Publications
Links to HMRN publications.
The Haematological Malignancy Research Network (HMRN): a
new information strategy for population based epidemiology
and health service research.
Author list: Alexandra Smith, Eve Roman, Debra
Howell, Richard Jones, Russell
Patmore and Andrew Jack on behalf of
the Haematological Malignancy Research
Network.
British Journal of Haematology
The Haematological Malignancy Research Network (HMRN) was established
in 2004 to provide robust generalizable data to inform clinical practice and
research. It comprises an ongoing population-based cohort of patients newly
diagnosed by a single integrated haematopathology laboratory in two
adjacent UK Cancer Networks (population 3.6 million). With an emphasis
on primary-source data, prognostic factors, sequential treatment/response
history, and socio-demographic details are recorded to clinical trial
standards. Data on 8131 patients diagnosed over the 4 years 2004–08 are
examined here using the latest World Health Organization classification.
HMRN captures all diagnoses (adult and paediatric) and the diagnostic age
ranged from 4 weeks to 99 years (median 70.4 years). In line with published
estimates, first-line clinical trial entry varied widely by disease subtype and
age, falling from 59.5% in those aged <15 years to 1.9% in those aged over
75 years – underscoring the need for contextual population-based treatment
and response data of the type collected by HMRN. The critical importance of
incorporating molecular and prognostic markers into comparative survival
analyses is illustrated with reference to diffuse-large B-cell lymphoma, acute
myeloid leukaemia and myeloma. With respect to aetiology, several
descriptive factors are highlighted and discussed, including the
unexplained male predominance evident for most subtypes across all ages.
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Rearrangement of MYC Is Associated With Poor Prognosis in Patients With Diffuse Large B-Cell Lymphoma Treated
in the Era of Rituximab
Author list: Sharon Barrans, Simon Crouch, Alex Smith, Kathryn Turner, Roger Owen, Russell Patmore, Eve Roman,
Andrew Jack
Journal of Clinical Oncology
Purpose Rearrangement of MYC occurs in a proportion of diffuse large B-cell lymphomas (DLBCL), where they may be
associated with an adverse clinical outcome. The aim of this study was to determine the frequency of MYC
translocations in DLBCL and their prognostic impact in the era of cyclophosphamide, doxorubicin, vincristine,
and prednisone plus rituximab (CHOP-R) therapy.
Patients and Methods Three hundred three patients with previously untreated DLBCL, with no evidence of underlying
follicular lymphoma, were investigated using immunohistochemistry and interphase fluorescent in situ hybridization
for MYC, BCL6, and t(14;18)/BCL2 rearrangements. All patients (median age, 71.1 years; range, 23 to 96 years) were
treated when CHOP-R was standard therapy for DLBCL and observed for a maximum of 4 years. Overall survival (OS) at
3 years was 49% (95% CI, 42% to 56%).
Results MYC rearrangements were demonstrated in 35 (14%) of 245 biopsies with data available. Of these, 26 (74%)
also had a t(14;18), 10 (26%) were BCL6 and MYC rearranged, and seven had all three abnormalities. Only age,
International Prognostic Index, and MYC rearrangement retained prognostic significance in the final model. OS
was significantly worse for patients with rearrangement of MYC (survival probability at 2 years = 0.35 in v 0.61
in the nonrearranged group).
Conclusion The presence of a MYC rearrangement is a strongly adverse prognostic factor in CHOP-R–treated patients
and can be used in combination with patients' age and IPI to accurately predict clinical outcome. In DLBCL,
rearrangement of MYC is rarely found as the sole genetic abnormality and the poor prognosis of these patients is
likely to reflect a synergistic effect alongside deregulation of BCL6 or BCL2.
JCO Abstract
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Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy
Author list: Debra A Howell, Eve Roman, Helen Cox, Alexandra G Smith, Russell Patmore, Anne C Garry, Martin R Howard
BMC Palliative Care
Haematological malignancies are a common, heterogeneous and complex group of diseases that are often associated
with poor outcomes despite intensive treatment. Research surrounding end-of-life issues, and particularly place
of death, is therefore of paramount importance, yet place of death has not been formally reviewed in these patients.
A systematic literature review and meta-analysis was undertaken using PubMed to identify all studies published
between 1966 and 2010. Studies examining place of death in adult haematology patients, using routinely compiled
morbidity and mortality data and providing results specific to this disease were included. 21 studies were
identified with descriptive and/or risk-estimate data; 17 were included in a meta-analysis.
Compared to other cancer deaths, haematology patients were more than twice as likely to die in hospital (Odds
Ratio 2.25 [95% Confidence Intervals, 2.07-2.44]).
Home is generally considered the preferred place of death but haematology patients usually die in hospital. This
has implications for patients who may not be dying where they wish, and also health commissioners who may be
funding costly end-of-life care in inappropriate acute hospital settings. More research is needed about preferred
place of care for haematology patients, reasons for hospital deaths, and how these can be avoided if home death
is preferred.
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