Publications by authors named "Caroline McNamara"

18 Publications

  • Page 1 of 1

Association of Factors influencing selection of upfront hematopoietic cell transplantation versus non-transplant therapies in Myelofibrosis: Transplant decisions in MF.

Transplant Cell Ther 2021 Mar 30. Epub 2021 Mar 30.

Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.

Background: Despite the curative potential of allogeneic hematopoietic cell transplantation (HCT) for myelofibrosis (MF), a significant number of patients do not undergo HCT. Factors influencing treatment preferences are not well studied in MF.

Objective(s): This study's objective was to identify patient, disease, and donor-related factors influencing HCT decision in MF. A secondary objective was to compare survival in patients who elected upfront HCT or non-transplant therapy.

Study Design: We conducted a retrospective chart review amongst patients meeting criteria for transplant indication, evaluating clinical characteristics, treatment preferences, and outcomes.

Results: Of the 183 study eligible patients <70 years, 129 (70%) developed an HCT indication. Age >60 years was significantly associated with higher rates of HLA-typing refusal (13/72 vs. 1/44, p = 0.02). Caucasian ethnicity was significantly associated with an increased rate of identifying well matched donors compared to non-Caucasian (75% vs. 48%, p = 0.02). Of the 69 patients with well-matched donors, 34 (49%) preferred not to pursue upfront HCT despite a transplant indication. Patient preferences for non-transplant therapies was the most common reason for declining HCT. We did not find any difference in survival between patients pursuing upfront HCT versus non-transplant therapies, although more patients were in remission in the HCT arm at the last follow-up.

Conclusion(s): Caucasian ethnicity patients were significantly more likely to identify a well-matched donor compared to non-Caucasian patients. Despite availability of a well-matched donor, a significant proportion of MF patients with transplant indication do not pursue HCT. Patient age, donor type and patient preferences play a major part in selection of upfront HCT. While a survival difference was not observed between upfront HCT versus non-transplant therapy, more patients in the HCT arm were in remission at the last follow up.
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http://dx.doi.org/10.1016/j.jtct.2021.03.027DOI Listing
March 2021

Prognostic impact of the adverse molecular-genetic profile on long-term outcomes following allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia.

Bone Marrow Transplant 2021 Mar 25. Epub 2021 Mar 25.

Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.

The impact of adverse risk genetic profiles on outcomes in acute myeloid leukemia (AML) patients following allogeneic hematopoietic stem cell transplantation (HCT) has not been fully elucidated. Accordingly, we have profiled somatic mutations at diagnosis using next-generation sequencing (NGS) in 178 AML patients who received allogeneic HCT. NGS revealed 598 somatic mutations in 165/178 patients (92.7%). Frequently mutated genes include DNMT3A, TET2, NPM1, RUNX1, IDH2, and FLT3. Commonly detected cytogenetic profiles include normal karyotype, trisomy 8, monosomal karyotype (MK), deletion 5, complex karyotype (CK), and monosomy 7. In univariate analyses, TP53 mutation, MK, CK, and monosomy 7 were associated with decreased overall survival (OS), relapse-free survival (RFS), and a higher relapse incidence (RI). We defined adverse molecular-genetic profile as harboring at least one of the molecular/genetic abnormalities of TP53 mutation, MK, CK, monosomy 7, and deletion 5. The patients harboring adverse molecular-genetic profile (n = 30) showed a lower 2-year OS (24.9% vs. 57.9%; p = 0.003), RFS (23.7% vs. 57.9%; p = 0.002), and higher RI (47.2% and 17.2%; p = 0.001) after HCT when compared to patients without those lesions. Multivariate analysis confirmed adverse molecular-genetic profile as an independent prognostic factor, associated with decreased OS (HR 2.19), RFS (HR 2.23), and higher RI (HR 2.94).
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http://dx.doi.org/10.1038/s41409-021-01255-4DOI Listing
March 2021

Risk of Thrombosis in Adult Philadelphia-Positive ALL Treated with an Asparaginase-Free ALL Regimen.

Curr Oncol 2020 Dec 22;28(1):128-137. Epub 2020 Dec 22.

Princess Margaret Cancer Centre, Department of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C1, Canada.

