Bio

Clinical Focus


  • Cancer Survivorship
  • Cancer > Breast Cancer
  • Breast cancer
  • Medical Oncology

Academic Appointments


Administrative Appointments


  • Medical Director, Stanford Cancer Center (2010 - Present)
  • Medical Director, University of Michigan Comprehensive Cancer Center (2003 - 2010)
  • President, Wilshire Oncology Medical Group, Inc. (1996 - 2003)

Honors & Awards


  • President, American Society of Clinical Oncology (2009-10)

Professional Education


  • Residency:UCSD School of Medicine (06/1980) CA
  • Medical Education:UC San Diego School of Medicine (06/1977) CA
  • Fellowship:National Cancer Institute - Center Cancer Research (08/1983) MD
  • Board Certification: Medical Oncology, American Board of Internal Medicine (1983)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (1980)
  • Fellowship, Medicine Branch, National Cancer Institute, Bethesda, Maryland (1983)
  • Fellowship, Environmental Epidemiology Branch, National Cancer Institute, Bethesda, Maryland (1983)
  • Resident, University of California Hospitals, San Diego (1980)
  • M.D., University of California, San Diego (1977)
  • B.S.E.E., Stanford University (1972)

Research & Scholarship

Current Research and Scholarly Interests


Use of medical informatics to improve quality delivery in cancer care

Clinical Trials


  • Chemotherapy With or Without Trastuzumab After Surgery in Treating Women With Invasive Breast Cancer Recruiting

    This randomized phase III clinical trial is studying chemotherapy with or without trastuzumab after surgery to see how well they work in treating women with invasive breast cancer. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) and giving chemotherapy after surgery may kill more tumor cells. Monoclonal antibodies, such as trastuzumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. It is not yet known whether combination chemotherapy is more effective with trastuzumab in treating breast cancer.

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Teaching

2013-14 Courses


Publications

Journal Articles


  • Breast cancer treatment across health care systems: linking electronic medical records and state registry data to enable outcomes research. Cancer Kurian, A. W., Mitani, A., Desai, M., Yu, P. P., Seto, T., Weber, S. C., Olson, C., Kenkare, P., Gomez, S. L., de Bruin, M. A., Horst, K., Belkora, J., May, S. G., Frosch, D. L., Blayney, D. W., Luft, H. S., Das, A. K. 2014; 120 (1): 103-111

    Abstract

    Understanding of cancer outcomes is limited by data fragmentation. In the current study, the authors analyzed the information yielded by integrating breast cancer data from 3 sources: electronic medical records (EMRs) from 2 health care systems and the state registry.Diagnostic test and treatment data were extracted from the EMRs of all patients with breast cancer treated between 2000 and 2010 in 2 independent California institutions: a community-based practice (Palo Alto Medical Foundation; "Community") and an academic medical center (Stanford University; "University"). The authors incorporated records from the population-based California Cancer Registry and then linked EMR-California Cancer Registry data sets of Community and University patients.The authors initially identified 8210 University patients and 5770 Community patients; linked data sets revealed a 16% patient overlap, yielding 12,109 unique patients. The percentage of all Community patients, but not University patients, treated at both institutions increased with worsening cancer prognostic factors. Before linking the data sets, Community patients appeared to receive less intervention than University patients (mastectomy: 37.6% vs 43.2%; chemotherapy: 35% vs 41.7%; magnetic resonance imaging: 10% vs 29.3%; and genetic testing: 2.5% vs 9.2%). Linked Community and University data sets revealed that patients treated at both institutions received substantially more interventions (mastectomy: 55.8%; chemotherapy: 47.2%; magnetic resonance imaging: 38.9%; and genetic testing: 10.9% [P < .001 for each 3-way institutional comparison]).Data linkage identified 16% of patients who were treated in 2 health care systems and who, despite comparable prognostic factors, received far more intensive treatment than others. By integrating complementary data from EMRs and population-based registries, a more comprehensive understanding of breast cancer care and factors that drive treatment use was obtained.

    View details for DOI 10.1002/cncr.28395

    View details for PubMedID 24101577

  • American society of clinical oncology 2013 top five list in oncology. Journal of clinical oncology Schnipper, L. E., Lyman, G. H., Blayney, D. W., Hoverman, J. R., Raghavan, D., Wollins, D. S., Schilsky, R. L. 2013; 31 (34): 4362-4370

    View details for DOI 10.1200/JCO.2013.53.3943

    View details for PubMedID 24170249

  • Computerized prescriber order entry implementation in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and task switching. Journal of oncology practice / American Society of Clinical Oncology Hanauer, D. A., Zheng, K., Commiskey, E. L., Duck, M. G., Choi, S. W., Blayney, D. W. 2013; 9 (4): e103-14

    Abstract

    Little is known about the impact of computerized prescriber order entry (CPOE) systems on inpatient hematology/oncology services. The objective of this study was to quantify the impact of an inpatient CPOE implementation on workflow, with an emphasis on ordering and direct patient care time.We conducted a direct-observation time-and-motion study of the provider team of a hematology/oncology inpatient service both before and after CPOE implementation, characterizing workflow into 60 distinct activity categories. The provider team comprised physician assistants supervised by attending physicians. Results were adjusted to account for variations in the census. We also conducted an analysis of computer logs to assess CPOE system usage.Study participants were observed for 228.0 hours over 53 observation sessions. There was little change in the proportion of census-adjusted time spent on ordering (10.2% before v 11.4% after) and on direct patient care (50.7% before v 47.8% after). Workflow fragmentation decreased, with providers spending an average of 131.2 seconds on a continuous task before implementation and 218.3 seconds after (P < .01). An eight-fold decrease in the number of pages was observed during the course of the study.CPOE implementation did not negatively affect time available for direct patient care. Workflow fragmentation decreased, which is likely beneficial.

