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  • 1
    In: Molecular Genetics & Genomic Medicine, Wiley, Vol. 5, No. 2 ( 2017-03), p. 130-140
    Abstract: Kleefstra syndrome ( KS ) is a rare autosomal dominant developmental disability, caused by microdeletions or intragenic mutations within the epigenetic regulator gene EHMT 1 (euchromatic histone lysine N ‐methyltransferase 1). In addition to common features of autism, young adult regressive behaviors have been reported. However, the genetic downstream effects of the reported deletions or mutations on KS phenotype have not yet been completely explored. While genetic backgrounds affecting drug metabolism can have a profound effect on therapeutic interventions, pharmacogenomic variations are seldom considered in directing psychotropic therapies. Methods In this report, we used next‐generation sequencing (exome sequencing and high‐throughput RNA sequencing) in a patient and his parents to identify causative genetic variants followed by pharmacogenomics‐guided clinical decision‐making for making positive changes toward his treatment strategies. The patient had an early autism diagnosis and showed significant regressive behaviors and physical aberrations at age 23. Results Exome sequencing identified a novel, de novo splice site variant NM _024757.4: c.2750‐1G 〉 T in EHMT 1, a candidate gene for Kleefstra syndrome, in the patient that results in exon skipping and downstream frameshift and termination. Gene expression results from the patient showed, when compared to his parents, there was a significant decreased expression of several reported gene variants associated with autism risk. Further, using a pharmacogenomics genotyping panel, we discovered that the patient had the CYP 2D6 nonfunctioning variant genotype *4/*4 that results in very low metabolic activity on a number of psychotropic drugs, including fluvoxamine which he was prescribed. As reported here, a change in psychotropic drugs and intense behavior therapies resulted in a significant reversal of the regressive behaviors and physical aberrations. Conclusion These results demonstrate an individualized approach that integrated genetic information and behavior therapies, resulting in a dramatic improvement in regressive behaviors associated with KS .
    Type of Medium: Online Resource
    ISSN: 2324-9269 , 2324-9269
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2734884-2
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  • 2
    In: Leukemia, Springer Science and Business Media LLC, Vol. 26, No. 1 ( 2012-01), p. 149-157
    Type of Medium: Online Resource
    ISSN: 0887-6924 , 1476-5551
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    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2012
    detail.hit.zdb_id: 2008023-2
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  • 3
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 1800-1800
    Abstract: Abstract 1800 Poster Board I-826 Background The prevalence of peripheral neuropathy (PNP) during the treatment of MM with Bortezomib is high. About 20% of patients develop a grade 3-4 PNP due to this treatment, and as a result Bortezomib treatment is stopped or a reduced dose is given. Therefore, there is a strong need to find markers which predict the susceptibility of a patient to develop Bortezomib related PNP. Materials and methods: Bortezomib treated patients from the Dutch/German Hovon 65 GMMG-HD4 trial and the French IFM-2005/01 trial were used for this analysis. In both trials, the efficacy of Bortezomib as induction treatment prior to high-dose therapy is evaluated and PNP status was recorded. Samples were genotyped using a custom-built molecular inversion probe (MIP)-based single nucleotide polymorphism (SNP) chip containing 3404 SNPs (Bank on a Cure program; Van Ness et al., 2008). In total, 232 patients who did not develop PNP were compared to 210 PNP cases (grade 1, n=82; grade 2 n=86, grade 3, n=31, grade 4, n=11). Results The data were processed on the basis of the following criteria. First, SNPs genotyped in less than 75% of the samples were removed (n=155). This resulted in elimination of 59% of the data with unknown genotype while only 1% of the genotyped data were lost. The remaining 41% of the missing data were imputed using BIMBAM (Guan et al., PLoS Genet. 4:e1000279, 2008). As reference panels, the data sets of the BOAC chips from this study, 500 random samples from the Rotterdam ERGO study (Köttgen et al., Nat. Genet. 41, 712–717, 2009) and 60 phased CEU HAPMAP samples were used. Secondly, SNPs were excluded which did not show any genotype variance and which were not in Hardy Weinberg equilibrium. As a last step the data was adjusted for stratification using Eigenstrat (Price et al., Nat. Genet. 38: 904–909, 2006). By removing 21 SNPs and 14 samples the variance between the IFM and Hovon was reduced to an acceptable level (p = 0.011). The resulting combined IFM/Hovon dataset now contained 2764 SNP and 428 samples. The data set was divided in 6/7 (n=367) part as a learning set and 1/7 (n=61) as a validation set. Possibly informative SNPs were selected using information gain as a feature selection method (Cover et al., Elements of information theory. New York, John Wiley, 1991). 