Alekist Quach

University of California, San Diego

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John M. Maris

Children's Hospital of Philadelphia

Susan Groshen

University of Southern California

Randall A. Hawkins

University of California, San Francisco

Katherine K. Matthay

University of California, San Francisco

Janet Veatch

University of California, San Francisco

John P. Huberty

University of California, San Francisco

Benjamin L. Franc

Stanford Medicine

Gregory A. Yanik

University of Michigan–Ann Arbor

Patricia Brophy

East Carolina University

Judith G. Villablanca

Children's Hospital of Los Angeles

Cooperative Institutions

University of California, San Francisco

University of California, San Diego

University of Southern California

University of Pennsylvania

Children's Hospital of Philadelphia

Children's Hospital of Los Angeles

UCSF Benioff Children's Hospital

Universidad Católica de Santa Fe

University of California San Francisco Medical Center

C. S. Mott Children's Hospital

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The human milk oligosaccharide 3’sialyllactose promotes inflammation resolution and reduces atherosclerosis development.

Atherosclerosis (2021)

Ariane Pessentheiner Nathanael J. Spann Cathleen Collins Bastian Ramms Austin W.T. Chiang

10.1016/j.atherosclerosis.2021.06.089

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Citations (3)

Comparison of Iodine-123 Metaiodobenzylguanidine (MIBG) Scan and [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography to Evaluate Response After Iodine-131 MIBG Therapy for Relapsed Neuroblastoma

Journal of Clinical Oncology (2009)

Denah R. Taggart Myo Han Alekist Quach Susan Groshen Wei Ye

Children with relapsed neuroblastoma have poor survival. It is crucial to have a reliable method for evaluating functional response to new therapies. In this study, we compared two functional imaging modalities for neuroblastoma: metaiodobenzylguanidine (MIBG) scan for uptake by the norepinephrine transporter and [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) uptake for glucose metabolic activity.Patients enrolled onto a phase I study of sequential infusion of iodine-131 ((131)I) MIBG (NANT-2000-01) were eligible for inclusion if they had concomitant FDG-PET and MIBG scans. (131)I-MIBG therapy was administered on days 0 and 14. For each patient, we compared all lesions identified on concomitant FDG-PET and MIBG scans and gave scans a semiquantitative score.The overall concordance of positive lesions on concomitant MIBG and FDG-PET scans was 39.6% when examining the 139 unique anatomic lesions. MIBG imaging was significantly more sensitive than FDG-PET overall and for the detection of bone lesions (P < .001). There was a trend for increased sensitivity of FDG-PET for detection of soft tissue lesions. Both modalities showed similar improvement in number of lesions identified from day 0 to day 56 scan and in semiquantitative scores that correlated with overall response. FDG-PET scans became completely negative more often than MIBG scans after treatment.MIBG scan is significantly more sensitive for individual lesion detection in relapsed neuroblastoma than FDG-PET, though FDG-PET can sometimes play a complementary role, particularly in soft tissue lesions. Complete response by FDG-PET metabolic evaluation did not always correlate with complete response by MIBG uptake.

Concomitant

Concordance

Fluorodeoxyglucose

10.1200/jco.2008.20.5732

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Citations (92)

Phase II Study on the Effect of Disease Sites, Age, and Prior Therapy on Response to Iodine-131-Metaiodobenzylguanidine Therapy in Refractory Neuroblastoma

Journal of Clinical Oncology (2007)

Katherine K. Matthay Gregory A. Yanik Julia A. Messina Alekist Quach John P. Huberty

To evaluate the effect of disease sites and prior therapy on response and toxicity after iodine-131-metaiodobenzylguanidine (131I-MIBG) treatment of patients with resistant neuroblastoma.One hundred sixty-four patients with progressive, refractory or relapsed high-risk neuroblastoma, age 2 to 30 years, were treated in a limited institution phase II study. Patients with cryopreserved hematopoietic stem cells (n = 148) were treated with 18 mCi/kg of 131I-MIBG. Those without hematopoietic stem cells (n = 16) received 12 mCi/kg. Patients were stratified according to prior myeloablative therapy and whether they had measurable soft tissue involvement or only bone and/or bone marrow disease.Hematologic toxicity was common, with 33% of patients receiving autologous hematopoietic stem cell support. Nonhematologic grade 3 or 4 toxicity was rare, with 5% of patients experiencing hepatic, 3.6% pulmonary, 10.9% infectious toxicity, and 9.7% with febrile neutropenia. The overall complete plus partial response rate was 36%. The response rate was significantly higher for patients with disease limited either to bone and bone marrow, or to soft tissue (compared with patients with both) for patients with fewer than three prior treatment regimens and for patients older than 12 years. The event-free survival (EFS) and overall survival (OS) times were significantly longer for patients achieving response, for those older than 12 years and with fewer than three prior treatment regimens. The OS was 49% at 1 year and 29% at 2 years; EFS was 18% at 1 year.The high response rate and low nonhematologic toxicity with 131I-MIBG suggest incorporation of this agent into initial multimodal therapy of neuroblastoma.

