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Au WY, Ma SK, Kwong YL. The occurrence of Philadelphia chromosome (Ph) negative leukemia after hematopoietic stem cell transplantation for Ph positive chronic myeloid leukemia: implications for disease monitoring and treatment. Leuk Lymphoma 2003; 44:1121-9. [PMID: 12916863 DOI: 10.1080/1042819031000079104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Chronic myeloid leukemia (CML) is a clonal neoplastic disorder, characterized by t(9;22)(q34;q11) that results in the formation of the Philadelphia chromosome (Ph) and the BCR/ABL fusion gene. Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for CML. Much of its therapeutic efficacy is attributed to a graft-versus-leukemia (GVL) effect exerted by donor-derived lymphoid cells against the Ph positive (Ph+) clone. Post-HSCT monitoring by cytogenetic and molecular detection of the Ph+ clone is necessary, so that pre-emptive immunologic or pharmacologic treatment may be administered at an early stage of relapse. However, under rare circumstances a second Ph negative (Ph-) leukemia may evolve post-HSCT. The pathogenetic possibilities included leukemia arising from donor-derived hematopoietic stem cells (HSCs), or transformation of residual recipient-derived Ph- HSCs that have survived the conditioning chemotherapy and radiotherapy. Recipient-derived Ph- leukemia may be related to genetic alterations that precede the onset of CML, or myelotoxic effects of the HSCT conditioning regimen. The diagnosis of Ph- relapses requires detailed investigations by conventional karyotyping, fluorescence in-situ hybridization (FISH), and molecular analysis; as well as chimerism studies that help to document the donor or recipient origin of the leukemia. Although uncommonly reported in the past, Ph- relapses may in fact be more frequent if leukemic relapses post-HSCT are more thoroughly evaluated with these investigations. The recognition of Ph- relapses are important in several ways. Ph- relapses cannot be identified by monitoring investigations targeting the Ph+ clone, so that the early detection of Ph- leukemia is usually not possible. Furthermore, Ph- relapses will not respond to therapeutic strategies effective against the Ph+ CML clone.
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MESH Headings
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/etiology
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Au WY, Chan EC, Lie AKW, Liang R, Leung AYH, Ma SK, Kwong YL. Poor engraftment after allogeneic bone marrow transplantation: role of chimerism analysis in treatment and outcome. Ann Hematol 2003; 82:410-5. [PMID: 12750845 DOI: 10.1007/s00277-003-0676-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2003] [Accepted: 04/17/2003] [Indexed: 11/30/2022]
Abstract
We analyzed the clinical course and risk factors of 18 patients with poor engraftment after allogeneic bone marrow transplantation (BMT), defined as absolute neutrophil count below 0.1 x 10(9)/l 28 days post-BMT. Significant risks associated with non-engraftment included HLA one antigen mismatch, BMT from matched unrelated donor, and a low dose of colony-forming units-granulocyte-macrophage (<10(4)/kg). Examined by a semiquantitative analysis of polymorphic microsatellite markers, donor DNA chimerism on day 28 was found to be predictive of treatment outcome. Seven patients had detectable donor DNA, varying from 43 to 100%. Five of them responded to granulocyte colony-stimulating factor (G-CSF) and achieved engraftment. Two were given further infusions of peripheral blood hematopoietic stem cells (PBSC) from the same donors, resulting in engraftment in one of them. Eleven patients had no detectable donor DNA, and none responded to G-CSF. Autologous regeneration occurred in six of these patients, four after infusion of backup marrow and two spontaneously. The remaining five patients died despite the administration of PBSC from the same or different donors. Regular monitoring of donor DNA chimerism is useful in the management of patients at high risk of poor engraftment.