    View details for DOI 10.1200/JOP.2012.000655

    View details for PubMedID 23942926

  • Measuring the Improving Quality of Outpatient Care in Medical Oncology Practices in the United States JOURNAL OF CLINICAL ONCOLOGY Neuss, M. N., Malin, J. L., Chan, S., Kadlubek, P. J., Adams, J. L., Jacobson, J. O., Blayney, D. W., Simone, J. V. 2013; 31 (11): 1471-1477

    Abstract

    The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) has provided a method for measuring process-based practice quality since 2006. We sought to determine whether QOPI scores showed improvement in measured quality over time and, if change was demonstrated, which factors in either the measures or participants were associated with improvement.The analysis included 156 practice groups from a larger group of 308 that submitted data from 2006 to 2010. One hundred fifty-two otherwise eligible practices were excluded, most commonly for insufficient data submission. A linear regression model that controlled for varied initial performance was used to estimate the effect of participation over time and evaluate participant and measure characteristics of improvement.Participants completed a mean of 5.06 (standard deviation, 1.94) rounds of data collection. Adjusted mean quality scores improved from 0.71 (95% CI, 0.42 to 0.91) to 0.85 (95% CI, 0.60 to 0.95). Overall odds ratio of improvement over time was 1.09 (P < .001). The greatest improvement was seen in measures that assessed newly introduced clinical information, in which the mean scores improved from 0.05 (95% CI, 0.01 to 0.17) to 0.69 (95% CI, 0.33 to 0.91; P < .001). Many measures showed no change over time.Many US oncologists have participated in QOPI over the past 6 years. Participation over time was highly correlated with improvement in measured performance. Greater and faster improvement was seen in measures concerning newly introduced clinical information. Some measures showed no change despite opportunity for improvement.

    View details for DOI 10.1200/JCO.2012.43.3300

    View details for Web of Science ID 000317174400022

    View details for PubMedID 23478057

  • Tumor Boards (Team Huddles) Aren't Enough to Reach the Goal JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE Blayney, D. W. 2013; 105 (2): 82-84

    View details for DOI 10.1093/jnci/djs523

    View details for Web of Science ID 000314865100005

    View details for PubMedID 23274389

  • Adoption of Gene Expression Profile Testing and Association With Use of Chemotherapy Among Women With Breast Cancer JOURNAL OF CLINICAL ONCOLOGY Hassett, M. J., Silver, S. M., Hughes, M. E., Blayney, D. W., Edge, S. B., Herman, J. G., Hudis, C. A., Marcom, P. K., Pettinga, J. E., Share, D., Theriault, R., Wong, Y., Vandergrift, J. L., Niland, J. C., Weeks, J. C. 2012; 30 (18): 2218-2226

    Abstract

    Gene expression profile (GEP) testing is a relatively new technology that offers the potential of personalized medicine to patients, yet little is known about its adoption into routine practice. One of the first commercially available GEP tests, a 21-gene profile, was developed to estimate the benefit of adjuvant chemotherapy for hormone receptor-positive breast cancer (HR-positive BC).By using a prospective registry data set outlining the routine care provided to women diagnosed from 2006 to 2008 with HR-positive BC at 17 comprehensive and community-based cancer centers, we assessed GEP test adoption and the association between testing and chemotherapy use.Of 7,375 women, 20.4% had GEP testing and 50.2% received chemotherapy. Over time, testing increased (14.7% in 2006 to 27.5% in 2008; P < .01) and use of chemotherapy decreased (53.9% in 2006 to 47.0% in 2008; P < .01). Characteristics independently associated with lower odds of testing included African American versus white race (odds ratio [OR], 0.70; 95% CI, 0.54 to 0.92) and high school or less versus more than high school education (OR, 0.63; 95% CI, 0.52 to 0.76). Overall, testing was associated with lower odds of chemotherapy use (OR, 0.70; 95% CI, 0.62 to 0.80). Stratified analyses demonstrated that for small, node-negative cancers, testing was associated with higher odds of chemotherapy use (OR, 11.13; 95% CI, 5.39 to 22.99), whereas for node-positive and large node-negative cancers, testing was associated with lower odds of chemotherapy use (OR, 0.11; 95% CI, 0.07 to 0.17).There has been a progressive increase in use of this GEP test and an associated shift in the characteristics of and overall reduction in the proportion of women with HR-positive BC receiving adjuvant chemotherapy.

    View details for DOI 10.1200/JCO.2011.38.5740

    View details for Web of Science ID 000305413200014

    View details for PubMedID 22585699

  • American Society of Clinical Oncology Identifies Five Key Opportunities to Improve Care and Reduce Costs: The Top Five List for Oncology JOURNAL OF CLINICAL ONCOLOGY Schnipper, L. E., Smith, T. J., Raghavan, D., Blayney, D. W., Ganz, P. A., Mulvey, T. M., Wollins, D. S. 2012; 30 (14): 1715-1724

    View details for DOI 10.1200/JCO.2012.42.8375

    View details for Web of Science ID 000303914800027

    View details for PubMedID 22493340

  • Michigan Oncology Practices Showed Varying Adherence Rates To Practice Guidelines, But Quality Interventions Improved Care HEALTH AFFAIRS Blayney, D. W., Severson, J., Martin, C. J., Kadlubek, P., Ruane, T., Harrison, K. 2012; 31 (4): 718-728

    Abstract

    Despite improvements in care for patients with cancer, and in their survival rates, it is not clear that best practices are uniformly delivered to patients. We measured the quality of outpatient cancer care, using validated quality measures, in a consortium of thirty-six outpatient oncology practices in Michigan. We discovered that throughout the measurement period, for breast and colorectal cancer care, there was a more than 85 percent rate of adherence to quality care processes. For end-of-life care processes, the adherence rate was 73 percent, and for symptom and toxicity management care processes, adherence was 56 percent. In particular, we found variations in care around the fundamental oncologic task of management of cancer pain. To address quality gaps, we developed interventions to improve adherence to treatment guidelines, improve pain management, and incorporate palliative care into oncology practice. We concluded that statewide consortia that assume much of the cost burden of quality improvement activities can bring together oncology providers and payers to measure quality and design interventions to improve care.

    View details for DOI 10.1377/hlthaff.2011.1295

    View details for Web of Science ID 000302777400009

    View details for PubMedID 22492888

  • Enhancing Quality Through Innovation: American Society of Clinical Oncology Presidential Address 2010 JOURNAL OF CLINICAL ONCOLOGY Blayney, D. W. 2010; 28 (28): 4283-4288

    View details for DOI 10.1200/JCO.2010.31.1696

    View details for Web of Science ID 000282272700024

    View details for PubMedID 20697071

  • Implementation of the Quality Oncology Practice Initiative at a University Comprehensive Cancer Center JOURNAL OF CLINICAL ONCOLOGY Blayney, D. W., McNiff, K., Hanauer, D., Miela, G., Markstrom, D., Neuss, M. 2009; 27 (23): 3802-3807

    Abstract

    The Quality Oncology Practice Initiative (QOPI) is a voluntary program developed by the American Society of Clinical Oncology (ASCO) to aid oncology practices in quality self-assessment. Few academic cancer centers have been QOPI participants.We implemented the QOPI process at the University of Michigan Comprehensive Cancer Center, a large, hospital-based academic cancer center, and report our experience with five rounds of data collection. Patient medical records were selected using QOPI-specified procedures and abstracted locally; results were entered into an ASCO-maintained database and analyzed.Abstractors who were not directly involved with patient care required an average of 62.3 minutes per medical record (4.7 minutes per data element) to abstract data. We found that compliance with quality measures was uniformly high when measures were structured into our electronic medical record. Results from other measures, including those measuring chemotherapy administration in the last 2 weeks of life, were initially markedly different from those reported by other QOPI participants. Our practice changed toward the QOPI national practice norm after a presentation of the results at a faculty research conference. We found that other measures were consistently greater than 90%, including disease-specific diagnosis and treatment measures.Measuring and showing performance data to physicians was sufficient to change some aspects of physician behavior. Improvement in other measures requires structural practice changes. QOPI, an oncologist-developed system, can be adapted for use in practice improvement at an academic medical center.

