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Stożek-Tutro A, Reczek M, Kawalec P. Safety profile of first-line targeted therapies in elderly and/or comorbid chronic lymphocytic leukaemia patients (unfit subpopulation). A systematic review and network meta-analysis. Crit Rev Oncol Hematol 2024; 201:104428. [PMID: 38969250 DOI: 10.1016/j.critrevonc.2024.104428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/14/2024] [Accepted: 06/22/2024] [Indexed: 07/07/2024] Open
Abstract
This systematic literature review (CRD42023393903) and a Bayesian network meta-analysis (NMA) aimed to assess the relative safety profile of first-line targeted therapies (acalabrutinib, ibrutinib, obinutuzumab, ofatumumab, pirtobrutinib, ublituximab, umbralisib, venetoclax, zanubrutinib) in chronic lymphocytic leukaemia (CLL) patients with advanced age and/or comorbidities. The NMA revealed that zanubrutinib was the safest treatment option in terms of the overall safety profile (e.g., serious adverse events [AEs] grade 1-5), followed by venetoclax-obinutuzumab, which showed an advantage in terms of AEs grade 1-5. The use of Bruton's tyrosine kinase inhibitor (BTKi) monotherapy was more favourable in terms of the risk of haematological AEs, but chemoimmunotherapy showed advantages in terms of cardiovascular, gastrointestinal, and infectious AEs. The risk of secondary cancers was similar between treatments. In conclusion, targeted therapies are associated with variable and clinically relevant AEs. The therapies appear to be safer when used as monotherapy rather than in combination with immunological agents in naïve CLL patients with advanced age and/or comorbidities.
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Affiliation(s)
- Anita Stożek-Tutro
- Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, Cracow, Poland.
| | | | - Paweł Kawalec
- Jagiellonian University Medical College Institute of Public Health, Cracow, Poland.
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Choquet S, Marchal C, Deygas F, Deslandes M, Macher N, de Pouvourville G, Levy V. A retrospective observational study of ibrutinib in chronic lymphocytic leukaemia in a real-life setting in France using the national claims database (OSIRIS). Ann Hematol 2024; 103:2969-2981. [PMID: 38965145 PMCID: PMC11283383 DOI: 10.1007/s00277-024-05859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Ibrutinib is a Bruton's tyrosine kinase inhibitor indicated for the first-line treatment and relapse of chronic lymphocytic leukaemia (CLL), Waldenström's macroglobulinemia (WM) and mantle cell lymphoma (MCL). This study aimed to describe the characteristics of CLL patients treated with ibrutinib and its effectiveness, safety, and treatment pattern in real life. METHODS All patients covered by the general health scheme (approximately 80% of the French population) with a first ibrutinib dispensation from August 1, 2017 (date of reimbursement in France) to December 31, 2020, were identified in the French National Health Insurance database (SNDS). An algorithm was developed to identify the disease (CLL, MCL or WM) for which ibrutinib was prescribed. This article focused on CLL patients. The time to next treatment (TTNT) was plotted using Kaplan‒Meier curves. RESULTS During this period, 6,083 patients initiated ibrutinib, among whom 2,771 (45.6%) patients had CLL (mean age of 74 years; 61% of men). At ibrutinib initiation, 46.6% of patients had a cardiovascular comorbidity. Most patients (91.7%) were not hospitalized during the exposure period for one of the cardiovascular or bleeding events studied. Hospitalizations were more frequent in patients with a cardiovascular comorbidity (5.9% versus 11.0%, p-value < 0.0001) and aged over 70 (5.9% versus 9.4%, p-value < 0.0001). The median TTNT was not reached. CONCLUSION This is one of the largest cohorts of ibrutinib-treated patients in the world. The profile of CLL patients treated with ibrutinib was in accordance with the marketing authorization and reimbursement. This study confirmed effectiveness and safety data.
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Affiliation(s)
| | | | | | | | - Nahid Macher
- Janssen-Cilag France, Issy-les-Moulineaux, France
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3
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Deng J, Qin X, Ma G, Shen X, Sun J, Zhao Y, Zhang Z, Sun Y, Jie G, Su L, Ma J, Tian W, Yang L, Wang Q, Huang H, Shi M, Ma Y, Gao W, Chen W. Development of a clinical prognostic model for primary plasma cell leukemia patients treated with novel agents: a multicenter retrospective cohort study. Ann Hematol 2024:10.1007/s00277-024-05862-1. [PMID: 39073588 DOI: 10.1007/s00277-024-05862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/20/2024] [Indexed: 07/30/2024]
Abstract
The prognosis of primary plasma cell leukemia (pPCL) is poor, and the relevant prognostic factors are incompletely understood. We aimed to explore the prognostic factors and develop a validated prognostic prediction model for pPCL patients in the new era. This multicenter retrospective study was conducted across 16 hospitals in China. Cox proportional hazards regression analysis was used to develop a prediction model. The predictive performance of the model was assessed using multiple metrics. Internal validation was conducted using bootstrap resampling. A total of 102 pPCL patients were included in this study, and 57 (55.9%) were male. The 12-month, 24-month, and 36-month OS rates for pPCL patients were 75.4%, 58.3%, and 47.6%, respectively. An overall survival prognostic nomogram for pPCL patients was established by integrating independent prognostic factors, including age, B2MG, and del17p. The nomogram exhibited good performance, with a C-index of 0.720 (95% CI 0.642-0.797) and an AUC of 0.653. Bootstrap validation yielded a C-index of 0.721 (95% CI 0.629-0.787) and an AUC of 0.653 (95% CI 0.546-0.759), indicating a relatively good fit of the calibration curve. A nomogram incorporating age, B2MG grade, and del17p were developed and validated to accurately and consistently predict the prognosis of pPCL patients.
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Affiliation(s)
- Jingjing Deng
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, China
| | - Xiaoqi Qin
- Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Guangyu Ma
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xuliang Shen
- Department of Hematology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Jingnan Sun
- Department of Oncology, The First Hospital of Jilin University, Changchun, China
| | - Yanhong Zhao
- Department of Hematology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Zhihua Zhang
- Department of Hematology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Ying Sun
- Department of Hematology, Chifeng Municipal Hospital, Chifeng, China
| | - Guitao Jie
- Department of Hematology, Linyi Central Hospital, Linyi, China
| | - Liping Su
- Department of Hematology, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Jie Ma
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weiwei Tian
- Department of Hematology, Shanxi Bethune Hospital of Shanxi Medical University, Taiyuan, China
| | - Lin Yang
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingming Wang
- Department of Hematology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongming Huang
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, China
| | - Mingxia Shi
- Department of Hematology, Hematology Research Center of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanping Ma
- Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Wen Gao
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, China.
| | - Wenming Chen
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, China.
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4
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Schubert ML, Dreger P. CD22 CAR T-cell therapy: new hope for patients with large B-cell lymphoma. Lancet 2024; 404:314-315. [PMID: 38996464 DOI: 10.1016/s0140-6736(24)00815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 07/14/2024]
Affiliation(s)
| | - Peter Dreger
- Department Medicine V, University of Heidelberg, Heidelberg 69120, Germany.
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5
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Rask Kragh Jørgensen R, Jakobsen LH, Eloranta S, Smedby KE, Pedersen RS, Jørgensen JM, Clausen MR, Brown P, Gang AO, Gade IL, Larsen TS, Jerkeman M, El-Galaly TC. Effectiveness of R-CHOP versus R-CHOEP for treatment of young patients with high-risk diffuse large B-cell lymphoma: A Danish observational population-based study. Eur J Haematol 2024. [PMID: 39037054 DOI: 10.1111/ejh.14275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Etoposide to standard R-CHOP is used for high-risk diffuse large B-cell lymphoma (DLBCL) in some countries. Due to the lack of randomized trials, a real-world data study using matching methods was used to test the potential effectiveness of R-CHOEP over R-CHOP. PATIENTS AND METHODS This study included patients from the Danish Lymphoma Register diagnosed between 2006 and 2020 at the age of 18-60 years with de novo DLBCL and age-adjusted IPI ≥2. R-CHOEP treated patients were matched 1:1 without replacement to R-CHOP treated patients using a hybrid exact and genetic matching technique. Primary endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS In total, 396 patients were included; 213 received R-CHOEP and 183 received R-CHOP. Unadjusted 5-year PFS and OS for R-CHOEP were 69% (95% Confidence intervals [CI]; 63%-76%) and 79% (CI;73%-85%) versus 62% (CI;55%-70%) and 76% (CI;69%-82%) for R-CHOP (log-rank test, PFS p = .25 and OS p = .31). A total of 127 patients treated with R-CHOEP were matched to 127 patients treated with R-CHOP. Matching-adjusted 5-year PFS and OS were 65% (CI; 57%-74%) and 79% (CI; 72%-84%) for R-CHOEP versus 63% (CI; 55%-73%) and 79% (CI;72%-87%) for R-CHOP (log-rank test, PFS p = .90 and OS p = .63). CONCLUSION The present study did not confirm superiority of R-CHOEP over R-CHOP for young patients with high-risk DLBCL.
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Affiliation(s)
- Rasmus Rask Kragh Jørgensen
- Department of Hematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lasse Hjort Jakobsen
- Department of Hematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Sandra Eloranta
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | | | - Judit M Jørgensen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter Brown
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Ortved Gang
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Inger-Lise Gade
- Department of Hematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Mats Jerkeman
- Department of Oncology, Institute of Clinical Science, Lund University and Skåne University Hospital, Lund, Sweden
| | - Tarec Christoffer El-Galaly
- Department of Hematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Odense University Hospital, Odense, Denmark
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Borsoi L, Costa F, Milano C, Segantin G, Ghia P, Armeni P. Elicitation of societal preferences for chronic lymphocytic leukemia's treatments: a discrete choice experiment. Leuk Lymphoma 2024:1-11. [PMID: 38980060 DOI: 10.1080/10428194.2024.2374041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
The overall value of treatments for chronic lymphocytic leukemia (CLL) depends on several factors, including preferences of the general population, who contributes to the financing of health systems. This study investigated societal preferences for attributes of CLL treatments in Italy. An online large-scale survey was designed using a discrete choice experiment (DCE) methodology and delivered to the Italian adult general population. Ten treatment attributes were identified, covering efficacy, safety, operational aspects and (hypothetical) out-of-pocket cost. DCE data were analyzed using a mixed logit regression model, estimating the willingness-to-pay for attribute levels' change. The general population significantly preferred more effective treatments, with shorter duration, administered orally rather than orally + intravenously. Changes in therapy duration, frequency of checkups and organ damage risk had the greatest impact on preferences. The integration of societal preferences in the value judgments of CLL therapies may help health authorities in establishing priority setting and taking pricing-reimbursement decisions.
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Affiliation(s)
- Ludovica Borsoi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Francesco Costa
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Carlo Milano
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Gaia Segantin
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Paolo Ghia
- Università Vita Salute San Raffaele, Milan, Italy
- IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizio Armeni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
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Yang P, Liu SZ, Li CY, Zhang WL, Wang J, Chen YT, Li S, Liu CL, Liu H, Cai QQ, Zhang W, Jing HM. Genetic and prognostic analysis of blastoid and pleomorphic mantle cell lymphoma: a multicenter analysis in China. Ann Hematol 2024; 103:2381-2391. [PMID: 38165416 DOI: 10.1007/s00277-023-05597-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
Blastoid or pleomorphic mantle cell lymphoma (B/P-MCL) is characterized by high invasiveness and unfavorable outcomes, which is still a challenge for treating MCL. This retrospective study was performed to comprehensively analyze the clinical, genomic characteristics and treatment options of patients with B/PMCL from multicenter in China. Data were obtained from 693 patients with B/PMCL from three centers in China between April 1999 and December 2019. Seventy-four patients with BMCL (n = 43) or PMCL (n = 31) were included in the analysis. The median age of the cohort was 60.0 years with a male-to-female ratio of 2.89:1. The 3-year progression-free survival (PFS) and overall survival (OS) rates were 44.1% and 46.0%, respectively. Mutations of TP53, ATM, NOTCH1, NOTCH2, NSD2, SMARCA4, CREBBP, KMT2D, FAT1, and TRAF2 genes were the most common genetic changes in B/P-MCL. Progression of disease within 12 months (POD12) could independently predict the poor prognosis of patients with blastoid and pleomorphic variants. Patients with POD12 carried a distinct mutation profile (TP53, SMARCA4, NSD2, NOTCH2, KMT2D, PTPRD, CREBBP, and CDKN2A mutations) compared to patients with non-POD12. First-line high-dose cytosine arabinoside exposure obtained survival benefits in these populations, and BTKi combination therapy as the front-line treatment had somewhat improvement in survival with no significant difference in the statistic. In conclusion, B/P-MCL had inferior outcomes and a distinct genomic profile. Patients with POD12 displayed a distinct mutation profile and a poor prognosis. New therapeutic drugs and clinical trials for B/P-MCL need to be further explored.
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Affiliation(s)
- Ping Yang
- Department of Hematology, Peking University Third Hospital, No. 49 Huayuan N Rd Haidian District, Beijing, China
| | - Shuo-Zi Liu
- Department of Hematology, Peking University Third Hospital, No. 49 Huayuan N Rd Haidian District, Beijing, China
| | - Chun-Yuan Li
- Department of Hematology, Peking University Third Hospital, No. 49 Huayuan N Rd Haidian District, Beijing, China
| | - Wei-Long Zhang
- Department of Hematology, Peking University Third Hospital, No. 49 Huayuan N Rd Haidian District, Beijing, China
| | - Jing Wang
- Department of Hematology, Peking University Third Hospital, No. 49 Huayuan N Rd Haidian District, Beijing, China
| | - Ying-Tong Chen
- Department of Hematology, Peking University Third Hospital, No. 49 Huayuan N Rd Haidian District, Beijing, China
| | - Sen Li
- Department of Hematology, Peking University Third Hospital, No. 49 Huayuan N Rd Haidian District, Beijing, China
| | - Cui-Ling Liu
- Department of Hematology, Peking University Third Hospital, No. 49 Huayuan N Rd Haidian District, Beijing, China
| | - Hui Liu
- Department of Hematology, Beijing Hospital, Beijing, China
| | - Qing-Qing Cai
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Hong-Mei Jing
- Department of Hematology, Peking University Third Hospital, No. 49 Huayuan N Rd Haidian District, Beijing, China.
