Scholars@Duke
Daphne Ruth Friedman

Daphne Ruth Friedman

Medical Professor in the Department of Medicine
Medicine, Medical Oncology
daphne.friedman@duke.edu
508 Fulton Street (111G), Durham, NC 27705
508 Fulton Street (111G), Durham VA Medical Center, Durham, NC 27705

Scholarly Works

Association Between Monoclonal Gammopathy of Undetermined Significance and Cardiovascular Disease Risk: A Veterans Health Administration Study.

Journal article J Am Heart Assoc · January 6, 2026 BACKGROUND: Monoclonal gammopathy of undetermined significance (MGUS) is associated with an increased risk of cardiovascular disease (CVD). However, its potential to provide additional prognostic information beyond traditional CVD risk assessments remains ... Full text Link to item Cite

Cancer decentralized clinical trials in the Veterans Health Administration.

Journal article J Natl Cancer Inst · January 1, 2026 BACKGROUND: Despite the importance of clinical trials in the advancement of cancer treatments, there are barriers to participant enrollment. Decentralized clinical trials are conducted at a different physical location than where patients receive medical ca ... Full text Link to item Cite

Rule-based natural language processing to extract clinical trial and research study enrollment history from unstructured notes.

Journal article Health Informatics J · 2026 Clinical trials are vital for advancing care. However, a systematic approach to tracking trial participation across different facilities and sponsors has been lacking. We developed natural language processing (NLP) methods to extract study enrollment histo ... Full text Link to item Cite

Quality of Care in Veterans Affairs Health Care System In-Person and National TeleOncology Service-Delivered Care.

Journal article JCO Oncol Pract · December 2025 PURPOSE: The Veterans Affairs Health Administration (VA) has experience using telehealth (TH) to deliver care to 10 million enrolled Veterans for many clinical care needs. The VA National TeleOncology Service (NTO) was established in 2020 to provide specia ... Full text Link to item Cite

Using Open-Source Large Language Models to Identify Access to Germline Genetic Testing in Veterans With Breast Cancer From Unstructured Text.

Journal article JCO Clin Cancer Inform · July 2025 PURPOSE: The ability of large language models (LLMs) to identify access to germline genetic testing from unstructured text remains unknown. The Department of Veterans Affairs (VA) assessed access in Veterans with breast cancer by implementing and evaluatin ... Full text Link to item Cite

Understanding the Barriers to Clinical Trial Referral and Enrollment Among Oncology Providers Within the Veterans Health Administration.

Journal article Mil Med · February 27, 2025 INTRODUCTION: Clinical trials are essential for advancing treatment options in oncology while providing cancer patients with innovative care; however, few cancer patients are referred to clinical trials. System-, provider-, and patient-level barriers to cl ... Full text Link to item Cite

Veterans with blood cancers: Clinical trial navigation and the challenge of rurality.

Journal article J Rural Health · January 2024 PURPOSE: The proportion of cancer patients who participate in clinical trials (CTs) remains low, despite an understanding of barriers to enrollment. The barrier of rural residence is relevant to Veterans, who more commonly live in rural areas than non-Vete ... Full text Open Access Link to item Cite

Educating Hematology-Oncology Fellows About How to Communicate with Patients About Clinical Trials: A Needs Assessment.

Journal article J Med Educ Curric Dev · 2024 OBJECTIVES: Only 5-8% of adults with cancer participate in cancer clinical trials (CCTs), with even lower rates among underrepresented groups. Improving oncologists' communication skills may enhance the frequency and quality of their discussions with patie ... Full text Open Access Link to item Cite

Clinical and Laboratory Indications for Serum Protein Electrophoresis Testing in US Veterans: A Retrospective Cohort Study

Conference Blood · November 2, 2023 Introduction: Serum Protein Electrophoresis (SPEP) is a frequently ordered diagnostic test when there is suspicion of plasma cell dyscrasia, based on clinical or laboratory abnormalities. This study describes the demogr ... Full text Cite

Monoclonal Gammopathy of Undetermined Significance and Risk of Cardiovascular Disease in US Veterans

Conference Blood · November 2, 2023 Background: Monoclonal gammopathy of undetermined significance (MGUS) has been associated with worse overall survival. The cause of this association is unclear but may result from increased risk of cardiovascular diseas ... Full text Cite

Impact of Social Determinants of Health and Novel Therapies on the Outcomes of Relapsed and Refractory Diffuse Large B Cell Lymphoma

Conference Blood · November 2, 2023 Introduction:Outcomes for patients with relapsed and refractory diffuse large B cell lymphoma (R/R DLBCL) have improved dramatically with the recent approvals of chimeric antigen recepto ... Full text Cite

Tolerability and Outcomes of Bruton Tyrosine Kinase Inhibitors for Chronic Lymphocytic Leukemia in Patients with Severe Renal Dysfunction

Conference Blood · November 2, 2023 Introduction:There is limited data on the outcomes and tolerability of Bruton Tyrosine Kinase (BTK) inhibitors for chronic lymphocytic leukemia (CLL) in patients with severe renal dysfun ... Full text Cite

Utility of pharmacogenomic testing in predicting intolerance to BTK inhibitors.