    View details for DOI 10.1200/JCO.2008.21.6770

    View details for Web of Science ID 000268769900013

    View details for PubMedID 19487377

  • Increasing chemotherapy dose density and intensity: Phase I trials in non-small cell lung cancer and non-Hodgkin's lymphoma ONCOLOGIST Blayney, D. W., McGuire, B. W., Cruickshank, S. E., Johnson, D. H. 2005; 10 (2): 138-149

    Abstract

    Dose densification and dose escalation of cytotoxic chemotherapy may be important in improving the cure rates of chemotherapy-responsive cancers. We conducted two phase I studies, in non-small cell lung cancer (NSCLC) and in lymphoma, to explore the possibility of intensifying chemotherapy by compressing the delivery of and escalating the dose of standard combination chemotherapy. One study used etoposide and cisplatin chemotherapy in patients with unresectable stage III or IV NSCLC, intensifying chemotherapy by reducing the cycle length. The second study used cyclophosphamide, doxorubicin, vincristine, and prednisone, CHOP chemotherapy, in the treatment of stage II-IV intermediate or immunoblastic high-grade lymphoma, intensifying chemotherapy first by reducing the cycle length and then by escalating the dosages of cyclophosphamide and doxorubicin. Filgrastim support was used during dose intensification. Fifty-five patients with NSCLC and 49 with non-Hodgkin's lymphoma (NHL) were enrolled and treated in successive cohorts. At standard dosages and intervals of chemotherapy, filgrastim support resulted in incidences of grade 3 and 4 neutropenia that were between 62% and 77% lower than those in the no-filgrastim control; the mean duration of neutropenia was, likewise, more than 80% lower. Absolute neutrophil counts were >/=2 x 10(9)/l at day 14 in virtually 100% of patients receiving filgrastim. In the NSCLC trial, etoposide and cisplatin were intensified by >50%, and in the lymphoma trial, cyclophosphamide was intensified by 270% and doxorubicin was intensified by 87%. Chemotherapy reductions or delays for neutropenia were rare in the groups receiving filgrastim; but at higher chemotherapy intensities, dose-limiting thrombocytopenia was encountered. We conclude that the delivery of myelosuppressive chemotherapy in both a dose-intense and a dose-dense manner is feasible with filgrastim support.

    View details for Web of Science ID 000227100700006

    View details for PubMedID 15709216

  • Breast Cancer Treatment Across Health Care Systems CANCER Kurian, A. W., Mitani, A., Desai, M., Yu, P. P., Seto, T., Weber, S. C., Olson, C., Kenkare, P., Gomez, S. L., de Bruin, M. A., Horst, K., Belkora, J., May, S. G., Frosch, D. L., Blayney, D. W., Luft, H. S., Das, A. K. 2014; 120 (1): 103-111

    View details for DOI 10.1002/cncr.28395

    View details for Web of Science ID 000328443000017

  • Myeloid Growth Factors JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Crawford, J., Armitage, J., Balducci, L., Becker, P. S., Blayney, D. W., Cataland, S. R., Heaney, M. L., Hudock, S., Kloth, D. D., Kuter, D. J., Lyman, G. H., McMahon, B., Rugo, H. S., Saad, A. A., Schwartzberg, L. S., Shayani, S., Steensma, D. P., Talbott, M., Vadhan-Raj, S., Westervelt, P., Westmoreland, M., Dwyer, M., Ho, M. 2013; 11 (10): 1266-1290

    Abstract

    Febrile neutropenia, a common side effect of myelosuppressive chemotherapy in patients with cancer, can result in prolonged hospitalization and broad-spectrum antibiotic use, often prompting treatment delays or dose reductions of drug regimens. Prophylactic use of myeloid growth factors (mainly the colony-stimulating factors filgrastim and pegfilgrastim) in patients of heightened risk can reduce the severity and duration of febrile neutropenia. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Myeloid Growth Factors provide recommendations on the use of these agents mainly in the oncology setting based on clinical evidence and expert consensus. This version includes revisions surrounding the issue of timing of pegfilgrastim administration. It also includes new sections on tbo-filgrastim, a recently approved agent that is biologically similar to filgrastim, and the role of myeloid growth factors in the hematopoietic cell transplant setting.

    View details for Web of Science ID 000325929600010

    View details for PubMedID 24142827

  • Measuring and improving quality of care in an academic medical center. Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W. 2013; 9 (3): 138-141

    Abstract

    The Donabedian definition of quality—structure, process, and outcome—provides a useful framework. A relentless focus on measuring process adherence and outcome is critical. Systemic improvements usually require teams to plan and to implement them. The lean or Toyota production system for process improvement is one useful method of organizing work, although different approaches are often necessary at the physician, practice unit, and statewide level. Challenges include scalability of the change (ie, rolling them out across the institution or system), tailoring the information technology tools, and building systems for sustainability.