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Zhou Y, Zhang X, Li X, Zhu G, Gao T, Deng Y, Huang L, Liu Z. Anthropometric indicators may explain the high incidence of follicular lymphoma in Europeans: Results from a bidirectional two-sample two-step Mendelian randomisation. Gene 2024; 911:148320. [PMID: 38452876 DOI: 10.1016/j.gene.2024.148320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Non-Hodgkin's lymphoma incidence rates vary between European and Asian populations. The reasons remain unclear. This two-sample two-step Mendelian randomisation (MR) study aimed to investigate the causal relationship between anthropometric indicators (AIs) and diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) and the possible mediating role of basal metabolic rate (BMR) in Europe. METHODS We used the following AIs as exposures: body mass index (BMI), whole-body fat mass (WBFM), whole-body fat-free mass (WBFFM), waist circumference(WC), hip circumference(HC), standing height (SH), and weight(Wt). DLBCL and FL represented the outcomes, and BMR was a mediator. A two-sample MR analysis was performed to examine the association between AIs and DLBCL and FL onset. We performed reverse-MR analysis to determine whether DLBCL and FL interfered with the AIs. A two-step MR analysis was performed to determine whether BMR mediated the causality. FINDINGS WBFFM and SH had causal relationships with FL. A causal association between AIs and DLBCL was not observed. Reverse-MR analysis indicated the causal relationships were not bidirectional. Two-step MR suggested BMR may mediate the causal effect of WBFFM and SH on FL. CONCLUSIONS We observed a causal relationship between WBFFM and SH and the onset of FL in Europeans, Which may explain the high incidence of follicular lymphoma in Europeans.
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Affiliation(s)
- Yanqun Zhou
- The Second Clinical Medical School of Guizhou University of Chinese Medicine, Guiyang, China; Department of Hematology, the Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China
| | - Xiongfeng Zhang
- The Second Clinical Medical School of Guizhou University of Chinese Medicine, Guiyang, China; Department of Hematology, the Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China
| | - Xiaozhen Li
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoqing Zhu
- The Second Clinical Medical School of Guizhou University of Chinese Medicine, Guiyang, China; Department of Hematology, the Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China
| | - Tianqi Gao
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yingying Deng
- School of Basic Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Liming Huang
- The Second Clinical Medical School of Guizhou University of Chinese Medicine, Guiyang, China; Department of Hematology, the Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China.
| | - Zenghui Liu
- Department of Hematology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Bruzzese A, Vigna E, Martino EA, Labanca C, Mendicino F, Lucia E, Olivito V, Stanzione G, Zimbo A, Lugli E, Neri A, Morabito F, Gentile M. The potential of triplet combination therapies for patients with FLT3-ITD -mutated acute myeloid leukemia. Expert Rev Hematol 2024; 17:241-253. [PMID: 38748404 DOI: 10.1080/17474086.2024.2356258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Acute myeloid leukemia (AML) encompasses a heterogeneous group of aggressive myeloid malignancies, where FMS-like tyrosine kinase 3 (FLT3) mutations are prevalent, accounting for approximately 25-30% of adult patients. The presence of this mutation is related to a dismal prognosis and high relapse rates. In the lasts years many FLT3 inhibitors have been developed. AREAS COVERED This review provides a comprehensive overview of FLT3mut AML, summarizing the state of art of current treatment and available data about combination strategies including an FLT3 inhibitor. EXPERT OPINION In addition, the review discusses the emergence of drug resistance and the need for a nuanced approaches in treating patients who are ineligible for or resistant to intensive chemotherapy. Specifically, it explores the historical context of FLT3 inhibitors (FLT3Is) and their impact on treatment outcomes, emphasizing the pivotal role of midostaurin, as well as gilteritinib and quizartinib, and providing detailed insights into ongoing trials exploring the safety and efficacy of novel triplet combinations involving FLT3Is in different AML settings.
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Affiliation(s)
| | - Ernesto Vigna
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | | | | | | | - Eugenio Lucia
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | | | - Gaia Stanzione
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Division of Hematology, Azienda Policlinico-S. Marco, University of Catania, Catania, Italy
| | - Annamaria Zimbo
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- UOC Laboratorio Analisi Cliniche, Biomolecolari e Genetica, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Elisabetta Lugli
- Ematologia Azienda USL-IRCSS Reggio Emilia, Emilia-Romagna, Italy
| | - Antonino Neri
- Scientific Directorate IRCCS of Reggio Emilia, Emilia-Romagna, Reggio Emilia, Italy
| | | | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Rende, Italy
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10
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Łobacz M, Mertowska P, Mertowski S, Kozińska A, Kwaśniewski W, Kos M, Grywalska E, Rahnama-Hezavah M. The Bloody Crossroads: Interactions between Periodontitis and Hematologic Diseases. Int J Mol Sci 2024; 25:6115. [PMID: 38892299 PMCID: PMC11173219 DOI: 10.3390/ijms25116115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Periodontitis is a common oral condition that can have a significant impact on the overall health of the body. In recent years, attention has been paid to potential relationships between periodontitis and various hematological disorders. This publication aims to present information available in the literature on this relationship, focusing on examples of red blood cell disorders (such as aplastic anemia and sickle cell anemia) and white blood cell disorders (such as cyclic neutropenia, maladaptive trained immunity, clonal hematopoiesis, leukemia, and multiple myeloma). Understanding these associations can help physicians and dentists better diagnose, monitor, and treat patients associated with both groups of conditions, highlighting the need for interdisciplinary care for patients with oral disorders and hematologic diseases.
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Affiliation(s)
- Michał Łobacz
- Chair and Department of Oral Surgery, Medical University of Lublin, 20-093 Lublin, Poland; (M.Ł.); (M.R.-H.)
| | - Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (P.M.)
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (P.M.)
| | - Aleksandra Kozińska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (P.M.)
- Student Research Group of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Wojciech Kwaśniewski
- Department of Gynecologic Oncology and Gynecology, Medical University of Lublin, Staszica 16 Street, 20-081 Lublin, Poland;
| | - Marek Kos
- Department of Public Health, Medical University of Lublin, 20-400 Lublin, Poland;
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (P.M.)
| | - Mansur Rahnama-Hezavah
- Chair and Department of Oral Surgery, Medical University of Lublin, 20-093 Lublin, Poland; (M.Ł.); (M.R.-H.)
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Javidi-Sharifi N, Brown JR. Evaluating zanubrutinib for the treatment of adults with chronic lymphocytic leukemia or small lymphocytic lymphoma. Expert Rev Hematol 2024; 17:201-210. [PMID: 38784995 DOI: 10.1080/17474086.2024.2356257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION This review evaluates zanubrutinib as a treatment option for adults with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). Zanubrutinib, a covalent BTK (Bruton's tyrosine kinase) inhibitor, was recently approved by the US FDA based in part on head-to-head data demonstrating improved efficacy and safety compared to ibrutinib. AREAS COVERED The review discusses the efficacy, safety, and comparative advantages of zanubrutinib, highlighting its safety profile compared to other BTK inhibitors. It also addresses the unmet needs of current therapies in CLL/SLL and provides an overview of competitor compounds and ongoing research in BTK inhibition. EXPERT OPINION Zanubrutinib, the first BTK inhibitor to demonstrate superior efficacy and safety compared to another BTK inhibitor in CLL, is likely to be widely adopted due to its high-quality data and ease of use. Looking ahead, pirtobrutinib, a novel non-covalent BTK inhibitor, has shown promise in heavily pretreated CLL patients, including those unresponsive to covalent inhibitors, with ongoing phase 3 trials comparing it against ibrutinib. The field is also exploring time-limited therapies like the combination of ibrutinib and venetoclax, with ongoing trials evaluating different combinations to optimize efficacy and minimize toxicity, indicating a promising future for combination therapies in CLL treatment.
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Affiliation(s)
- Nathalie Javidi-Sharifi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Qiu Y, Bai L, Zhao H, Mei X. Homoharringtonine enhances cytarabine-induced apoptosis in acute myeloid leukaemia by regulating the p38 MAPK/H2AX/Mcl-1 axis. BMC Cancer 2024; 24:520. [PMID: 38658865 PMCID: PMC11044605 DOI: 10.1186/s12885-024-12286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
Acute myeloid leukaemia (AML) is a fatal haematopoietic malignancy and is treated with the conventional combination of cytarabine (Ara-C) and daunorubicin (Dau). The survival rate of AML patients is lower due to the cardiotoxicity of daunorubicin. Clinically, homoharringtonine (HHT) plus Ara-C has been reported to be equally effective as Dau plus Ara-C in some types of AML patients with less toxic effects. We utilized the clinical use of homoharringtonine in combination with Ara-C to test its combination mechanism. We found that the insensitivity of AML cells to cytarabine-induced apoptosis is associated with increased Mcl-1 stability and p38 inactivation. HHT downregulates Mcl-1, phosphorylates H2AX and induces apoptosis by activating p38 MAPK. Inactivation of p38 through inhibitors and siRNA blocks apoptosis, H2AX phosphorylation and Mcl-1 reduction. HHT enhances Ara-C activation of the p38 MAPK signalling pathway, overcoming Ara-C tolerance to cell apoptosis by regulating the p38/H2AX/Mcl-1 axis. The optimal ratio of HHT to Ara-C for synergistic lethality in AML cells is 1:4 (M/M). HHT synergistically induces apoptosis in combination with Ara-C in vitro and prolongs the survival of xenografts. We provide a new mechanism for AML treatment by regulating the p38 MAPK/H2AX/Mcl-1 axis to improve cytarabine therapy.
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Affiliation(s)
- Yang Qiu
- School of Pharmacy, Jinzhou Medical University, Jinzhou, 121001, Liaoning, China.
- Liaoning Provincial Collaborative Innovation Center for Medical Testing and Drug Research, Jinzhou Medical University, Jinzhou, 121001, Liaoning, China.
- Liaoning Provincial Key Laboratory of Marine Bioactive Substances, Jinzhou Medical University, Jinzhou, 121001, Liaoning, China.
- Technological Innovation Center of Liaoning Pharmaceutical Action and Quality Evaluation, Jinzhou Medical University, Jinzhou, 121001, Liaoning, China.
| | - Lu Bai
- Affiliated Third Hospital of Jinzhou Medical University, Jinzhou, 121001, Liaoning, China
| | - Haosen Zhao
- Affiliated Third Hospital of Jinzhou Medical University, Jinzhou, 121001, Liaoning, China
| | - Xifan Mei
- Jinzhou Medical University, Jinzhou, 121001, Liaoning, China.
- Liaoning Provincial Collaborative Innovation Center for Medical Testing and Drug Research, Jinzhou Medical University, Jinzhou, 121001, Liaoning, China.
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Tang X, Xu R, Zheng W, Zhou Y, Cui S, Wang Y. Disease-controlled multiple myeloma in a patient with 17p gain and t(4;14): A case report. Heliyon 2024; 10:e28950. [PMID: 38596106 PMCID: PMC11002686 DOI: 10.1016/j.heliyon.2024.e28950] [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] [Received: 06/08/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024] Open
Abstract
Cytogenetic karyotypes such as t(4; 14), del(17p), t(14; 16), t(14; 20), and TP53 mutations are associated with high-risk multiple-myeloma (MM) and indicate poor prognosis. Therefore, cytogenetic testing is extremely important for determining prognosis of MM. However, the aberrant karyotypes reported in the current literature are incomplete. The cytogenetic karyotype 17p gain has not received widespread attention, and its relationship with MM prognosis is unknown; additionally, the prognosis of 17p gain associated with t(4; 14) has not been studied in depth. Therefore, we introduce a special case in which a patient had both 17p gain and t(4; 14). An 81-year-old woman was admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine for stomach discomfort. The patient had no relevant medical history. Laboratory tests, immunophenotyping, and haematological results suggested MM, and cytogenetic tests indicated 17p gain and t(4; 14) with no other abnormalities. She was treated with two different chemotherapeutic regimens and achieved very good partial response, but eventually experienced biochemical relapses after discontinuing therapy. However, she eventually achieved good disease control with a bortezomib, lenalidomide, and dexamethasone-based regimen; she has survived longer than 5 years, much longer than the 1 year reported for MM patients with t(4:14), and been progression-free more than 3 years. We use this case to explore the possible relationship between the 17p gain and prognosis of patients with MM, as well as the treatment of MM with high-risk cytogenetic karyotypes. This case enriches the clinical application of cytogenetic analysis and adds important indicators for the prognosis of MM patients.
