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Palandri F, Mora B, Gangat N, Catani L. Is there a gender effect in polycythemia vera? Ann Hematol 2021; 100:11-25. [PMID: 33006021 PMCID: PMC7782364 DOI: 10.1007/s00277-020-04287-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
In recent times, there has been a growing interest in understanding the impact of gender on disease biology and clinical outcomes in Philadelphia-negative chronic myeloproliferative neoplasms. Among those, polycythemia vera (PV) is characterized by increased thrombotic risk, systemic symptoms, and overall reduced survival. Here, we aim to summarize data on whether and to what extent female sex can affect PV biology and outcome. To this end, we will discuss the latest acquisitions in terms of pathogenesis, diagnosis, epidemiology, clinical presentation and symptoms burden, thrombotic risk and related treatment strategies, and prognosis in female patients affected by PV.
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Smith CJ, Kluck LA, Ruan GJ, Ashrani AA, Marshall AL, Pruthi RK, Shah MV, Wolanskyj-Spinner A, Gangat N, Litzow MR, Hogan WJ, Sridharan M, Go RS. Leukocytosis and Tobacco Use: An Observational Study of Asymptomatic Leukocytosis. Am J Med 2021; 134:e31-e35. [PMID: 32682870 DOI: 10.1016/j.amjmed.2020.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to characterize the white blood cell differential of tobacco smoking-induced leukocytosis and describe the longitudinal impact of smoking cessation on this peripheral blood abnormality. METHODS Medical records of patients undergoing evaluation by hematologists for persistent leukocytosis were reviewed. Patients in whom leukocytosis was determined to be secondary to tobacco use after exclusion of other causes were identified. Demographic and laboratory data were collected at time of diagnosis. Patients were longitudinally followed and information regarding smoking cessation and follow-up white blood cell values were recorded. RESULTS Forty patients were determined to have smoking-induced leukocytosis. The median age was 49.5 years (range: 28-75 years), 24 patients were female, and the mean body mass index (BMI) was 31.5 kg/m2. The mean white blood cell count was 13.3 × 109/L (range: 9.8-20.9 × 109/L); 39 patients had absolute neutrophilia (98%), 21 had lymphocytosis (53%), 20 had monocytosis (50%), and 19 had basophilia (48%). During follow-up, 11 patients either quit (n = 9) or reduced (n = 2) tobacco use. Reduction in tobacco smoking led to a significant decrease in mean white blood cell count (13.2 × 109/L vs 11.1 × 109/L, P = 0.02). The median time to decrease in white blood cell count following reduction in tobacco use was 8 weeks (range: 2-49 weeks). CONCLUSIONS Tobacco-induced leukocytosis was characterized by a mild elevation in total white blood cell count and was most commonly associated with neutrophilia, lymphocytosis, monocytosis, and basophilia. Cessation of smoking led to improvement in leukocytosis. Tobacco history should be elicited from all patients presenting with leukocytosis to limit unnecessary diagnostic testing, and counseling regarding smoking cessation should be offered.
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Gangat N, Szuber N, Pardanani A, Tefferi A. JAK2 unmutated erythrocytosis: current diagnostic approach and therapeutic views. Leukemia 2021; 35:2166-2181. [PMID: 34021251 PMCID: PMC8324477 DOI: 10.1038/s41375-021-01290-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 02/08/2023]
Abstract
JAK2 unmutated or non-polycythemia vera (PV) erythrocytosis encompasses both hereditary and acquired conditions. A systematic diagnostic approach begins with documentation of historical hematocrit (Hct)/hemoglobin (Hgb) measurements and classification of the process as life-long/unknown duration or acquired. Further investigation in both categories is facilitated by determination of serum erythropoietin level (EPO). Workup for hereditary/congenital erythrocytosis requires documentation of family history and laboratory screening for high-oxygen affinity hemoglobin variants, 2, 3 biphosphoglycerate deficiency, and germline mutations that are known to alter cellular oxygen sensing (e.g., PHD2, HIF2A, VHL) or EPO signaling (e.g., EPOR mutations); the latter is uniquely associated with subnormal EPO. Acquired erythrocytosis is often elicited by central or peripheral hypoxia resulting from cardiopulmonary disease/high-altitude dwelling or renal artery stenosis, respectively; EPO in the former instance is often normal (compensated by negative feed-back). Other conditions associated with acquired erythrocytosis include EPO-producing tumors and the use of drugs that promote erythropoiesis (e.g., testosterone, erythropoiesis stimulating agents). "Idiopathic erythrocytosis" loosely refers to an otherwise not explained situation. Historically, management of non-PV erythrocytosis has been conflicted by unfounded concerns regarding thrombosis risk, stemming from limited phenotypic characterization, save for Chuvash polycythemia, well-known for its thrombotic tendency. In general, cytoreductive therapy should be avoided and phlebotomy is seldom warranted where frequency is determined by symptom control rather than Hct threshold. Although not supported by hard evidence, cardiovascular risk optimization and low-dose aspirin use are often advised. Application of modern genetic tests and development of controlled therapeutic intervention trials are needed to advance current clinical practice.