    View details for DOI 10.1200/JOP.2013.000991

    View details for PubMedID 23942492

  • Time to diagnosis and breast cancer stage by race/ethnicity BREAST CANCER RESEARCH AND TREATMENT Warner, E. T., Tamimi, R. M., Hughes, M. E., Ottesen, R. A., Wong, Y., Edge, S. B., Theriault, R. L., Blayney, D. W., Niland, J. C., Winer, E. P., Weeks, J. C., Partridge, A. H. 2012; 136 (3): 813-821

    Abstract

    We examined differences in time to diagnosis by race/ethnicity, the relationship between time to diagnosis and stage, and the extent to which it explains differences in stage at diagnosis across racial/ethnic groups. Our analytic sample includes 21,427 non-Hispanic White (White), Hispanic, non-Hispanic Black (Black) and non-Hispanic Asian/Pacific Islander (Asian) women diagnosed with stage I to IV breast cancer between January 1, 2000 and December 31, 2007 at one of eight National Comprehensive Cancer Network centers. We measured time from initial abnormal mammogram or symptom to breast cancer diagnosis. Stage was classified using AJCC criteria. Initial sign of breast cancer modified the association between race/ethnicity and time to diagnosis. Among symptomatic women, median time to diagnosis ranged from 36 days among Whites to 53.6 for Blacks. Among women with abnormal mammograms, median time to diagnosis ranged from 21 days among Whites to 29 for Blacks. Blacks had the highest proportion (26 %) of Stage III or IV tumors. After accounting for time to diagnosis, the observed increased risk of stage III/IV breast cancer was reduced from 40 to 28 % among Hispanics and from 113 to 100 % among Blacks, but estimates remained statistically significant. We were unable to fully account for the higher proportion of late-stage tumors among Blacks. Blacks and Hispanics experienced longer time to diagnosis than Whites, and Blacks were more likely to be diagnosed with late-stage tumors. Longer time to diagnosis did not fully explain differences in stage between racial/ethnicity groups.

    View details for DOI 10.1007/s10549-012-2304-1

    View details for Web of Science ID 000312071000019

    View details for PubMedID 23099438

  • Clinicopathologic Features, Patterns of Recurrence, and Survival Among Women With Triple-Negative Breast Cancer in the National Comprehensive Cancer Network CANCER Lin, N. U., Vanderplas, A., Hughes, M. E., Theriault, R. L., Edge, S. B., Wong, Y., Blayney, D. W., Niland, J. C., Winer, E. P., Weeks, J. C. 2012; 118 (22): 5463-5472

    Abstract

    The objective of this study was to describe clinicopathologic features, patterns of recurrence, and survival according to breast cancer subtype with a focus on triple-negative tumors.In total, 15,204 women were evaluated who presented to National Comprehensive Cancer Network centers with stage I through III breast cancer between January 2000 and December 2006. Tumors were classified as positive for estrogen receptor (ER) and/or progesterone receptor (PR) (hormone receptor [HR]-positive) and negative for human epidermal growth factor receptor 2 (HER2); positive for HER2 and any ER or PR status (HER2-positive); or negative for ER, PR, and HER2 (triple-negative).Subtype distribution was triple-negative in 17% of women (n = 2569), HER2-positive in 17% of women (n = 2602), and HR-positive/HER2-negative in 66% of women (n = 10,033). The triple-negative subtype was more frequent in African Americans compared with Caucasians (adjusted odds ratio, 1.98; P < .0001). Premenopausal women, but not postmenopausal women, with high body mass index had an increased likelihood of having the triple-negative subtype (P = .02). Women with triple-negative cancers were less likely to present on the basis of an abnormal screening mammogram (29% vs 48%; P < .0001) and were more likely to present with higher tumor classification, but they were less likely to have lymph node involvement. Relative to HR-positive/HER2-negative tumors, triple-negative tumors were associated with a greater risk of brain or lung metastases; and women with triple-negative tumors had worse breast cancer-specific and overall survival, even after adjusting for age, disease stage, race, tumor grade, and receipt of adjuvant chemotherapy (overall survival: adjusted hazard ratio, 2.72; 95% confidence interval, 2.39-3.10; P < .0001). The difference in the risk of death by subtype was most dramatic within the first 2 years after diagnosis (overall survival for 0-2 years: OR, 6.10; 95% confidence interval, 4.81-7.74).Triple-negative tumors were associated with unique risk factors and worse outcomes compared with HR-positive/HER2-negative tumors.

    View details for DOI 10.1002/cncr.27581

    View details for Web of Science ID 000310483800002

    View details for PubMedID 22544643

  • The anemia impact measure (AIM): development and content validation of a patient-reported outcome measure of anemia symptoms and symptom impacts in cancer patients receiving chemotherapy QUALITY OF LIFE RESEARCH Kleinman, L., Benjamin, K., Viswanathan, H., Mattera, M. S., Bosserman, L., Blayney, D. W., Revicki, D. A. 2012; 21 (7): 1255-1266

    Abstract

    To develop a patient-reported outcome instrument for measuring anemia symptoms and their impact in patients with chemotherapy-induced anemia (CIA).Qualitative research was conducted using six focus groups and 24 interviews with 46 CIA patients, eight interviews in patients receiving chemotherapy with no CIA history and two interviews in patients successfully treated for CIA. Atlas.ti 5.0 was used to organize key concepts. Cognitive interviews with 16 CIA patients and assessment of relevance of each item to CIA by 10 clinicians were also conducted to evaluate content validity.Most CIA patients were white (76%) and female (83%), and the average age was 60 years. The most common cancer types were breast cancer (54%) and lung cancer (17%). Tiredness was the most prevalent symptom and rated as the most important by 83% of CIA patients; weakness, shortness of breath, lightheadedness, and dizziness were ranked next in importance. The final anemia impact measure (AIM) contains: (1) daily CIA symptom diary (9 items), and (2) impact of CIA-related tiredness (29 items covering daily living activities, social activities, cognitive function, and emotions). Cognitive interviews found that the AIM was relevant and easy to understand.The AIM assesses important patient-perceived CIA symptoms and their impact and was developed using extensive patient qualitative data.

    View details for DOI 10.1007/s11136-011-0034-1

    View details for Web of Science ID 000314910300016

    View details for PubMedID 21987032

  • The Effect of Age on Delay in Diagnosis and Stage of Breast Cancer ONCOLOGIST Partridge, A. H., Hughes, M. E., Ottesen, R. A., Wong, Y., Edge, S. B., Theriault, R. L., Blayney, D. W., Niland, J. C., Winer, E. P., Weeks, J. C., Tamimi, R. M. 2012; 17 (6): 775-782

    Abstract

    Young women with breast cancer are more likely to present with more advanced disease and are more likely to die as a result of breast cancer than their older counterparts. We sought to examine the relationship among young age (?40 years), the likelihood of a delay in diagnosis, and stage.We examined data from women with newly diagnosed stage I-IV breast cancer presenting to one of eight National Comprehensive Cancer Network centers in January 2000 to December 2007. Delay in diagnosis was defined as time from initial sign or symptom to breast cancer diagnosis >60 days.Among 21,818 women with breast cancer eligible for analysis, 2,445 were aged ?40 years at diagnosis. Young women were not more likely to have a delay in diagnosis >60 days (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.98-1.19) after adjustment for type of initial sign or symptom. Young women were only modestly more likely to present with higher stage disease after a similar adjustment (OR, 1.18; 95% CI, 1.07-1.31). Women presenting with symptomatic disease, more common in younger women, were more likely to have a delay in diagnosis (OR, 3.31; 95% CI, 3.08-3.56) and higher stage (OR, 4.31; 95% CI 4.05-4.58).Young age is not an independent predictor of delay in diagnosis of breast cancer and only modestly is associated with higher stage disease. Presenting with symptoms of breast cancer predicts delay and higher stage at diagnosis.