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Affiliation(s)
- Xinyu Tang
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ruirong Xu
- Department of Hematology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- Institute of Hematology, Shandong University of Traditional Chinese Medicine, Jinan, China
- Shandong Provincial Health Commission Key Laboratory of Hematology of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wei Zheng
- Department of Hematology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- Institute of Hematology, Shandong University of Traditional Chinese Medicine, Jinan, China
- Shandong Provincial Health Commission Key Laboratory of Hematology of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanfeng Zhou
- Department of Hematology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- Institute of Hematology, Shandong University of Traditional Chinese Medicine, Jinan, China
- Shandong Provincial Health Commission Key Laboratory of Hematology of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Siyuan Cui
- Department of Hematology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- Institute of Hematology, Shandong University of Traditional Chinese Medicine, Jinan, China
- Shandong Provincial Health Commission Key Laboratory of Hematology of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yan Wang
- Department of Hematology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- Institute of Hematology, Shandong University of Traditional Chinese Medicine, Jinan, China
- Shandong Provincial Health Commission Key Laboratory of Hematology of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Wolska-Washer A, Robak P, Witkowska M, Robak T. Metabolic and toxicological considerations of Bruton's tyrosine kinase inhibitors for the treatment of chronic lymphocytic leukemia/small lymphocytic lymphoma. Expert Opin Drug Metab Toxicol 2024; 20:207-224. [PMID: 38516702 DOI: 10.1080/17425255.2024.2334322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/20/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Bruton tyrosine kinase inhibitors (BTKi) have been used for the management of human diseases since the approval of the first-in class agent, ibrutinib, by the Food and Drug Administration in 2013 for the treatment of patients with mantle cell lymphoma (MCL). Ibrutinib is a covalent inhibitor along with second-class BTKis: acalabrutinib and zanubrutinib. These well-tolerated agents have transformed the treatment landscape of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). A new class of these inhibitors, non-covalent, might become an answer to the emerging resistance by avoiding the sustained contact with the kinase binding domain. AREAS COVERED This article examines the chemical composition, mechanism of action, metabolic characteristics, and potential toxicity of inhibitors targeting Bruton tyrosine kinase. A comprehensive search was conducted across English-language articles in PubMed, Web of Science, and Google Scholar. EXPERT OPINION Bruton tyrosine kinase inhibitors have greatly enhanced the armamentarium against lymphoid malignancies including CLL/SLL. Their future lies in the choice of appropriate patients who will benefit from the treatment without significant adverse reaction. Combination chemotherapy-free fixed-duration regimens with targeted molecules will allow for MRD-driven approach in patients with CLL/SLL in the near future.
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Affiliation(s)
- Anna Wolska-Washer
- Department of Hematology, Medical University of Lodz, Lodz, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
| | - Paweł Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
| | - Magdalena Witkowska
- Department of Hematology, Medical University of Lodz, Lodz, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland
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Carreras J, Ikoma H, Kikuti YY, Miyaoka M, Hiraiwa S, Tomita S, Kondo Y, Ito A, Nagase S, Miura H, Kawada H, Roncador G, Campo E, Hamoudi R, Nakamura N. Mutational, immune microenvironment, and clinicopathological profiles of diffuse large B-cell lymphoma and follicular lymphoma with BCL6 rearrangement. Virchows Arch 2024; 484:657-676. [PMID: 38462571 DOI: 10.1007/s00428-024-03774-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
BCL6-rearrangement (BCL6-R) is associated with a favorable prognosis of follicular lymphoma (FL), but the mechanism is unknown. We analyzed the clinicopathological, immune microenvironment (immune checkpoint, immuno-oncology markers), and mutational profiles of 10 BCL6-R-positive FL, and 19 BCL6-R-positive diffuse large B-cell lymphoma (DLBCL) cases (both BCL2-R and MYC-R negative). A custom-made panel included 168 genes related to aggressive B-cell lymphomas and FL. FL cases were nodal, histological grade 3A in 70%, low Ki67; and had a favorable overall and progression-free survival. DLBCL cases were extranodal in 60%, IPI high in 63%, non-GCB in 60%, EBER-negative; and had a progression-free survival comparable to that of DLBCL NOS. The microenvironment had variable infiltration of M2-like tumor-associated macrophages (TAMs) that were CD163, CSF1R, LAIR1, PD-L1, and CD85A (LILRB3) positive; but had low IL10 and PTX3 expression. In comparison to FL, DLBCL had higher TAMs, IL10, and PTX3 expression. Both lymphoma subtypes shared a common mutational profile with mutations in relevant pathogenic genes such as KMT2D, OSBPL10, CREBBP, and HLA-B (related to chromatin remodeling, metabolism, epigenetic modification, and antigen presentation). FL cases were characterized by a higher frequency of mutations of ARID1B, ATM, CD36, RHOA, PLOD2, and PRPRD (p < 0.05). DLBCL cases were characterized by mutations of BTG2, and PIM1; and mutations of HIST1H1E and MFHAS1 to disease progression (p < 0.05). Interestingly, mutations of genes usually associated with poor prognosis, such as NOTCH1/2 and CDKN2A, were infrequent in both lymphoma subtypes. Some high-confidence variant calls were likely oncogenic, loss-of-function. MYD88 L265P gain-of-function was found in 32% of DLBCL. In conclusion, both BCL6-R-positive FL and BCL6-R-positive DLBCL had a common mutational profile; but also, differences. DLBCL cases had a higher density of microenvironment markers.
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MESH Headings
- Humans
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/immunology
- Tumor Microenvironment/immunology
- Tumor Microenvironment/genetics
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/immunology
- Proto-Oncogene Proteins c-bcl-6/genetics
- Male
- Female
- Middle Aged
- Aged
- Mutation
- Adult
- Biomarkers, Tumor/genetics
- Aged, 80 and over
- Gene Rearrangement
- DNA Mutational Analysis
- Progression-Free Survival
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Grants
- 23K06454 the Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 15K19061 the Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 18K15100 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 24590430 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 2021-B04 Tokai University School of Medicine research incentive assistant plan
- VRI-20-10 ASPIRE, the technology program management pillar of Abu Dhabi's Advanced Technology Research Council (ATRC), via the ASPIRE Precision Medicine Research Institute Abu Dhabi (AS-PIREPMRIAD) award
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Affiliation(s)
- Joaquim Carreras
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan.
| | - Haruka Ikoma
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Yara Yukie Kikuti
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Masashi Miyaoka
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Shinichiro Hiraiwa
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Sakura Tomita
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Yusuke Kondo
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Atsushi Ito
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Shunsuke Nagase
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Hisanobu Miura
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
| | - Hiroshi Kawada
- Department of Hematology, School of Medicine, Tokai University, Tokyo, Japan
| | - Giovanna Roncador
- Monoclonal Antibodies Core Unit, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Elias Campo
- Department of Pathology, Esther Koplowitz Center (CEK), Centro de Investigacion Biomedica en Red de Cancer (CIBERONC), Hospital Clinic Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Rifat Hamoudi
- Research Institute for Medical and Health Science, Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Division of Surgery and Interventional Science, University College London, London, UK
- BIMAI-Lab, Biomedically Informed Artificial Intelligence Laboratory, University of Sharjah, Sharjah, United Arab Emirates
| | - Naoya Nakamura
- Department of Pathology, School of Medicine, Tokai University, Tokyo, Japan
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Bercier P, de Thé H. History of Developing Acute Promyelocytic Leukemia Treatment and Role of Promyelocytic Leukemia Bodies. Cancers (Basel) 2024; 16:1351. [PMID: 38611029 PMCID: PMC11011038 DOI: 10.3390/cancers16071351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
The story of acute promyelocytic leukemia (APL) discovery, physiopathology, and treatment is a unique journey, transforming the most aggressive form of leukemia to the most curable. It followed an empirical route fueled by clinical breakthroughs driving major advances in biochemistry and cell biology, including the discovery of PML nuclear bodies (PML NBs) and their central role in APL physiopathology. Beyond APL, PML NBs have emerged as key players in a wide variety of biological functions, including tumor-suppression and SUMO-initiated protein degradation, underscoring their broad importance. The APL story is an example of how clinical observations led to the incremental development of the first targeted leukemia therapy. The understanding of APL pathogenesis and the basis for cure now opens new insights in the treatment of other diseases, especially other acute myeloid leukemias.
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Affiliation(s)
- Pierre Bercier
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, Université PSL, 75231 Paris, France;
- GenCellDis, Inserm U944, CNRS UMR7212, Université Paris Cité, 75010 Paris, France
| | - Hugues de Thé
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, Université PSL, 75231 Paris, France;
- GenCellDis, Inserm U944, CNRS UMR7212, Université Paris Cité, 75010 Paris, France
- Hematology Laboratory, Hôpital St Louis, AP/HP, 75010 Paris, France
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Dutta S, Ganguly A, Ghosh Roy S. An Overview of the Unfolded Protein Response (UPR) and Autophagy Pathways in Human Viral Oncogenesis. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2024; 386:81-131. [PMID: 38782502 DOI: 10.1016/bs.ircmb.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Autophagy and Unfolded Protein Response (UPR) can be regarded as the safe keepers of cells exposed to intense stress. Autophagy maintains cellular homeostasis, ensuring the removal of foreign particles and misfolded macromolecules from the cytoplasm and facilitating the return of the building blocks into the system. On the other hand, UPR serves as a shock response to prolonged stress, especially Endoplasmic Reticulum Stress (ERS), which also includes the accumulation of misfolded proteins in the ER. Since one of the many effects of viral infection on the host cell machinery is the hijacking of the host translational system, which leaves in its wake a plethora of misfolded proteins in the ER, it is perhaps not surprising that UPR and autophagy are common occurrences in infected cells, tissues, and patient samples. In this book chapter, we try to emphasize how UPR, and autophagy are significant in infections caused by six major oncolytic viruses-Epstein-Barr (EBV), Human Papilloma Virus (HPV), Human Immunodeficiency Virus (HIV), Human Herpesvirus-8 (HHV-8), Human T-cell Lymphotropic Virus (HTLV-1), and Hepatitis B Virus (HBV). Here, we document how whole-virus infection or overexpression of individual viral proteins in vitro and in vivo models can regulate the different branches of UPR and the various stages of macro autophagy. As is true with other viral infections, the relationship is complicated because the same virus (or the viral protein) exerts different effects on UPR and Autophagy. The nature of this response is determined by the cell types, or in some cases, the presence of diverse extracellular stimuli. The vice versa is equally valid, i.e., UPR and autophagy exhibit both anti-tumor and pro-tumor properties based on the cell type and other factors like concentrations of different metabolites. Thus, we have tried to coherently summarize the existing knowledge, the crux of which can hopefully be harnessed to design vaccines and therapies targeted at viral carcinogenesis.
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Affiliation(s)
- Shovan Dutta
- Center for Immunotherapy & Precision Immuno-Oncology (CITI), Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Anirban Ganguly
- Department of Biochemistry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Sounak Ghosh Roy
- Henry M Jackson for the Advancement of Military Medicine, Naval Medical Research Command, Silver Spring, MD, United States.
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Ollivier L, Debbi K, To NH, Cailleteau A, Supiot S, Mervoyer A, Guimas V, Belkacémi Y. Is oligometastatic disease an applicable and useful concept in haematologic malignancies? A narrative review of radiation therapy standards, modern techniques, and innovations. Cancer Radiother 2024; 28:119-130. [PMID: 38143233 DOI: 10.1016/j.canrad.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Haematologic malignancies are particular in that they can generally be cured, even when distant metastases are present at diagnosis, unlike solid malignancies. Systemic treatments, including chemotherapy, targeted therapies, and immunotherapy, are the standard of care with excellent results. The considerable progress made in the management of these diseases in the last 20years has redefined the role of radiation therapy as minor in many clinical situations. We propose a literature review of data, showing that radiation therapy still has a role in curative, salvage, and palliative therapy situations. MATERIAL AND METHODS A document and literature search was carried out in the following databases: Medline and ClinicalTrial.gov, for the terms "radiotherapy", "haematologic malignancies", "Hodgkin lymphoma", "non-Hodgkin lymphoma", "CAR T cells", "multiple myeloma", "solitary plasmocytoma", "intensity-modulated radiotherapy", "extracranial stereotactic body radiation therapy" and "proton therapy references". RESULTS Haemopathological malignancies include a wide range of diseases and radiation therapy indications have been assessed over the past 20years. Currently, radiation therapy is indicated for localized disease (solitary plasmocytoma), as an adjuvant (Hodgkin lymphoma), in palliative settings, or after systemic treatment in relapsed patients (chimeric antigen receptor [CAR] T-cells) with a low recurrence burden, which can therefore be considered "oligorecurrence". Radiation therapy, through total body irradiation, has important indications, thanks to its immunomodulatory and/or myeloablative effects. Moreover, recent technological developments have made possible significant improvement in safety, contributing to radiation therapy being positioned in the treatment strategy of several indications. CONCLUSIONS Given the effectiveness of systemic treatments in hematologic malignancies, the oligometastasis stage is of little importance. A curative intent after local radiation therapy, even advanced stage, is possible, both with residual disease for advanced Hodgkin lymphoma, aggressive non-Hodgkin lymphoma, or solitary plasmocytoma, and even without evidence of disease after chemotherapy for Hodgkin or non-Hodgkin lymphoma. The role of new treatments, such as CAR T cells, allows us to consider radiation therapy after systemic treatment of relapsed diseases with low volume recurrence, which can be considered oligorecurrence.
