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1.
J Clin Oncol ; : JCO2401008, 2024 Jun 16.
Article in English | MEDLINE | ID: mdl-38879802

ABSTRACT

PURPOSE: We present a phase I/II first-in-human trial evaluating the safety and efficacy of 50 mg and 200 mg doses of linvoseltamab, a B-cell maturation antigen × CD3 bispecific antibody in relapsed/refractory multiple myeloma (RRMM). METHODS: Phase II eligible patients had RRMM that either progressed on/after ≥three lines of therapy including a proteasome inhibitor (PI), an immunomodulatory drug (IMiD), and an anti-CD38 antibody or was triple-class (PI/IMiD/anti-CD38) refractory. Phase II treatment was once a week through week 14 and then once every 2 weeks. Phase II 200 mg patients who achieved a ≥very good partial response by week 24 received linvoseltamab once every 4 weeks. The primary end point in phase II was overall response rate (ORR). RESULTS: Among the 117 patients treated with 200 mg, the median age was 70 years, 39% had high-risk cytogenetics, and 28% had penta-refractory disease. At a median follow-up of 14.3 months, the ORR was 71%, with 50% achieving ≥complete response (CR). In 104 patients treated with 50 mg at a median follow-up of 7.4 months, the ORR was 48%, with 21% achieving ≥CR. The median duration of response (DOR) for 200 mg patients (n = 83) was 29.4 months (95% CI, 19.2 to not evaluable). Among 200 mg patients, the most common adverse events included cytokine release syndrome (35.0% Gr1, 10.3% Gr2, 0.9% Gr3), neutropenia (0.9% Gr2, 18.8% Gr3, 23.1% Gr4), and anemia (3.4% Gr1, 4.3% Gr2, 30.8% Gr3). Immune effector cell-associated neurotoxicity syndrome occurred in 7.7% of patients (2.6% each Gr1, Gr2, Gr3). Infections were reported in 74.4% of patients (33.3% Gr3, 2.6% Gr4); infection frequency and severity declined over time. CONCLUSION: Linvoseltamab 200 mg induced deep and durable responses, with a median DOR of 29.4 months, in patients with RRMM with an acceptable safety profile.

2.
Blood Cancer Discov ; 5(2): 90-94, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38175152

ABSTRACT

SUMMARY: Immune-related toxicities including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are common side effects of bispecific antibody and chimeric antigen receptor (CAR) T-cell therapies of hematologic malignancies. As anti-inflammatory therapy (the standard of care) is variably effective in mitigating these toxicities after onset, here we discuss emerging evidence for shifting the strategy from mitigation to prevention.


Subject(s)
Antibodies, Bispecific , Hematologic Neoplasms , Neoplasms , Humans , Neoplasms/drug therapy , Hematologic Neoplasms/therapy , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/prevention & control , T-Lymphocytes
3.
Nat Cancer ; 4(12): 1660-1674, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37945755

ABSTRACT

Despite improving outcomes, 40% of patients with newly diagnosed multiple myeloma treated with regimens containing daratumumab, a CD38-targeted monoclonal antibody, progress prematurely. By integrating tumor whole-genome and microenvironment single-cell RNA sequencing from upfront phase 2 trials using carfilzomib, lenalidomide and dexamethasone with daratumumab ( NCT03290950 ), we show how distinct genomic drivers including high APOBEC mutational activity, IKZF3 and RPL5 deletions and 8q gain affect clinical outcomes. Furthermore, evaluation of paired bone marrow profiles, taken before and after eight cycles of carfilzomib, lenalidomide and dexamethasone with daratumumab, shows that numbers of natural killer cells before treatment, high T cell receptor diversity before treatment, the disappearance of sustained immune activation (that is, B cells and T cells) and monocyte expansion over time are all predictive of sustained minimal residual disease negativity. Overall, this study provides strong evidence of a complex interplay between tumor cells and the immune microenvironment that is predictive of clinical outcome and depth of treatment response in patients with newly diagnosed multiple myeloma treated with highly effective combinations containing anti-CD38 antibodies.