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Morsia E, McCullough K, Joshi M, Cook J, Alkhateeb HB, Al‐Kali A, Begna K, Elliott M, Hogan W, Litzow M, Shah M, Pardanani A, Patnaik M, Tefferi A, Gangat N. Venetoclax and hypomethylating agents in acute myeloid leukemia: Mayo Clinic series on 86 patients. Am J Hematol 2020; 95:1511-1521. [PMID: 32833294 DOI: 10.1002/ajh.25978] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Venetoclax and hypomethylating agent (HMA) combination therapy is FDA-approved for elderly or unfit acute myeloid leukemia (AML) patients unable to withstand intensive chemotherapy. The primary objective of the current study was to impart our institutional experience with the above regimen, outlining response, survival outcomes, and its determinants amongst 86 treatment- naïve and relapsed/refractory AML patients. A total of 44 treatment-naïve AML patients, median age 73.5 years, enriched with secondary, therapy related and ELN adverse risk disease (n = 27) were studied. The CR/CRi rates of 50% (22 of 44 patients) were superior to 23% in a matched AML cohort treated with HMA alone (P = .005). Response rates were similar with TP53, FLT3, NPM1 and IDH mutations (P = .31). Moreover, CEPBA mutations (P = .03) and neutropenia (P = .05) emerged as predictors of complete response. Survivalwas prolonged in patients achieving CR/CRi (17 vs 3 months without CR/CRi, P < .001; conversely adverse ELN risk portended inferior survival. Amongst 42 relapsed/refractory AML patients, half received ≥2 prior therapies excluding transplant, and 15 (35.7%) had received HMA. A group of 14 patients (33.3%) attained CR/CRi; age > 65 years, AML with myelodysplasia, JAK2, DNMT3A, and BCOR mutations predicted complete response. Survival distinctions were based on CR/CRi (median survival 15 vs 3 months with/without CR/CRi; P < .001), and TP53 mutation status (P = .04). In summary, we corroborate existing reports demonstrating superior response and prolonged survival with venetoclax and HMA in treatment -naïve and relapsed/refractory AML patients regardless of genotype. Additionally, we identify unique predictors of response to therapy which require validation.
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Gangat N, Tefferi A. Venetoclax-based chemotherapy in acute and chronic myeloid neoplasms: literature survey and practice points. Blood Cancer J 2020; 10:122. [PMID: 33230098 PMCID: PMC7684277 DOI: 10.1038/s41408-020-00388-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/24/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023] Open
Abstract
Venetoclax (VEN), a small-molecule inhibitor of B cell leukemia/lymphoma-2, is now FDA approved (November 2018) for use in acute myeloid leukemia (AML), specific to newly diagnosed elderly or unfit patients, in combination with a hypomethylating agent (HMA; including azacitidine or decitabine) or low-dose cytarabine. A recent phase-3 study compared VEN combined with either azacitidine or placebo, in the aforementioned study population; the complete remission (CR) and CR with incomplete count recovery (CRi) rates were 28.3% and 66.4%, respectively, and an improvement in overall survival was also demonstrated. VEN-based chemotherapy has also shown activity in relapsed/refractory AML (CR/CRi rates of 33-46%), high-risk myelodysplastic syndromes (CR 39% in treatment naïve, 5-14% in HMA failure), and blast-phase myeloproliferative neoplasm (CR 25%); in all instances, an additional fraction of patients met less stringent criteria for overall response. Regardless, venetoclax-induced remissions were often short-lived (less than a year) but long enough to allow some patients transition to allogeneic stem cell transplant. Herein, we review the current literature on the use of VEN-based combination therapy in both acute and chronic myeloid malignancies and also provide an outline of procedures we follow at our institution for drug administration, monitoring of adverse events and dose adjustments.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Azacitidine/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Clinical Trials, Phase III as Topic
- Cytarabine/therapeutic use
- Decitabine/therapeutic use
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Randomized Controlled Trials as Topic
- Sulfonamides/therapeutic use