66 SNPs with an information gain in allele and genotype frequency were selected (p value 〈 0.05 after permutation test (n=10000)). Classifiers generated by Partial C4.5 decision tree (PART), support vector machine (SVM) and Random forest learned on this set reached a better than random performance. Sensitivity, specificity, positive predictive value and negative predictive value were respectively 55%, 70%, 60%, and 66% for the PART classifier. Conclusion Preliminary classifiers generated by this dataset suggest that building a classifier with clinically relevant performance may be within reach. To this end, we will report on the outcome of different combinations of existing classifier methods and feature selection methods. Van Ness, B, Ramos, C, Haznadar, M, Hoering, A,Haessler, J, Crowley, J, Jacobus, S, Oken, M, Rajkumar, V, Greipp, P, Barlogie, B, Durie, B, Katz, M, Atluri, G, Ganf, G, Gupta, R, Steinbach, M, Kumar, V, Mushlin, R, Johnson, D, and Morgan, G. (2008). Genomic Variation in Myeloma: Design, content, and initial application of the Bank On A Cure SNP Panel to analysis of survival. BMC Medicine. 6:26. Disclosures Hanifi-Moghaddam: Skyline Diagnostics: Employment.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
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  • 4
    In: Blood, American Society of Hematology, Vol. 110, No. 11 ( 2007-11-16), p. 2493-2493
    Abstract: Whilst gene expression signatures have been defined that correspond to poor overall survival, the mechanism for deregulation of such genes is often elusive. We and others have described acquired copy number change as one potential mechanism of gene deregulation in myeloma. Other potential mechanisms exist that may influence the expression of myeloma-associated genes such as inherited SNPs and copy number variation (CNV). We have therefore embarked upon an integrated pharmacogenomic strategy to determine the importance of acquired and inherited genetic changes in determining response to therapy. We have carried out gene expression analysis on CD 138 selected bone marrow plasma cells from 231 newly diagnosed myeloma cases using Affymetrix U133 Plus 2.0 expression arrays and copy number analysis using 500K Gene Mapping arrays on a subset of 90 cases. Peripheral blood DNA has been genotyped using Affymetrix 500K Gene Mapping arrays and the BOAC chips. Cytogenetics was available in the majority of cases. Younger, fitter patients received either cyclophosphamide, thalidomide and dexamethasone (CTD) or cyclohosphamide-VAD (C-VAD), followed by high dose melphalan (HDM). Older, less fit patients received attenuated dose CTD or MP. Response was assessed before and after HDM in the intensive group and on completion of therapy in the non-intensive group using EBMT criteria plus the category of VGPR. We used a supervised approach to define a gene expression signature corresponding to high level response (CR, VGPR or PR) against poor response (NC, PD or MR) overall and for each of the three induction strategies, CTD/CTDA, CVAD and MP. We have combined the data from expression arrays together with mapping data from tumor DNA and 2 different SNP arrays performed on germline DNA. We defined a poor response expression signature initially and then identified the genomic loci of these genes and how they were affected by acquired copy number change. For each candidate gene we also examined the constitutional DNA to see if each fell within a region of inherited CNV and how this could be affected by acquired copy number change. In a similar fashion, we used the BOAC chip to define genes and SNPs associated with response. This is different as it utilized mostly functional cSNPs in candidate genes. We then looked at how CNV affected these genes. Although not all genes in which functional cSNPs are present would necessarily be expected to be expressed in plasma cells, this approach is a vital step in identifying the clinical relevance of such cSNPs in myeloma. We also took the alternate approach and designed an algorithm able to correlate acquired copy number change with paraprotein response. We then identified differentially expressed genes in these loci and their impact on response, narrowing the candidate genes down to define a signature which could be validated. Using this approach has allowed us to identify genes important in determining response and their relation to tumor-associated copy number change and inherited CNV. Overall, this methodology provides significant insight in to the factors that predict response to different chemotherapy regimens. Preliminary data will be presented.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2007
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  • 5
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 70, No. 8_Supplement ( 2010-04-15), p. 4737-4737
