Eileen Scigliano

Construct Validity of the Posttraumatic Stress Disorder Checklist in Cancer Survivors: Analyses Based on Two Samples.

The measurement of posttraumatic stress disorder (PTSD) is critically important for the identification and treatment of this disorder. The PTSD Checklist (PCL; F. W. Weathers and J. Ford, 1996) is a self-report measure that is increasingly used. In this study, the authors investigated the factorial validity of the PCL with data from 236 cancer survivors who received a bone marrow or stem cell transplantation. The authors examined the fit of these data with the clinical model of 3 symptom clusters for PTSD, as proposed in the Diagnostic and Statistical Manual of Mental Disorders, and alternative models tested in prior research. By using confirmatory factor analysis the authors found that a 4-first-order-factor model of PTSD provided the best fit. The relations of PTSD symptoms with sociodemographic and medical variables were also explored.

Randomized Clinical Trial of Telephone-Administered Cognitive-Behavioral Therapy to Reduce Post-Traumatic Stress Disorder and Distress Symptoms After Hematopoietic Stem-Cell Transplantation

PURPOSEnA significant number of survivors of hematopoietic stem-cell transplantation (HSCT) report enduring adverse effects of treatment, including illness-related post-traumatic stress disorder (PTSD) symptoms and general distress. We report results of a randomized clinical trial that tested the effects of a 10-session, telephone-administered cognitive-behavioral therapy (CBT) intervention on PTSD, depression, and distress symptoms.nnnMETHODSnSurvivors who had undergone HSCT 1 to 3 years earlier (N = 408) were assessed for study eligibility. Those who met study eligibility criteria (n = 89) completed a baseline assessment that included a clinical interview and self-report measures of PTSD symptoms (the primary outcome) and depression and general distress (the secondary outcomes). Next, they were randomly assigned to CBT or an assessment-only condition. Survivors in the CBT group completed 10 individual telephone-based CBT sessions (T-CBT) that included strategies to reduce PTSD symptoms, depression, and general distress. Follow-up assessments occurred at 6, 9, and 12 months after the baseline assessment.nnnRESULTSnLinear mixed-model analyses revealed that, compared with HSCT survivors in the assessment-only condition, survivors who completed T-CBT reported fewer illness-related PTSD symptoms, including less avoidance (P < .001) and fewer intrusive thoughts (P < .05) as well as less general distress and fewer depressive symptoms (P < .05) even after controlling for potential demographic and medical covariates. These results were consistent across the three follow-up assessments.nnnCONCLUSIONnA brief, telephone-administered CBT intervention developed for HSCT survivors is an efficacious treatment for reducing illness-related PTSD symptoms and general distress.

Soluble circulating Fcγ receptors in human serum: a new ELISA assay for specific and quantitative detection

We have developed a simple, rapid, and sensitive enzyme-linked immunoadsorbent assay (ELISA) to measure soluble cell-free human Fc gamma receptor (Fc gamma R) in serum. This assay is based on the use of two monoclonal antibodies directed against different epitopes expressed on the same low avidity human Fc gamma R (CD16), which is present on polymorphonuclear leukocytes, macrophages and NK cells. This sandwich ELISA, which can measure 2 nM concentration of Fc gamma R, has enabled us to demonstrate the presence and to measure the level of soluble cell-free human Fc gamma R (CfH-Fc gamma R) in normal human serum.

Effectiveness of Partner Social Support Predicts Enduring Psychological Distress after Hematopoietic Stem Cell Transplantation

OBJECTIVEnHematopoietic stem cell transplant (HSCT) survivors who are 1 to 3 years posttransplant are challenged by the need to resume valued social roles and activities--a task that may be complicated by enduring transplant-related psychological distress common in this patient population. The present study investigated whether transplant survivors who receive adequate social support from their spouse or intimate partner experience lower distress.nnnMETHODnEffects of receiving a greater quantity of partner support (a common approach to studying enacted support) were compared with effects of receiving more effective partner support (i.e., support that more closely matches their needs in terms of its quantity and quality). Men and women (N = 230) who were 1 to 3 years posttransplant completed measures of partner support quantity (Manne & Schnoll, 2001), partner social support effectiveness (Rini & Dunkel Schetter, 2010), and psychological distress (Brief Symptom Inventory; Derogatis & Spencer, 1982). Potential medical and sociodemographic confounds were controlled in analyses.nnnRESULTSnAs hypothesized, survivors reported less distress when they received more effective partner support (p < .001). Quantity of partner support was not associated with distress (p = .23). An interaction revealed that when partner support was effective, the quantity of support survivors received was not associated with their distress (p = .90); however, when partner support was ineffective, receiving a greater quantity of partner support was associated with substantially elevated distress (p = .002).nnnCONCLUSIONSnFindings suggest that clinical approaches to addressing or preventing enduring distress after HSCT should target features of partner support related to its appraised effectiveness.