Subject(s)
Immunotherapy , Multiple Myeloma , Humans , Dexamethasone/therapeutic use , Genomics , Lenalidomide/therapeutic use , Multiple Myeloma/genetics , Multiple Myeloma/pathology , Multiple Myeloma/therapy , Tumor Microenvironment/genetics
4.
Am J Cardiol ; 204: 360-365, 2023 10 01.
Article in English | MEDLINE | ID: mdl-37573615

ABSTRACT

Randomized controlled trials have demonstrated mortality benefits for several medication classes in patients with heart failure (HF), especially with reduced ejection fraction (EF). However, the benefit of these traditional HF therapies in patients with HF from cardiac amyloidosis is unclear. our study aimed to evaluate the safety and efficacy of traditional HF therapies in patients with cardiac amyloidosis and HF with reduced EF or HF with mid-range EF (HFmrEF). We conducted a single-center retrospective study. Patients were included if they were diagnosed with cardiac amyloidosis and HF with reduced EF or HF with mid-range EF between January 2012 and 2022. The primary outcomes of interest were medication use patterns (for ß blockers [BB], angiotensin-converting enzyme inhibitors [ACEI], angiotensin receptor blockers [ARBs], angiotensin receptor neprilysin inhibitors [ARNI], and mineralocorticoid receptor antagonists [MRAs]); potential medication side effects (symptomatic bradycardia, fatigue, hypotension, lightheadedness, and syncope); hospitalization; and death. The associations of BB, ACEI/ARB/ARNI, and MRA use with clinical outcomes were evaluated using Kaplan-Meier and Cox proportional hazards regression. A total of 82 patients met study criteria. At time of cardiac amyloidosis diagnosis, 63.4% were on a BB, 51.2% were on an ACEI/ARB/ARNI, and 43.9% were on an MRA. At last follow-up, 51.2% were on a BB, 35.4% were on an ACEI/ARB/ARNI, and 43.9% were on an MRA. There were no statistically significant differences in rates of potential medication side effects in patients on the medication class compared with those who were not. There was no association with hospitalization or mortality for baseline or follow-up BB, ACEI/ARB/ARNI, or MRA use. In conclusion, BBs, ACEI/ARB/ARNIs, and MRAs may be safely used in this population. However, their use does not appear to improve mortality or hospitalization.


Subject(s)
Heart Failure , Ventricular Dysfunction, Left , Humans , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Angiotensin Receptor Antagonists/adverse effects , Retrospective Studies , Stroke Volume , Heart Failure/complications , Heart Failure/drug therapy , Heart Failure/chemically induced , Ventricular Dysfunction, Left/chemically induced , Adrenergic beta-Antagonists/therapeutic use , Adrenergic beta-Antagonists/pharmacology , Mineralocorticoid Receptor Antagonists/therapeutic use , Mineralocorticoid Receptor Antagonists/pharmacology
6.
Future Cardiol ; 19(1): 7-17, 2023 01.
Article in English | MEDLINE | ID: mdl-36715498

ABSTRACT

WHAT IS THIS PLAIN LANGUAGE SUMMARY ABOUT?: This summary presents the results from an ongoing, long-term extension study that followed an earlier study called ATTR-ACT. People who took part in this extension study and ATTR-ACT have a type of heart disease known as transthyretin amyloid cardiomyopathy (ATTR-CM for short), which causes heart failure and death. In ATTR-ACT, people took either a medicine called tafamidis or a placebo (a pill that looks like the study drug but does not contain any active ingredients) for up to 2½ years. So far, in the long-term extension study, people have continued taking tafamidis, or switched from taking a placebo to tafamidis, for another 2½ years. Researchers looked at how many people died in ATTR-ACT and the extension study. The long-term extension study is expected to end in 2027, so these are interim (not final) results. WHAT DID RESEARCHERS FIND OUT?: In the extension study of ATTR-ACT, the risk of dying was lower in people who took tafamidis continuously throughout ATTR-ACT and the extension study than in people who took placebo in ATTR-ACT and switched to tafamidis in the extension study. WHAT DO THE RESULTS MEAN?: Taking tafamidis increases how long people with ATTR-CM live. People with ATTR-CM who take tafamidis early and continuously are more likely to live longer than those who do not. These results highlight the importance of early detection and treatment in people with ATTR-CM. Clinical Trial Registration: NCT01994889 (ClinicalTrials.gov) Clinical Trial Registration: NCT02791230 (ClinicalTrials.gov).