Journal article Journal of Clinical Oncology · June 1, 2023 7541 Background: Oral inhibitors of Bruton’s tyrosine kinase (BTKi) are used for a number of B-cell malignancies, including chronic lymphocytic leukemia (CLL), mantle cell lymphoma (MCL), marginal zone lymphoma (MZL) and lymphopl ... Full text Cite

Clinicopathologic features and outcomes associated with induction regimen intensity among older veterans with myeloma.

Conference Journal of Clinical Oncology · June 1, 2023 e20054 Background: More than one third of patients diagnosed with multiple myeloma (MM) are 75 years or older. Though registries and clinical trials have conveyed the disease features across myeloma patients and have confirmed im ... Full text Cite

Telemedicine-supervised cancer therapy for patients with an aggressive lymphoma and metastatic lung cancer in the U.S. Veterans Affairs National TeleOncology Service.

Conference Journal of Clinical Oncology · June 1, 2023 1602 Background: Telemedicine is increasingly used in cancer care but has mostly been applied to surveillance and oral therapy rather than parenteral treatments. In the U.S. Veterans Affairs National TeleOncology service (NTO), p ... Full text Cite

Reply to B.L. King-Kallimanis et al.

Journal article JCO Clin Cancer Inform · July 2022 Full text Link to item Cite

Integration of Patient-Reported Outcome Measures in the Electronic Health Record: The Veterans Affairs Experience.

Journal article JCO Clin Cancer Inform · February 2022 PURPOSE: There are growing efforts to integrate patient-reported outcome (PRO) data into electronic health records (EHRs) to bring together disparate sources of patient information and improve medical care. PRO measures can be used to assess cancer symptom ... Full text Link to item Cite

Identifying and Overcoming Barriers in Clinical Trial Enrollment for Veterans with Blood Cancers

Conference Blood · November 5, 2021 AbstractIntroductionEquitable and diverse clinical trials participation is essential for practice-changing results to be applicable to all patients. However, patients who ide ... Full text Cite

Sequential Targeted Treatment for a Geriatric Patient with Acute Myeloid Leukemia with Concurrent FLT3-TKD and IDH1 Mutations.

Journal article Fed Pract · January 2021 Targeting and monitoring several acute myeloid leukemia mutations sequentially provides insights into optimal treatment plans. ... Full text Link to item Cite

Implementation of the VA Symptom Assessment Scale (VSAS): Five-year experience.

Conference Journal of Clinical Oncology · May 20, 2019 e23120 Background: Cancer patients experience symptoms which may precede diagnosis, occur during therapy, and persist into survivorship. Symptom assessments and patient reported outcomes have been shown to improve quality of life ... Full text Cite

SET alpha and SET beta mRNA isoforms in chronic lymphocytic leukaemia.

Journal article Br J Haematol · February 2019 Alteration in RNA splicing is implicated in carcinogenesis and progression. Mutations in spliceosome genes and alternative splicing of other genes have been noted in chronic lymphocytic leukaemia (CLL), a common B cell malignancy with heterogeneous outcome ... Full text Link to item Cite

Reflections on and future of hematologic malignancies research in the Veterans Health Administration.

Journal article Semin Oncol · 2019 Research in the Veterans Health Administration (VHA) has played an integral part in learning about cancer biology and treatment. Here we provide examples of past research performed in the VHA focusing on hematologic malignancies, and identify future opport ... Full text Link to item Cite

Clinical outcomes in chronic lymphocytic leukaemia associated with expression of CD5, a negative regulator of B-cell receptor signalling.

Journal article Br J Haematol · December 2018 Chronic lymphocytic leukaemia (CLL) is characterized by expression of CD5 on clonal B cells, and is partly driven by activated B-cell receptor (BCR) signalling. While CD5 is known to be a negative regulator of BCR signalling, it is unknown if variability i ... Full text Link to item Cite

Surface CD5 Protein Risk Stratifies Chronic Lymphocytic Leukemia

Conference Blood · December 2, 2016 AbstractIntroduction: Chronic Lymphocytic Leukemia (CLL) is a malignancy characterized by B-lymphocytes with aberrant expression of CD5. In normal T-lymphocytes, CD5 is an important regulator of T-cell recep ... Full text Cite

Relationship of blood monocytes with chronic lymphocytic leukemia aggressiveness and outcomes: a multi-institutional study.