    View details for DOI 10.1634/theoncologist.2011-0469

    View details for Web of Science ID 000306147200009

    View details for PubMedID 22554997

  • Comparative outcome of initial therapy for younger patients with mantle cell lymphoma: an analysis from the NCCN NHL Database BLOOD LaCasce, A. S., Vandergrift, J. L., Rodriguez, M. A., Abel, G. A., Crosby, A. L., Czuczman, M. S., Nademanee, A. P., Blayney, D. W., Gordon, L. I., Millenson, M., Vanderplas, A., Lepisto, E. M., Zelenetz, A. D., Niland, J., Friedberg, J. W. 2012; 119 (9): 2093-2099

    Abstract

    Few randomized trials have compared therapies in mantle cell lymphoma (MCL), and the role of aggressive induction is unclear. The National Comprehensive Cancer Network (NCCN) Non-Hodgkin Lymphoma (NHL) Database, a prospective cohort study collecting clinical, treatment, and outcome data at 7 NCCN centers, provides a unique opportunity to compare the effectiveness of initial therapies in MCL. Patients younger than 65 diagnosed between 2000 and 2008 were included if they received RHCVAD (rituximab fractionated cyclophosphamide, vincristine, adriamycin, and dexamethasone), RCHOP+HDT/ASCR (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone + high-dose therapy/autologous stem cell rescue), RHCVAD+HDT/ASCR, or RCHOP. Clinical parameters were similar for patients treated with RHCVAD (n = 83, 50%), RCHOP+HDT/ASCR (n = 34, 20%), RCHOP (n = 29, 17%), or RHCVAD+HDT/ASCR (n = 21, 13%). Overall, 70 (42%) of the 167 patients progressed and 25 (15%) expired with a median follow-up of 33 months. There was no difference in progression-free survival (PFS) between aggressive regimens (P > .57), which all demonstrated superior PFS compared with RCHOP (P < .004). There was no difference in overall survival (OS) between the RHCVAD and RCHOP+HDT/ASCR (P = .98). RCHOP was inferior to RHCVAD and RCHOP+HDT/ASCR, which had similar PFS and OS. Despite aggressive regimens, the median PFS was 3 to 4 years. Future trials should focus on novel agents rather than comparing current approaches.

    View details for DOI 10.1182/blood-2011-07-369629

    View details for Web of Science ID 000300949500019

    View details for PubMedID 22234679

  • The impact of obesity on receipt of adjuvant chemotherapy for breast cancer in the National Comprehensive Cancer Network (NCCN) centers BREAST CANCER RESEARCH AND TREATMENT Brewster, A. M., Etzel, C., Zhou, R., Wong, Y., Edge, S., Blayney, D. W., Wilson, J., Hudis, C., Ottesen, R., Hughes, M. E., Weeks, J. C., Theriault, R. L. 2011; 130 (3): 897-904

    Abstract

    Disparities in the receipt of adjuvant chemotherapy for early stage breast cancer is an important factor influencing mortality. We investigated whether greater body mass index (BMI) decreases receipt of adjuvant chemotherapy among women with operable breast cancer. In the NCCN breast cancer outcomes database, we identified women aged ? 70 with newly diagnosed stage I, II, or III breast cancer between 1997 and 2007, for whom use of adjuvant chemotherapy was classified as either standard-of-care or discretionary based on their clinical characteristics. Body mass index was assessed in categories (<18.5 kg/m(2) [underweight], 18.5 to <25 kg/m(2) [normal], 25 to <30 kg/m(2) [overweight], 30-39 kg/m(2) [obese], ? 40 kg/m(2) [extreme obese]). Multivariable logistic regression analysis was used to examine the association between BMI and receipt of chemotherapy in each classification group. 9,527 women were eligible for the study; 40% normal weight or less; 31% overweight; 24% obese; and 5% extremely obese. In multivariable analysis, there was no significant association between BMI and receipt of chemotherapy in either classification group. Among women for whom chemotherapy would be considered standard-of-care, older age (P < 0.001), comorbidity (P < 0.001), and non-Hispanic black ethnicity (P = 0.002) were associated with a lower likelihood of receipt of chemotherapy; however, the effect of ethnicity was not modified by obesity. Among women treated for operable breast cancer in the NCCN centers, BMI had no impact on receipt of adjuvant chemotherapy and did not modify the lower likelihood of chemotherapy among non-Hispanic black patients. Further investigation is needed into other factors that contribute to patient disparities in the receipt of chemotherapy in major academic centers.

    View details for DOI 10.1007/s10549-011-1516-0

    View details for Web of Science ID 000297225600018

    View details for PubMedID 21809116

  • Commentary: six years of trends in oncology practice data. Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W. 2011; 7 (5): 291-293

    View details for DOI 10.1200/JOP.2011.000412

    View details for PubMedID 22211123

  • Myeloid Growth Factors JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Crawford, J., Allen, J., Armitage, J., Blayney, D. W., Cataland, S. R., Heaney, M. L., Htoy, S., Hudock, S., Kloth, D. D., Kuter, D. J., Lyman, G. H., McMahon, B., Steensma, D. P., Vadhan-Raj, S., Westervelt, P., Westmoreland, M. 2011; 9 (8): 914-?

    View details for Web of Science ID 000293583500007

    View details for PubMedID 21900221

  • Institutional Variation in the Surgical Treatment of Breast Cancer A Study of the NCCN ANNALS OF SURGERY Greenberg, C. C., Lipsitz, S. R., Hughes, M. E., Edge, S. B., Theriault, R., Wilson, J. L., Carter, W. B., Blayney, D. W., Niland, J., Weeks, J. C. 2011; 254 (2): 339-345

    Abstract

    To investigate the relationship between supply of subspecialty care and type of procedure preferentially performed for early stage breast cancer.Three surgical options exist for early stage breast cancer: (1) breast conserving surgery (BCS), (2) mastectomy with reconstruction (RECON), and (3) mastectomy alone. Current guidelines recommend that surgical treatment decisions should be based on patient preference if a patient is eligible for all 3. However, studies demonstrate persistent variation in the use of BCS and RECON.Patients undergoing an operation for DCIS or stage I or II breast cancer at NCCN institutions between 2000 and 2006 were identified. Institutional procedure rates were determined. Spearman correlations measured the association between procedure types. Patient-level logistic regression models investigated predictors of procedure type and association with institutional supply of subspecialty care.Among 10,607 patients, 19% had mastectomy alone, 60% BCS, and 21% RECON. The institutional rate of BCS and RECON were strongly correlated (r = -0.80, P = 0.02). Institution was more important than all patient factors except age in predicting receipt of RECON or BCS. RECON was more likely for patients treated at an institution with a greater supply of reconstructive surgeons or where patients live further from radiation facilities. RECON was less likely at institutions with longer waiting times for surgery with reconstruction.Even within the NCCN, a consortium of multidisciplinary cancer centers, the use of BCS and mastectomy with reconstruction substantially varies by institution and correlates with the supply of subspecialty care.