Subject(s)
Amyloid Neuropathies, Familial , Cardiomyopathies , Humans , Amyloid Neuropathies, Familial/drug therapy , Prealbumin/therapeutic use , Benzoxazoles/therapeutic use
7.
Blood Adv ; 7(7): 1168-1177, 2023 04 11.
Article in English | MEDLINE | ID: mdl-36534160

ABSTRACT

This pilot study assessed the safety and efficacy of letetresgene autoleucel (lete-cel; GSK3377794), a genetically modified autologous T-cell therapy targeting New York esophageal squamous cell carcinoma-1 (NY-ESO-1)/L antigen family member 1 isoform A (LAGE-1a)-positive myeloma cells, alone or in combination with pembrolizumab in patients with relapsed/refractory multiple myeloma. Eligible patients expressed NY-ESO-1 and/or LAGE-1a and either HLA-A∗02:01, ∗02:05, or ∗02:06. Patients received lete-cel single infusion alone (arm 1) or with pembrolizumab (arm 2). 127 patients were screened, and 6 patients (3 per arm) were enrolled; patients in arm 1 and 2 received lete-cel alone, or with pembrolizumab, respectively. All patients exhibited grade 3/4 cytopenias, which resolved or improved to grade 1. One patient (arm 1) had grade 3/4 lete-cel-related adverse events (AEs); 2 patients (arm 2) had grade 3/4 AEs related to lete-cel and lymphodepletion. Three patients with grade 1/2 cytokine release syndrome (CRS) exhibited elevated post-lete-cel interleukin-6 levels versus those without CRS. Pooled overall response rate was 50% including 1 patient each with confirmed clinical response, very good clinical response, and partial response, and progression-free survival ranged from 1.3 to 5.2 months. Responders (arm 1: n = 1; arm 2: n = 2) had a time-to-response of 3 weeks, duration of response of 2.1 months. Two responders, but no nonresponders, exhibited elevated cytokine levels after lete-cel infusion. Lete-cel had a manageable safety profile and demonstrated clear but transient antitumor activity in patients with relapsed/refractory multiple myeloma. This trial was registered at www.clinicaltrials.gov as #NCT03168438.


Subject(s)
Esophageal Neoplasms , Esophageal Squamous Cell Carcinoma , Multiple Myeloma , Humans , Multiple Myeloma/drug therapy , Multiple Myeloma/genetics , Pilot Projects
8.
Future Cardiol ; 2022 03 17.
Article in English | MEDLINE | ID: mdl-35297655