    Abstract: Classic epidemiological approaches aimed at identifying environmental exposures associated with aetiology of Multiple Myeloma (MM) have failed to identify a common cause. The majority of the studies aimed at identifying genetic risk in MM have been underpowered and limited in coverage. We have taken a candidate gene approach by assaying 3,404 single nucleotide polymorphism (SNPs) selected in approximately 983 candidate genes on a “Bank on a Cure” (BOAC) Targeted Genotyping assay, focusing on coding SNPs and SNPs in regulatory regions. SNPs were genotyped using DNA extracted from peripheral blood. 2595 presenting MM cases were derived from clinical trials held within the UK (1228), US (697) and the Netherlands (670). Genotype data were available from large population control datasets, which were used to examine 1809 SNPs for association with MM risk. The control population sets consisted of the UK Wellcome Trust Case-Control Consortium 2 (WTCCC2) study with 3,000 individuals from the 1958 British Birth Cohort and the UK Blood Service collections, genotyped on both the Illumina 1.2M Duo (Human1-2M-DuoCustom_v1) and the Affymetrix SNP 6.0 array; 2350 US Caucasian controls from the Nurses’ Health Study (NHS), genotyped on the Illumina 550K chip, and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), genotyped on Illumina 317K plus 240K; and 5974 Dutch & gt;55yrs old population controls from the Erasmus Rotterdam Health for the Elderly (ERGO) study, genotyped on the Illumina 550K array. We have also used fluorescence in situ hybridization (FISH) status for 702 of the UK cases to perform a subset analysis for hyperdiploidy and IgH translocations, two of the major myeloma pathogenic subgroups. Quality control measures were performed on the datasets to protect against artificial effects, induced by population stratification, cross platform genotyping and low genotyping quality (95% call rate and HWE (p & lt;10−5)). In the uni-variant analysis across the three population sets we found a number of SNPs associated with greater susceptibility to MM with p & lt;10−6. These SNPs included IL6 (−174 C/G), AURKA Phe31Ile, DDX18 Thr94Ser and MYEOV Val159Ala. We examined weaker MM associated regulatory SNPs and their relationship with expression in a subset of 254 UK cases using data derived from the Affymetrix 133U+2 expression array. We also performed a semi-exhaustive search of pair-wise interactions using epistasis analysis within PLINK. We will present the results of this integrative approach of associating Myeloma risk with inherited genetic variation, with findings from the validation of these associations across three large datasets Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4737.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2010
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    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 6
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 426-426
    Abstract: Abstract 426 It is anticipated that inherited single nucleotide polymorphisms (SNPs) in genes involved in drug absorption, distribution, metabolism and excretion influence individual response to thalidomide therapies in Multiple Myeloma. We extracted peripheral blood DNA from 631 myeloma patients of European descent enrolled in the MRC Myeloma IX trial who had received induction thalidomide (50-200mg). We genotyped 3404 SNPs selected in 983 candidate genes that may influence myeloma disease response, toxicity, and/or survival, on a “Bank on a Cure” (BOAC) Affymetrix® true-tag array. The BOAC array is a custom genotyping chip focused on coding and predicted regulatory SNPs. Quality control (QC) measures were applied on the resulting genotype data such that individual samples failing a chip call rate ( 〉 95%), and SNP assays with missing data ( 〈 0.05%) or with extreme departures from Hardy-Weinberg equilibrium (p 〉 10-5) were excluded from the statistical analysis. We then performed 2-way log rank tests under recessive, dominant and trend genetic models for each SNP which passed QC for both overall survival and PFS on the training and validation sets. Our training set consisted of 379 myeloma patients from the intensive pathway of the Myeloma IX trial who received CTD (cyclophosphamide, thalidomide, dexamethasone), with a validation set of 252 myeloma patients from the non-intensive pathway who received an attenuated CTD regime. Although the overall and progression-free survival is shorter for individuals in the non-intensive arm in comparison to the younger and fitter patients in the intensive arm, we expected variants influencing overall survival and PFS related to thalidomide to associate with outcome, if both pathways were analysed separately. We looked for significant associations (log-rank chi-squares 〉 6.5, p 〉 10-3) across both the training and validation sets, and discounted associations where the number of cases in any one genotype group 〈 10. We detected significant cross validating associations in the survival analysis with genes involved in double-strand break repair: BLM, LIG1, MRE11A, SHFM1 and RAD51L3, and also saw associations with genes important in response to DNA damage stimulus: CYP19A1, GSTA4 and MGST1, along with other notably associations in genes NFKBIE, NFKB1 and SELL. We saw cross validating SNP associations in the progression-free survival analysis in genes including the cytokines: IL10, IL13, as well as NFATC1. In this large study we have seen results indicating that genetic variation plays a role in both overall and progression free survival following thalidomide treatment in multiple myeloma patients, and in doing so we have highlighted SNPs and pathways that may be important and informative in predictive classification of patients for overall survival and PFS following treatment with thalidomide containing regimes. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
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    detail.hit.zdb_id: 80069-7
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  • 7
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 620-620