Journal article Am J Hematol · July 2016 Monocyte-derived cells, constituents of the cancer microenvironment, support chronic lymphocytic leukemia (CLL) cell survival in vitro via direct cell-cell interaction and secreted factors. We hypothesized that circulating absolute monocyte count (AMC) ref ... Full text Link to item Cite

Perifosine as a potential novel anti-telomerase therapy.

Journal article Oncotarget · September 8, 2015 Most tumors circumvent telomere-length imposed replicative limits through expression of telomerase, the reverse transcriptase that maintains telomere length. Substantial evidence that AKT activity is required for telomerase activity exists, indicating that ... Full text Link to item Cite

Abstract A24: The dual PI3K δ/γ inhibitor, RP6530, in combination with ibrutinib or fludarabine, synergistically enhances cytotoxicity in primary CLL cells in vitro.

Conference Clinical Cancer Research · September 1, 2015 AbstractBackground: The PI3K pathway is a central pro-survival mechanism in chronic lymphocytic leukemia (CLL). While the delta isoform of PI3K is largely associated with B-cell signaling, gamma is involved ... Full text Cite

Utilization of the Eμ-Myc mouse to model heterogeneity of therapeutic response.

Journal article Mol Cancer Ther · December 2014 Human aggressive B-cell non-Hodgkin lymphomas (NHL) encompass the continuum between Burkitt lymphoma and diffuse large B-cell lymphoma (DLBCL), and display considerable clinical and biologic heterogeneity, most notably related to therapy response. We previ ... Full text Link to item Cite

Abstract 4518: The PI3K-δ inhibitor TGR-1202 induces cytotoxicity and inhibits phosphorylation of AKT in 17p deleted and non-17p deleted CLL cells in vitro

Conference Cancer Research · October 1, 2014 AbstractBackground: The PI3K pathway is a central pro-survival mechanism in chronic lymphocytic leukemia (CLL), with expression of the delta isoform of PI3K largely restricted to lymphocytes. Clinical evalua ... Full text Cite

Perifosine treatment in chronic lymphocytic leukemia: results of a phase II clinical trial and in vitro studies.

Journal article Leuk Lymphoma · May 2014 Abstract Because of the importance of the phosphoinositide 3-kinase (PI3K)/AKT pathway in chronic lymphocytic leukemia (CLL), we evaluated in vitro cytotoxicity induced by perifosine, an AKT inhibitor, in CLL lymphocytes and found that the mean 50% effecti ... Full text Link to item Cite

Molecular and Clinical Associations Between Vitamin D and Chronic Lymphocytic Leukemia

Conference Blood · November 15, 2013 AbstractIntroductionVitamin D deficiency is common in the general population. Approximately 25-50% of adult patients seen at routine v ... Full text Cite

Chronic lymphocytic leukemia and regulatory B cells share IL-10 competence and immunosuppressive function.

Journal article Leukemia · January 2013 Chronic lymphocytic leukemia (CLL) can be immunosuppressive in humans and mice, and CLL cells share multiple phenotypic markers with regulatory B cells that are competent to produce interleukin (IL)-10 (B10 cells). To identify functional links between CLL ... Full text Link to item Cite

Clinical and biological relevance of genomic heterogeneity in chronic lymphocytic leukemia.

Journal article PLoS One · 2013 BACKGROUND: Chronic lymphocytic leukemia (CLL) is typically regarded as an indolent B-cell malignancy. However, there is wide variability with regards to need for therapy, time to progressive disease, and treatment response. This clinical variability is du ... Full text Link to item Cite

CD38 Variation in Chronic Lymphocytic Leukemia

Conference Blood · November 16, 2012 AbstractAbstract 4576Background:Chronic lymphocytic leukemia (CLL) has a highly variable clinical cou ... Full text Cite

Phase II study of cenersen, an antisense inhibitor of p53, in combination with fludarabine, cyclophosphamide and rituximab for high-risk chronic lymphocytic leukemia.

Journal article Leuk Lymphoma · February 2012 Patients with chronic lymphocytic leukemia (CLL) with deletion or mutation of TP53 have exceedingly poor clinical outcomes. Cenersen, an oligonucleotide targeting TP53, has been shown to abrogate the activity of TP53 gain-of-function mutants and to increas ... Full text Link to item Cite

Genomic Heterogeneity in B-Cell Malignancies

Conference BLOOD · November 18, 2011 Link to item Cite

SET oncoprotein overexpression in B-cell chronic lymphocytic leukemia and non-Hodgkin lymphoma: a predictor of aggressive disease and a new treatment target.