ABSTRACT

WHAT IS THIS PLAIN LANGUAGE SUMMARY ABOUT?: This plain language summary describes some results of a study called ATTR-ACT. This was the first large study to include people with wild-type and hereditary transthyretin amyloid cardiomyopathy (ATTR-CM for short). ATTR-CM is a type of heart disease that happens when abnormal clumps of protein build up in the heart. This build-up prevents the heart from working properly, causing a condition called heart failure. Wild-type ATTR-CM happens for unknown reasons in some people as they get older. Hereditary ATTR-CM can happen because of changes in people's genes (known as gene variants or mutations). IMPORTANT INFORMATION ABOUT ATTR-ACT: In this study, 441 people with ATTR-CM took either a medicine called tafamidis or a placebo (a capsule that looked like tafamidis but didn't contain any active medicine) by mouth for 30 months, once a day. The researchers' main aim was to find out how tafamidis treatment affected the risk of people dying or being admitted to the hospital for heart problems. They found that tafamidis lowered these risks by about one-third compared with placebo. WHAT ELSE DID RESEARCHERS FIND OUT IN ATTR-ACT?: As described in this summary, after ATTR-ACT was completed, researchers looked back at the results from people who took placebo to learn how ATTR-CM progressed without treatment. The researchers found that about 4 in 10 people with wild-type ATTR-CM who took placebo died and 6 in 10 were admitted to the hospital because of heart problems over 30 months. People who took placebo also could not walk as far at the end of the study as they did at the start because their heart function worsened over time. WHY ARE THESE RESULTS IMPORTANT?: By showing how ATTR-CM affects people's health when they do not take treatment, these results highlight the benefits of early diagnosis and treatment of ATTR-CM. ClinicalTrials.gov NCT number: NCT01994889.

9.
Circ Heart Fail ; 15(1): e008193, 2022 01.
Article in English | MEDLINE | ID: mdl-34923848

ABSTRACT

BACKGROUND: Tafamidis is approved in many countries for the treatment of transthyretin amyloid cardiomyopathy. This study reports data on the long-term efficacy of tafamidis from an ongoing long-term extension (LTE) to the pivotal ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial). METHODS: Patients with transthyretin amyloid cardiomyopathy who completed ATTR-ACT could enroll in an LTE, continuing with the same tafamidis dose or, if previously treated with placebo, randomized (2:1) to tafamidis meglumine 80 or 20 mg. All patients in the LTE transitioned to tafamidis free acid 61 mg (bioequivalent to tafamidis meglumine 80 mg) following a protocol amendment. In this interim analysis, all-cause mortality was assessed in patients treated with tafamidis meglumine 80 mg in ATTR-ACT continuing in the LTE, compared with those receiving placebo in ATTR-ACT transitioning to tafamidis in the LTE. RESULTS: Median follow-up was 58.5 months in the continuous tafamidis group (n=176) and 57.1 months in the placebo to tafamidis group (n=177). There were 79 (44.9%) deaths with continuous tafamidis and 111 (62.7%) with placebo to tafamidis (hazard ratio, 0.59 [95% CI, 0.44-0.79]; P<0.001). Mortality was also reduced in the continuous tafamidis (versus placebo to tafamidis) subgroups of: variant transthyretin amyloidosis (0.57 [0.33-0.99]; P=0.05) and wild-type transthyretin amyloidosis (0.61 [0.43-0.87]; P=0.006); and baseline New York Heart Association class I and II (0.56 [0.38-0.82]; P=0.003) and class III (0.65 [0.41-1.01]; P=0.06). CONCLUSIONS: In the LTE, patients initially treated with tafamidis in ATTR-ACT had substantially better survival than those first treated with placebo, highlighting the importance of early diagnosis and treatment in transthyretin amyloid cardiomyopathy. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01994889 and NCT02791230.


Subject(s)
Amyloid Neuropathies, Familial/drug therapy , Amyloid Neuropathies, Familial/mortality , Benzoxazoles/pharmacology , Cardiomyopathies/mortality , Time , Aged , Aged, 80 and over , Amyloid Neuropathies, Familial/complications , Cardiomyopathies/complications , Cardiomyopathies/drug therapy , Female , Heart Failure/complications , Heart Failure/drug therapy , Heart Failure/mortality , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Prealbumin/pharmacology , Proportional Hazards Models
10.
BMC Cancer ; 21(1): 993, 2021 Sep 06.
Article in English | MEDLINE | ID: mdl-34488662