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Jawaid T, Gangat N, Weister T, Kashyap R. An Electronic Search Algorithm for Early Disseminated Intravascular Coagulopathy Diagnosis in the Intensive Care Unit: A Derivation and Validation Study. Cureus 2020; 12:e10972. [PMID: 33209530 PMCID: PMC7667609 DOI: 10.7759/cureus.10972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim: We aim to create and validate an electronic search algorithm for accurate detection of disseminated intravascular coagulopathy (DIC) from medical records. Methods: Patients with DIC in Mayo Clinic’s intensive care units (ICUs) from Jan 1, 2007, to May 4, 2018, were included in the study. An algorithm was developed based on clinical notes and ICD diagnosis codes. A cohort of 50 patients was included with DIC diagnosis, its variations, and no diagnosis of DIC. Then, the next set of 50 patients was used to refine the algorithm. Results were compared with a manual reviewer and the disagreements were resolved by the third reviewer. The same process was repeated with 'revised clinical note search' for the first and second derivation cohort with additional exclusion terms. The obtained sensitivity and specificity were reported. The generated algorithm was applied to another set of 50 patients for validation. Results: In the first derivation cohort- DIC search by clinical notes and diagnosis codes had 92% sensitivity and 100% specificity. Sensitivity dropped to 71% in the second cohort although specificity remains the same. Therefore, the algorithm was refined to clinical notes search only. The revised search was reapplied to first and second derivation cohorts and results obtained for the first derivation were the same but 91.3% sensitive and 100% specific for the second derivation. The search was locked and applied in the validation cohort with 95.8% sensitivity and 100% specificity, respectively. Conclusion: The revised clinical note based electronic search algorithm was found to be highly sensitive and specific for DIC during the corresponding ICU duration.
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Gangat N, Pardanani A, Tefferi A. Erythrocytosis associated with cerebral hemangiomas and multiple venous anomalies. Am J Hematol 2020; 95:1224-1225. [PMID: 32602123 DOI: 10.1002/ajh.25913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/30/2022]
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133
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Ruan GJ, Smith CJ, Day C, Harmsen WS, Zblewski DL, Alkhateeb H, Begna K, Al-Kali A, Litzow MR, Hogan W, Gangat N, Patnaik MS, Pardanani A, Tefferi A, Go RS, Shah MV. A population-based study of chronic eosinophilic leukemia-not otherwise specified in the United States. Am J Hematol 2020; 95:E257-E260. [PMID: 32533865 DOI: 10.1002/ajh.25906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/08/2022]
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Gangat N, Morsia E, Foran JM, Palmer JM, Elliott MA, Tefferi A. Venetoclax plus hypomethylating agent in blast-phase myeloproliferative neoplasm: preliminary experience with 12 patients. Br J Haematol 2020; 191:e120-e124. [PMID: 32945528 DOI: 10.1111/bjh.17084] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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135
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Smith CJ, Kluck LA, Ruan GJ, Ashrani AA, Hook CC, Marshall AL, Pruthi RK, Shah MV, Wolanskyj‐Spinner A, Gangat N, Go RS. The differential diagnosis of basophilia in patients undergoing BCR-ABL testing. Am J Hematol 2020; 95:E216-E217. [PMID: 32314427 DOI: 10.1002/ajh.25830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/07/2022]
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136
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Patnaik MM, Lasho T, Padron E, McCullough K, Al‐kali A, Tefferi A, Zeidan AM, Gangat N, Savona M, Steensma DP, Solary E. Special considerations in the management of patients with myelodysplastic myndrome / myeloproliferative neoplasm overlap syndromes during the SARS-CoV-2 pandemic. Am J Hematol 2020; 95:E203-E208. [PMID: 32356322 PMCID: PMC7267346 DOI: 10.1002/ajh.25853] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 01/08/2023]
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Morsia E, Reichard K, Pardanani A, Tefferi A, Gangat N. WHO defined chronic eosinophilic leukemia, not otherwise specified (CEL, NOS): A contemporary series from the Mayo Clinic. Am J Hematol 2020; 95:E172-E174. [PMID: 32243620 DOI: 10.1002/ajh.25811] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 01/18/2023]