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Affiliation(s)
- L Ollivier
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France.
| | - K Debbi
- Department of Radiation Oncology, centre Sein Henri-Mondor, CHU Henri-Mondor, AP-HP, university Paris Est Créteil (Upec), Créteil, France
| | - N-H To
- Department of Radiation Oncology, centre Sein Henri-Mondor, CHU Henri-Mondor, AP-HP, university Paris Est Créteil (Upec), Créteil, France; Institut Mondor de recherche biomédicale (IMRB), Inserm U955, i-Biot, Créteil, France
| | - A Cailleteau
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - S Supiot
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - A Mervoyer
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - V Guimas
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - Y Belkacémi
- Department of Radiation Oncology, centre Sein Henri-Mondor, CHU Henri-Mondor, AP-HP, university Paris Est Créteil (Upec), Créteil, France; Institut Mondor de recherche biomédicale (IMRB), Inserm U955, i-Biot, Créteil, France
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19
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Lamb M, Painter D, Howell D, Barrans S, Cargo C, de Tute R, Tooze R, Burton C, Patmore R, Roman E, Smith A. Lymphoid blood cancers, incidence and survival 2005-2023: A report from the UK's Haematological Malignancy Research Network. Cancer Epidemiol 2024; 88:102513. [PMID: 38160571 DOI: 10.1016/j.canep.2023.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Population-based information on cancer incidence and outcome are required to inform clinical practice and research; but contemporary data are lacking for many lymphoid cancer subtypes. METHODS Set within a socio-demographically representative UK population of ∼4 million, data are from an established UK patient cohort (N = 22,414 diagnoses). Information on incidence (crude and age-standardised) and survival (overall and net) is presented for > 40 subtypes. RESULTS The median diagnostic age was 69.9 years (interquartile range 59.1-78.3), but unlike many other cancers, lymphoid malignancies can be diagnosed at any age; different subtypes dominating at different ages. Males were more likely to be diagnosed than females (age-standardised sex rate ratio: 1.55 (95% Confidence Interval: 1.50,1.59)), and most subtypes had a male predominance, some more than three-fold (e.g. Burkitt lymphoma 3.26 (2.42, 4.40)). Five-year net survival estimates varied hugely, ranging from 97.4% (95% CI: 56.5, 99.9) in patients with hairy cell leukaemia to 31.6% (95% CI: 2.5, 69.8) in those with T-cell prolymphocytic leukaemia. No significant sex difference in survival were observed for the majority of diagnoses; one exception being classical Hodgkin lymphoma, where males had a higher mortality (Excess Mortality Ratio: 1.44 (95% CI: 1.11, 1.87)). An improvement in survival over time was observed for some, but not all, of the major diagnostic groups. CONCLUSIONS Marked incidence and survival variations by subtype, sex and age confirm the heterogeneity of lymphoid neoplasms and highlight the importance of accurately characterising disease entities. Despite recent improvements, routine cancer registration of lymphoid neoplasms remains challenging and new issues continue to emerge; including the lack of an international consensus on classification and the recording of progressions and transformations. Furthermore, the increasing need for additional molecular and genomic information required for accurate classification is likely to impact negatively on the quality of cancer registration data, especially in low income countries.
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Affiliation(s)
- Maxine Lamb
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Debra Howell
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Sharon Barrans
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Catherine Cargo
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Ruth de Tute
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Reuben Tooze
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Russell Patmore
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, United Kingdom
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom.
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20
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Usuki K, Ohtake S, Honda S, Matsuda M, Wakita A, Nawa Y, Takase K, Maeda A, Sezaki N, Yokoyama H, Takada S, Hirano D, Tomikawa T, Sumi M, Yano S, Handa H, Ota S, Fujita H, Fujimaki K, Mugitani A, Kojima K, Kajiguchi T, Fujimoto K, Asou N, Usui N, Ishikawa Y, Katsumi A, Matsumura I, Miyazaki Y, Kiyoi H. Real-world data of MDS and CMML in Japan: results of JALSG clinical observational study-11 (JALSG-CS-11). Int J Hematol 2024; 119:130-145. [PMID: 38091231 DOI: 10.1007/s12185-023-03686-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 02/01/2024]
Abstract
We conducted a multicenter, prospective observational study of acute myeloid leukemia (AML), myelodysplastic syndromes (MDS), and chronic myelomonocytic leukemia (CMML) in Japan. From August 2011 to January 2016, we enrolled 6568 patients. Herein, we report the results for MDS (n = 2747) and CMML (n = 182). The percentage of patients aged 65 years or older was 79.5% for MDS and 79.7% for CMML. The estimated overall survival (OS) rate and cumulative incidence of AML evolution at 5 years were 32.3% (95% confidence interval: 30.2-34.5%) and 25.7% (23.9-27.6%) for MDS, and 15.0% (8.9-22.7%) and 39.4% (31.1-47.6%) for CMML. Both diseases were more common in men. The most common treatment for MDS was azacitidine, which was used in 45.4% of higher-risk and 12.7% of lower-risk MDS patients. The 5-year OS rate after treatment with azacitidine was 12.1% (9.5-15.1%) for of higher-risk MDS patients and 33.9% (25.6-42.4%) for lower-risk patients. The second most common treatment was erythropoiesis-stimulating agents, given to just 20% of lower-risk patients. This is the first paper presenting large-scale, Japanese data on survival and clinical characteristics in patients with MDS and CMML.
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Affiliation(s)
- Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Higashi-Gotanda 5-9-22, Shinagawa-ku, Tokyo, 141-8625, Japan.
| | | | - Sumihisa Honda
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Atsushi Wakita
- Nagoya City University East Medical Center, Nagoya, Japan
| | - Yuichiro Nawa
- Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | | | | | | | | | - Satoru Takada
- Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Daiki Hirano
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Tatsuki Tomikawa
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | | | - Shingo Yano
- Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Hiroyuki Fujita
- Department of Hematology, Yokohama Nanbu Hospital, Yokohama, Japan
| | | | | | - Kensuke Kojima
- Department of Hematology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tomohiro Kajiguchi
- Department of Hematology and Oncology, Tosei General Hospital, Seto, Japan
| | - Ko Fujimoto
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Norio Asou
- International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Noriko Usui
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Yuichi Ishikawa
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Katsumi
- Department of Hematology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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21
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Saba L, Landau KS, Liang H, Fu CL, Chaulagain CP. Real world analysis on the determinants of survival in primary plasma cell leukemia in the United States. Leukemia 2024; 38:435-437. [PMID: 38049508 DOI: 10.1038/s41375-023-02100-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Ludovic Saba
- Department of Hematology and Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Kevin S Landau
- Department of Hematology and Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Hong Liang
- Department of Clinical Research, Cleveland Clinic Florida, Weston, FL, USA
| | - Chieh-Lin Fu
- Department of Hematology and Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Chakra P Chaulagain
- Department of Hematology and Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA.
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22
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Jerez J, Sanchez F, Flores F, Guajardo L, Briones JL, Selman C. Early Detection and Diagnostic Approach Through Automated Hematological Analysis for Plasma Cell Leukemia. J Med Cases 2024; 15:31-36. [PMID: 38328809 PMCID: PMC10846498 DOI: 10.14740/jmc4188] [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] [Received: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
Plasma cell leukemia (PCL) is a clinically aggressive variant of multiple myeloma, characterized by a high burden of circulating plasma cells, necessitating swift and accurate diagnosis due to its poor prognosis. The conventional diagnostic criteria, including the recent recommendation by the International Myeloma Working Group (IMWG) of > 5% circulating plasma cells as positive, have evolved over time. In this context, we present a detailed case report that underscores the pivotal role of the ADVIA 2120 automated hematology counter in detecting plasma cells through cytogram analysis, along with the significance of routine peripheral blood smear analysis and the utility of a large unstained cells (LUCs) threshold of > 4.5% as an indicator for PCL. The case involves a 64-year-old patient with relapsed multiple myeloma and stable paraprotein levels who experienced sudden renal impairment. In this case report, we highlight how ADVIA analysis and cytochemistry assisted in the diagnosis, and further explore ADVIA's utility in this challenging leukemia.
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Affiliation(s)
- Joaquin Jerez
- Department of Haematology, Fundacion Arturo Lopez Perez, Providencia, Chile
| | - Francisca Sanchez
- Department of Diagnostics Units, Fundacion Arturo Lopez Perez, Providencia, Chile
| | - Francisco Flores
- Department of Diagnostics Units, Fundacion Arturo Lopez Perez, Providencia, Chile
| | - Lissette Guajardo
- Department of Diagnostics Units, Fundacion Arturo Lopez Perez, Providencia, Chile
| | - Jose Luis Briones
- Department of Haematology, Fundacion Arturo Lopez Perez, Providencia, Chile
- Department of Diagnostics Units, Fundacion Arturo Lopez Perez, Providencia, Chile
| | - Carolina Selman
- Department of Diagnostics Units, Fundacion Arturo Lopez Perez, Providencia, Chile
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23
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Usuki K, Ohtake S, Honda S, Matsuda M, Wakita A, Nawa Y, Takase K, Maeda A, Sezaki N, Yokoyama H, Takada S, Hirano D, Tomikawa T, Sumi M, Yano S, Handa H, Ota S, Fujita H, Fujimaki K, Mugitani A, Kojima K, Kajiguchi T, Fujimoto K, Asou N, Usui N, Ishikawa Y, Katsumi A, Matsumura I, Kiyoi H, Miyazaki Y. Real-world data of AML in Japan: results of JALSG clinical observational study-11 (JALSG-CS-11). Int J Hematol 2024; 119:24-38. [PMID: 38015362 DOI: 10.1007/s12185-023-03677-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
This report covers acute myeloid leukemia (AML) results from a multicenter, prospective observational study of AML, myelodysplastic syndromes, and chronic myelomonocytic leukemia in Japan. From August 2011 to January 2016, 3728 AML patients were registered. Among them, 42% were younger than 65, and the male-to-female ratio was 1.57:1. With a median follow-up time of 1807 days (95% confidence interval [CI]: 1732-1844 days), the estimated 5-year overall survival (OS) rate in AML patients (n = 3707) was 31.1% (95% CI: 29.5-32.8%). Trial-enrolled patients had a 1.7-fold higher OS rate than non-enrolled patients (5-year OS, 58.9% [95% CI: 54.5-63.1%] vs 35.5% [33.3-37.8%], p < 0.0001). Women had a higher OS rate than men (5-year OS, 34% [95% CI; 31.4-36.7%] vs 27.7% [25.7-29.7%], p < 0.0001). The OS rate was lower in patients aged 40 and older than those under 40, and even lower in those over 65 (5-year OS for ages < 40, 40-64, 65-74, ≥ 75: 74.5% [95% CI; 69.3-79.0%] vs 47.5% [44.4-50.6%] vs 19.3% [16.8-22.0%] vs 7.3% [5.5-9.4%], respectively). This is the first paper to present large-scale data on survival and clinical characteristics in Japanese AML patients.
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Affiliation(s)
- Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Higashi-Gotanda 5-9-22, Shinagawa-Ku, Tokyo, 141-8625, Japan.
| | | | - Sumihisa Honda
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Atsushi Wakita
- Nagoya City University East Medical Center, Nagoya, Japan
| | - Yuichiro Nawa
- Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | | | | | | | | | - Satoru Takada
- Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Daiki Hirano
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Tatsuki Tomikawa
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | | | - Shingo Yano
- Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Hiroyuki Fujita
- Department of Hematology, Yokohama Nanbu Hospital, Yokohama, Japan
| | | | | | - Kensuke Kojima
- Department of Hematology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tomohiro Kajiguchi
- Department of Hematology and Oncology, Tosei General Hospital, Seto, Japan
| | - Ko Fujimoto
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Norio Asou
- International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Noriko Usui
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Yuichi Ishikawa
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Katsumi
- Department of Hematology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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24
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Lu T, Zhang J, McCracken JM, Young KH. Recent advances in genomics and therapeutics in mantle cell lymphoma. Cancer Treat Rev 2024; 122:102651. [PMID: 37976759 DOI: 10.1016/j.ctrv.2023.102651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
Over the past decades, significant strides have been made in understanding the pathobiology, prognosis, and treatment options for mantle cell lymphoma (MCL). The heterogeneity observed in MCL's biology, genomics, and clinical manifestations, including indolent and aggressive forms, is intricately linked to factors such as the mutational status of the variable region of the immunoglobulin heavy chain gene, epigenetic profiling, and Sox11 expression. Several intriguing subtypes of MCL, such as Cyclin D1-negative MCL, in situ mantle cell neoplasm, CCND1/IGH FISH-negative MCL, and the impact of karyotypic complexity on prognosis, have been explored. Notably, recent immunochemotherapy regimens have yielded long-lasting remissions in select patients. The therapeutic landscape for MCL is continuously evolving, with a shift towards nonchemotherapeutic agents like ibrutinib, acalabrutinib, and venetoclax. The introduction of BTK inhibitors has brought about a transformative change in MCL treatment. Nevertheless, the challenge of resistance to BTK inhibitors persists, prompting ongoing efforts to discover strategies for overcoming this resistance. These strategies encompass non-covalent BTK inhibitors, immunomodulatory agents, BCL2 inhibitors, and CAR-T cell therapy, either as standalone treatments or in combination regimens. Furthermore, developing novel drugs holds promise for further improving the survival of patients with relapsed or refractory MCL. In this comprehensive review, we methodically encapsulate MCL's clinical and pathological attributes and the factors influencing prognosis. We also undertake an in-depth examination of stratified treatment alternatives. We investigate conceivable resistance mechanisms in MCL from a genetic standpoint and offer precise insights into various therapeutic approaches for relapsed or refractory MCL.
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Affiliation(s)
- Tingxun Lu
- Division of Hematopathology, Duke University Medical Center, Durham, NC 27710, USA; Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Jie Zhang
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Jenna M McCracken
- Division of Hematopathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Ken H Young
- Division of Hematopathology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Duke University, Durham, NC 27710, USA.
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25
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Kaprio E, Prusila R, Tokola S, Kuusisto MEL, Jantunen E, Kuitunen H, Turpeenniemi‐Hujanen T, Kuittinen O. Drug-induced pneumonitis risk in diffuse large B-cell/follicular lymphoma patients treated with R-CHOP-like regimen is associated with the use of granulocyte colony-stimulating growth factors. Cancer Med 2024; 13:e6898. [PMID: 38164067 PMCID: PMC10807566 DOI: 10.1002/cam4.6898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Rituximab-based combinations are the standard of care in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). Despite being on market for over 20 years, some of the adverse effects associated with the use of rituximab are not well known. Drug-induced interstitial pneumonitis (DIP) is a potentially fatal complication of the treatment. Granulocyte colony-stimulating factors (G-CSF) are supportive agents commonly used to prevent neutropenic infections. G-CSF are reported to have pulmonary toxicity, but the risk of DIP is greater when used in combination with other potentially pulmotoxic agents. METHODS In this retrospective study, we reported the G-CSF use and risk of DIP in 234 DLBCL patients and 87 FL patients receiving R-CHOP-type immunochemotherapy. RESULTS In 72% of patients, the treatment included a G-CSF support. The overall incidence of treatment-induced pneumonitis was 6.9% in this patient group. All the DIP cases (n = 16) were among patients receiving G-CSF support (p = 0.03). Older age (over 60 years) and higher disease stage (Ann Arbor 3-4) also increased the risk of DIP. CONCLUSIONS These findings suggest that the use of G-CSF increases the risk of DIP, when used in combination with rituximab-containing regimen.