ABSTRACT

BACKGROUND: Selinexor is an oral, selective nuclear export inhibitor. STORM was a phase 2b, single-arm, open-label, multicenter trial of selinexor with low dose dexamethasone in patients with penta-exposed relapsed/refractory multiple myeloma (RRMM) that met its primary endpoint, with overall response of 26% (95% confidence interval [CI], 19 to 35%). Health-related quality of life (HRQoL) was a secondary endpoint measured using the Functional Assessment of Cancer Therapy - Multiple Myeloma (FACT-MM). This study examines impact of selinexor treatment on HRQoL of patients treated in STORM and reports two approaches to calculate minimal clinically important differences for the FACT-MM. METHODS: FACT-MM data were collected at baseline, on day 1 of each 4-week treatment cycle, and at end of treatment (EOT). Changes from baseline were analyzed for the FACT-MM total score, FACT-trial outcome index (TOI), FACT-General (FACT-G), and the MM-specific domain using mixed-effects regression models. Two approaches for evaluating minimal clinically important differences were explored: the first defined as 10% of the instrument range, and the second based on estimated mean baseline differences between Eastern Cooperative Oncology Group performance status (ECOG PS) scores. Post-hoc difference analysis compared change in scores from baseline to EOT for treatment responders and non-responders. RESULTS: Eighty patients were included in the analysis; the mean number of prior therapies was 7.9 (standard deviation [SD] 3.1), and mean duration of myeloma was 7.6 years (SD 3.4). Each exploratory minimal clinically important difference threshold yielded consistent results whereby most patients did not experience HRQoL decline during the first six cycles of treatment (range: 53.9 to 75.7% for the first approach; range: 52.6 to 72.9% for the second). Treatment responders experienced less decline in HRQoL from baseline to EOT than non-responders, which was significant for the FACT-G, but not for other scores. CONCLUSION: The majority of patients did not experience decline in HRQoL based on minimal clinically important differences during early cycles of treatment with selinexor and dexamethasone in the STORM trial. An anchor-based approach utilizing patient-level data (ECOG PS score) to define minimal clinically important differences for the FACT-MM gave consistent results with a distribution-based approach. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov under the trial-ID NCT02336815 on January 8, 2015.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Drug Resistance, Neoplasm , Multiple Myeloma/drug therapy , Neoplasm Recurrence, Local/drug therapy , Quality of Life , Adult , Aged , Aged, 80 and over , Dexamethasone/administration & dosage , Female , Follow-Up Studies , Humans , Hydrazines/administration & dosage , Male , Middle Aged , Multiple Myeloma/pathology , Neoplasm Recurrence, Local/pathology , Prognosis , Survival Rate , Triazoles/administration & dosage
11.
ESC Heart Fail ; 8(5): 3875-3884, 2021 10.
Article in English | MEDLINE | ID: mdl-34432383

ABSTRACT

AIMS: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, fatal disorder that remains underdiagnosed. The Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) was the first large clinical trial to include both wild-type (ATTRwt) and hereditary (ATTRv) patients. A description of the natural history of ATTR-CM, utilizing data from placebo-treated patients in ATTR-ACT, will provide a greater understanding of presentation and progression of ATTR-CM and may aid in disease awareness, earlier diagnosis and treatment monitoring. METHODS AND RESULTS: Changes in clinical endpoints (mortality, cardiovascular [CV]-related hospitalizations, 6-min walk test [6MWT] distance and Kansas City Cardiomyopathy Questionnaire Overall Summary [KCCQ-OS] score) from baseline to Month 30 in the 177 patients (134 ATTRwt, 43 ATTRv) who received placebo in ATTR-ACT were assessed. ATTRwt patients tended to have less severe disease at baseline. Over the duration of ATTR-ACT, there were 76 (42.9%) all-cause deaths, and 107 (60.5%) patients had a CV-related hospitalization. There was a lower proportion of all-cause deaths in ATTRwt (49, 36.6%) than ATTRv (27, 62.8%). There was a similar, steady decline in mean (SD) 6MWT distance from baseline to Month 30 in ATTRwt (93.9 [93.7] m) and ATTRv (89.1 [107.2] m) patients. The decline in mean (SD) KCCQ-OS score was less severe in ATTRwt (13.8 [20.7]) than ATTRv (21.0 [26.4]) patients. CONCLUSIONS: Patients with ATTR-CM experience a severe, progressive disease. In ATTR-ACT, placebo-treated patients with ATTRv, compared with ATTRwt, had more severe disease at baseline, and their disease progressed more rapidly as shown by mortality, hospitalizations and quality of life over time.