Background: venous thromboembolism (VTE) is a well-known complication in adults with acute lymphoblastic leukemia (ALL), especially in patients treated with asparaginase (ASNase)-including regiments. However, VTE risk in adult Philadelphia-positive ALL (Ph+ve ALL) patients treated with non-hyperCVAD chemotherapy is unclear. In this study, we examined VTE incidence in adult Ph+ve ALL patients treated with imatinib plus a pediatric-inspired asparaginase (ASNase)-free regimen modified from the Dana Farber Cancer Institute (DFCI) ALL protocol.

Methods: a single centre retrospective review of Ph+ve ALL patients treated at Princess Margaret Cancer Center (PMCC) from 2008-2019 with imatinib plus modified DFCI protocol was conducted.

Results: of the 123 patients included, 30 (24.3%) had at least 1 radiology confirmed VTE event from diagnosis to the end of maintenance therapy. 86.7% (26/30) of the VTE events occurred during active treatment. Of all VTE events, the majority (53.3%) were DVT and/or PE while another significant portion were catheter-related (40.0%). Major bleeding was observed in 1 patient on VTE treatment with low molecular weight heparin (LMWH).

Conclusion: a high VTE incidence (24.3%) was observed in adults Ph+ve ALL patients treated with imatinib plus an ASNase-free modified DFCI pediatric ALL protocol, suggesting prophylactic anticoagulation should be considered for all adult Ph+ve ALL patients including those treated with ASNase-free regimens.
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http://dx.doi.org/10.3390/curroncol28010016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816186PMC
December 2020

Risk of hepatitis B virus reactivation in HBsAg-negative, anti-HBc-positive patients with myeloproliferative neoplasms treated with ruxolitinib.

Leuk Lymphoma 2021 02 14;62(2):495-497. Epub 2020 Oct 14.

Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.

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http://dx.doi.org/10.1080/10428194.2020.1832671DOI Listing
February 2021

Azacitidine and venetoclax for the treatment of accelerated and blast phase myeloproliferative neoplasms and chronic myelomonocytic leukemia: a case series.

Leuk Lymphoma 2021 Jan 15:1-6. Epub 2021 Jan 15.

Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.

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http://dx.doi.org/10.1080/10428194.2020.1869961DOI Listing
January 2021

Anticoagulation prophylaxis reduces venous thromboembolism rate in adult acute lymphoblastic leukaemia treated with asparaginase-based therapy.

Br J Haematol 2020 12 12;191(5):748-754. Epub 2020 May 12.

Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.

Venous thromboembolism (VTE) is a well-known complication in adults receiving asparaginase (ASNase)-based intensification chemotherapy for acute lymphoblastic leukaemia (ALL). The optimal preventative strategy is unclear. Our objective is to determine the effects of low-molecular-weight heparin (LMWH) as primary VTE prophylaxis. A single-centred retrospective cohort study of adult patients with Philadelphia chromosome negative (Ph-) ALL who received ASNase-based intensification from 2001 to 2017, with prophylaxis given from 2011 to 2017. In all, 214 patients were included in this study with 99 in the historical control group and 125 in the prophylaxis group. The mean (range) enoxaparin dose was 0·79 (0·39-1·2) mg/kg. Of the 125 patients in the prophylaxis group 17 (13·6%) developed VTE during the intensification phase, while 27/99 patients (27·3%) in the control cohort experienced at least one thrombotic event (odds ratio [OR] 0·42, 95% confidence interval [CI] 0·21-0·83). Overall, the main sites of VTE incidences included deep vein thrombosis in the lower extremity (54·6%), pulmonary embolism (13·6%) and catheter-related thrombosis (22·7%). In addition, we found that after adjusting for age, T-phenotype ALL was associated with VTE development (OR 3·07, 95% CI 1·04-9·08). There was no documented major bleeding in the prophylaxis group. LMWH prophylaxis reduced the incidence of symptomatic VTE in adult patients with ALL receiving intensification chemotherapy with ASNase.
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http://dx.doi.org/10.1111/bjh.16695DOI Listing
December 2020

Patterns of Ruxolitinib Therapy Failure and Its Management in Myelofibrosis: Perspectives of the Canadian Myeloproliferative Neoplasm Group.

JCO Oncol Pract 2020 07 5;16(7):351-359. Epub 2020 Mar 5.

Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.