    View details for DOI 10.1097/SLA.0b013e3182263bb0

    View details for Web of Science ID 000292908700023

    View details for PubMedID 21725233

  • Continued Use of Trastuzumab Beyond Disease Progression in the National Comprehensive Cancer Network: Should We Practice Ahead of the Evidence? ONCOLOGIST Wong, Y., Ottesen, R. A., Hughes, M. E., Niland, J. C., Theriault, R., Edge, S. B., Blayney, D., Weeks, J. C. 2011; 16 (5): 559-565

    Abstract

    The role of continued trastuzumab after progression in women with human epidermal growth factor receptor (HER)-2+ metastatic breast cancer is controversial. Controlled clinical trials that establish a benefit from continued trastuzumab have been difficult to complete.In the National Comprehensive Cancer Center Network (NCCN) Breast Cancer Outcomes Database, we identified women treated with trastuzumab for metastatic or relapsed HER-2+ breast cancer at eight NCCN centers who subsequently progressed. Patients were eligible for this analysis if they initiated treatment at an NCCN institution between July 1997 and December 2004, received trastuzumab-containing treatment, and progressed while on therapy. We calculated the proportion of patients who received trastuzumab after progression, and in a multivariate analysis assessed the association of patient and provider characteristics with continued trastuzumab therapy.Our final cohort consisted of 218 women who experienced disease progression while on trastuzumab-containing therapy. Of these, 168 (77%) continued trastuzumab. Of these, 36 patients (17%) received therapy as part of a clinical trial. The only factors significantly associated with continuation of trastuzumab beyond progression were the presence of bone metastases and more recent year of development of progressive disease.Prior to the availability of any high-quality evidence supporting this practice, over three quarters of patients treated with trastuzumab for HER-2+ metastatic breast cancer at eight NCCN centers continued therapy beyond progression. Further work is needed to understand how physicians adopt new treatments when there is ambiguity surrounding their benefit.

    View details for DOI 10.1634/theoncologist.2010-0360

    View details for Web of Science ID 000290661900005

    View details for PubMedID 21450786

  • Expansion of cancer care and control in countries of low and middle income: a call to action LANCET Farmer, P., Frenk, J., Knaul, F. M., Shulman, L. N., Alleyne, G., Armstrong, L., Atun, R., Blayney, D., Chen, L., Feachem, R., Gospodarowicz, M., Gralow, J., Gupta, S., Langer, A., Lob-Levyt, J., Neal, C., Mbewu, A., Mired, D., Piot, P., Reddy, K. S., Sachs, J. D., Sarhan, M., Seffrin, J. R. 2010; 376 (9747): 1186-1193

    Abstract

    Substantial inequalities exist in cancer survival rates across countries. In addition to prevention of new cancers by reduction of risk factors, strategies are needed to close the gap between developed and developing countries in cancer survival and the effects of the disease on human suffering. We challenge the public health community's assumption that cancers will remain untreated in poor countries, and note the analogy to similarly unfounded arguments from more than a decade ago against provision of HIV treatment. In resource-constrained countries without specialised services, experience has shown that much can be done to prevent and treat cancer by deployment of primary and secondary caregivers, use of off-patent drugs, and application of regional and global mechanisms for financing and procurement. Furthermore, several middle-income countries have included cancer treatment in national health insurance coverage with a focus on people living in poverty. These strategies can reduce costs, increase access to health services, and strengthen health systems to meet the challenge of cancer and other diseases. In 2009, we formed the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, which is composed of leaders from the global health and cancer care communities, and is dedicated to proposal, implementation, and evaluation of strategies to advance this agenda.

    View details for DOI 10.1016/S0140-6736(10)61152-X

    View details for Web of Science ID 000282915700035

    View details for PubMedID 20709386

  • Challenges to National Cancer Institute-Supported Cooperative Group Clinical Trial Participation: An ASCO Survey of Cooperative Group Sites. Journal of oncology practice / American Society of Clinical Oncology Baer, A. R., Kelly, C. A., Bruinooge, S. S., Runowicz, C. D., Blayney, D. W. 2010; 6 (3): 114-117

    Abstract

    Anecdotal information regarding clinical research sites limiting participation in NCI-funded cooperative group studies prompted ASCO to collect data on and investigate the reasons behind this trend.

    View details for DOI 10.1200/JOP.200028

    View details for PubMedID 20808551

  • Partnering with payers for success: quality oncology practice initiative, blue cross blue shield of michigan, and the michigan oncology quality consortium. Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W., Stella, P. J., Ruane, T., Martin, J., Lavasseur, B., Leyden, T., Malloy, M. 2009; 5 (6): 281-284

    Abstract

    More than 16% of the total sites participating nationally in the QOPI survey are in Michigan. A significant component of the growth in QOPI participation in Michigan can be attributed to the involvement and quality improvement efforts of Blue Cross Blue Shield of Michigan.

    View details for DOI 10.1200/JOP.091043

    View details for PubMedID 21479071

  • Lymphoma After Solid Organ Transplantation: Risk, Response to Therapy, and Survival at a Transplantation Center JOURNAL OF CLINICAL ONCOLOGY Knight, J. S., Tsodikov, A., Cibrik, D. M., Ross, C. W., Kaminski, M. S., Blayney, D. W. 2009; 27 (20): 3354-3362