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Wan TSK, Ma SK, Au WY, Chan LC. Derivative chromosome 9 deletions in chronic myeloid leukaemia: interpretation of atypical D-FISH pattern. J Clin Pathol 2003; 56:471-4. [PMID: 12783977 PMCID: PMC1769964 DOI: 10.1136/jcp.56.6.471] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS New molecular cytogenetic techniques are increasingly applied as a routine investigative tool in haematological malignancies, both at diagnosis and subsequent monitoring. This report describes the interpretation of atypical signal patterns encountered using BCR-ABL dual colour dual fusion fluorescence in situ hybridisation (D-FISH) translocation probes in chronic myeloid leukaemia (CML). METHODS Interphase FISH experiments were carried out using BCR-ABL D-FISH probes in 46 patients with CML at diagnosis and during subsequent disease monitoring. Atypical hybridisation signal patterns were characterised by molecular cytogenetic techniques and correlated with conventional karyotyping. RESULTS Two patients showed atypical interphase D-FISH patterns with one orange, one green, and one fusion (1O1G1F) signal. The presence of BCR-ABL gene fusion was documented by a dual colour single fusion (S-FISH) probe. The submicroscopic deletion of the ABL-BCR fusion gene on the derivative chromosome 9 in these cases was subsequently characterised by metaphase FISH on relocated G banded metaphases. CONCLUSIONS Atypical interphase D-FISH patterns should not be interpreted in isolation and should be considered in conjunction with other cytogenetic or molecular genetic investigations.
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Au WY, Lie AKW, Chim CS, Liang R, Ma SK, Chan CH, Mak YK, Chen YT, So CC, Yeung YM, Yip SF, Wong LG, Chan JC, Liu SY, Kwong YL. Arsenic trioxide in comparison with chemotherapy and bone marrow transplantation for the treatment of relapsed acute promyelocytic leukaemia. Ann Oncol 2003; 14:752-7. [PMID: 12702530 DOI: 10.1093/annonc/mdg208] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The best overall treatment strategy for patients with acute promyelocytic leukaemia (APL) in relapse with chemotherapy, bone marrow transplantation (BMT) or arsenic trioxide (As(2)O(3)) based therapy remains undefined. PATIENTS AND METHODS We reviewed the clinical course and treatment outcome of 143 APL cases seen in four major hospitals in Hong Kong over a 10-year period. RESULTS Complete remission (CR) was attained in 113 cases (79%) with all-trans retinoic acid (ATRA) and chemotherapy. Relapse occurred at a median of 16 months in 54 cases, with a 3-year disease free survival of 56%. Post-relapse treatment was successful in 41 cases (76%), giving an actuarial 3-year overall survival (OS) of 81% from CR1. Three different protocols were used: chemotherapy alone (n = 19), allogeneic BMT (n = 14) and an As(2)O(3)-based regimen (n = 21). Chemotherapy was associated with the highest treatment-related mortality (TRM) at 53%, giving a CR2 rate of 47%. TRM was 36% for BMT. The CR2 rate for the As(2)O(3)-based regimen was 100%, with no TRM. However, 38% of As(2)O(3) treated patients had subsequent relapses, which were further salvaged in 75% by combined As(2)O(3) plus ATRA. The actuarial OS for the three protocols leveled off by 2 years at 82% for As(2)O(3), 43% for BMT and 23% for chemotherapy (P = 0.0004). CONCLUSIONS Our results suggest that As(2)O(3) may be superior to chemotherapy and BMT for the treatment of APL in relapse.
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Au WY, Fung A, Man C, Ma SK, Wan TS, Liang R, Kwong YL. Aberrant p15 gene promoter methylation in therapy-related myelodysplastic syndrome and acute myeloid leukaemia: clinicopathological and karyotypic associations. Br J Haematol 2003; 120:1062-5. [PMID: 12648079 DOI: 10.1046/j.1365-2141.2003.04194.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Seventeen patients with therapy-related myelodysplastic syndrome/acute myeloid leukaemia (t-MDS/AML) were examined for aberrant p15 gene methylation by methylation-specific polymerase chain reaction. Ten patients (58%) showed p15 methylation, which was significantly related to monosomy/deletion of chromosome 7q, but not to antecedent chemotherapy, blast count, leukaemic evolution or survival. In three of six patients with marrow samples obtained prior to the diagnosis of t-MDS/AML, p15 methylation predated disease development by up to 2 years. Bone marrow transplantation led to the disappearance of p15 methylation in one patient. These results showed that p15 methylation was an early event in the evolution of some t-MDS/AML patients.