Ruxolitinib improves splenomegaly and other disease-related symptoms in patients with myelofibrosis, but over time, many patients lose this benefit. It is difficult to determine whether this is due to resistance or intolerance to the drug; thus, we have used the more inclusive term of ruxolitinib failure. The survival of patients with myelofibrosis after ruxolitinib failure is poor but varies significantly by the pattern of the failure, underlining the need for a clinically appropriate classification. In this review, we propose diagnostic guidance for early recognition of the pattern of ruxolitinib failure and we recommend treatment options. The most frequent patterns of ruxolitinib failure are loss or failure to obtain a significant reduction in splenomegaly or symptom response, and the development or persistence of clinically significant cytopenias. Ruxolitinib dose modification and other ancillary therapies are sometimes helpful, and splenectomy is a palliative option in selected cases. Stem-cell transplantation is the only curative option for these patterns of failure, but its restricted applicability due to toxicity highlights the importance of ongoing clinical trials in this area. Recent approval of fedratinib by the US Food and Drug Administration provides an alternative option for patients with suboptimal or loss of spleen response. The transformation of myelofibrosis to accelerated or blast phase is an infrequent form of failure with an extremely poor prognosis, whereby patients who are ineligible for transplantation have limited treatment options.
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http://dx.doi.org/10.1200/JOP.19.00506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359776PMC
July 2020

A 14-year retrospective analysis of indications and outcomes of autologous haemopoietic stem cell transplantation in regional Queensland: a single-centre experience.

Intern Med J 2020 02;50(2):214-221

Icon Group, Brisbane, Queensland, Australia.

Background: The Townsville Hospital is a tertiary hospital in North Queensland with one of the largest regional transplant centres in Australia, performing primarily autologous haemopoietic stem cell transplants (HSCT) for various haematological malignancies.

Aims: This single-centre, retrospective, observational study aims to describe the activity and outcomes of autologous HSCT at The Townsville Hospital between 2003 and 2017 to verify safety standards.

Methods: Patient-level data were collected, including demographics, frequency and indication for transplant, conditioning, current clinical status and cause of death. Key outcomes included overall survival, non-relapse mortality, incidence of therapy-related neoplasm and causes of death. Progression-free survival in the multiple myeloma (MM) subgroup was also assessed.

Results: There were 319 autologous HSCT in 286 patients, with a median age of 58 years (range 14-71 years); 62% of patients were male. Indications for transplantation were: MM 53.7%, non-Hodgkin lymphoma 29.4%, Hodgkin lymphoma 5.0% and other 11.9%. Causes of death were: disease progression/relapse (65.2%), second malignancy (17.0%), infection (9.8%) and other (8.0%). Non-relapse mortality was 1.2% (95% confidence interval 0.4-3.0) and 3.2% (1.7-5.7) at 100 days and 1 year, respectively, post-HSCT. Overall survival at 2 years was 81.0% (73.8-86.4) for MM and 69.6% (58.8-78.1) for non-Hodgkin lymphoma. The median progression-free survival in the MM cohort was 3.3 years.

Conclusion: The Townsville Hospital transplant centre provides an important transplant service in regional Queensland, with outcomes comparable to national data. We reported a relatively high rate of second malignancy as a cause of death.
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http://dx.doi.org/10.1111/imj.14395DOI Listing
February 2020

Measurable residual disease monitoring provides insufficient lead-time to prevent morphologic relapse in the majority of patients with core-binding factor acute myeloid leukemia.

Haematologica 2021 01 1;106(1):56-63. Epub 2021 Jan 1.

Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.

