and tumor marker results will be provided. Conclusions: ENCO + BINI + CETUX is generally well tolerated and has encouraging clinical activity in BRAFV 600E mCRC, with a confirmed ORR of 41%. In pts with study treatment duration ≥5.6 mo, the tumor markers CEA and CA19-9 decreased markedly and to the same degree in responders vs pts with prolonged SD, providing additional evidence of the meaningful clinical activity of this regimen. Clinical trial information: NCT02928224.