Refractory (planetary science)

10.1200/jco.2006.09.3484

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Citations (236)

131I-Metaiodobenzylguanidine (131I-MIBG) double infusion with autologous stem cell transplant for neuroblastoma: A New Approaches to Neuroblastoma Therapy (NANT) study

Journal of Clinical Oncology (2006)

K. K. Matthay Alekist Quach John P. Huberty Benjamin L. Franc Susan Groshen

9011 Background: 131 I-MIBG provides targeted radiotherapy with >30% response in refractory neuroblastoma, but the activity infused is limited by radiation safety and hematologic toxicity. The goal was to determine the maximum tolerated dose of 131 I-MIBG in two consecutive infusions at a 2-week interval, supported by autologous stem cell transplant (ASCT) 2 weeks after the second dose. Methods: The 131 I-MIBG was escalated in a 3+3 Phase I trial design, with levels calculated by total red marrow radiation index (RMI) from the double infusion. The first infusion of 131 I-MIBG was 12, 15, 18 and 21 mCi/kg for levels 1, 2, 3 and 4 respectively. Using detailed dosimetry, the second infusion was adjusted to achieve the target RMI, except at Level 4, where the second infusion was capped at 21 mCi/kg. Results: Twenty-one patients were enrolled at Level 1–4, with 18 evaluable for toxicity. Median age at enrollment was 7 years, all were heavily pretreated, including 12 with prior high dose therapy and ASCT, and 12 patients had bone marrow tumor. Cumulative 131 I-MIBG given to achieve the target RMI ranged from 18 mci/kg to 49 mCi/kg. RMI delivered per mCi of MIBG decreased in 15/19 patients by mean of 0.21 cGy/mCi with the second infusion. Hematologic toxicity was acceptable, with median time to ANC>500 after ASCT of 13 (4–27) days. Platelet transfusion was required in 15/18 patients, with median time to platelet independence of 18 (6–47) days after ASCT. There were no non-hematologic toxicities above grade 2 attributed to therapy, though 9 patients had grade 1–2 elevations of transaminase, and 1 had grade 2 hypothyroidism. Responses in 17 evaluable patients included 1 PR, 4 MR, 6 SD, and 6 PD. Eleven patients are alive at median of 361 days (46–483); 5 died of PD and 1 of unrelated toxicity. Conclusion: The lack of toxicity with this approach allowed dramatic dose intensification of 131 I-MIBG, with minimal toxicity and the possibility of improved response. [Table: see text] No significant financial relationships to disclose.

Platelet Transfusion

Refractory (planetary science)

10.1200/jco.2006.24.18_suppl.9011

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Citations (6)

Cardiac death in a patient with adult-onset Still's disease treated with the interleukin 1 receptor inhibitor anakinra

Annals of the Rheumatic Diseases (2006)

P. J Ruiz Eliezer Masliah Taylor A. Doherty Alekist Quach Gary S. Firestein

We report a case of adult-onset Still’s disease (AOSD) with rapid deterioration of cardiac function when treated with recombinant human interleukin (IL) 1 receptor antagonist. Pro-inflammatory cytokines such as IL 1 and tumour necrosis factor (TNF) have been implicated in the pathogenesis of cardiac dysfunction, partly because of their negative inotropic activities in vitro and in vivo.1–3 This concept led to clinical trials evaluating the utility of TNF inhibitors in patients with congestive heart failure. Surprisingly, TNF blockade considerably increased the incidence of cardiac death. On the basis of these observations, TNF inhibitors are usually discontinued in patients with cardiac dysfunction.4,5 However, there is no information on the risks of other cytokine inhibitors. A 29-year-old woman with a 4-year history …

Adult-onset Still's disease

10.1136/ard.2006.060541

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Citations (23)

Fostering medical students’ lifelong learning skills with a dashboard, coaching and learning planning

Perspectives on Medical Education (2018)

Karen E. Hauer Nicholas Iverson Alekist Quach Patrick Yuan Stephanie Kaner

To develop lifelong learning skills, students need feedback, access to performance data, and coaching. A new medical curriculum incorporated infrastructural supports based on self-regulated learning theory and the Master Adaptive Learner framework to engage students in reflection and learning planning. This study examines students' experience with a performance dashboard, longitudinal coaching, and structured time for goal-setting.Focus groups with first-year medical students explored performance dashboard usage, coaching and learning planning. We analyzed findings using thematic analysis. Results informed development of a 29-item survey rated strongly disagree (1) to strongly agree (5) to investigate experience with the dashboard, coaching and learning goals program. The survey was distributed to one first-year medical student class. We performed descriptive statistics and factor analysis.In three focus groups with 21 participants, students endorsed using the dashboard to access performance information but had trouble interpreting and integrating information. They valued coaches as sources of advice but varied in their perceptions of the value of discussing learning planning. Of 152 students, 114 (75%) completed the survey. Exploratory factor analysis yielded 5 factors explaining 57% of the variance: learning goals development (α = 0.88; mean 3.25 (standard deviation 0.91)), dashboard usage (α = 0.82; 3.36 (0.64)), coaching (α = 0.71; 3.72 (0.64)), employment of learning strategies (α = 0.81; 3.67 (0.79)), and reflection (α = 0.63; 3.68 (0.64)).The student performance dashboard provides efficient feedback access, yet students' use of this information to guide learning is variable. These results can inform other programs seeking to foster lifelong learning skills.