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Affiliation(s)
- Elina Kaprio
- Faculty of Health Medicine, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
| | - Roosa Prusila
- Department of PediatricsKuopio University HospitalKuopioFinland
| | - Susanna Tokola
- Department of Oncology and Radiotherapy, Medical Research CenterOulu University HospitalOuluFinland
| | - Milla E. L. Kuusisto
- Translational Medicine Research UnitUniversity of OuluOuluFinland
- The North Karelia Central HospitalJoensuuFinland
- Cancer Center, Kuopio University HospitalKuopioFinland
| | - Esa Jantunen
- The North Karelia Central HospitalJoensuuFinland
- Länsi‐Pohja Central Hospital, Kauppakatu 25KemiFinland
| | - Hanne Kuitunen
- Department of Oncology and Radiotherapy, Medical Research CenterOulu University HospitalOuluFinland
- Translational Medicine Research UnitUniversity of OuluOuluFinland
| | - Taina Turpeenniemi‐Hujanen
- Department of Oncology and Radiotherapy, Medical Research CenterOulu University HospitalOuluFinland
- Translational Medicine Research UnitUniversity of OuluOuluFinland
| | - Outi Kuittinen
- Faculty of Health Medicine, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
- Department of Oncology and Radiotherapy, Medical Research CenterOulu University HospitalOuluFinland
- Translational Medicine Research UnitUniversity of OuluOuluFinland
- Länsi‐Pohja Central Hospital, Kauppakatu 25KemiFinland
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26
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Shah P, Sperling AS. Chimeric Antigen Receptor T Cells in Multiple Myeloma. Hematol Oncol Clin North Am 2023; 37:1089-1105. [PMID: 37563077 DOI: 10.1016/j.hoc.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Multiple myeloma is the second most common hematological malignancy with an approximate incidence of up to 8.5 cases per 100,000 persons per year. Over the last decade, therapy for multiple myeloma has undergone a revolutionary change. Chimeric antigen receptor (CAR) T-cell therapy has played a major role in this evolution. In this review, we discuss the existing state of CAR T-cell therapy in myeloma while evaluating several newer therapies and targets expected in the near future.
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Affiliation(s)
- Parth Shah
- Department of Hematology, Dartmouth Cancer Center, 1 Medical Center Drive, Lebanon, NH 03750, USA; Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Adam S Sperling
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA; Division of Hematology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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27
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Guan J, Ma J, Chen B. Clinical and cytogenetic characteristics of primary and secondary plasma cell leukemia under the new IMWG definition criteria: a retrospective study. Hematology 2023; 28:2254556. [PMID: 37732631 DOI: 10.1080/16078454.2023.2254556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Plasma cell leukemia (PCL) is a rare and aggressive plasma cell disorder, exhibiting a more unfavorable prognosis than multiple myeloma. PCL is classified into pPCL and sPCL. Recently, the IMWG has recommended new PCL definition criteria, which require the presence of ≥5% circulating plasma cells in peripheral blood smears. Due to its low incidence, research on pPCL and sPCL is limited. METHODS We conducted a retrospective study and analyzed clinical and cytogenetic data of pPCL and sPCL patients. Overall survival (OS) and progression-free survival (PFS) were assessed by the Kaplan-Meier method, and survival distributions were compared using the log-rank test. RESULTS This is a small cohort comprising 23 pPCL and 9 sPCL patients. Notably, sPCL patients showed a higher incidence of extramedullary infiltration and a higher percentage of bone marrow plasma cells (p = 0.015 and 0.025, respectively). Although no significant difference was found between the two groups in OS and PFS, a trend emerged suggesting a superior survival outcome for pPCL patients, with a higher cumulative 1-year PFS rate (38.3% vs. 13.3%) and a lower early mortality rate (mortality rate at 3 months: 15% vs. 33%). We also suggested that pPCL patients carrying t(11;14) may have a longer median survival time than individuals with other cytogenetic abnormalities, but this was not confirmed due to the small sample size. CONCLUSION Our study revealed clinical and cytogenetic features of pPCL and sPCL patients according to the new diagnostic criteria. The findings suggested a generally better prognosis for pPCL than sPCL and the likelihood of t(11;14) translocation acting as a favorable prognostic factor in pPCL. It is important to note that our study had a limited sample size, which may lead to bias. We hope well-designed studies can be conducted to provide more results.
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Affiliation(s)
- Jiaheng Guan
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Jinlong Ma
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
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28
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Yu J, Fu L, Zhang Z, Ding L, Hong L, Gao F, Jin J, Feng W, Fu J, Hong P, Xu C. Causal relationships between circulating inflammatory cytokines and diffuse large B cell lymphoma: a bidirectional Mendelian randomization study. Clin Exp Med 2023; 23:4585-4595. [PMID: 37910257 DOI: 10.1007/s10238-023-01221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Studies indicated that inflammatory cytokines involved in the occurrence and progression of DLBCL and it is challenging to discern causality from the effects due to the presence of feedback loops. We conducted a bidirectional Mendelian randomization (MR) study to investigate the potential causal relationship between DLBCL and inflammatory cytokines. The genetic variants associated with inflammatory cytokines were obtained from a genome-wide association study (GWAS) involving 8293 European participants, and the data on 1010 individuals with DLBCL were sourced from the FinnGen consortium. The primary method employed in this study was the inverse-variance weighted (IVW) method, with supplementary analyses conducted using the MR-Egger, weighted median, and MR-PRESSO approaches. Based on the IVW method, genetically predicted that increasing level of Monokine induced by interferon gamma (MIG/CXC chemokine ligand 9, CXCL9) [OR: 1.31; 95% CI: 1.05-1.62; P = 0.01] and interferon gamma-induced protein 10(IP-10/CXC chemokine ligand 10, CXCL10) [OR: 1.30; 95% CI: 1.02-1.66; P = 0.03] showed suggestive associations with DLBCL risk. DLBCL may increase the level of macrophage colony-stimulating factor (M-CSF) [OR: 1.12; 95% CI: 1.01-1.2; P = 0.03], tumor necrosis factor beta (TNF-β) [OR: 1.16; 95% CI: 1.02-1.31; P = 0.02] and TNF-related apoptosis-inducing ligand (TRAIL) [OR: 1.07; 95% CI: 1.01-1.13; P = 0.02]. This study presents evidence supporting a causal relationship between inflammation cytokines and DLBCL. Specifically, MIG/CXCL9 and IP-10/CXCL10 were identified as indicators of upstream causes of DLBCL; while, DLBCL itself was found to elevate the levels of M-CSF, TNF-β, and TRAIL. These findings suggest that targeting specific inflammatory factors through regulation and intervention could serve as a potential approach for the treatment and prevention of DLBCL.
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Affiliation(s)
- Jieni Yu
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Leihua Fu
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Zhijian Zhang
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Lina Ding
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Li Hong
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Feidan Gao
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Jing Jin
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Weiying Feng
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Jiaping Fu
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Pan Hong
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Chao Xu
- Department of Vascular and Hernia Surgery, Shaoxing People's Hospital, Shaoxing, 312000, Zhejiang, People's Republic of China.
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29
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Ananta, Benerjee S, Tchounwou PB, Kumar S. Mechanistic update of Trisenox in blood cancer. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2023; 5:100166. [PMID: 38074774 PMCID: PMC10701371 DOI: 10.1016/j.crphar.2023.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/28/2023] [Accepted: 11/14/2023] [Indexed: 02/12/2024] Open
Abstract
Acute promyelocytic leukemia (APL)/blood cancer is M3 type of acute myeloid leukemia (AML) formed inside bone marrow through chromosomal translocation mutation usually between chromosome 15 & 17. It accounts around 10% cases of AML worldwide. Trisenox (TX/ATO) is used in chemotherapy for treatment of all age group of APL patients with highest efficacy and survival rate for longer period. High concentration of TX inhibits growth of APL cells by diverse mechanism however, it cures only PML-RARα fusion gene/oncogene containing APL patients. TX resistant APL patients (different oncogenic make up) have been reported from worldwide. This review summarizes updated mechanism of TX action via PML nuclear bodies formation, proteasomal degradation, autophagy, p53 activation, telomerase activity, heteromerization of pRb & E2F, and regulation of signaling mechanism in APL cells. We have also provided important information of combination therapy of TX with other molecules mechanism of action in acute leukemia cells. It provides updated information of TX action for researcher which may help finding new target for further research in APL pathophysiology or new TX resistant APL patients drug designing.
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Affiliation(s)
- Ananta
- Department of Life Sciences, School of Earth, Biological, and Environmental Sciences, Central University of South Bihar, Gaya, India
| | - Swati Benerjee
- Department of Life Sciences, School of Earth, Biological, and Environmental Sciences, Central University of South Bihar, Gaya, India
| | - Paul B. Tchounwou
- RCMI Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD 21251, USA
| | - Sanjay Kumar
- Department of Life Sciences, School of Earth, Biological, and Environmental Sciences, Central University of South Bihar, Gaya, India
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Cui Z, Cheng F, Wang L, Zou F, Pan R, Tian Y, Zhang X, She J, Zhang Y, Yang X. A pharmacovigilance study of etoposide in the FDA adverse event reporting system (FAERS) database, what does the real world say? Front Pharmacol 2023; 14:1259908. [PMID: 37954852 PMCID: PMC10637489 DOI: 10.3389/fphar.2023.1259908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction: Etoposide is a broad-spectrum antitumor drug that has been extensively studied in clinical trials. However, limited information is available regarding its real-world adverse reactions. Therefore, this study aimed to assess and evaluate etoposide-related adverse events in a real-world setting by using data mining method on the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. Methods: Through the analysis of 16,134,686 reports in the FAERS database, a total of 9,892 reports of etoposide-related adverse drug events (ADEs) were identified. To determine the significance of these ADEs, various disproportionality analysis algorithms were applied, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multi-item gamma Poisson shrinker (MGPS) algorithms. Results: As a result, 478 significant disproportionality preferred terms (PTs) that were identified by all four algorithms were retained. These PTs included commonly reported adverse events such as thrombocytopenia, leukopenia, anemia, stomatitis, and pneumonitis, which align with those documented in the drug's instructions and previous clinical trials. However, our analysis also uncovered unexpected and significant ADEs, including thrombotic microangiopathy, ototoxicity, second primary malignancy, nephropathy toxic, and ovarian failure. Furthermore, we examined the time-to-onset (TTO) of these ADEs using the Weibull distribution test and found that the median TTO for etoposide-associated ADEs was 10 days (interquartile range [IQR] 2-32 days). The majority of cases occurred within the first month (73.8%) after etoposide administration. Additionally, our analysis revealed specific high-risk signals for males, such as pneumonia and cardiac infarction, while females showed signals for drug resistance and ototoxicity. Discussion: These findings provide valuable insight into the occurrence of ADEs following etoposide initiation, which can potentially support clinical monitoring and risk identification efforts.
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Affiliation(s)
- Zhiwei Cui
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feiyan Cheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lihui Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fan Zou
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Rumeng Pan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuhan Tian
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiyuan Zhang
- Department of General Medicine, Yanan University Affiliated Hospital, Yan'an, China
| | - Jing She
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yidan Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinyuan Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Xu YF, Wang GY, Zhang MY, Yang JG. Hub genes and their key effects on prognosis of Burkitt lymphoma. World J Clin Oncol 2023; 14:357-372. [PMID: 37970111 PMCID: PMC10631346 DOI: 10.5306/wjco.v14.i10.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Burkitt lymphoma (BL) is an exceptionally aggressive malignant neoplasm that arises from either the germinal center or post-germinal center B cells. Patients with BL often present with rapid tumor growth and require high-intensity multi-drug therapy combined with adequate intrathecal chemotherapy prophylaxis, however, a standard treatment program for BL has not yet been established. It is important to identify biomarkers for predicting the prognosis of BLs and discriminating patients who might benefit from the therapy. Microarray data and sequencing information from public databases could offer opportunities for the discovery of new diagnostic or therapeutic targets. AIM To identify hub genes and perform gene ontology (GO) and survival analysis in BL. METHODS Gene expression profiles and clinical traits of BL patients were collected from the Gene Expression Omnibus database. Weighted gene co-expression network analysis (WGCNA) was applied to construct gene co-expression modules, and the cytoHubba tool was used to find the hub genes. Then, the hub genes were analyzed using GO and Kyoto Encyclopedia of Genes and Genomes analysis. Additionally, a Protein-Protein Interaction network and a Genetic Interaction network were constructed. Prognostic candidate genes were identified through overall survival analysis. Finally, a nomogram was established to assess the predictive value of hub genes, and drug-gene interactions were also constructed. RESULTS In this study, we obtained 8 modules through WGCNA analysis, and there was a significant correlation between the yellow module and age. Then we identified 10 hub genes (SRC, TLR4, CD40, STAT3, SELL, CXCL10, IL2RA, IL10RA, CCR7 and FCGR2B) by cytoHubba tool. Within these hubs, two genes were found to be associated with OS (CXCL10, P = 0.029 and IL2RA, P = 0.0066) by survival analysis. Additionally, we combined these two hub genes and age to build a nomogram. Moreover, the drugs related to IL2RA and CXCL10 might have a potential therapeutic role in relapsed and refractory BL. CONCLUSION From WGCNA and survival analysis, we identified CXCL10 and IL2RA that might be prognostic markers for BL.