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Au WY, Ma SK, Wan TS, Wang EP, Lau TCM, Kwong YL. Concurrent mediastinal B cell lymphoma and chronic myeloid leukemia with an unusually favorable response to chemotherapy. Leuk Lymphoma 2003; 44:535-8. [PMID: 12688328 DOI: 10.1080/1042819021000038029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 67-year-old Chinese woman presented with mediastinal B cell lymphoma in 1992 with incidental leukocytosis. Bone marrow and peripheral blood findings confirmed the diagnosis of chronic myeloid leukemia (CML). After combination chemotherapy and radiotherapy for lymphoma, her peripheral blood counts remained normal, and she refused further treatment for nearly six years. Frank hematologic relapse occurred in 1998 and low dose hydroxyurea was used, which was stopped after six months owing to cytopenia. She remained well without treatment at 12-year follow up. Retrospective Southern blot analysis confirmed BCR gene rearrangement in marrow in 1992 and 1998, but not in the lymphoma or the latest peripheral blood. Fluorescence in-situ hybridzation analysis showed no Philadelphia chromosome positive (Ph+) cells in the peripheral blood at last (FISH) follow-up, but BCR/ABL remained detectable. The relevance of the concomitant occurrence of CML and lymphoma and the unusually favorable response of CML to chemotherapy to the pathogenesis of CML is discussed.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Clone Cells/pathology
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Female
- Fusion Proteins, bcr-abl/analysis
- Fusion Proteins, bcr-abl/genetics
- Humans
- Hydroxyurea/therapeutic use
- In Situ Hybridization, Fluorescence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukocytosis/etiology
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/radiotherapy
- Mediastinal Neoplasms/drug therapy
- Mediastinal Neoplasms/genetics
- Mediastinal Neoplasms/pathology
- Mediastinal Neoplasms/radiotherapy
- Neoplasms, Multiple Primary/genetics
- Prednisolone/administration & dosage
- Procarbazine/administration & dosage
- Remission Induction
- Vincristine/administration & dosage
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Kim SW, Ma SK, Yeum CH, Kim NH, Choi KC. Decreased formation of nitric oxide in rats treated with FK506. Transplant Proc 2003; 35:181-3. [PMID: 12591357 DOI: 10.1016/s0041-1345(02)03894-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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33
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Au WY, Liu CL, Lo CM, Fan ST, Ma SK. Essential thrombocytosis and liver transplantation. Am J Hematol 2003; 72:152-3. [PMID: 12555224 DOI: 10.1002/ajh.10275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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34
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Wan TSK, Ma SK, Au WY, Liu HSY, Chan JCW, Chan LC. Trisomy 21 and other chromosomal abnormalities in acute promyelocytic leukemia. CANCER GENETICS AND CYTOGENETICS 2003; 140:170-3. [PMID: 12645658 DOI: 10.1016/s0165-4608(02)00684-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe a case of acute promyelocytic leukemia (APL) with t(15;17)(q22;q12) and trisomy 21 as an additional change in a patient who died at relapse after achieving complete remission (CR) for the duration of 20 months. A survey of 42 cases of APL with cytogenetic study performed at our institutionover the past 10 years showed 12 cases (28.6%) having chromosomal changes in addition to t(15;17). Trisomy 8 and trisomy 21 as additional changes were noted in 4 and 2 cases, respectively, with one patient showing both trisomies simultaneously. Two cases showed t(15;17) in hyperdiploid clones. Among the 10 patients with follow-up data, all eventually relapsed and none achieved continuous complete remission 1. Survival analysis performed in APL patients with adequate follow-up data showed no significant difference in overall and disease free survival between those with and without additional cytogenetic changes. After excluding cases with one induction death, the overall survival was significantly in favor of the group without additional cytogenetic abnormalities (P = 0.022). Late relapses may therefore be significantly more common in APL patients with additional cytogenetic abnormalities, and may not be reflected by analysis focused at three-year survival only. As APL is now considered a curable disease, any confirmed long-term survival impact of additional cytogenetic changes is expected to have important management implications.