Core-binding factor acute myeloid leukemia is characterized by t(8;21) or inv(16) and the fusion proteins RUNX1-RUNX1T1 and CBFB-MYH11. International guidelines recommend monitoring for measurable residual disease every 3 months for 2 years after treatment. However, it is unknown if serial molecular monitoring can predict and prevent morphologic relapse. We conducted a retrospective single-center study of 114 patients in complete remission who underwent molecular monitoring with RT-qPCR of RUNX1-RUNX1T1 or CBFB-MYH11 transcripts every 3 months. Morphologic relapse was defined as re-emergence of >5% blasts and molecular relapse as ≥1 log increase in transcript level between 2 samples. Over a median follow-up time of 3.7 years (range 0.2-14.3), remission persisted in 71 (62.3%) patients but 43 (37.7%) developed molecular or morphologic relapse. Patients who achieved <3 log reduction in RUNX1-RUNX1T1 or CBFB-MYH11 transcripts at end of chemotherapy had a significantly higher risk of relapse compared to patients who achieved ≥3 log reduction (61.1% vs. 33.7%, p=0.004). The majority of relapses (74.4%, n=32) were not predicted by molecular monitoring and occurred rapidly with <100 days from molecular to morphologic relapse. Molecular monitoring enabled the detection of impending relapse and permitted pre-emptive intervention prior to morphologic relapse in only 11 (25.6%) patients. The current practice of molecular monitoring every 3 months provided insufficient lead-time to identify molecular relapses and prevent morphologic relapse in the majority of patients with core-binding factor acute myeloid leukemia treated at our institution. Further research is necessary to determine the optimal monitoring strategies for these patients.
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http://dx.doi.org/10.3324/haematol.2019.235721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776265PMC
January 2021

Impact of High-Molecular-Risk Mutations on Transplantation Outcomes in Patients with Myelofibrosis.

Biol Blood Marrow Transplant 2019 06 6;25(6):1142-1151. Epub 2019 Jan 6.

Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address:

Mutational profiling has demonstrated utility in predicting the likelihood of disease progression in patients with myelofibrosis (MF). However, there is limited data regarding the prognostic utility of genetic profiling in MF patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT). We performed high-throughput sequencing of 585 genes on pre-transplant samples from 101 patients with MF who underwent allo-HCT and evaluated the association of mutations and clinical variables with transplantation outcomes. Overall survival (OS) at 5 years post-transplantation was 52%, and relapse-free survival (RFS) was 51.1 % for this cohort. Nonrelapse mortality (NRM) accounted for most deaths. Patient's age, donor's age, donor type, and Dynamic International Prognostic Scoring System score at diagnosis did not predict for outcomes. Mutations known to be associated with increased risk of disease progression, such as ASXL1, SRSF2, IDH1/2, EZH2, and TP53, did not impact OS or RFS. The presence of U2AF1 (P = .007) or DNMT3A (P = .034) mutations was associated with worse OS. A Mutation-Enhanced International Prognostic Scoring System 70 score was available for 80 patients (79%), and there were no differences in outcomes between patients with high risk scores and those with intermediate and low risk scores. Collectively, these data identify mutational predictors of outcome in MF patients undergoing allo-HCT. These genetic biomarkers in conjunction with clinical variables may have important utility in guiding transplantation decision making.
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http://dx.doi.org/10.1016/j.bbmt.2019.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918823PMC
June 2019

The mutational landscape of accelerated- and blast-phase myeloproliferative neoplasms impacts patient outcomes.

Blood Adv 2018 10;2(20):2658-2671

Department of Medical Oncology and Hematology and.

There is a paucity of data regarding the impact of mutations on outcomes in accelerated-phase (AP) and blast-phase (BP) myeloproliferative neoplasms (MPNs). Moreover, it is unknown whether mutational status affects survival, as seen in chronic-phase MPNs. Therefore, we performed a retrospective analysis of all patients treated at our institution with AP/BP MPNs (N = 122; AP = 14; BP = 108) to comprehensively describe the mutational profile and correlate with clinical outcomes. Targeted sequencing with a 54-gene panel was performed. Forty-four patients were treated with intensive therapy, 27 with nonintensive therapy, and 51 with best supportive care (BSC). The most common mutation was , occurring in 55% of subjects; was found in 13% of patients and in 6%. Thirty-two (26%) patients were triple negative. Other frequently mutated genes were (30%), (25%), (22%), (20%), and (17%). Mutations in 1, 2, 3, and ≥4 genes were seen in 15%, 13%, 25%, and 46% of patients, respectively. There was no difference in survival between patients treated with intensive vs nonintensive therapy, and the benefit of intensive therapy was limited to patients who were able to undergo transplantation. was the only individual mutation to correlate with shorter overall survival (hazard ratio, 1.89; = .03). In the multivariate analysis, mutated , ≥4 mutations, low albumin, increased peripheral blood blasts, ≥3 cytogenetic abnormalities, and BSC were associated with shorter survival. In conclusion, mutational data enhance the understanding of patients with AP/BP MPN who are likely to benefit from current therapeutic options.
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http://dx.doi.org/10.1182/bloodadvances.2018021469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199664PMC
October 2018

Clinical Utility of Next-generation Sequencing in the Management of Myeloproliferative Neoplasms: A Single-Center Experience.