Subject(s)
Amyloid Neuropathies, Familial , Cardiomyopathies , Cardiomyopathies/diagnosis , Hospitalization , Humans , Prealbumin/genetics , Quality of Life
12.
Cognition ; 214: 104730, 2021 09.
Article in English | MEDLINE | ID: mdl-33975124

ABSTRACT

In the emotion induced blindness (EIB) paradigm, participants search for a single target picture embedded in a rapidly presented sequence of "background" pictures. When the sequence also contains a task-irrelevant, emotional distractor appearing shortly before the target, awareness for the target is severely impaired (Most, Chun, Widders, & Zald, 2005). This temporary "blindness" for the target is thought to reflect attention capture by the emotionally salient distractor which blocks the target's access to the attention system. However, there are also reasons to suspect that physical salience may play an important role in the initial attention capture process. The emotional pictures consist of close-ups of people and animals while the background pictures are wide-angle views of landscapes and cityscapes. These physical differences might result in pop-out of the distractor picture that is at least partially based on physical and not emotional salience. We investigated the role of physical salience in emotional capture by comparing the typical EIB paradigm, which uses dissimilar distractors, with one in which the background pictures consist of people and animals in non-emotional settings (similar distractors). If emotional salience is the basis of attention capture in EIB, we should see similar amounts of target suppression in both conditions. Instead, we found that the EIB effect was reduced and possibly eliminated in the similar background condition. A control experiment revealed that emotional information was still available in the similar background condition because the blink was restored when the emotional picture was designated for report by a salient cue. These findings are clearly inconsistent with current theories of EIB (e.g., McHugo, Olatunji, & Zald, 2013) which assume that initial attention capture is driven by emotional not physical salience.


Subject(s)
Attention , Emotions , Blindness , Humans , Reaction Time
14.
Hematol Oncol Clin North Am ; 34(6): 1099-1113, 2020 12.
Article in English | MEDLINE | ID: mdl-33099427

ABSTRACT

Clinical features of soft tissue amyloid light-chain (AL) amyloidosis include macroglossia, arthropathy, muscle pseudohypertrophy, skin plaques, and carpal tunnel syndrome. Vascular manifestations of AL amyloid include periorbital ecchymosis, jaw or limb claudication, and even myocardial infarction caused by occlusion of small vessel coronary arteries. Some of these features, such as macroglossia, periorbital ecchymosis, and the so-called shoulder-pad sign, are pathognomonic for AL amyloidosis. These findings may be the initial presenting features of the disease, and the recognition of these red flag symptoms is very important for the diagnosis and early intervention on the underlying plasma cell disease.


Subject(s)
Antibodies, Monoclonal/metabolism , Carpal Tunnel Syndrome , Coronary Artery Disease , Ecchymosis , Immunoglobulin Light Chains/metabolism , Immunoglobulin Light-chain Amyloidosis , Macroglossia , Carpal Tunnel Syndrome/etiology , Carpal Tunnel Syndrome/metabolism , Carpal Tunnel Syndrome/pathology , Carpal Tunnel Syndrome/therapy , Coronary Artery Disease/etiology , Coronary Artery Disease/metabolism , Coronary Artery Disease/pathology , Coronary Artery Disease/therapy , Ecchymosis/etiology , Ecchymosis/metabolism , Ecchymosis/pathology , Ecchymosis/therapy , Humans , Immunoglobulin Light-chain Amyloidosis/complications , Immunoglobulin Light-chain Amyloidosis/metabolism , Immunoglobulin Light-chain Amyloidosis/pathology , Immunoglobulin Light-chain Amyloidosis/therapy , Macroglossia/etiology , Macroglossia/metabolism , Macroglossia/pathology , Macroglossia/therapy
15.
BMJ Case Rep ; 13(8)2020 Aug 25.
Article in English | MEDLINE | ID: mdl-32843454