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MESH Headings
- Adolescent
- Adult
- Antineoplastic Agents/therapeutic use
- Chromosome Aberrations
- Chromosome Banding
- Chromosomes, Human, Pair 15/ultrastructure
- Chromosomes, Human, Pair 17/ultrastructure
- Chromosomes, Human, Pair 21
- Death, Sudden
- Fatal Outcome
- Female
- Hong Kong/epidemiology
- Humans
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/mortality
- Male
- Middle Aged
- Pulmonary Embolism/etiology
- Remission Induction
- Retrospective Studies
- Survival Analysis
- Translocation, Genetic
- Tretinoin/therapeutic use
- Trisomy
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Au WY, Chan EC, Siu LLP, Lau TCM, Lie AKW, Ma SK, Kwong YL. Leukaemic relapse of donor origin after allogeneic bone marrow transplantation from a donor who later developed bronchogenic carcinoma. Br J Haematol 2002; 119:777-80. [PMID: 12437659 DOI: 10.1046/j.1365-2141.2002.03925.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Donor-derived leukaemia is exceptional after allogeneic bone marrow transplantation (BMT). A woman with chronic myeloid leukaemia received an allogeneic BMT from a human leucocyte antigen-identical brother. The donor, a 50-year-old non-smoker, died of squamous cell bronchogenic carcinoma 1 year later. At 4 years post BMT, the patient became BCR/ABL positive and relapsed with acute myeloid leukaemia, which was shown to be donor-derived cytogenetically and molecularly. Retrospective analysis showed that the donor-leukaemic clone had started to evolve as early as 6 months post BMT. Sequencing of p53 ruled out Li-Fraumeni syndrome. Predisposition to malignancy might be an underlying mechanism of donor-cell leukaemia.
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Wan TSK, Ma SK, Yip SF, Yeung YM, Chan LC. Two balanced and novel chromosomal translocations in myeloid malignancies. characterization by multiplex fluorescence in situ hybridization. CANCER GENETICS AND CYTOGENETICS 2002; 139:52-6. [PMID: 12547159 DOI: 10.1016/s0165-4608(02)00611-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe two novel chromosomal translocations in two cases of leukemia in which these translocations were further characterized as the sole acquired karyotypic abnormality by mutliplex fluorescence in situ hybridization (M-FISH). They comprised a case of acute myeloid leukemia with t(6;10)(q21;p12) and a case of chronic myelomonocytic leukemia with t(5;12)(q34;q24). To the best of our knowledge, these two balanced translocations are novel and are hitherto unrecognized in hematologic malignancies. While the clinical and pathogenic significance of these translocations remains to be defined, the present report illustrates that M-FISH technology contributes to the exclusion of subtle or cryptic translocations in sole karyotypic aberrations and the confirmation of novel chromosomal arrangements in neoplastic disorders.
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MESH Headings
- Chromosome Mapping
- Chromosomes, Human, Pair 10
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 5
- Chromosomes, Human, Pair 6
- Humans
- In Situ Hybridization, Fluorescence/methods
- Karyotyping
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myelomonocytic, Chronic/genetics
- Translocation, Genetic
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Au WY, Ma SK, Chung LP, Chim CS, Kwong YL. Two cases of therapy-related acute promyelocytic leukemia (t-APL) after mantle cell lymphoma and gestational trophoblastic disease. Ann Hematol 2002; 81:659-61. [PMID: 12454706 DOI: 10.1007/s00277-002-0552-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2002] [Accepted: 09/10/2002] [Indexed: 10/27/2022]
Abstract
We report two cases of secondary acute promyelocytic leukemia (APL). One patient presented with concurrent APL and missed abortion 1 year after etoposide-based chemotherapy for gestational trophoblastic disease. A prolonged complete remission was achieved with standard chemotherapy. An elderly man developed APL 1 year after alkylator-based chemotherapy for mantle cell lymphoma (MCL). A complete clinical and molecular remission was obtained with chemotherapy and all- trans retinoic acid, followed by arsenic consolidation. Concomitant molecular relapse of APL and MCL clones was detected at 1 year, both of which responded to oral arsenic therapy. High-dose epipodophyllin is a dose risk for secondary APL, but alkylating agents may also be implicated. For patients with a history of active malignancy and heavy previous chemotherapy exposure, the use of nontoxic arsenic therapy appeared to be effective and prudent.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents, Alkylating/adverse effects
- Antineoplastic Agents, Alkylating/therapeutic use
- Arsenic Trioxide
- Arsenicals/therapeutic use
- Etoposide/adverse effects
- Etoposide/therapeutic use
- Female
- Gestational Trophoblastic Disease/drug therapy
- Gestational Trophoblastic Disease/pathology
- Humans
- Leukemia, Promyelocytic, Acute/chemically induced
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/etiology
- Lymphoma, Mantle-Cell/drug therapy