    Abstract

    We studied the incidence, risk factors, treatment, and outcomes of post-transplantation lymphoproliferative disorder (PTLD) that occurred at the University of Michigan since 1964.We identified 7,040 patients who received solid organ transplantation (SOT) and post-transplantation immunosuppressive therapy. Seventy-eight patients developed PTLD.Diffuse large B-cell lymphoma (n = 43), polymorphic PTLD (n = 10), Hodgkin's lymphoma (n = 7), Burkitts lymphoma (n = 6), plasmacytoma (n = 5), and mucosa-associated lymphoid tissue lymphoma (n = 3) were all over-represented in the SOT population compared with a population sample from the Surveillance, Epidemiology, and End Results (SEER) database; follicular lymphoma (n = 0) was underrepresented. Negative pretransplantation Epstein-Barr virus (EBV) serology was a risk factor for PTLD. Available histologic analysis of tumor tissue showed that 75% were CD20 positive and that 62% were EBV positive; EBV-positive tumors occurred sooner after SOT than EBV-negative tumors (mean, 29 v 66 months). Extralymphatic disease (79%), poor performance status (68%), elevated lactate dehydrogenase (LDH; 71%), and advanced stage (68%) disease were all common at the time of lymphoma diagnosis. Two thirds of patients had a complete response when treated with cyclophosphamide, doxorubicin, vincristine, and prednisone-like chemotherapy (either with or without rituximab). Median overall survival in all patients with PTLD was 8.23 years (95% CI, 2.28 to 30.0 years).EBV-naïve patients who receive a donor organ from an EBV-infected donor are in the highest-risk situation for PTLD development. Most of these lymphomas are CD20 positive. Follicular lymphoma is unusual. With treatment, survival of patients with PTLD was indistinguishable from that of the SEER population sample.

    View details for DOI 10.1200/JCO.2008.20.0857

    View details for Web of Science ID 000267821400016

    View details for PubMedID 19451438

  • Chemotherapy Use for Hormone Receptor-Positive, Lymph Node-Negative Breast Cancer JOURNAL OF CLINICAL ONCOLOGY Hassett, M. J., Hughes, M. E., Niland, J. C., Edge, S. B., Theriault, R. L., Wong, Y., Wilson, J., Carter, W. B., Blayney, D. W., Weeks, J. C. 2008; 26 (34): 5553-5560

    Abstract

    To describe the frequency of chemotherapy use for hormone receptor (HR)-positive, lymph node (LN)-negative breast cancer from 1997 to 2004 at eight National Comprehensive Cancer Network institutions, to explore whether chemotherapy use varied over time and between institutions, and to identify factors associated with the decision to forego chemotherapy.Among women younger than age 70 years with HR-positive, LN-negative breast cancer measuring more than 1 cm, we analyzed the frequency of chemotherapy use on a yearly basis. A multivariable logistic regression model assessed the relationship between receipt of chemotherapy and year of diagnosis, institution, tumor features, and patient characteristics. Interaction terms were added to the model, and stratified analyses were conducted to further explore the determinants of chemotherapy use.Fifty-five percent of 3,190 women received chemotherapy. Chemotherapy use was less common for patients with 1.1- to 2-cm tumors than for patients tumors greater 2 cm (47% v 87%, respectively; P < .01) and for women age 60 to 69 years versus women younger than age 50 years (24% v 76%, respectively; P < .01). On multivariable analysis, predictors independently associated with receiving chemotherapy included larger tumor size, higher grade, human epidermal growth factor receptor 2 overexpression, younger age, and institution (P < .01 for all). Institutions exhibited dramatically different rates of chemotherapy use (from 46% to 65%) and patterns of change in chemotherapy use over time (from a 79% relative increase to a 22% relative decrease).Although institutions seemed to agree that not all women with HR-positive, LN-negative breast cancer need chemotherapy, there did not seem to be consensus regarding which women should get chemotherapy. Only prospective randomized controlled trials will conclusively establish which subtypes of HR-positive, LN-negative breast cancer benefit from chemotherapy.

    View details for DOI 10.1200/JCO.2008.17.9705

    View details for Web of Science ID 000261199700012

    View details for PubMedID 18955448

  • The registry case finding engine: An automated tool to identify cancer cases from unstructured, free-text pathology reports and clinical notes. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Hanauer, D. A., Miela, G., Chinnaiyan, A. M., Chang, A. E., Blayney, D. W. 2007; 205 (5): 690-697

    Abstract

    The American College of Surgeons mandates the maintenance of a cancer registry for hospitals seeking accreditation. At the University of Michigan Health System, more than 90% of all registry patients are identified by manual review, a method common to many institutions. We hypothesized that an automated computer system could accurately perform this time- and labor-intensive task. We created a tool to automatically scan free-text medical documents for terms relevant to cancer.We developed custom-made lists containing approximately 2,500 terms and phrases and 800 SNOMED codes. Text is processed by the Case Finding Engine (CaFE), and relevant terms are highlighted for review by a registrar and used to populate the registry database. We tested our system by comparing results from the CaFE to those by trained registrars who read through 2,200 pathology reports and marked relevant cases for the registry. The clinical documentation (eg, electronic chart notes) of an additional 476 patients was also reviewed by registrars and compared with the automated process by the CaFE.For pathology reports, the sensitivity for automated case identification was 100%, but specificity was 85.0%. For clinical documentation, sensitivity was 100% and specificity was 73.7%. Types of errors made by the CaFE were categorized to direct additional improvements. Use of the CaFE has resulted in a considerable increase in the number of cases added to the registry each month.The system has been well accepted by our registrars. CaFE can improve the accuracy and efficiency of tumor registry personnel and helps ensure that cancer cases are not overlooked.

    View details for DOI 10.1016/j.jamcollsurg.2007.05.014

    View details for Web of Science ID 000250649800009

    View details for PubMedID 17964445

  • Defining Quality: QOPI Is a Start. Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W. 2006; 2 (5): 203-?

    View details for PubMedID 20859337

  • Dose-intense chemotherapy every 2 weeks with dose-intense cyclophosphamide, doxorubicin, vincristine, and prednisone may improve survival in intermediate- and high-grade lymphoma: A phase II study of the Southwest Oncology Group (SWOG 9349) JOURNAL OF CLINICAL ONCOLOGY Blayney, D. W., LeBlanc, M. L., Grogan, T., GAYNOR, E. R., Chapman, R. A., Spiridonidis, C. H., Taylor, S. A., Bearman, S. I., MILLER, T. P., Fisher, R. I. 2003; 21 (13): 2466-2473

    Abstract

    To test the hypothesis that therapy of intermediate- and high-grade (excluding Burkitt lymphoblastic) lymphoma with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) could be safely dose-intensified with routine filgrastim support.Eligible patients were those who were previously untreated and who had either bulky stage II, or stage III or IV lymphoma with working formulation histology D, E, F, G, H, or J; performance status < or = 2; and acceptable end organ function. No upper age limit was specified. Therapy was dose-intensified CHOP (CHOP-DI) with filgrastim support. Each course was repeated every 14 days for six planned courses.Eighty-eight eligible patients were treated with CHOP-DI and had a median follow-up of 5.1 years on this phase II study, designated Southwest Oncology Group (SWOG) 9349. The progression-free survival was 51% at 2 years and 41% at 5 years. The overall survival was 60% at 5 years. Three fatal treatment-related events occurred. One patient with myelodysplastic syndrome was reported.Treatment with CHOP-DI can be safely administered in the cooperative group setting and results in improved survival. Estimated overall survival at 5 years was 14% better than that of patients treated with standard-dose CHOP in an earlier SWOG study, although progression-free survival of 60% at 2 years-the prespecified end point-was not achieved. CHOP-DI, given every 2 weeks at escalated doses, is a strategy that should be tested in a future randomized clinical trial in lymphoma.