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Affiliation(s)
- Yan-Feng Xu
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Guan-Yun Wang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ming-Yu Zhang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ji-Gang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Bewarder M, Kaddu-Mulindwa D, Kos IA, Lesan V, Held G, Poeschel V, Thurner L, Bittenbring JT, Schmitz N, Truemper L, Pfreundschuh M, Christofyllakis K, Loeffler M, Altmann B, Ziepert M. Impact of vincristine dose reduction on outcomes of patients with aggressive B-cell lymphoma treated with (R)-CHOP. Haematologica 2023; 108:2844-2849. [PMID: 36815369 PMCID: PMC10543194 DOI: 10.3324/haematol.2022.282126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Affiliation(s)
- Moritz Bewarder
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar.
| | - Dominic Kaddu-Mulindwa
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Igor Age Kos
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Vadim Lesan
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Gerhard Held
- Department of Internal Medicine 1, Westpfalz-Klinikum, Kaiserslautern
| | - Viola Poeschel
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Lorenz Thurner
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Joerg Thomas Bittenbring
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Norbert Schmitz
- Department of Medicine A, University Hospital Muenster, Muenster
| | - Lorenz Truemper
- Department of Hematology and Oncology, Georg August University of Goettingen, Goettingen
| | - Michael Pfreundschuh
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Konstantinos Christofyllakis
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig
| | - Bettina Altmann
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig
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Fischer L, Jiang L, Bittenbring JT, Huebel K, Schmidt C, Duell J, Metzner B, Krauter J, Glass B, Huettmann A, Schaefer-Eckart K, Silkenstedt E, Klapper W, Hiddemann W, Unterhalt M, Dreyling M, Hoster E. The addition of rituximab to chemotherapy improves overall survival in mantle cell lymphoma-a pooled trials analysis. Ann Hematol 2023; 102:2791-2801. [PMID: 37552322 PMCID: PMC10492741 DOI: 10.1007/s00277-023-05385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
Mantle cell lymphoma (MCL) is a distinct subtype of B-cell lymphoma and commonly used induction immunochemotherapies include the anti-CD20 antibody rituximab. However, efficacy data for rituximab regarding overall survival (OS) in first line MCL therapy remain conflicting.We report long-term outcomes of a pooled trials analysis comparing Cyclophosphamide, Doxorubicine, Vincristine, Prednisone (CHOP) to R-CHOP in MCL to confirm efficacy on failure free survival (FFS) and OS in relevant subgroups. Untreated, adult MCL patients of two prospective trials assigned to CHOP or R-CHOP were included. Primary endpoints were FFS and OS, secondary endpoints included duration of response (DOR), secondary malignancies and OS after relapse. Between 1996 and 2003, 385 MCL patients were assigned to CHOP (201) or R-CHOP (184). After a median follow-up of 13.4 years, the addition of Rituximab significantly improved FFS (1.36 vs. 2.07 years, HR 0.62 (0.50-0.77)), OS (4.84 vs. 5.81 years, HR 0.78 (0.61-0.99)) and DOR (1.48 vs. 2.08 years, HR 0.67 (0.53-0.86)). Furthermore, Rituximab improved survival across different MCL risk groups. In a post-hoc analysis of OS after relapse comparing patients receiving chemotherapy with / without rituximab, rituximab maintained efficacy with a median OS of 3.10 vs. 2.11 years (HR 0.70, 0.54-0.91). The rate of secondary malignancies was 0.5 and 3.9% for hematological and 7 and 8% for non-hematological malignancies for CHOP and R-CHOP patients, respectively. We present mature results of a pooled MCL cohort, demonstrating prolonged FFS, OS and DOR for the combined immuno-chemotherapy, confirming the standard of care in first line treatment.
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Affiliation(s)
- Luca Fischer
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
| | - Linmiao Jiang
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | | | | | - Christian Schmidt
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Duell
- Department of Internal Medicine II, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Bernd Metzner
- University Clinic for Oncology and Hematology, Klinikum Oldenburg, Oldenburg, Germany
| | - Juergen Krauter
- Department of Internal Medicine III, Braunschweig Municipal Hospital, Brunswick, Germany
| | - Bertram Glass
- Department of Hematology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Andreas Huettmann
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center Essen, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany
| | | | | | - Wolfram Klapper
- Department of Pathology, Hematopathology Section, University Hospital Schleswig-Holstein, Christian-Albrecht-University of Kiel, Kiel, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Michael Unterhalt
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Eva Hoster
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
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Witkowska M, Majchrzak A, Robak P, Wolska-Washer A, Robak T. Metabolic and toxicological considerations for phosphoinositide 3-kinase delta inhibitors in the treatment of chronic lymphocytic leukemia. Expert Opin Drug Metab Toxicol 2023; 19:617-633. [PMID: 37714711 DOI: 10.1080/17425255.2023.2260305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/22/2023] [Accepted: 09/14/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Phosphoinositide 3-kinase delta (PI3Kδ) inhibitors are a class of novel agents that are mainly used to treat B-cell malignancies. They function by inhibiting one or more enzymes which are part of the PI3K/AKT/mTOR pathway. Idelalisib is a first-in-class PI3Kδ inhibitor effective in patients with B-cell lymphoid malignancies. AREAS COVERED This article reviews the chemical structure, mechanism of action, and metabolic and toxicological properties of PI3Kδ inhibitors and discusses their clinical applications in monotherapy and in combination with other agents for the treatment of chronic lymphocytic leukemia (CLL). A search was conducted of PubMed, Web of Science, and Google Scholar for articles in English. RESULTS/CONCLUSION PI3Kδ inhibitors hold potential for the treatment of B-cell malignancies, including CLL. However, their use is also associated with severe toxicities, including pneumonia, cytopenias, hepatitis, and rash. Newer drugs are in development to reduce toxicity with novel schedules and/or combinations. EXPERT OPINION The development of novel PI3Kδ inhibitors might help to reduce toxicity and improve efficacy in patients with CLL and other B-cell lymphoid malignancies.
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Affiliation(s)
- Magdalena Witkowska
- Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
| | - Agata Majchrzak
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland
| | - Paweł Robak
- Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
| | - Anna Wolska-Washer
- Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
| | - Tadeusz Robak
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland
- Department of Hematology, Medical University of Lodz, Lodz, Poland
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Jani CT, Ahmed A, Singh H, Mouchati C, Al Omari O, Bhatt PS, Sharma R, Farooq M, Liu W, Shalhoub J, Marshall D, Salciccioli JD, Warner JL, Lam P. Burden of AML, 1990-2019: Estimates From the Global Burden of Disease Study. JCO Glob Oncol 2023; 9:e2300229. [PMID: 37992271 PMCID: PMC10681472 DOI: 10.1200/go.23.00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE AML accounts for 80% of acute leukemia in adults. While progress has been made in treating younger patients in the past 2 decades, there has been limited improvement for older patients until recently. This study examines the global and European Union (EU) 15+ trends in AML between 1990 and 2019. METHODS We extracted age-standardized incidence rates (ASIRs), age-standardized death rates (ASMRs), and disability-adjusted life years, stratified by sex from the Global Burden of Disease Study database, and mortality-to-incidence ratio (MIR) were computed. Trends were compared using Joinpoint regression. RESULTS The findings show a global increase in AML incidence for both sexes from 1990 to 2019. In the EU15+ countries, most countries exhibited an increase in ASIR for both sexes. Joinpoint revealed that globally for male patients, ASIR steadily increased until 2010, remained stable until 2015 followed by a decline till 2019. Similar trends were observed in female patients. For ASMR, although there was an increase globally and in most EU15+ countries, there was a statistically significant decrease in mortality rates globally and in the majority of EU15+ countries in recent years. MIR improved in both sexes globally. On age stratification, AML burden was highest among older groups (55 years and older), while the lowest rates were observed in younger than 20 years. CONCLUSION The findings from our study indicate a global rise in AML incidence and mortality in both sexes and decrease in MIR from 1990 to 2019 suggesting a better survival. However, on Joinpoint analysis, there is no change in MIR in women in the past decade and past 4 years in men indicating plateau in survival trends despite recent advances.
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Affiliation(s)
- Chinmay T. Jani
- Sylvester Comprehensive Cancer Center at University of Miami, Miami, FL
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
| | - Alaaeldin Ahmed
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
| | - Harpreet Singh
- M.D.R Collaborative Group, London, United Kingdom
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI
| | - Christian Mouchati
- M.D.R Collaborative Group, London, United Kingdom
- Department of Neurology, Cleveland Clinic, Cleveland, OH
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
- Department of Pulmonary and Critical Care, Temple University, Philadelphia, PA
| | - Padmanabh S. Bhatt
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
| | - Rajesh Sharma
- Humanities and Social Science, National Institute of Technology Kurukshetra, Haryana, India
| | | | - Weitao Liu
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Joseph Shalhoub
- M.D.R Collaborative Group, London, United Kingdom
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Dominic Marshall
- M.D.R Collaborative Group, London, United Kingdom
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Justin D. Salciccioli
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
- Department of Pulmonary and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jeremy L. Warner
- Center for Clinical Cancer Informatics and Data Science, Legorreta Cancer Center, Brown University, Providence, RI
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI
| | - Prudence Lam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
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Broccia G, Carter J, Ozsin-Ozler C, De Matteis S, Cocco P. Epidemiology of Chronic Lymphocytic Leukemia in Sardinia, Italy (1974-2003). Exp Hematol 2023; 125-126:37-44. [PMID: 37567460 DOI: 10.1016/j.exphem.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Abstract
Several reports have described a worldwide increasing incidence of chronic lymphocytic leukemia (CLL) dating back seven to eight decades. Although genetic susceptibility would be an implausible explanation, the determinants of this upward trend and its spatial coordinates are poorly understood. We explored CLL incidence in Sardinia, Italy, using a validated database including the 1700 CLL cases diagnosed during 1974-2003. We applied Bayesian methods to map the CLL probability by administrative unit and Poisson regression analysis to investigate socioeconomic and environmental determinants adjusting by possible confounders. The standardized (Standard European population) incidence rate for the Sardinian population over the study period was 5.1 per 100,000 (95% confidence interval [CI] 4.9-5.3), increased annually by 5.8% (95% CI 5.7-6.0) consistently by sex and age, and was more noticeable in urban areas. Five administrative units exceeded the 95% posterior probability of an elevated CLL incidence: these were rural areas spread over the regional territory, not suggestive of spatial clustering. The Poisson regression analysis showed that the risk was elevated in urban areas (RR = 1.11, 95% CI 1.05-1.17), among residents ≥ 30 km from the nearest hospital (RR = 1.09, 95% CI 1.06-1.12), and with the local prevalence of cork harvesting (RR = 1.62, 95% CI 1.12-2.34). Our results suggest that better access to health care facilities and improvements in diagnostic efficacy might have generated the observed upward trend in CLL incidence, along with contributing environmental factors.
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Affiliation(s)
- Giorgio Broccia
- Department of Haematology and Bone Marrow Transplants, Hospital A. Businco, Cagliari, Sardinia, Italy
| | | | - Cansu Ozsin-Ozler
- Department of Paediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Sara De Matteis
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Pierluigi Cocco
- Centre for Occupational and Environmental Health, Division of Public Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK.
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Colita A, Tanase AD, Tomuleasa C, Colita A. Hematopoietic Stem Cell Transplantation in Acute Promyelocytic Leukemia in the Era of All-Trans Retinoic Acid (ATRA) and Arsenic Trioxide (ATO). Cancers (Basel) 2023; 15:4111. [PMID: 37627139 PMCID: PMC10452822 DOI: 10.3390/cancers15164111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Acute promyelocytic leukemia (APL) currently represents one of the malignant hemopathies with the best therapeutic responses, following the introduction of all-trans retinoic acid (ATRA) and subsequently of arsenic trioxide (ATO) treatment. As a result, a large proportion of patients with APL achieve long-term responses after first-line therapy, so performing a hematopoietic stem cell transplant as consolidation of first complete remission (CR) is no longer necessary. Even in the case of relapses, most patients obtain a new remission as a result of therapy with ATO and ATRA, but an effective consolidation treatment is necessary to maintain it. The experience accumulated from studies published in the last two decades shows the effectiveness of hematopoietic stem cell transplantation (HSCT) in improving the outcome of patients who achieve a new CR. Thus, the expert groups recommend transplantation as consolidation therapy in patients with a second CR, with the indication for autologous HSCT in cases with molecular CR and for allogeneic HSCT in patients with the persistence of minimal residual disease (MRD) or with early relapse. However, there is a variety of controversial aspects related to the role of HSCT in APL, ranging from the fact that outcome data are obtained almost exclusively from retrospective studies and historical analyses to questions related to the type of transplantation, the impact of minimal residual disease, conditioning regimens, or the role of other therapeutic options. All these questions justify the need for controlled prospective studies in the following years.
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Affiliation(s)
- Andrei Colita
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Hematology, Coltea Clinical Hospital, 030171 Bucharest, Romania
| | - Alina Daniela Tanase
- Department of Bone Marrow Transplantation, Fundeni Clinical Institute, 022338 Bucharest, Romania
- Department of Transplant Immunology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ciprian Tomuleasa
- Department of Hematology, Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400015 Cluj Napoca, Romania
| | - Anca Colita
- Department of Bone Marrow Transplantation, Fundeni Clinical Institute, 022338 Bucharest, Romania
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Loscertales J, Abrisqueta-Costa P, Gutierrez A, Hernández-Rivas JÁ, Andreu-Lapiedra R, Mora A, Leiva-Farré C, López-Roda MD, Callejo-Mellén Á, Álvarez-García E, García-Marco JA. Real-World Evidence on the Clinical Characteristics and Management of Patients with Chronic Lymphocytic Leukemia in Spain Using Natural Language Processing: The SRealCLL Study. Cancers (Basel) 2023; 15:4047. [PMID: 37627075 PMCID: PMC10452602 DOI: 10.3390/cancers15164047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The SRealCLL study aimed to obtain real-world evidence on the clinical characteristics and treatment patterns of patients with chronic lymphocytic leukemia (CLL) using natural language processing (NLP). Electronic health records (EHRs) from seven Spanish hospitals (January 2016-December 2018) were analyzed using EHRead® technology, based on NLP and machine learning. A total of 534 CLL patients were assessed. No treatment was detected in 270 (50.6%) patients (watch-and-wait, W&W). First-line (1L) treatment was identified in 230 (43.1%) patients and relapsed/refractory (2L) treatment was identified in 58 (10.9%). The median age ranged from 71 to 75 years, with a uniform male predominance (54.8-63.8%). The main comorbidities included hypertension (W&W: 35.6%; 1L: 38.3%; 2L: 39.7%), diabetes mellitus (W&W: 24.4%; 1L: 24.3%; 2L: 31%), cardiac arrhythmia (W&W: 16.7%; 1L: 17.8%; 2L: 17.2%), heart failure (W&W 16.3%, 1L 17.4%, 2L 17.2%), and dyslipidemia (W&W: 13.7%; 1L: 18.7%; 2L: 19.0%). The most common antineoplastic treatment was ibrutinib in 1L (64.8%) and 2L (62.1%), followed by bendamustine + rituximab (12.6%), obinutuzumab + chlorambucil (5.2%), rituximab + chlorambucil (4.8%), and idelalisib + rituximab (3.9%) in 1L and venetoclax (15.5%), idelalisib + rituximab (6.9%), bendamustine + rituximab (3.5%), and venetoclax + rituximab (3.5%) in 2L. This study expands the information available on patients with CLL in Spain, describing the diversity in patient characteristics and therapeutic approaches in clinical practice.