Journal article Blood · October 13, 2011 B-cell chronic lymphocytic leukemia (CLL), an incurable leukemia, is characterized by defective apoptosis. We found that the SET oncoprotein, a potent inhibitor of the protein phosphatase 2A (PP2A) tumor suppressor, is overexpressed in primary CLL cells an ... Full text Link to item Cite

Deep sequencing of the small RNA transcriptome of normal and malignant human B cells identifies hundreds of novel microRNAs.

Journal article Blood · December 2, 2010 A role for microRNA (miRNA) has been recognized in nearly every biologic system examined thus far. A complete delineation of their role must be preceded by the identification of all miRNAs present in any system. We elucidated the complete small RNA transcr ... Full text Link to item Cite

LMP-420: a novel purine nucleoside analog with potent cytotoxic effects for CLL cells and minimal toxicity for normal hematopoietic cells.

Journal article Leukemia · September 2010 B-cell chronic lymphocytic leukemia (CLL) is characterized by slow accumulation of malignant cells, which are supported in the microenvironment by cell-cell interactions and soluble cytokines such as tumor necrosis factor (TNF). We evaluated the effect of ... Full text Link to item Cite

A genomic approach to improve prognosis and predict therapeutic response in chronic lymphocytic leukemia.

Journal article Clin Cancer Res · November 15, 2009 Featured Publication PURPOSE: Chronic lymphocytic leukemia (CLL) is a B-cell malignancy characterized by a variable clinical course. Several parameters have prognostic capabilities but are associated with altered response to therapy in only a small subset of patients. EXPERIME ... Full text Link to item Cite

Survivorship care planning needs in diffuse large B-cell lymphoma (DLBCL).

Journal article J Clin Oncol · May 20, 2009 e20703 Background: Cancer survivorship care plans inform and direct care in the survivorship setting. These care plans should be tailored to individual medical information, needs, and circumstances, as providing excess information can be overwhelming. Acco ... Link to item Cite

Patterns of microRNA expression characterize stages of human B-cell differentiation.

Journal article Blood · May 7, 2009 Featured Publication Mature B-cell differentiation provides an important mechanism for the acquisition of adaptive immunity. Malignancies derived from mature B cells constitute the majority of leukemias and lymphomas. These malignancies often maintain the characteristics of th ... Full text Link to item Cite

Clinical and molecular predictors of disease severity and survival in chronic lymphocytic leukemia.

Journal article Am J Hematol · December 2007 Featured Publication Several parameters may predict disease severity and overall survival in chronic lymphocytic leukemia (CLL). The purpose of our study of 190 CLL patients was to compare immunoglobulin heavy chain variable region (IgV(H)) mutation status, cytogenetic abnorma ... Full text Link to item Cite

A Genomic Strategy To Refine Prognosis and Predict Response to Therapy in Chronic Lymphocytic Leukemia.

Conference Blood · November 16, 2007 AbstractChronic Lymphocytic Leukemia (CLL) is notable for variation in aggressiveness of disease. Many patients with low-risk disease at diagnosis can be followed expectantly, while others rapidly require th ... Full text Cite

Review of targeted cancer therapies for the palliative care provider Part 1: Small molecules

Journal article Progress in Palliative Care · October 29, 2007 The incorporation of 'targeted therapies' into standard cancer care has changed how clinicians treat cancer. Small molecule inhibitors, antibodies, and conjugated agents target cancer cells more specifically than traditional chemotherapy. These therapies c ... Full text Cite

Review of targeted cancer therapies for the palliative care provider PART 2: Antibodies and conjugated agents

Journal article Progress in Palliative Care · October 29, 2007 The incorporation of 'targeted therapies' into standard cancer care has changed how clinicians treat cancer. Small molecule inhibitors, antibodies, and conjugated agents target cancer cells more specifically than traditional chemotherapy. These therapies c ... Full text Cite

Cocaine-induced pseudovasculitis.

Journal article Mayo Clin Proc · May 2005 Pseudovasculitis is a disease process that mimics the presentation and possibly the laboratory findings of true vasculitis. However, biopsy specimens do not reveal the typical histopathologic findings expected in vasculitis. One often overlooked cause of p ... Full text Link to item Cite

Interleukin-15 augments superoxide production and microbicidal activity of human monocytes against Candida albicans.

Journal article Infect Immun · January 1998 Interleukin-15 (IL-15) is a newly described cytokine that shares biological activities with IL-2. We report here results demonstrating the ability of IL-15 to enhance superoxide production and antifungal activity of human monocytes. After 18 and 48 h of tr ... Full text Link to item Cite