Development of a Precision Medicine Workflow in Hematological Cancers, Aalborg University Hospital, Denmark

Within recent years, many precision cancer medicine initiatives have been developed. Most of these have focused on solid cancers, while the potential of precision medicine for patients with hematological malignancies, especially in the relapse situation, are less elucidated. Here, we present a demographic unbiased and observational prospective study at Aalborg University Hospital Denmark, referral site for 10% of the Danish population. We developed a hematological precision medicine workflow based on sequencing analysis of whole exome tumor DNA and RNA. All steps involved are outlined in detail, illustrating how the developed workflow can provide relevant molecular information to multidisciplinary teams. A group of 174 hematological patients with progressive disease or relapse was included in a non-interventional and population-based study, of which 92 patient samples were sequenced. Based on analysis of small nucleotide variants, copy number variants, and fusion transcripts, we found variants with potential and strong clinical relevance in 62% and 9.5% of the patients, respectively. The most frequently mutated genes in individual disease entities were in concordance with previous studies. We did not find tumor mutational burden or micro satellite instability to be informative in our hematologic patient cohort

Supplementary Table_S1: Direct costs of antineoplastic and supportive treatment for progressive multiple myeloma in a tax-based health system.xlsx

Supplementary Figure 1. Direct costs of antineoplastic and supportive treatment for progressive multiple myeloma in a tax-based health system This table contains the Anatomical Therapeutic Chemical (ATC) codes for all drugs included in this analysis

Supplementary Table_S1: Direct costs of antineoplastic and supportive treatment for progressive multiple myeloma in a tax-based health system.xlsx

Supplementary Figure 1. Direct costs of antineoplastic and supportive treatment for progressive multiple myeloma in a tax-based health system This table contains the Anatomical Therapeutic Chemical (ATC) codes for all drugs included in this analysis

Study protocol: follow-up home visits with nutrition: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Geriatric patients are at high risk of re-admission after discharge. Pre-existing nutritional risk amongst these patients is of primary concern, with former nutritional intervention studies being largely ineffective. None of these studies has included individual dietary counselling by a registered dietician or has considered competing medical conditions in the participants. A former randomised study has shown that comprehensive discharge follow-up in geriatric patients homes by general practitioners and district nurses was effective in reducing the re-admission risk in the intervention group compared to the control group. That study did not include a nutritional intervention. The purpose of this study is to assess the combined benefits of an intervention consisting of discharge follow-up in geriatric patients' home by a general practitioner and a registered dietician.</p> <p>Methods/design</p> <p>This single-blind randomised controlled study, will recruit 160 hospitalised geriatric medical patients (65+ y) at nutritional risk. Participants will be randomly allocated to receive in their homes, either 12 weeks individualised nutritional counselling by a registered dietician complemented with follow-up by general practitioners or a 12 weeks follow-up by general practitioners alone.</p> <p>Discussion</p> <p>This trial is the first of its kind to provide individual nutritional intervention combined with follow-up by general practitioner as an intervention to reduce risk of re-admission after discharge among geriatric medical patients. The results will hopefully help to guide the development of more effective rehabilitation programs following hospital admissions, which may ultimately lead to reduced health care costs, and improvement in mobility, independence and quality of life for geriatric patients at nutritional risk.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov 2010 <a href="http://www.clinicaltrials.gov/ct2/show/NCT01249716">NCT01249716</a></p