Claire Johns

All Publications

• Liposarcoma and Leiomyosarcoma as the First Manifestation of Familial Retinoblastoma: Implications for Genetic Testing and Carrier Surveillance. JCO precision oncology Johns, C., McGuinness, M., Kingham, K., Suarez, C. J., Mruthyunjaya, P., Ford, J. M., Saab, R. 2025; 9: e2500668

  View details for DOI 10.1200/PO-25-00668

  View details for PubMedID 41197085

• Case report: sub-clinical extramedullary B-ALL in the setting of relapse following targeted therapy. Frontiers in immunology Johns, C., Erickson, C., Jacobs, A., Moon, J., Baggott, C., Dagher, R., Nadel, H., Balagtas, J., Aftandilian, C., Ramakrishna, S., Lacayo, N., Davis, K. L., Stieglitz, E., Schultz, L. 2024; 15: 1423487

  Abstract

  Standard testing for disease evaluation in B-cell acute lymphoblastic leukemia (B-ALL) includes examination of the bone marrow and cerebrospinal fluid. Radiographic or functional imaging are indicated when clinical signs of non-CNS extramedullary disease are present but are not standard in the relapsed/refractory setting. We describe two cases of patients with relapsed/refractory B-ALL with prior exposure to blinatumomab and/or inotuzumab ozogamicin presenting for CAR-T cell treatment. Both patients were thought to only have minimal residual disease (MRD) at the pre-CAR disease assessment, with MRD of 6,648 (0.66%) and 100 (0.01%) cells per million cells, respectively, as measured by next-generation sequencing (NGS) in their bone marrows. Both patients for distinct reasons unrelated to non-CNS extra-medullary (EM) symptoms had PET-MRIs prior to lymphodepletion and CAR T cell infusion. In both cases patients were found to have significant bulky subclinical EM disease that required changes in clinical management. In the newly-emergent era of antigen-targeted immunotherapy, it is foundational that incidence and relapse patterns following targeted therapy are well-understood. Herein we contribute to a growing body of literature addressing this fundamental clinical gap and highlight a future role for formal prospective imaging studies to better establish response, toxicity and relapse patterns following CAR-T cell therapy in EM B-ALL.

  View details for DOI 10.3389/fimmu.2024.1423487

  View details for PubMedID 39386214

• Anti-SARS-CoV-2 and Autoantibody Profiles in the Cerebrospinal Fluid of 3 Teenaged Patients With COVID-19 and Subacute Neuropsychiatric Symptoms. JAMA neurology Bartley, C. M., Johns, C., Ngo, T. T., Dandekar, R., Loudermilk, R. L., Alvarenga, B. D., Hawes, I. A., Zamecnik, C. R., Zorn, K. C., Alexander, J. R., Wapniarski, A. E., DeRisi, J. L., Francisco, C., Nash, K. B., Wietstock, S. O., Pleasure, S. J., Wilson, M. R. 2021; 78 (12): 1503-1509

  Abstract

  Neuropsychiatric manifestations of COVID-19 have been reported in the pediatric population.To determine whether anti-SARS-CoV-2 and autoreactive antibodies are present in the cerebrospinal fluid (CSF) of pediatric patients with COVID-19 and subacute neuropsychiatric dysfunction.This case series includes 3 patients with recent SARS-CoV-2 infection as confirmed by reverse transcriptase-polymerase chain reaction or IgG serology with recent exposure history who were hospitalized at the University of California, San Francisco Benioff Children's Hospital and for whom a neurology consultation was requested over a 5-month period in 2020. During this period, 18 total children were hospitalized and tested positive for acute SARS-CoV-2 infection by reverse transcriptase-polymerase chain reaction or rapid antigen test.Detection and characterization of CSF anti-SARS-CoV-2 IgG and antineural antibodies.Of 3 included teenaged patients, 2 patients had intrathecal anti-SARS-CoV-2 antibodies. CSF IgG from these 2 patients also indicated antineural autoantibodies on anatomic immunostaining. Autoantibodies targeting transcription factor 4 (TCF4) in 1 patient who appeared to have a robust response to immunotherapy were also validated.Pediatric patients with COVID-19 and prominent subacute neuropsychiatric symptoms, ranging from severe anxiety to delusional psychosis, may have anti-SARS-CoV-2 and antineural antibodies in their CSF and may respond to immunotherapy.