Barriers to mental health service use among hematopoietic SCT survivors

This study examined barriers to mental health service use and the demographic, medical and psychosocial correlates of these barriers among hematopoietic SCT (HSCT) survivors. A sample of 253 HSCT survivors who were 1 to 3 years posttransplant completed measures of demographic, physical, psychological and social characteristics as well as a newly modified measure of barriers to mental health service use. Only 50% of distressed HSCT survivors had received mental health services. An exploratory factor analysis of the barriers to mental health service use scale yielded four factors: scheduling barriers, knowledge barriers, emotional barriers and illness-related barriers. Patients with higher social constraints (perceived problems discussing the illness experience with significant others) reported higher levels of all four types of barriers. General distress and transplant-related posttraumatic stress symptoms were positively associated with emotional, knowledge and illness-related barriers to mental health service use, whereas physical and functional well-being were inversely associated with these barriers. Having more knowledge barriers and more emotional barriers predicted a lower likelihood of receiving mental health services, as did lower levels of education and general distress. Results suggest that a significant number of HSCT survivors may benefit from education about mental health services that is tailored to individual barriers.

Systematic Light Exposure in the Treatment of Cancer-Related Fatigue: A Preliminary Study

Psycho-Oncology Psycho-Oncology (2014) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3553 Clinical Correspondence Systematic light exposure in the treatment of cancer-related fatigue: a preliminary study William H. Redd 1 *, Heiddis Valdimarsdottir 1,2 , Lisa M. Wu 1 , Gary Winkel 1 , Emily E. Byrne 1 , Melba A. Beltre 1 , Elizabeth S. Liebman 1 , Tanya Erazo 1 , Judy A. Hayes 1 , Luis Isola 3 , Eileen Scigliano 3 , Yeraz Meschian 1 , Susan Lutgendorf 4 and Sonia Ancoli-Israel 5 Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Psychology, Reykjavik University, Iceland Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Psychology, University of Iowa, Iowa, IA, USA Departments of Psychiatry and Medicine, University of California, San Diego, CA, USA *Correspondence to: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. E-mail: william. redd@mssm.edu Received: 1 October 2013 Revised: 13 March 2014 Accepted: 25 March 2014 Dear Editor, Introduction Cancer-related fatigue (CRF) is the most commonly reported side effect of cancer treatment [1]. It is defined by the National Comprehensive Cancer Network as ‘a distressing, persistent, subjective sense of physical, emotional, and cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity’. Patients feel tired even after resting, have reduced capacity to carry out normal activities, experience slow physical recovery from tasks, and report diminished concentration. Most patients experience CRF during their treatment, and many continue to experience CRF long after all treatment has ended. In our research with survivors of hematopoietic stem cell transplantation (HSCT) 1–3 years off treatment, 40% of those interviewed reported clinically significant CRF. Various pharmacological and nonpharmacological interventions have been studied to treat CRF with generally mild to moderate effect sizes [1]. An alternate intervention may be systematic bright white light (BWL) exposure, which is far less costly and involves less patient burden than other interventions. Reviews and meta-analyses [2] have reported that BWL is effective in reducing sleep and circadian rhythm problems associated with other disorders (e.g., depression and jet lag) but has not been previously tested for the effect on fatigue. Recent research from our group has shown that, when given during chemotherapy, BWL compared with Copyright

A case report of secondary autograft failure due to Gaucher disease

To the Editor: Recently, Mistry et al. [1] suggested that diagnostic delays in Gaucher disease (GD) resulted in severe disease manifestations. We present a case where the delayed treatment of known GD after transplant led to secondary engraftment failure. A 69-year-old Ashkenazi male with a history of asymptomatic GD underwent autologous stem cell transplant (ASCT) for relapsed non-Hodgkin’s lymphoma (NHL) lymphoma. His GD was diagnosed with his initial presentation of lymphoma with Gaucher cells in bone marrow. His initial lymphoma was treated with rituximab, cyclophosphamide, doxorubicin, prednisolone (R-CHOP) and achieved complete remission for 3 years. Reoccurence was detected on routine positron emission tomography (PET) and he was referred for ASCT. Prior to transplant, his CBC showed a white blood cell (WBC) count of 8.9 10/L, hemoglobin of 14.1 g/dL, and platelets of 142 10/L. No positron emission tomography and computerized tomography (PETCT) was available. He received rituximab, ifosfamide, carboplatin, etoposide (R-ICE) followed by carmustine, etoposide, cytarabine, melphalan (BEAM) and ASCT. Neutrophil engraftment occurred on day þ12 but was followed by an absolute neutroprhil count (ANC) nadir of 0.85 10/L on day þ93 requiring filgrastim. Platelet engraftment occurred on day þ35, but platelets were never >45 10/L. His average hemoglobin was 9.1 g/dL despite blood transfusions and weekly epoetin alpha administration. At þ90 days, a bone marrow biopsy (see Fig. 1) showed infiltrates of Gaucher cells but no evidence of lymphoma, and GD evaluation was initiated. GD was confirmed by enzyme studies. Mutational analysis showed homozygosity for the N370S (1226G) mutation. Evaluation revealed diffuse infiltration of the femurs with increased marrow activity, mild splenomegaly (seen on PETCT with cranial–caudate measurement of 13.2 cm, normal <12 cm), osteopenia (seen on dual-energy x-ray absorptiometry (DEXA) scan with a hip bone density of 1.18), and an elevated chitotriosidase level (448 mol/mL, normal <300). The patient refused to have an MRI; therefore, liver and spleen volumes are unavailable. Enzyme replacement therapy (ERT) with imiglucerase at 60 U/kg IV every 2 weeks was started on day þ153. Peripheral counts have improved after ERT during these past 8 months. Prior to ERT, his platelets were >45 10/L, but after ERT, they have increased to >70 10/L. He has not required blood transfusions, and epoetin alpha was last needed 42 days after ERT. At 1 year posttransplant, his CBC showed an ANC of 2.07 10/L, hemoglobin of 11.4 g/dL, and platelets of 73 10/L, and a PETCT found NHL remission with a normal spleen (cranial–caudate measurement of 11.4 cm) with DEXA pending. Prior to transplant, he was asymptomatic with mild thrombocytopenia. After transplant he was pancytopenic requiring transfusion and growth factor support until the initiation of ERT. Gaucher cells were resistant to chemotherapy and may have contributed to secondary graft failure. It is interesting to speculate whether the chemotherapy, transplant, or growth factor support may have accelerated the GD phenotype by causing accelerated bone marrow turnover and increased substrate loading. In summary, patients with GD should be carefully evaluated in anticipation of high-dose chemotherapy and ASCT. ERT may be indicated in anticipation after ASCT to avoid secondary graft failure.