    Abstract: Inherited change in individual patients can govern not only the risk of developing Multiple Myeloma (MM), but also treatment related side effects and clinical outcome. The challenge is to identify and observe the changes clinically. This can be done by the use of genome wide scans with regularly placed SNPs or by the use of a candidate functional SNPs. Several genotyping platforms are available, which allow assaying of 1000’s of SNP’s simultaneously. We have been evaluating the use of Parallele’s MegAllele™ System with the Affymetrix® GeneChip® 3000 Scanner system. The system uses a Molecular Inversion Probes (MIP) based technology. MIP is a oligonucleotide that can undergo a unimolecular rearrangement from a molecule that cannot be amplified, into one that can be amplified. The rearrangement is mediated by hybridization to gDNA and an enzymatic “gap fill” process that occurs in an allele-specific manner. The circularized probe can then be separated from cross-reacted or unreacted probes by an exonuclease reaction. The unimolecular design of this assay allows multiplexing 10,000 targeted SNPs without background from cross-reactions among probes in a single assay. Initial evaluation, using a 10K non-synonymous cSNP panel was run on 22 patients from the S9321 trial and correlated with ISS stage. 101 SNPs with a univariate p value from a fisher’s exact test & lt;0.05 were found; 18 SNPs were found p & lt;0.01. Cluster algorithms demonstrated SNP groupings associated with stage; however, the sample size is small and the reported p-values were not adjusted for an inflated error rate associated with multiple comparisons. Examination of the SNP panel content revealed significant omissions relevant to MM. For this reason we designed a 3K Custom panel containing 3,500 targeted SNPs with possible functional interest in MM. Pertinent candidate genes were selected through discussions between MM groups in an International Myeloma Foundation led Bank On A CureTM collaboration. We supplemented an initial list with referencing pathway databases such as BioCarta, KEGG, and Pathway Assist. The list was sectioned into 25 groups including: Angiogenesis, Drug Transport & Metabolism, DNA repair and covering some 67 molecular pathways important in MM. SNPs were systematically selected from the gene list by: Literature searches to identify SNPs cited with a suspected association with etiology or treatment; A dbSNP database search for all non-synonymous SNPs with a minor allele frequency (MAF) & gt;2%; A search of promoter SNPs present in homologous regions between Human and Mouse with a MAF & gt; 2%, lying in or adjacent to transcription binding sites using Promolign. Additional promoter SNPs were identified using FESD. SNPs were also selected for the panel by the addition of: TagSNPs across selected candidate genes; admixture SNPs from the X chromosome; pharmacologically functional SNPs; Affymetrix validated SNPs and by selecting all Non-synonymous SNPs in Phosphatase, Kinase, and Transferase genes with a MAF & gt; 2%. This panel is currently being assembled and we will present results on its use for the analysis of inherited genetic variation in several large European and American clinical trial series.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 8
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 29, No. 7 ( 2011-03-01), p. 797-804
    Abstract: To indentify genetic variation that can modulate and predict the risk of developing thalidomide-related peripheral neuropathy (TrPN). Patients and Methods We analyzed DNA from 1,495 patients with multiple myeloma. Using a custom-built single nucleotide polymorphism (SNP) array, we tested the association of TrPN with 3,404 SNPs. The SNPs were selected in predicted functional regions within 964 genes spanning 67 molecular pathways thought to be involved in the pathogenesis, treatment response, and adverse effects associated with myeloma and its therapy. Patient cases and controls were derived from two large clinical trials that compared thalidomide with conventional-based treatment in myeloma patients (Medical Research Council Myeloma-IX and HOVON-50/GMMG-HD3). Results We report TrPN associations with SNPs—ABCA1 (rs363717), ICAM1 (rs1799969), PPARD (rs2076169), SERPINB2 (rs6103), and SLC12A6 (rs7164902)—where we show cross validation of the associations in both trials. To investigate whether TrPN SNP associations were related to exposure to thalidomide only or general drug-related peripheral neuropathy, we performed a second analysis on patients treated with vincristine. We report SNPs associated with vincristine neuropathy, with a seemingly distinct underlying genetic mechanism. Conclusion Our results are consistent with the hypothesis that an individual's risk of developing a peripheral neuropathy after thalidomide treatment can be mediated by polymorphisms in genes governing repair mechanisms and inflammation in the peripheral nervous system. These findings will contribute to the development of future neuroprotective strategies with thalidomide therapy and the better use of this important compound.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2011
    detail.hit.zdb_id: 2005181-5
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  • 9
    In: Blood, American Society of Hematology, Vol. 108, No. 11 ( 2006-11-16), p. 131-131