- Lymphoma, Mantle-Cell/pathology
- Male
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/etiology
- Oxides/therapeutic use
- Pregnancy
- Tretinoin/therapeutic use
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38
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Li YH, Ma SK, Wan TSK, Au WY, Fung LF, Leung AYH, Lie AKW, Chan LC. Lineage-specific differences in telomere length after bone marrow transplantation. Bone Marrow Transplant 2002; 30:475-7. [PMID: 12368963 DOI: 10.1038/sj.bmt.1703669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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39
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Au WY, Lie AKW, Ma SK, Wan TS, Liang R, Chan EC, Kwong YL. Tyrosine kinase inhibitor STI571 in the treatment of Philadelphia chromosome-positive leukaemia failing myeloablative stem cell transplantation. Bone Marrow Transplant 2002; 30:453-7. [PMID: 12368958 DOI: 10.1038/sj.bmt.1703678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2002] [Accepted: 07/08/2002] [Indexed: 11/09/2022]
Abstract
Eight patients with Philadelphia chromosome-positive (Ph(+)) leukaemia relapsing from stem cell transplantation (SCT) (one syngeneic and seven allogeneic) were treated with the tyrosine kinase inhibitor STI571. Five patients relapsing as chronic myeloid leukaemia (CML) in chronic phase achieved a complete haematological response, with complete and major cytogenetic responses occurring in four and one cases, respectively. One patient became negative for BCR/ABL in the bone marrow. Three patients relapsed as acute leukaemia (two CML in myeloblastic crisis and one Ph(+) acute lymphoblastic leukaemia), all of whom achieved haematological and cytogenetic responses. One patient also became BCR/ABL negative. However, pancytopenia and graft-versus-host disease led to cessation of treatment in the remaining two cases, which was followed by disease recurrence refractory to further STI treatment. Our results showed that Ph(+) leukaemic relapses after SCT might respond well to STI571 therapy.
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40
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Ma SK, Ma V, Chan AYY, Chan LC, Chui DHK. Routine screening of (--(SEA)) alpha-thalassemia deletion by an enzyme-linked immunosorbent assay for embryonic zeta-globin chains. Acta Haematol 2002; 108:8-12. [PMID: 12145460 DOI: 10.1159/000063060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We evaluated an enzyme-linked immunosorbent assay (ELISA) for embryonic zeta-globin chains as a routine screening test for (--(SEA)) alpha-thalassemia deletion (SEA deletion). A total of 174 consecutive patient samples with a request for Hb analysis were recruited. The ELISA method was evaluated against a polymerase chain reaction (PCR)-based technique that was taken as the standard. Among 56 simple carriers of SEA deletion diagnosed by PCR and 112 subjects without the SEA deletion, the sensitivity and specificity of the ELISA method was 89.3-96.4 and 98.2-100%, respectively, depending on the cutoff value for optical density that was adopted. The ELISA method was able to detect both subjects with SEA deletion and concurrent beta-thalassemia trait in this series, but only 1 out of 4 patients (25%) with Hb H disease. We speculate that incomplete lysis of hypochromic microcytic red cells together with the low red cell count in Hb H disease might account for the false-negative results. We showed that the ELISA method for embryonic zeta-chains was a sensitive method of screening for SEA deletion carriers at our locality, and should be easily adopted in a routine diagnostic laboratory. The method was rapid and also amendable to automation. In areas with a high prevalence of alpha-thalassemia, improved detection of SEA deletion carriers would ultimately facilitate the identification of pregnancies at risk of hydrops fetalis and its prevention through prenatal diagnosis.
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Au WY, Yuen MF, Lai KC, Wan TSK, Ma SK. Clonal marrow abnormalities after azathioprine and sulfasalazine exposure in Crohn's disease: a cautionary tale. Leuk Lymphoma 2002; 43:1679-81. [PMID: 12400612 DOI: 10.1080/1042819021000003027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We report a patient with longstanding Crohn's disease (CD) developing recurrent sepsis and impaired neutrophil function tests. His inflammatory bowel disease was controlled with local steroids and sulfasalazine with only short exposure to azathioprine. His blood counts remained within normal range, but the marrow showed mild dysplasia. Repeated cytogenetic examinations revealed trisomies 8 and 9, which are typical for therapy related myelodysplasia. Fluorescent in situ hybridization (FISH) study showed stable persistent trisomies, confined to the myeloid lineage, one year after discontinuation of sulfasalazine. The long-term use of immunodulating agents in patients with CD is not without risks, and early therapy related myelodysplasia might not be easily detected by blood count and morphology assessment alone.