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Saliba AN, Ferrer A, Gangat N, Pruthi RK, Tefferi A, Higgins A, Bezerra ED, Buglioni A, Salama ME, Klee EW, Pinto E Vairo F, Mangaonkar A, Majerus J, Chen D, Patnaik MM. Aetiology and outcomes of secondary myelofibrosis occurring in the context of inherited platelet disorders: A single institutional study of four patients. Br J Haematol 2020; 190:e316-e320. [PMID: 32567678 DOI: 10.1111/bjh.16897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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139
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Ruan GJ, Smith CJ, Day C, Harmsen WS, Zblewski DL, Alkhateeb H, Begna K, Al-Kali A, Litzow MR, Hogan W, Szuber N, Gangat N, Patnaik MS, Pardanani A, Elliott MA, Tefferi A, Go RS, Shah MV. A population-based study of chronic neutrophilic leukemia in the United States. Blood Cancer J 2020; 10:68. [PMID: 32541648 PMCID: PMC7296009 DOI: 10.1038/s41408-020-0334-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022] Open
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Buradkar A, Bezerra E, Coltro G, Lasho TL, Finke CM, Gangat N, Carr RM, Binder M, Mangaonkar AA, Ketterling R, Khan S, Rodriguez V, Tefferi A, Patnaik MM. Landscape of RAS pathway mutations in patients with myelodysplastic syndrome/myeloproliferative neoplasm overlap syndromes: a study of 461 molecularly annotated patients. Leukemia 2020; 35:644-649. [PMID: 32513965 DOI: 10.1038/s41375-020-0889-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022]
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Li M, Binder M, Basha B, Zhang B, Ferrer A, Liu Y, Patnaik M, Viswanatha D, Gangat N. Abstract B03: Acute megakaryoblastic leukemia is associated with poor overall survival and enriched in JAK2 variants. Cancer Res 2020. [DOI: 10.1158/1538-7445.camodels2020-b03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In this study, we aimed to characterize the molecular mechanisms of two very rare subtypes of AML: acute megakaryoblastic leukemia (AMKL) and acute panmyelosis with myelofibrosis (APMF). Our goal is to describe the clinical-pathologic features of APMF and explore the genomic landscape AMKL to further understand these rare malignancies. We identified 35 patients diagnosed with AMKL (n=27) and APMF (n=8) at Mayo Clinic between 1995 and 2015 by retrospective chart review. For 10 of the AMKL patients, tissue was available for whole-exome sequencing and was analyzed in comparison to a published AML reference population. The median overall survival was shorter in patients with AMKL (3.9 months, 95% CI 1.7-7.4) than in patients with APMF (14.3 months, 95% CI 0.7-NE, p = 0.026,). For both AMKL and APMF, patients who underwent allogeneic hematopoietic stem cell transplantation had better overall survival (14.3 months, 95% CI 1.9-NE) compared to those not undergoing transplantation (4.6 months, 95% CI 1.5-7.4, p = 0.003). Patients with AMKL presented more frequently with splenomegaly, with higher peripheral blood blast counts, and with higher serum lactate dehydrogenase concentrations. 9 out of 10 AMKL patients with available tissue for sequencing demonstrated variants in 22 of 35 AML driver genes, with JAK2 V617F as the most common mutation. Although our small study numbers preclude firm conclusions, it does reflect the rarity of these AML subtypes. Furthermore, inferior survival in AMKL (compared to APMF) was reflected in its proliferative disease features such as splenomegaly, high blast counts, and high lactate dehydrogenase. Interestingly, the presence of JAK2 V617F variants in 40% of the interrogated samples was higher than expected. Although JAK2 is a known molecular driver in myeloproliferative neoplasms, it is actually very rare in de novo AML (~1%). Despite improved survival with allogeneic stem cell transplant, we can conclude that treatment outcomes for AMKL and APMF with standard-of-care therapy were sobering and that patients with these rare AML subtypes should undergo molecular evaluation to qualify them for clinical trials with novel targeted therapies.
Citation Format: Marissa Li, Moritz Binder, Basma Basha, Ben Zhang, Alejandro Ferrer, Yuanhan Liu, Mrinal Patnaik, David Viswanatha, Naseema Gangat. Acute megakaryoblastic leukemia is associated with poor overall survival and enriched in JAK2 variants [abstract]. In: Proceedings of the AACR Special Conference on the Evolving Landscape of Cancer Modeling; 2020 Mar 2-5; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2020;80(11 Suppl):Abstract nr B03.
