Micro-computed tomography (micro-CT) coupled with tissue, or vascular, specific contrast agent has emerged as a powerful tool for detecting and monitoring tumor growth in the liver of murine animals. Intravenous injections of contrast agents can be technically challenging and lead to errors that can considerably influence the outcome of a preclinical study, prompting an alternative method. Here we assessed the effectiveness of intraperitoneal injections of polyiodinated triglycerides emulsions (Fenestra LC) in micro-CT imaging of young SCID (8 weeks) and old BALB/c (48 weeks) mice with xenograft or carcinogen-induced liver tumors, respectively, and determined an optimal acquisition time. Utilizing an intraperitoneal injection is a viable alternative administration route for using Fenestra in detection and quantification of murine liver tumor burden.
Psoriasis is a skin condition that affects over 100 million people worldwide, while multiple myeloma (MM) accounts for 10% of all hematologic malignancies in the US. There has been limited research on the intersection of psoriasis and MM, and clinicians often face difficult decisions in treating patients diagnosed with both conditions. For instance, the management of psoriasis with systemic immunotherapies in MM patients can be challenging because of concern about immunosuppression and possible worsening of MM. Online crowdsourcing platforms have recently become innovative tools that can actively empower patients in Digital Features To view digital features for this article go to
Background: The rapid outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the delay of non-urgent or routine medical appointments, placing tremendous burden on cancer patients. Meanwhile, the emotional effect of the novel coronavirus (COVID-19) on high-risk groups, such as multiple myeloma (MM) patients, remains unclear. The purpose of this project was to understand psychosocial distress and unmet needs among patients with active MM during the acute phase of social distancing and COVID-19 impact in the United States. Methods: We utilized HealthTree (healthtree.org) and invited patients with active MM cancer or precursor conditions to participate in an online survey curated through a partnership with the Cancer Support Community (CSC). Participants were asked to rate their level of concern (Not at All to Very Seriously) on 12 items assessing psychosocial, practical, and physical needs (selected from CSC’s CancerSupportSource® distress screening tool) during the COVID-19 pandemic. De-identified responses were aggregated and reviewed. The survey was determined to be exempt by the Western Institutional Review Board. Results: 1,079 MM pts participated in the survey between April 15, 2020 and June 8, 2020. The percentages of patients responding moderately to very seriously concerned are reported here. Eating and nutrition (71%), sleep problems (49%), pain and/or physical discomfort (46%), and feeling too tired to do the things you need or want to do (44%) made up the physical/health concerns. Psychosocial/emotional concerns included worrying about the future and what lies ahead (46%), worry about family, children, and/or friends (44%), feeling irritable (37%), feeling sad or depressed (30%), feeling nervous or afraid (25%), feeling lonely or isolated (20%), and relationship problems with your spouse/partner (11%). Finally, 32% reported insurance or money concerns. Conclusions: Respondents to our survey were most concerned with eating and nutrition, sleep problems, pain and/or physical discomfort, and worrying about the future. Informing patients and medical professionals of physical and psychosocial distress experienced by patients could create a unified approach to decreasing distress levels and increase patient overall health, even during a pandemic or when care is delayed. Patient-reported surveys via an online portal, like HealthTree, can help investigators assess the patient community and result in hypothesis-generating research questions to enhance patient outcomes. Citation Format: Nathan W. Sweeney, Jenny Ahlstrom. Cancer-related distress among multiple myeloma patients during the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-009.
Background:The rapid outbreak of coronavirus disease 2019 (COVID-19) led to delays of non-urgent or routine medical care. Regulatory waivers and policy changes from the Centers of Medicare and Medicaid Services (CMS) for the use of telehealth came as a solution to help fight the outbreak. The aim of this project was to survey the change in the frequency of use of telehealth services among multiple myeloma (MM) patients during the COVID-19 pandemic. Methods:We utilized HealthTree Cure Hub For Multiple Myeloma (healthree.org) and invited patients with active MM cancer or precursor conditions to participate in an online survey. We analyzed patient responses to doctor visits, the use of telehealth before and after the COVID-19 pandemic, and whether they had sufficient access to their doctor. Results:1,301 MM pts participated in the survey between April 15, 2020, and June 8, 2020. During the pandemic, 36% of patients indicated visiting with their physician less often than before, 2% visited more often, and 62% had no change in the frequency of their visits. The percent of patients responding “Sometimes” or “Yes” to the use of telehealth are reported here. Before the pandemic, 10% of patients used telehealth, while 62% of patients indicated using telehealth during the pandemic, a 523% increase. When asked if they had sufficient access to their MM healthcare provider 90% of patients indicated that they did, while 10% indicated they did not. Conclusions:There were significantly fewer in-person visits during the COVID-19 pandemic likely due to the CDC-recommended physical distancing practices. During this time, telehealth use among MM patients dramatically increased compared to telehealth use before the pandemic. It is reasonable to assume that patients indicated having sufficient access to their healthcare provider as a result of patients receiving care through telehealth visits. The authors encourage readers to think more broadly about the benefits of telehealth. Maintaining sufficient access to one healthcare provider addressed in this abstract is only a fraction of the benefits telehealth offers. MM is a rare cancer and as a result, some states have few if any specialists. Maintaining telehealth policy changes made during the pandemic would remove geographical barriers and open access to specialists across the country. Citation Format: Nathan W. Sweeney, Scott R. Goldsmith, Jennifer M. Ahlstrom. Telehealth use among multiple myeloma patients during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 716.