Graft versus host disease after stem cell allotransplantation with low-dose total body irradiation, fludarabine, and antithymocyte globulin.

Background. We previously showed that antithymocyte globulin (ATG) given with total body irradiation (TBI) 200 cGy and fludarabine results in high rate of donor engraftment. Its influence on acute and chronic graft versus host disease (GVHD) and on graft versus tumor effect is less known. Methods. Sixty-five patients underwent nonmyeloablative stem cell transplant with ATG, TBI 200 cGy, and fludarabine. GVHD prophylaxis was mycophenolate mofetil and cyclosporine. Forty-two patients (pts) (65%) had match related donors, 18 (27%) match unrelated, 1 (1.5%) mismatch related, and 4 (6%) mismatch unrelated donors. Results. At a median follow-up of 862 days, 24 patients (37%) developed GVHD. The median age of the patients with and without GVHD was 56 years respectively. Acute GVHD grade II-IV developed in 19 pts (29%). Fatal GVHD of liver and/or gut occurred in nine pts (14%). Forty-one pts survived more than 100 days. Five pts (12%) had chronic GVHD, two had extensive, and three had limited involvement. Relapsed disease was observed in 22 pts (34%). Infections occurred in 15 pts (23%) and were fatal in 13 (20%). Conclusions. The addition of ATG to TBI 200cGy and fludarabine resulted in a modest incidence of GVHD. The best transplant outcomes were observed in pts with lymphoid malignancies.

Lymph nodes can accurately be measured on PET-CT for lymphoma staging/restaging without a concomitant contrast enhanced CT scan

Abstract Dual imaging with both contrast enhanced CT scan and PET-CT is recommended for evaluation of lymphoma. We compared the performance in identification and size measurements of involved lymph nodes in FDG-avid lymphomas on the low dose non-contrast enhanced CT of a PET-CT scan with those on a diagnostic contrast enhanced CT scan. The size of FDG-avid lymph nodes was measured in both the short and long axis on both the low dose non-contrast CT of the PET-CT and the contrast enhanced CT by two independent readers. A total of 307 FGD avid lymph nodes were identified in 52 patients. There was no statistically significant differences in the measured size of the nodes on the non-contrast and contrast enhanced scans (pu2009=u20090.21). Baseline staging and restaging of FDG-avid lymphomas can be performed with one test, PET-CT, without an accompanying contrast enhanced CT scan, with no effect on the measured nodal size.

Retrospective analysis of prognosticators in patients with relapsed Hodgkin's Lymphoma treated with autologous transplant: results of a single center

Hodgkin’s Lymphoma (HL) is highly chemoresponsive, and majority of patients respond to therapy except for a small number which require high-dose therapy and stem cell rescue for salvage. We report the results of a single-center experience in 41 patients with relapsed HL treated with high-dose therapy at the time of relapse from the year 1989–2010. The 7-year OS for the group is 39.2xa0%; the median progression-free survival is 30.6xa0months. Univariate analysis identified refractory disease at transplant and extranodal involvement as important prognosticators. The 100-day mortality was 5xa0%. The most common cause for delayed mortality was disease progression. The incidence of secondary malignancy in the group was 2xa0%. Our results reinforce the significance of long-term follow up as late relapses are observed. Additionally, identifying biological prognosticators and implying them for treatment may improve the outcomes in poor-risk patients.