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Affiliation(s)
- Javier Loscertales
- Hematology Department, Hospital Universitario de la Princesa, Calle de Diego de León 62, 28006 Madrid, Spain;
| | - Pau Abrisqueta-Costa
- Hematology Department, Hospital Universitari Vall d’Hebron, Pg de la vall d’Hebron 199, 08035 Barcelona, Spain
| | - Antonio Gutierrez
- Hematology Department, Hospital Son Espases/IdISBa, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain;
| | - José Ángel Hernández-Rivas
- Hematology Department, Hospital Universitario Infanta Leonor, Avda. Gran Vía del Este 80, 28031 Madrid, Spain;
| | - Rafael Andreu-Lapiedra
- Hematology Department, Hospital Universitario La Fe, Avinguda de Fernando Abril Martorell 106, 46026 Valencia, Spain;
| | - Alba Mora
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Calle de St. Antoni Maria Claret 167, 08025 Barcelona, Spain;
| | - Carolina Leiva-Farré
- Medical Department, Astrazeneca Farmacéutica Spain S.A., Calle del Puerto de Somport 21, 28050 Madrid, Spain; (C.L.-F.); (M.D.L.-R.); (Á.C.-M.); (E.Á.-G.)
| | - María Dolores López-Roda
- Medical Department, Astrazeneca Farmacéutica Spain S.A., Calle del Puerto de Somport 21, 28050 Madrid, Spain; (C.L.-F.); (M.D.L.-R.); (Á.C.-M.); (E.Á.-G.)
| | - Ángel Callejo-Mellén
- Medical Department, Astrazeneca Farmacéutica Spain S.A., Calle del Puerto de Somport 21, 28050 Madrid, Spain; (C.L.-F.); (M.D.L.-R.); (Á.C.-M.); (E.Á.-G.)
| | - Esther Álvarez-García
- Medical Department, Astrazeneca Farmacéutica Spain S.A., Calle del Puerto de Somport 21, 28050 Madrid, Spain; (C.L.-F.); (M.D.L.-R.); (Á.C.-M.); (E.Á.-G.)
| | - José Antonio García-Marco
- Hematology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, 28222 Majadahonda, Spain;
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Nogués-Castell J, Feu-Basilio S, Felguera García Ó, Fernández de Larrea C, Oliver-Caldés A, Balagué Ponz O, Fassi JM. Bilateral orbital plasmacytomas as first sign of extramedullary progression post CAR-T therapy: case report and literature review. Front Oncol 2023; 13:1217714. [PMID: 37637047 PMCID: PMC10450026 DOI: 10.3389/fonc.2023.1217714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/14/2023] [Indexed: 08/29/2023] Open
Abstract
Background Plasma cell leukemia (PCL) is an aggressive and rare form of plasma cell dyscrasia characterized by peripheral blood expression, poor prognosis, and high relapse rates. Extramedullary plasmacytomas are common in this entity and can affect various organs and soft tissues. Chimeric antigen receptor-T-cell (CAR-T) therapy is a novel immunotherapy for hematological malignancies with promising results. However, it is not indicated for PCL, and experience in this condition is limited. This case is a rare presentation of bilateral orbital plasmacytomas after CAR-T therapy in a patient with PCL history. Case presentation We present the case of a 51-year-old female patient with a history of previous primary PCL treated with CAR-T therapy achieving complete response and without evidence of systemic progression. Six months after the treatment, she developed subacute proptosis and ptosis on the left eye.An orbital CT scan was performed and showed an orbital tumor in both eyes. A surgical biopsy with histological examination revealed plasma cells, consistent with a plasmacytoma. PET-CT and MRI confirmed the presence of tumors in both orbits. The patient was treated with dexamethasone and chemotherapy along with palliative radiation therapy to the left orbit which had a good response. Conclusion Orbital involvement in multiple myeloma and PCL is rare, with plasmacytomas being more common in other parts of the body. In this report, we present a case of a patient with PCL history, treated with multiple therapeutic lines including CAR-T therapy, who presented bilateral orbital plasmacytomas as the first sign of extramedullary progression after the treatment. This case should be considered by specialist to be aware that the orbits are a possible location of extramedullary progression.
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Affiliation(s)
- Javier Nogués-Castell
- Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
| | - Silvia Feu-Basilio
- Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
| | - Óscar Felguera García
- Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Aina Oliver-Caldés
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Olga Balagué Ponz
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
- Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jessica Matas Fassi
- Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
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Vergnolle I, Ceccomarini T, Canali A, Rieu JB, Vergez F. Use of a hybrid intelligence decision tree to identify mature B-cell neoplasms. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023. [PMID: 37539849 DOI: 10.1002/cyto.b.22136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Mature B-cell neoplasms are challenging to diagnose due to their heterogeneity and overlapping clinical and biological features. In this study, we present a new workflow strategy that leverages a large amount of flow cytometry data and an artificial intelligence approach to classify these neoplasms. METHODS By combining mathematical tools, such as classification algorithms and regression tree (CART) models, with biological expertise, we have developed a decision tree that accurately identifies mature B-cell neoplasms. This includes chronic lymphocytic leukemia (CLL), for which cytometry has been extensively used, as well as other non-CLL subtypes. RESULTS The decision tree is easy to use and proposes a diagnosis and classification of mature B-cell neoplasms to the users. It can identify the majority of CLL cases using just three markers: CD5, CD43, and CD200. CONCLUSION This approach has the potential to improve the accuracy and efficiency of mature B-cell neoplasm diagnosis.
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Affiliation(s)
- Inès Vergnolle
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Theo Ceccomarini
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Alban Canali
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Jean-Baptiste Rieu
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - François Vergez
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
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Jeon BE, Lee JE, Park J, Jung H, Park EG, Lee DH, Seo YS, Kim HS, Shin HJ, Kim SW. Transcriptomic analysis of neutrophil apoptosis induced by diffuse large B-cell lymphoma unveils a potential role in neutropenia. Genes Genomics 2023; 45:1013-1024. [PMID: 37266765 PMCID: PMC10237082 DOI: 10.1007/s13258-023-01404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/15/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is an aggressive lymphoma that arises from malignant transformation of B lymphocytes. Outcome of patients with DLBCL has been significantly improved by rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy, which is regarded "gold standard" of DLBCL therapy. It is unfortunate that febrile neutropenia, a decrease of the neutrophil count in the blood accompanying fever, is one of the most common complications that DLBCL patients receiving R-CHOP regimen experience. Given the critical role of neutrophils against bacterial and fungal infections, neutropenia could be deadly. While the association between R-CHOP therapy and neutropenia has been well-established, the negative effect of DLBCL cells on the survival of neutrophils has not been clearly understood. Our previous study have shown that conditioned medium (CM) derived from Ly1 DLBCL cells induces apoptosis in murine neutrophils ex vivo. Additionally, Ly1 CM and doxorubicin synergize to further enhance apoptotic rate in neutrophils, possibly contributing to neutropenia in DLBCL patients. OBJECTIVE We investigated the mechanism and genes that regulate neutrophil apoptosis induced by secretome of DLBCL cells, which would give insight into the potential role of DLBCL in neutropenia. METHOD Murine neutrophils were isolated from bone marrow in C57BL6/J mice using flow cytometry. QuantSeq 3' mRNA-sequencing was conducted on neutrophils following exposure to CM derived from Ly1 DLBCL cells or murine bone marrow cells (control). Quantseq 3'mRNA sequencing data were aligned to identify differentially expressed mRNAs. Next, the expression of genes related to neutrophil apoptosis and proliferation were analyzed and Gene classification and ontology were analyzed. RESULT We identified 1196 (198 upregulated and 998 downregulated) differentially expressed genes (DEGs) in Ly1 DLBCL co-culture group compared to the control group. The functional enrichment analyses of DEGs in co-culture group revealed significant enriched in apoptosis process, and immune system process in gene ontology and the highly enriched pathway of various bacterial infection, leukocyte transendothelial migration, apoptosis, and cell cycle in KEGG pathway. Importantly, Bcl7b, Bnip3, Bmx, Mcl1, and Pim1 were identified as critical regulators of neutrophil apoptosis, which may be potential drug targets for the treatment of neutropenia. We are currently testing the efficacy of the activators/inhibitors of the proteins encoded by these genes to investigate whether they would block DLBCL-induced neutrophil apoptosis. CONCLUSION In the present study, bioinformatic analyses of gene expression profiling data revealed the crucial genes involved in neutrophil apoptosis and gave insight into the underlying mechanism. Given our data, it may be likely that novel opportunities for the treatment of neutropenia, and eventually improvement of prognosis of DLBCL patients, might emerge.
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MESH Headings
- Animals
- Mice
- Neutrophils/metabolism
- Neutrophils/pathology
- Transcriptome
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/genetics
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Rituximab/adverse effects
- Rituximab/genetics
- Neutropenia/chemically induced
- Neutropenia/genetics
- Neutropenia/drug therapy
- Doxorubicin/pharmacology
- Cyclophosphamide/adverse effects
- Vincristine/adverse effects
- Prednisone/adverse effects
- Apoptosis/genetics
- Gene Expression Profiling
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
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Affiliation(s)
- Byeol-Eun Jeon
- Department of Integrated Biological Science, Pusan National University, Pusan, 46241, Republic of Korea
| | - Ji-Eun Lee
- Department of Integrated Biological Science, Pusan National University, Pusan, 46241, Republic of Korea
| | - Jungwook Park
- Biotechnology Research Division, National Institute of Fisheries Science, Busan, 46083, Korea
| | - Hyejung Jung
- Department of Integrated Biological Science, Pusan National University, Pusan, 46241, Republic of Korea
- Department of Microbiology, Pusan National University, Pusan, 46241, Republic of Korea
| | - Eun Gyung Park
- Department of Integrated Biological Science, Pusan National University, Pusan, 46241, Republic of Korea
- Institute of Systems Biology, Pusan National University, Busan, 46241, Republic of Korea
| | - Du Hyeong Lee
- Department of Integrated Biological Science, Pusan National University, Pusan, 46241, Republic of Korea
- Institute of Systems Biology, Pusan National University, Busan, 46241, Republic of Korea
| | - Young-Su Seo
- Department of Integrated Biological Science, Pusan National University, Pusan, 46241, Republic of Korea
- Department of Microbiology, Pusan National University, Pusan, 46241, Republic of Korea
| | - Heui-Soo Kim
- Institute of Systems Biology, Pusan National University, Busan, 46241, Republic of Korea
- Department of Biological Sciences, Pusan National University, Pusan, 46241, Republic of Korea
| | - Ho-Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, Biochemical Research Institution, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.
| | - Sang-Woo Kim
- Department of Integrated Biological Science, Pusan National University, Pusan, 46241, Republic of Korea.
- Department of Biological Sciences, Pusan National University, Pusan, 46241, Republic of Korea.
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Ryu D, Bak T, Ahn D, Kang H, Oh S, Min HS, Lee S, Lee J. Deep learning-based label-free hematology analysis framework using optical diffraction tomography. Heliyon 2023; 9:e18297. [PMID: 37576294 PMCID: PMC10412892 DOI: 10.1016/j.heliyon.2023.e18297] [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] [Received: 03/04/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Hematology analysis, a common clinical test for screening various diseases, has conventionally required a chemical staining process that is time-consuming and labor-intensive. To reduce the costs of chemical staining, label-free imaging can be utilized in hematology analysis. In this work, we exploit optical diffraction tomography and the fully convolutional one-stage object detector or FCOS, a deep learning architecture for object detection, to develop a label-free hematology analysis framework. Detected cells are classified into four groups: red blood cell, abnormal red blood cell, platelet, and white blood cell. In the results, the trained object detection model showed superior detection performance for blood cells in refractive index tomograms (0.977 mAP) and also showed high accuracy in the four-class classification of blood cells (0.9708 weighted F1 score, 0.9712 total accuracy). For further verification, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were compared with values obtained from reference hematology equipment, with our results showing reasonable correlation in both MCV (0.905) and MCH (0.889). This study provides a successful demonstration of the proposed framework in detecting and classifying blood cells using optical diffraction tomography for label-free hematology analysis.
