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Angels Camp, CA, United States

Krishnan A.,City of Hope | Palmer J.M.,City of Hope | Tsai N.-C.,City of Hope | Simpson J.R.,Clinical Trials Office | And 4 more authors.
Biology of Blood and Marrow Transplantation | Year: 2012

We conducted a matched-cohort analysis of autologous transplant conditioning regimens for diffuse large cell lymphoma in 92 patients treated with either radioimmunotherapy (RIT) or total body irradiation (TBI)-based conditioning regimens. The RIT regimen consisted of 0.4 mCi/kg of 90Y-ibritumomab tiuxetan plus BEAM (BCNU, etoposide, cytarabine, melphalan). The TBI-based regimen combined fractionated TBI at 1200 cGy, with etoposide and cyclophosphamide. Five factors were matched between 46 patient pairs: age at transplant ±5 years, disease status at salvage, number of prior regimens, year of diagnosis ±5 years, and year of transplantation ±5 years. Patients in the TBI group had higher rates of cardiac toxicity and mucositis, whereas Z-BEAM patients had a higher incidence of pulmonary toxicity. Overall survival at 4 years was 81.0% for the Z-BEAM and 52.7% for the TBI group (P = .01). The 4-year cumulative incidence of relapse/progression was 40.4% and 42.1% for Z-BEAM and TBI, respectively (P = .63). Nonrelapse mortality was superior in the Z-BEAM group: 0% compared with 15.8% for TBI at 4 years (P < .01). Our data demonstrate that RIT-based conditioning had a similar relapse incidence to TBI, with lower toxicity, resulting in improved overall survival, particularly in patients with ≥2 prior regimens. © 2012 American Society for Blood and Marrow Transplantation. Source

Merlano M.C.,S. Croce General Hospital | Monteverde M.,Translational Oncology Laboratory | Colantonio I.,S. Croce General Hospital | Denaro N.,S. Croce General Hospital | And 6 more authors.
Oral Oncology | Year: 2012

Introduction: The purpose of this study is to retrospectively analyze acute toxicity encountered in young and old patients treated with chemo-radiation or bio-radiation at the S. Croce General Hospital between 1997 and 2008, in daily clinical practice. Material and methods: Three hundred and seventeen patients were allocated into two groups according to age (cut-off 65 years). The two groups were compared in terms of treatment related toxicities, treatment activity and efficacy. Epidermal Growth factor receptor (EGFr), Human papillomavirus (HPV) and p53 status were also considered. Results: As expected, overall survival was significantly worse in elderly patients (p = 0.005), but response rate, including complete response rate, was similar between the two age groups, as were most of the side effects analyzed. However, infections (p = 0.011) and in particular pneumonias (p = 0.002) were significantly more represented in elderly patients. Conclusion: Elderly patients treated with chemo-radiation or bio-radiation in our centre had a higher risk of infection and in particular, pneumonia. These data suggest a more careful follow-up, but age alone does not justify their exclusion from treatment. © 2012 Elsevier Ltd. All rights reserved. Source

Khaled S.K.,City of Hope | Palmer J.,City of Hope | Stiller T.,City of Hope | Senitzer D.,HLA Laboratory | And 11 more authors.
Bone Marrow Transplantation | Year: 2013

We report on a prospective phase II trial of 32 patients who underwent unrelated-donor hematopoietic cell transplantation, with a tacrolimus, sirolimus and rabbit anti-thymoctye globulin GVHD prophylactic regimen. The primary study endpoint was incidence of grades II-IV acute (aGVHD), with 80% power to detect a 30% decrease compared with institutional historical controls. Median age at transplant was 60 (19-71). In total, 23 patients (72%) received reduced-intensity conditioning, whereas the remainder received full-intensity regimens. Median follow-up for surviving patients was 35 months (range: 21-49). The cumulative incidence of aGVHD was 37.3%, and the 2-year cumulative incidence of chronic GVHD was 63%. We observed thrombotic microangiopathy in seven patients (21.8%), one of whom also developed sinusoidal obstructive syndrome (SOS). Four of the 32 patients (12.5%) failed to engraft, and 3 of these 4 died. As a result, enrollment to this trial was closed before the targeted accrual of 60 patients. Two-year OS was 65.5% and EFS was 61.3%. Two-year cumulative incidence of relapse was 12.5% and non-relapse mortality (NRM) was 15.6%. NRM and aGVHD rates were lower than historical rates. However, the unexpectedly high incidence of graft failure requires caution in the design of future studies with this regimen. © 2013 Macmillan Publishers Limited All rights reserved. Source

Gandini S.,Italian National Cancer Institute | Puntoni M.,Clinical Trials Office | Heckman-Stoddard B.M.,U.S. National Cancer Institute | Dunn B.K.,U.S. National Cancer Institute | And 3 more authors.
Cancer Prevention Research | Year: 2014

Previous meta-analyses have shown that the antidiabetic agent metformin is associated with reduced cancer incidence and mortality. However, this effect has not been consistently demonstrated in animal models and recent epidemiologic studies. We performed a meta-analysis with a focus on confounders and biases, including body mass index (BMI), study type, and time-related biases. We identified 71 articles published between January 1, 1966, and May 31, 2013, through Pubmed, ISI Web of Science (Science Citation Index Expanded), Embase, and the Cochrane library that were related to metformin and cancer incidence or mortality. Study characteristics and outcomes were abstracted for each study that met inclusion criteria. We included estimates from 47 independent studies and 65,540 cancer cases in patients with diabetes. Overall cancer incidence was reduced by 31% [summary relative risk (SRR), 0.69; 95% confidence interval (CI), 0.52-0.90], although between-study heterogeneity was considerable (I2= 88%). Cancer mortality was reduced by 34% (SRR, 0.66; 95% CI, 0.54-0.81; I2= 21%). BMIadjusted studies and studies without time-related biases also showed significant reduction in cancer incidence (SRR, 0.82; 95% CI, 0.70-0.96 with I2= 76% and SRR, 0.90; 95% CI, 0.89-0.91 with I2= 56%, respectively), albeit with lesser magnitude (18% and 10% reduction, respectively). However, studies of cancer mortality and individual organ sites did not consistently show significant reductions across all types of analyses. Although these associations may not be causal, our results show that metformin may reduce cancer incidence and mortality in patients with diabetes However, the reduction seems to be of modest magnitude and not affecting all populations equally. Clinical trials are needed to determine if these observations apply to nondiabetic populations and to specific organ sites. © 2014 American Association for Cancer Research. Source

Fair A.M.,Meharry Medical College | Wujcik D.,Clinical Trials Office | Lin J.-M.S.,Centers for Disease Control and Prevention | Zheng W.,Vanderbilt University | And 3 more authors.
Journal of Health Care for the Poor and Underserved | Year: 2010

This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR52.53, 95% CI51.12-5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value5.02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value,.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted. Source

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