ABSTRACT

Lymphoid malignancies represent 0. 008% of all cervical tumours. While uncommon, lymphoid malignancies of the gynaecological tract require careful diagnosis and classification to ensure appropriate treatment. We present a case of a 54-year-old woman with HIV who presented with urinary and faecal incontinence for 2 weeks, associated with the feeling of a mass in her vagina. A smooth flesh-coloured pelvic mass was seen on physical examination, and a transvaginal biopsy revealed infiltration of atypical lymphoid cells with fluorescence in situ hybridisation positive for MYC and BCL6, and negative for IGH/BCL2. Bone marrow and cerebral spinal fluid analysis also showed involvement by atypical lymphocytes. She was diagnosed with stage IV high-grade B-cells lymphoma (HGBLs) with MYC and BCL6 rearrangements. She was given R-CODOX-M plus IVAC with no evidence of disease at 4-month follow-up. To our knowledge, this is the first literature report of a HGBL with MYC and BCL6 rearrangement presenting as a cervical mass.


Subject(s)
Gene Rearrangement , Leukemia, B-Cell/genetics , Lymphoma, Non-Hodgkin/genetics , Proto-Oncogene Proteins c-bcl-6/genetics , Proto-Oncogene Proteins c-myc/genetics , Uterine Cervical Neoplasms/genetics , Female , Humans , Middle Aged
16.
Ecancermedicalscience ; 14: 1028, 2020.
Article in English | MEDLINE | ID: mdl-32368253

ABSTRACT

Multiple myeloma is a hematologic malignancy that classically manifests with hypercalcaemia, renal insufficiency, anaemia and lytic bone lesions. Liver dysfunction in multiple myeloma is a lesser known complication that occurs through biliary obstruction, liver infiltration by plasma cells, amyloid/light chain deposition or due to liver injury from medications. Although transfusion-related hepatic iron overload-leading to significant liver disease-is a recognised complication in certain hematologic malignancies, little is known about transfusional iron overload in patients with multiple myeloma. We present a case of a 49-year-old female with relapsed/refractory multiple myeloma who presented with rapid onset liver failure, due to both iron deposition and malignant plasma cell infiltration of the liver as a terminal event. A review of the literature on hepatic complications in multiple myeloma patients is presented.

18.
Cortex ; 122: 140-158, 2020 01.
Article in English | MEDLINE | ID: mdl-31003713

ABSTRACT

The present research used behavioral and event-related brain potentials (ERP) measures to determine whether emotional capture is automatic in the emotion-induced blindness (EIB) paradigm. The first experiment varied the priority of performing two concurrent tasks: identifying a negative or neutral picture appearing in a rapid serial visual presentation (RSVP) stream of pictures and multiple object tracking (MOT). Results showed that increased attention to the MOT task resulted in decreased accuracy for identifying both negative and neutral target pictures accompanied by decreases in the amplitude of the P3b component. In contrast, the early posterior negativity (EPN) component elicited by negative pictures was unaffected by variations in attention. Similarly, there was a decrement in MOT performance for dual-task versus single task conditions but no effect of picture type (negative vs neutral) on MOT accuracy which isn't consistent with automatic emotional capture of attention. However, the MOT task might simply be insensitive to brief interruptions of attention. The second experiment used a more sensitive reaction time (RT) measure to examine this possibility. Results showed that RT to discriminate a gap appearing in a tracked object was delayed by the simultaneous appearance of to-be-ignored distractor pictures even though MOT performance was once again unaffected by the distractor. Importantly, the RT delay was the same for both negative and neutral distractors suggesting that capture was driven by physical salience rather than emotional salience of the distractors. Despite this lack of emotional capture, the EPN component, which is thought to reflect emotional capture, was still present. We suggest that the EPN doesn't reflect capture but rather downstream effects of attention, including object recognition. These results show that capture by emotional pictures in EIB can be suppressed when attention is engaged in another difficult task. The results have important implications for understanding capture effects in EIB.