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Ruan G, Smith C, Day CN, Harmsen WS, Zblewski D, Alkhateeb H, Al-Kali A, Litzow MR, Hogan WJ, Szuber N, Gangat N, Patnaik M, Pardanani AD, Elliott MA, Tefferi A, Go RS, Shah MV. A population-based study of chronic neutrophilic leukemia in the United States: 2004 to 2015. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19538 Background: Chronic neutrophilic leukemia (CNL) is a rare and aggressive myeloproliferative neoplasm with poor survival. No standard of care exists. Case reports describe allogeneic stem cell transplantation (ASCT) as the only curative therapy. Using the National Cancer Database (NCDB), we studied prognostic factors and survival outcomes of CNL. Methods: Patients diagnosed in 2004-2015 were included. 9963/3 was the ICD-O-3 code. Overall survival (OS) was analyzed using the Kaplan-Meier method. Hazard ratios (HR) with confidence intervals (CI) were calculated using Cox proportional hazards model. Variables significant in univariate analysis were included in a multivariate analysis. Data on incidence was obtained from the Surveillance, Epidemiology, and End Results Program (SEER) 21 Registries (2004-2015). The analysis was done with SEER*Stat software. Incidence was age-adjusted to the U.S. 2000 standard population. Results: A total of 121 CNL patients were in NCDB. The median age at diagnosis was 70 years (range 21-90); 74 (61%) were males and 107 (88%) were ≥ 50 years. The median follow up time was 5.8 years (interquartile range [IQR] 2.9-7.4). 32 (26%) had a Charlson Deyo score (CDS) > 1. 80 (70%) had government insurance, while 34 (30%) had private insurance. Median OS was 2.2 years (IQR 0.8-6.7). OS was 70% at 1 year, 29% at 5 years, and 11% at 10 years. The year of diagnosis was not associated with improved OS (HR: 0.95 (95% CI: 0.88-1.02), p =0.14). 71 (59%) patients received chemotherapy. The median time to chemotherapy from the day of diagnosis was 15 days (IQR 7-35). The OS of those who received chemotherapy was 71% at 1 year and 27% at 5 years versus 69% and 32% at 1- and 5- years for those who did not ( p= 0.38). 2 patients received ASCT (age 52 and 61 years) as initial therapy and both were alive at 5 years. Factors predicting inferior OS on univariate analysis were age ≥ 50 years at diagnosis ( p= 0.005), male ( p< 0.001), CDS > 1 ( p= 0.038), and government insurance ( p= 0.004). The table shows the multivariate (MV) analysis. The overall incidence of CNL was 0.1 cases/1,000,000 individuals and did not change significantly from 2004-2015. The incidences by male, female, White, Black, and American Indian/Alaska Native were also 0.1 cases/1,000,000 individuals. Conclusions: OS and incidence of CNL have not changed over the years. Age ≥ 50 years, male gender, and use of government insurance predicted inferior OS. [Table: see text]
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Gangat N, Joshi M, Shah S, Yogarajah M, Patnaik MM, Pardanani A, Wolanskyj‐Spinner AP, Tefferi A. Pregnancy outcomes in myeloproliferative neoplasms: A Mayo Clinic report on 102 pregnancies. Am J Hematol 2020; 95:E114-E117. [PMID: 32020655 DOI: 10.1002/ajh.25748] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/06/2022]
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Coltro G, Antelo G, Lasho TL, Finke CM, Pardanani A, Gangat N, Carr RM, Binder M, Mangaonkar AA, Ketterling R, Fernandez‐Zapico ME, Robertson KD, Bosi A, Vannucchi AM, Tefferi A, Patnaik MM. Phenotypic correlates and prognostic outcomes of TET2 mutations in myelodysplastic syndrome/myeloproliferative neoplasm overlap syndromes: A comprehensive study of 504 adult patients. Am J Hematol 2020; 95:E86-E89. [PMID: 31925810 DOI: 10.1002/ajh.25721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
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Gangat N, Tefferi A. Myelofibrosis biology and contemporary management. Br J Haematol 2020; 191:152-170. [PMID: 32196650 DOI: 10.1111/bjh.16576] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/25/2022]
Abstract
Myelofibrosis is an enigmatic myeloproliferative neoplasm, despite noteworthy strides in understanding its genetic underpinnings. Driver mutations involving JAK2, CALR or MPL in 90% of patients mediate constitutive JAK-STAT signaling which, in concert with epigenetic alterations (ASXL1, DNMT3A, SRSF2, EZH2, IDH1/2 mutations), play a fundamental role in disease pathogenesis. Aberrant immature megakaryocytes are a quintessential feature, exhibiting reduced GATA1 protein expression and secreting a plethora of pro-inflammatory cytokines (IL-1 ß, TGF-ß), growth factors (b-FGF, PDGF, VEGF) in addition to extra cellular matrix components (fibronectin, laminin, collagens). The ensuing disrupted interactions amongst the megakaryocytes, osteoblasts, endothelium, stromal cells and myofibroblasts within the bone marrow culminate in the development of fibrosis and osteosclerosis. Presently, prognostic assessment tools for primary myelofibrosis (PMF) are centered on genetics, with incorporation of cytogenetic and molecular information into the mutation-enhanced (MIPSS 70-plus version 2.0) and genetically-inspired (GIPSS) prognostic scoring systems. Both models illustrate substantial clinical heterogeneity in PMF and serve as the crux for risk-adapted therapeutic decisions. A major challenge remains the dearth of disease-modifying drugs, whereas allogeneic transplant offers the chance of long-term remission for some patients. Our review serves to synopsise current appreciation of the pathogenesis of myelofibrosis together with emerging management strategies.