    View details for DOI 10.1200/JCO.2003.06.137

    View details for Web of Science ID 000183818800005

    View details for PubMedID 12829664

  • DECREASING RISK OF LEUKEMIA WITH PROLONGED FOLLOW-UP AFTER CHEMOTHERAPY AND RADIOTHERAPY FOR HODGKINS-DISEASE NEW ENGLAND JOURNAL OF MEDICINE Blayney, D. W., Longo, D. L., Young, R. C., Greene, M. H., Hubbard, S. M., POSTAL, M. G., Duffey, P. L., DeVita, V. T. 1987; 316 (12): 710-714

    Abstract

    Acute nonlymphocytic leukemia is a recognized complication of combined chemotherapy and radiation treatment of patients with Hodgkin's disease. Previous studies have suggested that the risk of leukemia in these patients increases with time after treatment. We analyzed the occurrence of second neoplasms among 192 patients with Hodgkin's disease who were followed for a median of over 15 years. We originally planned to identify prospectively the morphologic changes in bone marrow that precede the development of acute leukemia. All 63 patients consenting to bone marrow aspiration had normal marrow morphology, and no case of acute leukemia occurred more than 11 years after treatment. Actuarial analysis revealed that the peak onset of leukemia-related complications was between three and nine years after first treatment. We conclude that there appears to be a period of increased risk in patients treated with chemotherapy and radiation, after which the risk of secondary leukemia decreases. Patients surviving for more than 11 years after treatment appear to be at no increased risk of acute leukemia.

    View details for Web of Science ID A1987G405500003

    View details for PubMedID 3821809

  • THE HUMAN T-CELL LEUKEMIA-LYMPHOMA VIRUS IN THE SOUTHEASTERN UNITED-STATES JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Blayney, D. W., Blattner, W. A., ROBERTGUROFF, M., Jaffe, E. S., Fisher, R. I., Bunn, P. A., PATTON, M. G., RARICK, H. R., Gallo, R. C. 1983; 250 (8): 1048-1052

    Abstract

    The human T-cell leukemia-lymphoma virus (HTLV) is a recently described RNA tumor virus associated with human T-cell malignant neoplasms. In two geographic areas, Japan and the Caribbean basin, clusters of adult T-cell leukemia-lymphoma are "sentinel diseases" and have suggested an underlying prevalence of HTLV infection in both family members of the index cases and in the population. Four cases of lymphoma from the United States are described as illustrative of the sentinel disease. Serological studies of families and of a small population sample suggest that HTLV infection is endemic in certain parts of the southeastern United States at rates similar to those seen in Caribbean blacks but at a lower rate than that observed in southwestern Japan.

    View details for Web of Science ID A1983RD90600015

    View details for PubMedID 6308290

  • THE HUMAN T-CELL LEUKEMIA LYMPHOMA VIRUS, LYMPHOMA, LYTIC BONE-LESIONS, AND HYPERCALCEMIA ANNALS OF INTERNAL MEDICINE Blayney, D. W., Jaffe, E. S., Fisher, R. I., Schechter, G. P., Cossman, J., ROBERTGUROFF, M., Kalyanaraman, V. S., Blattner, W. A., Gallo, R. C. 1983; 98 (2): 144-151

    Abstract

    The human T-cell lymphoma (HTL) virus is a type C RNA tumor virus isolated from patients with malignancies of mature T cells. We report three patients with peripheral T-cell lymphoma, hypercalcemia, and antibodies to HTL virus. One patient presented with idiopathic hypercalcemia of 6 months' duration, two with striking lytic bone lesions, and two with circulating malignant lymphocytes. Malignant cells from all patients had surface markers characteristic of thymic-derived lymphocytes (T cells), and all patients had natural serum antibodies to disrupted HTL virus and to one or both viral structural proteins p19 and p24. Patients with adult peripheral T-cell lymphomas, particularly those that present with hypercalcemia and lytic bone lesions, may have antibodies to the type C RNA human tumor virus, HTL virus.

    View details for Web of Science ID A1983QB56900004

    View details for PubMedID 6600592

  • THE HUMAN T-CELL LEUKEMIA LYMPHOMA VIRUS ASSOCIATED WITH AMERICAN ADULT T-CELL LEUKEMIA LYMPHOMA BLOOD Blayney, D. W., Jaffe, E. S., Blattner, W. A., Cossman, J., ROBERTGUROFF, M., Longo, D. L., Bunn, P. A., Gallo, R. C. 1983; 62 (2): 401-405

    Abstract

    The human T-cell leukemia/lymphoma virus (HTLV) is a novel type-C retrovirus isolated from patients with T-lymphoproliferative malignancies. Thirteen cases of HTLV-associated malignancy from US centers were studied in detail. Ten of these cases share common clinical features and define a typical virus-associated adult T-cell leukemia/lymphoma (ATL). All ten patients presented with Ann Arbor stage IV lymphoma because of skin involvement, bone marrow involvement, or lymphomatous leptomeningitis. Lymphadenopathy occurred in 7 of 10 patients at presentation, and the malignant cells were cytologically pleomorphic. Leukemia occurred in 60% of the patients at presentation. Hypercalcemia was found initially in two-thirds of the patients, with lytic bone lesions or positive bone scans in 7 of 10. Complete remission occurred in 40%, but all have relapsed. These cases closely resemble those virus-positive cases of adult T-cell leukemia/lymphoma (ATL) reported from Japan and the Caribbean. Three additional virus-positive patients had atypical presentations and diagnoses (acute lymphocytic leukemia, Sézary's syndrome, leukemic reticuloendotheliosis), usually with less aggressive clinical courses and atypical demographic and laboratory features. Presence of HTLV serum antibodies in cases of ATL (with hypercalcemia and circulating malignant cells) appears to define a distinct clinicopathologic entity that may occur in geographic clusters.

    View details for Web of Science ID A1983RC87400025

    View details for PubMedID 6223675

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