  View details for DOI 10.1001/jamaneurol.2021.3821

  View details for PubMedID 34694339

  View details for PubMedCentralID PMC8546622

• A Single-Center Description of Pediatric Transfusion Reactions and Preventable Patient Harm. Hospital pediatrics Johns, C., Bakhtary, S., Wu, R., Nedelcu, E. 2021; 11 (11): e334-e338

  Abstract

  In previous studies, researchers highlight that children have higher rates of transfusion reactions than adults. However, little is known about the pediatric populations that experience reactions, and there are no reports that consider appropriateness of pediatric transfusions in relation to preventable harm. With this study, we aim to describe pediatric transfusion reactions occurring at an academic institution and to quantify transfusion reactions that resulted from inappropriate transfusion indications, thereby identifying an area of potentially preventable patient harm (PPH).This is a case series of acute transfusion reactions in pediatric patients at a single institution from January 2018 to December 2019. We reviewed patient data, clinical documentation, and transfusion reaction reports to determine the appropriateness of transfusions and calculate PPH.A total 155 acute transfusion reactions occurred in 106 pediatric patients, amounting to a total reaction rate of 544 of 100 000 transfusions. In 65% of reactions, the indication for transfusion was appropriate by institutional standards; 23% had questionable indication; and 12% were not indicated. The rate of potential PPH from inappropriate transfusions was 67 of 100 000 transfusions.Transfusion reactions that occur during inappropriately ordered blood transfusions represent PPH. Efforts should be made to develop transfusion guidelines, standardize practice, and educate physicians to prevent transfusion-related harm.

  View details for DOI 10.1542/hpeds.2020-005173

  View details for PubMedID 34635509

• Alternate Week Gemcitabine and Capecitabine: An Effective Treatment for Patients With Pancreatic Adenocarcinoma. Pancreas Johns, C., Diaz, C. L., Hwang, J., Kerridge, W. D., Ko, A. H., Tempero, M. A. 2019; 48 (7): 927-930

  Abstract

  Determine whether a regimen of fixed dose rate gemcitabine plus capecitabine is effective and tolerable for advanced pancreatic adenocarcinoma.We performed a retrospective analysis of 62 patients with locally advanced or metastatic pancreatic adenocarcinoma treated at the University of California San Francisco between 2008 and 2016. Treatment was an alternate week schedule of fixed dose rate 1000 mg/m gemcitabine and capecitabine 1000 mg/m (58 patients), 1200 mg/m (12 patients), or 650 mg/m (1 patient) for intended 12 cycles. We evaluated overall survival (OS), progression-free survival (PFS), radiologic response, and adverse events necessitating treatment modification.For metastatic patients, median OS was 10.3 months (95% confidence interval [CI], 6.7-12.1 months), and PFS was 5.6 months (95% CI, 2.6-7.7 months). In locally advanced patients, OS was 12.0 months (95% CI, 4.9-17.1 months), and PFS was 5.4 months (95% CI, 2.5-9.4 months). Radiologic response for metastatic disease (42 patients) was 19% objective response, 45% stable disease, and 36% progressive disease. Treatment required modification for 22 patients due to adverse events, most frequently hand-foot syndrome (18 patients).Alternate week schedule of fixed dose rate gemcitabine and capecitabine was active and tolerable for advanced pancreatic adenocarcinoma. Overall survival and PFS were comparable to first-line treatments. Importantly, adverse effects appear less severe than first-line treatments.

  View details for DOI 10.1097/MPA.0000000000001354

  View details for PubMedID 31268983

• Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions. Breast cancer research and treatment Johns, C., Seav, S. M., Dominick, S. A., Gorman, J. R., Li, H., Natarajan, L., Mao, J. J., Irene Su, H. 2016; 156 (3): 415-426

  Abstract

  Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions.

  View details for DOI 10.1007/s10549-016-3765-4

  View details for PubMedID 27015968

  View details for PubMedCentralID PMC4838539

• Sox10 Regulates Stem/Progenitor and Mesenchymal Cell States in Mammary Epithelial Cells. Cell reports Dravis, C., Spike, B. T., Harrell, J. C., Johns, C., Trejo, C. L., Southard-Smith, E. M., Perou, C. M., Wahl, G. M. 2015; 12 (12): 2035-48

  Abstract

  To discover mechanisms that mediate plasticity in mammary cells, we characterized signaling networks that are present in the mammary stem cells responsible for fetal and adult mammary development. These analyses identified a signaling axis between FGF signaling and the transcription factor Sox10. Here, we show that Sox10 is specifically expressed in mammary cells exhibiting the highest levels of stem/progenitor activity. This includes fetal and adult mammary cells in vivo and mammary organoids in vitro. Sox10 is functionally relevant, as its deletion reduces stem/progenitor competence whereas its overexpression increases stem/progenitor activity. Intriguingly, we also show that Sox10 overexpression causes mammary cells to undergo a mesenchymal transition. Consistent with these findings, Sox10 is preferentially expressed in stem- and mesenchymal-like breast cancers. These results demonstrate a signaling mechanism through which stem and mesenchymal states are acquired in mammary cells and suggest therapeutic avenues in breast cancers for which targeted therapies are currently unavailable.

  View details for DOI 10.1016/j.celrep.2015.08.040

  View details for PubMedID 26365194

  View details for PubMedCentralID PMC4591253