    Abstract: While there are certain common clinical features in myeloma, the disease shows significant heterogeneity with regard to disease progression, and responses to therapy, affecting both survival and toxicities. Heritable variations in a wide variety of genes and pathways affecting cellular functions and drug responses likely impact patient outcomes. In the Bank On A Cure (BOAC) program we have developed a custom chip that assesses 3,404 SNPs representing variations in cellular functions and pathways that may be involved in myeloma progression and response. The chip has gone through rigorous quality controls checks for high call rates, accuracy, and reproducibility that will be presented. Using the BOAC chip, we have conducted studies to look for SNPs that may identify biologic variations that are associated with good or poor response across a variety of treatments. In this study we looked for SNPs that may distinguish short term and long term survivors in two phase III clinical trials: ECOG E9486 and intergroup trial S9321. E9487 patients were treated with VBMCP followed by randomization to no further treatment, IFN-alpha, or cylcophosphamide; and, although there was variation in survival, no significant differences in survival were noted among the 3 arms of the trial. Patients included in this SNP study from S9321 received VAD induction followed by randomization to VBMCP or high dose melphalan + TBI. SNP profiles were obtained for patients with less than 1 year EFS (n=20 in E9487; n=50 in S9321) and patients showing greater than 3 years EFS (n=32 in E9486; n=41 in S9321). Statistical approaches were performed to identify single and groups of SNPs that best discriminated the survival groups. Previous studies have suggested genetic variations in drug metabolism genes, p-glycoprotein transport, and DNA repair genes may influence survival outcomes. Our results show significant survival associations of genetic variations in genes within these functional categories (eg. GST, XRCC, ABCB, and CYP genes). Although genetic variations were found that were uniquely associated with each clinical trial, several of these genetic variations show survival associations that increase in significance when the two trials were examined as a conglomerate data set. Grouping genetic variations through common pathway approaches using gene set enrichment analysis, as well as clustering or partitioning algorithms, further improve the value of the SNPs as potential prognostic markers of survival outcomes. These results and statistical approaches will be presented, and represent steps toward identifying patient variations in biologic mechanisms important in predicting therapeutic outcomes.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2006
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 10
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 2715-2715
    Abstract: The Bank On A Cure (BOAC) has established DNA banks from multiple cooperative and institutional clinical trials, and platforms for examining the association of genetic variations (SNPs) with disease risk and outcomes in myeloma. We have previously described the development and content of a novel custom SNP panel that contains 3,404 SNPs in 983 genes, representing cellular functions and pathways that may influence disease response, toxicities, complications, and survival. Although survival certainly varies according to tumor heterogeneity (ie. chromosomal abnormalities, gene expression variations) germline variations that influence the microenvironment, drug distribution, drug transport and metabolism, may also have an association with event free survival outcomes. To explore SNP associations with progression free survival (PFS) we compared the BOAC SNP profiles of short term PFS (less than 1 year, n=70) versus long term PFS (greater than 3 years, n=73) in two phase III clinical trials (ECOG E9487 and SWOG S9321). A variety of analytical approaches was undertaken including univariate rank ordering, recursive partitioning, and support vector machine learning tools (SVM). Each of these approaches has advantages and limitations in dealing with type I false positive errors as well as sensitivity and specificity. We included subset validation approaches and randomization of classes to address how robust and predictive different approaches were. From our analysis we conclude germline genomic variations do have an impact on progression free survival, with a subset of SNPs from the panel reaching 76% predictive association and hazard ratios of PFS of 9.6 (CI 4.5, 20.5), p & lt;0.001, using SVM analysis. Based on univariate approaches, we find the most significant variations associated with PFS differences were genes that could be functionally categorized as pharmacologic. The presentation will focus on the analytical approaches, and refinements necessary to assure predictive value compared to random associations. Notwithstanding the clear importance of tumor cell variations in genetic deregulation, we conclude that various functions within the bone marrow and drug response likely interplay as a complex influence on disease progression, response, and survival. This suggests combining gene expression profiles of the tumors with germline SNP profiles may provide more accurate prognosis. These combined analytical approaches are currently being developed with BOAC data bases, and examples will be discussed.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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