e20024 Background: Chimeric antigen receptor (CAR) T-cell therapies are in clinical development for multiple myeloma (MM). Patient-reported outcomes (PRO) can provide valuable insights into how patients perceive the relative risks and benefits of these new therapies. This study aimed to evaluate CAR T-cell therapy in relapsed/refractory MM (RRMM) patients. Methods: We utilized HealthTree Cure Hub for Multiple Myeloma to analyze patient-reported data from 17 patients who participated in CAR T-cell clinical trials. In this study, we examined total prior lines of therapy, time to next treatment (TNT), overall survival (OS), patient-reported toxicity and severity, and patient-reported outcomes (myeloma reduction or no myeloma reduction). The Kaplan-Meier model was used to calculate overall survival. The severity of toxicity was assessed using a 1 to 10 scale (1 = minimal and 10 = severe). Results: Our analysis of the 17 patients found a median of 10 lines of therapy prior to CAR T-cell treatment. Ten patients had no new treatments to report at the time of this study, 5 patients reported new treatment with a median TNT of 15.9 months, and for 2 patients we did not have data. The median OS was 24 months (95% CI 21-30 months). The probability that a patient remained alive at 2 years was 0.48 (95% CI: 0.195, 1). Four of the 17 patients died with a median of 22.5 months post-CAR T-cell therapy. Two of these patients died without reporting a change in treatment. There was a total of 36 different side effects reported by patients as a result of the therapy. Table lists the side effects experienced by 2 or more patients and the corresponding average severity. Finally, 76% of patients treated with CAR T-cell therapy reported a reduction in their myeloma, four of these patients had m-protein levels reported and saw an average decrease of 93%. Of the remaining patients, three (18%) reported little to no reduction in their myeloma, and one patient (6%) did not know their response at the time of this analysis. Conclusions: Our investigation of patient-reported results suggests an emerging and viable immunotherapy treatment option for RRMM, with encouraging outcomes and manageable side effects. Future directions include analysis of genetics and treatment options post CAR T-cell therapy. These data highlight the expedited benefit of using PROs via an online platform, like HealthTree Cure Hub, to assess new therapeutics in the research community.[Table: see text]
PurposeNonalcoholic fatty liver disease (NAFLD) is considered the most common form of silent liver disease in the United States and obesity is associated with increased risk of NAFLD. Obstructive sleep apnea (OSA) which is common in obese individuals is associated with a greater incidence of NAFLD, which in turn, increases the risk for hepatocellular carcinoma (HCC). It is unclear how obesity, OSA and NAFLD interrelate nor how they collectively contribute to an increased risk for developing HCC.Patients and methodsMale BALB/c mice were exposed to diethylnitrosamine and phenobarbital followed by 48 weeks of either standard chow diet (chow), chow with hypoxia, high-fat diet, or a combination of hypoxia and high-fat diet. We noninvasively monitored tumor development using micro-CT imaging. We tracked the total weight gained throughout the study. We evaluated liver histology, fat accumulation, carbonic anhydrase 9 (CA9) and hypoxia-inducible factor 1-alpha (HIF-1α) expression, as well as, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT).ResultsA high-fat diet without hypoxia led to the development of obesity that induced hepatic steatosis and promoted tumorigenesis. Animals on a high-fat diet and that were also exposed to hypoxia had lower total weight gain, lower steatosis, lower serum AST and ALT levels, and fewer number of hepatic adenomas than a high-fat diet without hypoxia.ConclusionThese findings suggest that hypoxia abrogates obesity, hepatic steatosis, and hepatic tumorigenesis related to a high-fat diet.
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