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42
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Au WY, Ma SK, Wan TS, Jim MH, Kwong YL. Subvalvular pulmonary stenosis, demyelination and myelodysplasia with monosomy 7. Leuk Lymphoma 2002; 43:1505-7. [PMID: 12389638 DOI: 10.1080/10428190290033530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report a 23-year-old male with subvalvular pulmonary stenosis (PS) presenting with concurrent acute demyelinating neuropathy and myelodysplasia with monosomy 7. There was no stigmata of Noonan syndrome or neurofibromatosis, nor any family history of cardiac or hematologic disorders. There are 40 reported pediatric cases of Noonan syndrome with subvalvular PS that developed leukemia, over two-thirds with monosomy 7. There is also a genetic overlap between Noonan syndrome and neurofibromatosis, which is also closely associated with demyelination and leukemia. The importance of recognition of rare clinical syndromes that may predispose to leukemia is discussed.
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43
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Ma SK, Wan TSK, Au WY, Fung LF, So CK, Chan LC. Chromosome 11q deletion in myeloid malignancies. Leukemia 2002; 16:953-5. [PMID: 11986961 DOI: 10.1038/sj.leu.2402442] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2001] [Accepted: 12/20/2001] [Indexed: 11/09/2022]
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Wan TSK, Yip SF, Yeung YM, Chan LC, Ma SK. Fatal diffuse alveolar damage complicating acute myeloid leukemia with abnormal eosinophils and trisomy X. Ann Hematol 2002; 81:167-9. [PMID: 11904745 DOI: 10.1007/s00277-001-0423-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2001] [Accepted: 12/13/2001] [Indexed: 10/27/2022]
Abstract
We describe a case of acute myeloid leukemia (AML) with abnormal eosinophils in a 44-year-old Chinese woman that was complicated by diffuse alveolar damage (DAD) and pulmonary hemorrhage (PH) shortly after induction chemotherapy. Cytogenetic study of bone marrow cells at diagnosis showed a rare aberration of trisomy X (+X) as the sole acquired karyotypic abnormality. We speculate that tissue damage by cellular constituents of the abnormal eosinophils that were released on cell lysis after chemotherapy might be etiologically linked to the occurrence of fatal pulmonary complications.
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Au WY, Ma SK, Lie AKW, Liang R, Cheng T, Kwong YL. Glucose-6-phosphate dehydrogenase deficiency and hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 29:399-402. [PMID: 11919729 DOI: 10.1038/sj.bmt.1703369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2001] [Accepted: 12/03/2001] [Indexed: 11/09/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked hemolytic enzymopathy affecting 3% of Southern Chinese males. Among 275 adult allogeneic hematopoietic stem cell transplantations (SCT), five cases (1.8%) each of donors and recipients were G6PD deficient. Among 107 autologous SCT, four patients (3.7%) were G6PD deficient. All subjects were male, except for two female patients with chronic myeloid leukemia (CML). The incidence of G6PD deficiency in female CML patients was significantly higher than the background female incidence (P = 0.004), but comparable with that in the males (P = 0.664). There was no significant hemolysis or delay in red cell engraftment, and all but one patient converted to donor G6PD screening status. One female patient achieved partial correction of her G6PD status and relapsed at 10 months. We suggest that G6PD deficiency should be tested for in all marrow donors and recipients in susceptible populations. From our data, there is a suggestion of increased clinical incidence of G6PD deficiency in female patients with multi-lineage clonal marrow disorders.