Hemasphere 2018 Jun 4;2(3):e44. Epub 2018 May 4.

Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.

Although next-generation sequencing (NGS) has helped characterize the complex genomic landscape of myeloid malignancies, its clinical utility remains undefined. This has resulted in variable funding for NGS testing, limiting its accessibility. At our center, targeted sequencing (TAR-SEQ) using a 54-gene NGS myeloid panel is offered to all new patients referred for myeloid malignancies, as part of a prospective observational study. Here, we evaluated the diagnostic, prognostic, and potential therapeutic utility of clinical grade TAR-SEQ in the routine workflow of 179 patients with myeloproliferative neoplasms (MPN). Of 13 patients with triple negative (TN) MPN, who lacked driver mutations in , , and , TAR-SEQ confirmed clonal hematopoiesis in 8 patients. In patients with intermediate-risk myelofibrosis (MF), TAR-SEQ helped optimize clinical decisions in hematopoietic cell transplant (HCT)-eligible patients through identifying a high molecular risk (HMR) mutation profile. The presence of an HMR profile favored HCT in 9 patients with intermediate-1 risk MF. Absence of an HMR profile resulted in a delayed HCT strategy in 10 patients with intermediate-2 risk MF, 7 of which were stable at the last follow-up. Finally, TAR-SEQ identified patients with various targetable mutations in (4%), spliceosome genes (28%), and (7%). Some of these patients can be potential candidates for future targeted therapy trials. In conclusion, we have demonstrated that TAR-SEQ improves the characterization of TN MPN, can be integrated in clinical practice as an additional tool to refine decision making in HCT, and has the potential to identify candidates for future targeted therapy trials.
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http://dx.doi.org/10.1097/HS9.0000000000000044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745993PMC
June 2018

Impact of genomic alterations on outcomes in myelofibrosis patients undergoing JAK1/2 inhibitor therapy.

Blood Adv 2017 Sep 8;1(20):1729-1738. Epub 2017 Sep 8.

Department of Medical Oncology and Hematology.

In myelofibrosis (MF), driver mutations in or impact survival and progression to blast phase, with the greatest risk conferred by triple-negative status. Subclonal mutations, including mutations in high-molecular risk (HMR) genes, such as and have also been associated with inferior prognosis. However, data evaluating the impact of next-generation sequencing in MF patients treated with JAK1/2 inhibitors are lacking. Using a 54-gene myeloid panel, we performed targeted sequencing on 100 MF patients treated with ruxolitinib (n = 77) or momelotinib (n = 23) and correlated mutational profiles with treatment outcomes. Ninety-nine patients had at least 1 mutation identified, 46 (46%) had 2 mutations, and 34 (34%) patients had ≥3 mutations. Seventy-nine patients carried a mutation in 14 patients had mutations in 6 patients had an mutation, and 2 patients were triple negative. No mutation was significantly associated with spleen or anemia response. A high Dynamic International Prognostic Scoring System score and pretreatment transfusion dependence were associated with a shorter time to treatment failure (TTF), and this association retained significance on multivariable analysis. Patients with (hazard ratio [HR], 1.86; = .03) and mutations (HR, 2.94; = .009) and an HMR profile (HR, 2.06; = .01) had shorter TTF. On multivariate analysis, or mutations were independently associated with shorter TTF and overall survival. These findings help identify patients unlikely to have a durable response with current JAK1/2 inhibitors and provide a framework for future studies.
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http://dx.doi.org/10.1182/bloodadvances.2017009530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728340PMC
September 2017

Distribution and Impact of Comorbidities on Survival and Leukemic Transformation in Myeloproliferative Neoplasm-Associated Myelofibrosis: A Retrospective Cohort Study.

Clin Lymphoma Myeloma Leuk 2017 11 29;17(11):774-781. Epub 2017 Jun 29.

Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address:

Background: We sought to describe the distribution and impact of comorbidities on outcomes in patients with myelofibrosis, a disease characterized by aberrant bone marrow function with eventual fibrosis. Comorbidities were scored using the Adult Comorbidity Evaluation-27 (ACE-27) and the Hematopoietic Cell Transplant Comorbidity Index (HCT-CI), in which a score ≥ 3 indicates severe comorbidities.

Patients And Methods: We conducted a retrospective study of 306 patients with a confirmed diagnosis of myelofibrosis. Patients were seen from 1999 to 2014 with a median follow-up of 2 years. Multivariable Cox proportional hazards models were constructed to assess the impact of comorbidities on overall survival and leukemic transformation from the date of presentation to our center. A series of descriptive analyses were performed examining the distribution of comorbidities captured by the scales.

Results: On multivariable survival analysis, an ACE-27 score of 3 was associated with an almost twofold increase in the risk of all-cause death (hazard ratio [HR] 1.95; 95% confidence interval [CI], 1.06-3.58; P = .03) compared with a lower score of 0 to 1. An HCT-CI score ≥ 3 was marginally significantly associated with an increased risk of all-cause death (HR 1.60; 95% CI 0.96-2.68; P = .07). ACE-27 captured a greater spectrum of cardiovascular and venous thrombotic disease. No impact of comorbidities on leukemic transformation was observed.

Conclusions: Although the presence of severe comorbidities was lower when assessed by ACE-27 (13%) compared with HCT-CI (23%), and the spectrums of comorbidities captured were different, the overall impact of severe comorbidities as assessed by both scales appears to be similar and associated with a survival disadvantage.
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http://dx.doi.org/10.1016/j.clml.2017.06.031DOI Listing
November 2017

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma.

Am J Hematol 2015 Aug 29;90(8):E145. Epub 2015 May 29.

Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.

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http://dx.doi.org/10.1002/ajh.24041DOI Listing
August 2015

Emotional responses to food, body dissatisfaction and other eating disorder features in children, adolescents and young adults.

Appetite 2008 Jan 29;50(1):102-9. Epub 2007 Jun 29.

Discipline of Psychiatry, School of Medicine, James Cook University, Townsville, Qld 4811, Australia.

We aimed to assess and compare emotional responses to different foods in relationship to eating disorder and associated features, across gender and age groups. We hypothesized that negative emotional responses to images of foods would be higher in (i) those with higher body dissatisfaction and (ii) older females. Five hundred and thirty-six (18% Grade 5, 39% Grade 8 or 9, and 43% Grade 11 or 12) school, and 93 university students participated. Emotive responses to images of foods were assessed with a PowerPoint presentation of 16 differing food and four 'neutral' images shown over 30s intervals. Responses were rated on three 10-cm visual analog scales measuring levels of happiness, fear and disgust. Body image concern was assessed with the nine-item body dissatisfaction subscale of the EDI and eating disorder symptoms with the Eating Disorder Examination Questionnaire. With increasing age all three emotional responses towards food fell and body dissatisfaction increased. Compared to females, males showed significantly higher levels of a 'happy' response to food, and in adult females a fear emotive response correlated positively with eating concern and body dissatisfaction. In men, positive emotive responses to food may be indicative of broader factors that reduce their vulnerability to eating disorders.
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http://dx.doi.org/10.1016/j.appet.2007.06.004DOI Listing
January 2008

Emotional responses to food in adults with an eating disorder: a qualitative exploration.

Eur Eat Disord Rev 2008 Mar;16(2):115-23

James Cook University, Townsville Campus, Queensland, Australia.

There is a dearth of qualitative research exploring eating disordered individuals' emotional responses to the sight of different types of food. In this study we asked 10 adult women diagnosed with bulimia nervosa, anorexia nervosa or an eating disorder not otherwise specified (EDNOS) to articulate their thoughts whilst viewing slides of a range of different foodstuffs, during an in-depth interview session. The data were transcribed and subjected to qualitative analysis. A core theme of 'Control' was identified. Whilst control has been previously acknowledged in the literature as an important aspect of eating disordered behaviour, this is the first report to link control with negative emotional responses to the sight of food. Clinically, an exploration of the notion of control and how it relates to particular foods may be beneficial in therapy.
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http://dx.doi.org/10.1002/erv.810DOI Listing
March 2008