Dashboard

Thematic Analysis

10.1007/s40037-018-0449-2

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Citations (32)

Rituximab Desensitizations in Pediatric and Adult Patients at a Tertiary Care Center

Journal of Allergy and Clinical Immunology (2021)

Alekist Quach Anthony Wong Lulu Tsao Angela Y. Chang Lauren A. Sanchez

10.1016/j.jaci.2020.12.091

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Thyroid and hepatic function after high‐dose ¹³¹I‐metaiodobenzylguanidine (¹³¹I‐MIBG) therapy for neuroblastoma

Pediatric Blood & Cancer (2010)

Alekist Quach Lingyun Ji Vikash Kumar Mishra Aimee Sznewajs Janet Veatch

Abstract Background 131 I‐Metaiodobenzylguanidine ( 131 I‐MIBG) provides targeted radiotherapy for children with neuroblastoma, a malignancy of the sympathetic nervous system. Dissociated radioactive iodide may concentrate in the thyroid, and 131 I‐MIBG is concentrated in the liver after 131 I‐MIBG therapy. The aim of our study was to analyze the effects of 131 I‐MIBG therapy on thyroid and liver function. Procedure Pre‐ and post‐therapy thyroid and liver functions were reviewed in a total of 194 neuroblastoma patients treated with 131 I‐MIBG therapy. The cumulative incidence over time was estimated for both thyroid and liver toxicities. The relationship to cumulative dose/kg, number of treatments, time from treatment to follow‐up, sex, and patient age was examined. Results In patients who presented with Grade 0 or 1 thyroid toxicity at baseline, 12 ± 4% experienced onset of or worsening to Grade 2 hypothyroidism and one patient developed Grade 2 hyperthyroidism by 2 years after 131 I‐MIBG therapy. At 2 years post‐ 131 I‐MIBG therapy, 76 ± 4% patients experienced onset or worsening of hepatic toxicity to any grade, and 23 ± 5% experienced onset of or worsening to Grade 3 or 4 liver toxicity. Liver toxicity was usually transient asymptomatic transaminase elevation, frequently confounded by disease progression and other therapies. Conclusion The prophylactic regimen of potassium iodide and potassium perchlorate with 131 I‐MIBG therapy resulted in a low rate of significant hypothyroidism. Liver abnormalities following 131 I‐MIBG therapy were primarily reversible and did not result in late toxicity. 131 I‐MIBG therapy is a promising treatment for children with relapsed neuroblastoma with a relatively low rate of symptomatic thyroid or hepatic dysfunction. Pediatr Blood Cancer 2011;56:191–201. © 2010 Wiley‐Liss, Inc.

Liver function

10.1002/pbc.22767

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Citations (55)

Iodine-131—Metaiodobenzylguanidine Double Infusion With Autologous Stem-Cell Rescue for Neuroblastoma: A New Approaches to Neuroblastoma Therapy Phase I Study

Journal of Clinical Oncology (2009)

Katherine K. Matthay Alekist Quach John P. Huberty Benjamin L. Franc Randall A. Hawkins

Purpose Iodine-131—metaiodobenzylguanidine ( 131 I-MIBG) provides targeted radiotherapy with more than 30% response rate in refractory neuroblastoma, but activity infused is limited by radiation safety and hematologic toxicity. The goal was to determine the maximum-tolerated dose of 131 I-MIBG in two consecutive infusions at a 2-week interval, supported by autologous stem-cell rescue (ASCR) 2 weeks after the second dose. Patients and Methods The 131 I-MIBG dose was escalated using a 3 + 3 phase I trial design, with levels calculated by cumulative red marrow radiation index (RMI) from both infusions. Using dosimetry, the second infusion was adjusted to achieve the target RMI, except at level 4, where the second infusion was capped at 21 mCi/kg. Results Twenty-one patients were enrolled onto the study at levels 1 to 4, with 18 patients assessable for toxicity and 20 patients assessable for response. Cumulative 131 I-MIBG given to achieve the target RMI ranged from 22 to 50 mCi/kg, with cumulative RMI of 3.2 to 8.92 Gy. No patient had a dose-limiting toxicity. Reversible grade 3 nonhematologic toxicity occurred in six patients at level 4, establishing the recommended cumulative dose as 36 mCi/kg. The median time to absolute neutrophil count more than 500/μL after ASCR was 13 days (4 to 27 days) and to platelet independence was 17 days (6 to 47 days). Responses included two partial responses, eight mixed responses, three stable disease, and seven progressive disease. Responses by semiquantitative MIBG score occurred in eight patients, soft tissue responses occurred in five of 11 patients, but bone marrow responses occurred in only two of 13 patients. Conclusion The lack of toxicity with this approach allowed dramatic dose intensification of 131 I-MIBG, with minimal toxicity and promising activity.

Cumulative dose

Refractory (planetary science)

Radionuclide therapy

10.1200/jco.2007.15.7628

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Citations (116)