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Joshi M, Greipp P, Ball C, Vinod Shah M, Khurana A, Yogarajah M, Nguyen P, He R, Viswanatha D, Jevremovic D, Salama M, Alkhateeb HB, Gangat N, Patnaik M, Begna K, Hogan W, Zblewski D, Litzow M, Al-Kali A. Characteristics of patients with myelodysplastic syndrome with balanced translocations. Br J Haematol 2020; 190:244-248. [PMID: 32181489 DOI: 10.1111/bjh.16551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/31/2020] [Indexed: 12/01/2022]
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147
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Antelo G, Mangaonkar AA, Coltro G, Buradkar A, Lasho TL, Finke C, Carr R, Binder M, Gangat N, Al-Kali A, Elliott MA, King RL, Howard M, Melody ME, Hogan W, Litzow MR, Tefferi A, Fernandez-Zapico ME, Komrokji R, Patnaik MM. Response to erythropoiesis-stimulating agents in patients with WHO-defined myelodysplastic syndrome/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T). Br J Haematol 2020; 189:e104-e108. [PMID: 32128785 DOI: 10.1111/bjh.16515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/08/2020] [Indexed: 11/27/2022]
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148
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Anagnostou T, Knudson RA, Pearce KE, Meyer RG, Pitel BA, Peterson JF, Baughn LB, Reichard KK, Ketterling RP, Kloft‐Nelson SM, Knutson DL, Khan SP, Gangat N, Litzow MR, Hogan WJ, Wolanskyj A, Al‐Kali A, Begna KH, Elliott M, Pardanani A, Foran J, Shah M, Tefferi A, Alkhateeb H, Halling K, Rodriguez V, Greipp PT, Patnaik MM. Clinical utility of fluorescence in situ hybridization-based diagnosis of BCR-ABL1 like (Philadelphia chromosome like) B-acute lymphoblastic leukemia. Am J Hematol 2020; 95:E68-E72. [PMID: 31919873 DOI: 10.1002/ajh.25729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/05/2022]
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149
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DiFilippo EC, Coltro G, Carr RM, Mangaonkar AA, Binder M, Khan SP, Rodriguez V, Gangat N, Wolanskyj A, Pruthi RK, Chen D, He R, Viswanatha DS, Lasho T, Finke C, Tefferi A, Pardanani A, Patnaik MM. Spectrum of abnormalities and clonal transformation in germline RUNX1 familial platelet disorder and a genomic comparative analysis with somatic RUNX1 mutations in MDS/MPN overlap neoplasms. Leukemia 2020; 34:2519-2524. [PMID: 32060405 DOI: 10.1038/s41375-020-0752-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
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150
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Li M, Shah M, Binder M, Lasho T, Carr R, Mangaonkar A, Gangat N, Coltro G, Tefferi A, Dao L, Peters M, Chiu A, Patnaik MM. Cutaneous blastic plasmacytoid dendritic cell neoplasm arising in the context of TET2 and ZRSR2 mutated clonal cytopenias of unknown significance, secondary to somatic copy number losses involving CDK2NA/2NB and MTAP. Am J Hematol 2020; 95:E31-E34. [PMID: 31705546 DOI: 10.1002/ajh.25675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022]
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