Subject(s)
Electroencephalography , Emotions , Blindness , Evoked Potentials , Humans , Photic Stimulation , Visual Perception
19.
N Engl J Med ; 381(8): 727-738, 2019 08 22.
Article in English | MEDLINE | ID: mdl-31433920

ABSTRACT

BACKGROUND: Selinexor, a selective inhibitor of nuclear export compound that blocks exportin 1 (XPO1) and forces nuclear accumulation and activation of tumor suppressor proteins, inhibits nuclear factor κB, and reduces oncoprotein messenger RNA translation, is a potential novel treatment for myeloma that is refractory to current therapeutic options. METHODS: We administered oral selinexor (80 mg) plus dexamethasone (20 mg) twice weekly to patients with myeloma who had previous exposure to bortezomib, carfilzomib, lenalidomide, pomalidomide, daratumumab, and an alkylating agent and had disease refractory to at least one proteasome inhibitor, one immunomodulatory agent, and daratumumab (triple-class refractory). The primary end point was overall response, defined as a partial response or better, with response assessed by an independent review committee. Clinical benefit, defined as a minimal response or better, was a secondary end point. RESULTS: A total of 122 patients in the United States and Europe were included in the modified intention-to-treat population (primary analysis), and 123 were included in the safety population. The median age was 65 years, and the median number of previous regimens was 7; a total of 53% of the patients had high-risk cytogenetic abnormalities. A partial response or better was observed in 26% of patients (95% confidence interval, 19 to 35), including two stringent complete responses; 39% of patients had a minimal response or better. The median duration of response was 4.4 months, median progression-free survival was 3.7 months, and median overall survival was 8.6 months. Fatigue, nausea, and decreased appetite were common and were typically grade 1 or 2 (grade 3 events were noted in up to 25% of patients, and no grade 4 events were reported). Thrombocytopenia occurred in 73% of the patients (grade 3 in 25% and grade 4 in 33%). Thrombocytopenia led to bleeding events of grade 3 or higher in 6 patients. CONCLUSIONS: Selinexor-dexamethasone resulted in objective treatment responses in patients with myeloma refractory to currently available therapies. (Funded by Karyopharm Therapeutics; STORM ClinicalTrials.gov number, NCT02336815.).


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Dexamethasone/administration & dosage , Hydrazines/administration & dosage , Karyopherins/antagonists & inhibitors , Multiple Myeloma/drug therapy , Receptors, Cytoplasmic and Nuclear/antagonists & inhibitors , Triazoles/administration & dosage , Administration, Oral , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Biomarkers, Tumor/blood , Dexamethasone/adverse effects , Drug Administration Schedule , Drug Resistance, Neoplasm , Female , Humans , Hydrazines/adverse effects , Intention to Treat Analysis , Male , Middle Aged , Survival Analysis , Thrombocytopenia/chemically induced , Triazoles/adverse effects , Young Adult , Exportin 1 Protein
20.
Atten Percept Psychophys ; 80(5): 1030-1034, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29869150

ABSTRACT

A towering figure in experimental psychology, Charles W. Eriksen, passed away in February this year. "Erik" made extensive original and lasting contributions to both research methods and theories in several areas of psychology, especially involving visual information processing. His research exhibited consistent concerns with experimental methods for distinguishing among alternative explanations and distinguishing perception from behavior. Erik pioneered many research methods now in common use-including converging operations, visual search, rapid serial presentations, the stop-signal paradigm, temporal integration in form perception, spatial cues for guiding selective attention, and the flankers task. He also introduced and tested many theories of selective attention. Erik was the founding editor of Perception & Psychophysics, and served for 23 years as its principal editor. An impressive and unforgettable person, Erik was a compelling personification of "the greatest generation."


Subject(s)
Attention , Psychophysics/history , History, 20th Century , Humans , United States
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