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MESH Headings
- Adolescent
- Adult
- Anemia, Hemolytic/chemically induced
- Anemia, Hemolytic/enzymology
- Anemia, Hemolytic/prevention & control
- Anti-Infective Agents/adverse effects
- China/epidemiology
- Contraindications
- Female
- Glucosephosphate Dehydrogenase/blood
- Glucosephosphate Dehydrogenase Deficiency/complications
- Glucosephosphate Dehydrogenase Deficiency/diagnosis
- Glucosephosphate Dehydrogenase Deficiency/etiology
- Hematologic Diseases/complications
- Hematologic Diseases/enzymology
- Hematologic Diseases/therapy
- Humans
- Incidence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Mass Screening
- Middle Aged
- Myeloproliferative Disorders/enzymology
- Stem Cell Transplantation/adverse effects
- Stem Cell Transplantation/methods
- Tissue Donors
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46
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Chim CS, Ma SK. Acute biphenotypic leukaemia. Haematologica 2002; 87:EIM03. [PMID: 11801484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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47
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Yeum CH, Kim SW, Nah MY, Ma SK, Ko JH, Kim NH, Choi KC. Percutaneous catheterization of the internal jugular vein for hemodialysis. Korean J Intern Med 2001; 16:242-6. [PMID: 11855153 PMCID: PMC4578054 DOI: 10.3904/kjim.2001.16.4.242] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The present study was aimed at evaluating the clinical experiences in the internal jugular venous catheterization for hemodialysis. METHODS We retrospectively analyzed the data on internal jugular venous catheterization at Chonnam National University Hospital from May 2000 to February 2001. RESULTS There were 132 uremic patients with a total of 150 attempts of internal jugular cannulation. Overall success rate was 90.9% with average puncture trials of 2.3 +/- 2.1. 124 (82.7%) of the catheterization attempts were made on the right side and 26 (17.3%) were made on the left. The catheters were left in place from 2 to 87 days with an average of 19.5 +/- 15.3 days per catheter. The dialysis sessions per catheter were from 2 to 58 with an average of 11.3 +/- 6.8. The mean blood flow during hemodialysis immediately after catheterization was 213.4 +/- 42.2 ml/min. Thirty two (21.3%) patients had early complications. These included carotid artery puncture (11.3%), local bleeding (4.7%), local pain (3.3%), neck hematoma (0.7%) and malposition of the catheter (1.3%). Seventeen (11.3%) patients had late complications. These included fever or infection (11.3%), inadequate blood flow rate (3.3%) and inadvertent withdrawal (2.0%). There was no catheter-related mortality. CONCLUSIONS Our experiences revealed that the internal jugular vein catheterization is relatively safe and efficient for temporary vascular access for hemodialysis.
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Li H, Ma SK, Hu XP, Zhang GY, Fei J. Norepinephrine transporter (NET) is expressed in cardiac sympathetic ganglia of adult rat. Cell Res 2001; 11:317-20. [PMID: 11787777 DOI: 10.1038/sj.cr.7290102] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The sympathetic nervous system plays a cardinal role in regulating cardiac function through releasing the neurotransmitter norepinephrine (NE). In comparison with central nervous system, the molecular mechanism of NE uptake in myocardium is not clear. In present study, we proved that in rat the CNS type of NE transporter (NET) was also expressed in middle cervical-stellate ganglion complex (MC-SG complex) which is considered to control the activity of heart, but not expressed in myocardium. The results also showed that NET expression level in right ganglion was significantly higher than in the left, rendering the greater capacity of NE uptake in right ventricle, a fact which may contribute to the maintenance of right ventricular function under pathologic state.
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Wan TS, Ma SK, Ho MY, Chan LC, Yip SF, Wong LG, Yeung YM. Cytogenetic biclonality in polycythemia vera: unusual and unrelated clones. CANCER GENETICS AND CYTOGENETICS 2001; 131:86-9. [PMID: 11734326 DOI: 10.1016/s0165-4608(01)00493-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Ma SK, Chan AY, Chiu EK, Chan LC. Haemoglobin H disease due to (--SEA) alpha-globin gene deletion and alpha2-codon 30 (DeltaGAG) mutation: a family study. CLINICAL AND LABORATORY HAEMATOLOGY 2001; 23:325-7. [PMID: 11703416 DOI: 10.1046/j.1365-2257.2001.00411.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A Chinese family in which two siblings suffer from haemogloblin (Hb) H disease due to (--SEA) alpha-globin gene deletion and alpha2-codon 30 (DeltaGAG) mutation is described. Both siblings are transfusion-independent and have survived to adulthood. In contrast to previous report of hydrops fetalis associated with zeta-alpha-thal-1 and alpha2-codon 30 (DeltaGAG) mutation, the zeta-globin genes are intact in the two siblings, which most probably alleviates the gamma-chain excess and protects the fetus from severe anaemia. Correlation of genotype with phenotype in Hb H disease is important for genetic counselling, especially in the antenatal setting.
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