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Affiliation(s)
- Dongmin Ryu
- Tomocube Inc., Daejeon, 34109, Republic of Korea
| | - Taeyoung Bak
- Department of Computer Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Daewoong Ahn
- Tomocube Inc., Daejeon, 34109, Republic of Korea
| | - Hayoung Kang
- Tomocube Inc., Daejeon, 34109, Republic of Korea
| | - Sanggeun Oh
- Tomocube Inc., Daejeon, 34109, Republic of Korea
| | | | - Sumin Lee
- Tomocube Inc., Daejeon, 34109, Republic of Korea
| | - Jimin Lee
- Department of Nuclear Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
- Graduate School of Artificial Intelligence (AIGS), Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
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Bektan Kanat B, Suzan V, Ulugerger Avci G, Mungan HE, Unal D, Emiroglu Gedik T, Suna Erdincler D, Doventas A, Yavuzer H. Comprehensive evaluation of older patients with suspected malignancy: 5-year experience of a tertiary geriatric inpatient unit. Curr Med Res Opin 2023; 39:1085-1091. [PMID: 37501602 DOI: 10.1080/03007995.2023.2242246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Geriatric cancer population is growing. Both cancer and geriatric conditions are associated with some degree of inflammatory burden. To comprehensively present our five years of experience in patients with suspicion of a malignancy, signs and symptoms that are more prominent as indicator of malignancies, conditions that cause malignancy-like symptoms, and common malignancies and newly diagnosed malignancies in geriatric patients with a history of cancer. METHODS Patients hospitalized with suspected malignancy in a geriatric inpatient unit were included. Demographic data, hospitalization symptoms, clinical findings, smoking history, laboratory and further examinations, comprehensive geriatric assessment scores, length of hospital stay and discharge diagnoses were examined. Endoscopy and colonoscopy findings were also recorded. RESULTS Of the 1,104 patients hospitalized for various reasons in the five-year period, 197 (106 women) were suspected of having a malignancy. Mean age was 78.22 ± 7.27. A total of 65 (33%) patients were diagnosed with a malignancy. Amount of smoking (pack/year) and geriatric depression scale (GDS) scores were significantly higher in malignant group (p = .009; p < .001; respectively). Of the hospitalization symptoms, frequency of lumbar-hip-back pain was significantly higher in the malignant group (p = .043). The three most common cancers were hematologic (32%), lung (15%), and gastrointestinal cancers (15%). Gastritis was the most common pathological finding from gastroscopies (58%), and adenoma from colonoscopies (24%). Malignancies were detected in 40% of patients with a history of malignancy, and 55% of the newly detected malignancies were new primaries. Immunoglobulin G4-related disease was one of the detected interested benign conditions. CONCLUSION The frequency and presentation patterns of malignancies may differ in older adults. Depressive symptoms are common in geriatric cancer patients. Geriatric patients with a history of malignancy should be evaluated in detail for new primary malignancies.
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Affiliation(s)
- Bahar Bektan Kanat
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Veysel Suzan
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulru Ulugerger Avci
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Halit Eyyup Mungan
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Damla Unal
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tugce Emiroglu Gedik
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Suna Erdincler
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Alper Doventas
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Rodrigues N, Fragão-Marques M, Costa C, Branco C, Marques F, Vasconcelos P, Martins C, Leite-Moreira A, Lopes JA. Predictive Risk Score for Acute Kidney Injury in Hematopoietic Stem Cell Transplant. Cancers (Basel) 2023; 15:3720. [PMID: 37509381 PMCID: PMC10377961 DOI: 10.3390/cancers15143720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Hematopoietic stem cell transplant (HSCT) is an important treatment option for hematologic malignancies. Acute kidney injury (AKI) is a common complication in HSCTs and is related to worse outcomes. We aimed to create a predictive risk score for AKI in HSCT considering variables available at the time of the transplant. We performed a retrospective cohort study. AKI was defined by the KDIGO classification using creatinine and urinary output criteria. We used survival analysis with competing events. Continuous variables were dichotomized according to the Liu index. A multivariable analysis was performed with a backward stepwise regression. Harrel's C-Statistic was used to evaluate the performance of the model. Points were attributed considering the nearest integer of two times each covariate's hazard ratio. The Liu index was used to establish the optimal cut-off. We included 422 patients undergoing autologous (61.1%) or allogeneic (38.9%) HSCTs for multiple myeloma (33.9%), lymphoma (27.3%), and leukemia (38.8%). AKI cumulative incidence was 59.1%. Variables eligible for the final score were: hematopoietic cell transplant comorbidity index ≥2 (HR: 1.47, 95% CI: 1.08-2.006; p = 0.013), chronic kidney disease (HR: 2.10, 95% CI: 1.31-3.36; p = 0.002), lymphoma or leukemia (HR: 1.69, 95% CI: 1.26-2.25; p < 0.001) and platelet-to-lymphocyte ratio > 171.9 (HR: 1.43, 95% CI: 1.10-1.86; p = 0.008). This is the first predictive risk score for AKI in patients undergoing HSCTs and the first study where the platelet-to-lymphocyte ratio is independently associated with AKI.
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Affiliation(s)
- Natacha Rodrigues
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Mariana Fragão-Marques
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
| | - Cláudia Costa
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Carolina Branco
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Filipe Marques
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Pedro Vasconcelos
- Division of Hematology, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Carlos Martins
- Division of Hematology, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Adelino Leite-Moreira
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
| | - José António Lopes
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
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Mangone L, Penna D, Marinelli F, Roncaglia F, Bisceglia I, Merli F, Ruffini A, Gamberi B, Tieghi A, Valli R, Albertazzi L, Iori M, Giorgi Rossi P, Vener C, Morabito F, Neri A, Luminari S. Incidence, mortality, and survival of hematological malignancies in Northern Italian patients: an update to 2020. Front Oncol 2023; 13:1182971. [PMID: 37534259 PMCID: PMC10391155 DOI: 10.3389/fonc.2023.1182971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/15/2023] [Indexed: 08/04/2023] Open
Abstract
Background Hematological malignancies (HMs) represent a heterogeneous group of diseases with diverse etiology, pathogenesis, and prognosis. HMs' accurate registration by Cancer Registries (CRs) is hampered by the progressive de-hospitalization of patients and the transition to molecular rather than microscopic diagnosis. Material and methods A dedicated software capable of automatically identifying suspected HMs cases by combining several databases was adopted by Reggio Emilia Province CR (RE-CR). Besides pathological reports, hospital discharge archives, and mortality records, RE-CR retrieved information from general and biomolecular laboratories. Incidence, mortality, and 5-year relative survival (RS) reported according to age, sex, and 4 HMs' main categories, were noted. Results Overall, 7,578 HM cases were diagnosed from 1996 to 2020 by RE-CR. HMs were more common in males and older patients, except for Hodgkin Lymphoma and Follicular Lymphoma (FL). Incidence showed a significant increase for FL (annual percent change (APC)=3.0), Myeloproliferative Neoplasms (MPN) in the first period (APC=6.0) followed by a significant decrease (APC=-7.4), and Myelodysplastic Syndromes (APC=16.4) only in the first period. Over the years, a significant increase was observed in 5-year RS for Hodgkin -, Marginal Zone -, Follicular - and Diffuse Large B-cell-Lymphomas, MPN, and Acute Myeloid Leukemia. The availability of dedicated software made it possible to recover 80% of cases automatically: the remaining 20% required direct consultation of medical records. Conclusions The study emphasizes that HM registration needs to collect information from multiple sources. The digitalization of CRs is necessary to increase their efficiency.
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Affiliation(s)
- Lucia Mangone
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Penna
- PhD Program in Clinical and Experimental Medicine, University of Modena and, Reggio Emilia, Italy
| | | | | | - Isabella Bisceglia
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Merli
- Hematology Unit, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessia Ruffini
- Gruppo Amici Dell’Ematologia Foundation-GrADE, Reggio Emilia, Italy
| | - Barbara Gamberi
- Hematology Unit, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessia Tieghi
- Hematology Unit, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Riccardo Valli
- Pathology Unit, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Albertazzi
- Laboratory of Clinical Chemistry, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudia Vener
- Department of Oncology and Hemato-oncology, Università di Milano, Milano, Italy
| | | | - Antonino Neri
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Chimomo Department, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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46
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Chauhan S, Valenta J, Dhillon GS, Phan P, Huh Y, Manov AE, Wierman A. A Rare Case of Nodular Mantle Cell Lymphoma of the Gastrointestinal Tract Discovered During a Routine Colonoscopy With a Positive Response to R-CHOP Chemotherapy Regimen. Cureus 2023; 15:e42516. [PMID: 37637598 PMCID: PMC10457472 DOI: 10.7759/cureus.42516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
This report describes the case of a 73-year-old female patient who presented with abdominal symptoms. A colonoscopy identified a cecal mass confirmed as mantle cell lymphoma (MCL). Imaging showed extensive lymph node involvement. The patient received rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (R-CHOP) chemotherapy, resulting in tumor reduction and adenopathy resolution. Despite a typically unfavorable prognosis associated with a high Ki-67 index, the patient responded well to chemotherapy and achieved a favorable outcome. This case highlights the importance of early detection, appropriate treatment which in our case was R-CHOP, and personalized management approaches in addressing MCL.
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Affiliation(s)
| | - Jordan Valenta
- Internal Medicine, MountainView Hospital, Las Vegas, USA
| | | | - Preston Phan
- Medicine, Touro University Nevada, Henderson, USA
| | - Yongwoon Huh
- Family Medicine, Valley Health System, Las Vegas, USA
| | - Andre E Manov
- Internal Medicine, Sunrise Health Graduate Medical Education (GME) Consortium, Las Vegas, USA
| | - Ann Wierman
- Hematology/Oncology, MountainView Hospital, Las Vegas, USA
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47
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Liu YC, Geyer JT. Pediatric Hematopathology in the Era of Advanced Molecular Diagnostics: What We Know and How We Can Apply the Updated Classifications. Pathobiology 2023; 91:30-44. [PMID: 37311434 PMCID: PMC10857803 DOI: 10.1159/000531480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
Pediatric hematologic malignancies often show genetic features distinct from their adult counterparts, which reflect the differences in their pathogenesis. Advances in the molecular diagnostics including the widespread use of next-generation sequencing technology have revolutionized the diagnostic workup for hematologic disorders and led to the identification of new disease subgroups as well as prognostic information that impacts the clinical treatment. The increasing recognition of the importance of germline predisposition in various hematologic malignancies also shapes the disease models and management. Although germline predisposition variants can occur in patients with myelodysplastic syndrome/neoplasm (MDS) of all ages, the frequency is highest in the pediatric patient population. Therefore, evaluation for germline predisposition in the pediatric group can have significant clinical impact. This review discusses the recent advances in juvenile myelomonocytic leukemia, pediatric acute myeloid leukemia, B-lymphoblastic leukemia/lymphoma, and pediatric MDS. This review also includes a brief discussion of the updated classifications from the International Consensus Classification (ICC) and the 5th edition World Health Organization (WHO) classification regarding these disease entities.
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Affiliation(s)
- Yen-Chun Liu
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Julia T. Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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48
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Hallek M. First line therapy of CLL. Hematol Oncol 2023; 41 Suppl 1:129-135. [PMID: 37294974 DOI: 10.1002/hon.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/11/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is one of the most frequent types of leukemia. It typically occurs in elderly patients and has a highly variable clinical course. Only patients with active or symptomatic disease or with advanced Binet or Rai stages require therapy. When treatment is indicated, several therapeutic options exist today and need to be selected. A combination of the BCL2 inhibitor venetoclax with obinutuzumab, monotherapy with inhibitors of Bruton tyrosine kinase (BTK) such as ibrutinib, acalabrutinib or zanubrutinib, while chemoimmunotherapy (CIT) is disappearing as a therapeutic option.
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Affiliation(s)
- Michael Hallek
- Department I of Internal Medicine, University of Cologn, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Köln Düsseldorfe, Bonn, Germany
- Center of Excellence on "Cellular Stress Responses in Aging-Associated Diseases", University of Cologne, Cologne, Germany
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49
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Yang P, Cai Q, Zhang W, Liu S, Liu H, Sun X, Dong Y, Xiao X, Wang J, Li Z, Huang W, Li L, Bao H, Yang W, Wang Y, Wang S, He J, Li X, Liu A, Jing H. Real-world treatment and outcome patterns of patients with mantle cell lymphoma in China: A large, multicenter retrospective analysis. Cancer Med 2023; 12:13204-13216. [PMID: 37148540 PMCID: PMC10315753 DOI: 10.1002/cam4.6009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/04/2023] [Accepted: 04/15/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Mantle cell lymphoma (MCL) is an uncommon heterogeneous subtype of B cell non-Hodgkin lymphoma, and clinical features in MCL appear regional characteristics. MCL treatment opinions are not uniform between countries or regions within Asia and China, and Asian patient-specific data for MCL treatment are fewer. The study aims to explore the clinical characteristics, treatment patterns and prognosis of MCL patients in China. METHODS A total of 805 patients diagnosed with MCL between April 1999 and December 2019 at 19 comprehensive hospitals in China were included in this retrospective analysis. Kaplan-Meier method coupled with the log-rank test was used for univariate analysis, and COX proportional hazards model was used for multivariate analysis (MVA). p < 0.05 was consided statistically significant. All outputs were produced using R version 4.1.0. RESULTS The median age of the cohort was 60.0 years with a male-to-female ratio of 3.36:1. Five-year progression-free survival (PFS) and overall survival (OS) rates were 30.9% and 65.0%, respectively. High-intermediate/high-risk group according to MIPI-c, without high-dose cytarabine, lack of Auto-SCT as consolidation and maintenance treatment and SD/PD in initial treatment remained statistically relevant to poor PFS on MVA, and ki67 ≥50%, B symptoms, high-intermediate/high risk group according to MIPI-c, without high-dose cytarabine, lack of maintenance treatment, SD/PD in initial treatment and relapse/refractory state were independently associated with poorer OS on MVA. CONCLUSIONS First-line high dose cytarabine exposure, auto-SCT as consolidation therapy obtained survival benefits in Chinese population. Our study further confirmed the value of maintenance treatment and explored the application of new drug treatment and bendamustine in R/R MCL patients.
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Affiliation(s)
- Ping Yang
- Department of HematologyPeking University Third HospitalBeijingChina
| | - Qing‐qing Cai
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Wei Zhang
- Department of HematologyPeking Union Medical College HospitalBeijingChina
| | - Shuo‐zi Liu
- Department of HematologyPeking University Third HospitalBeijingChina
| | - Hui Liu
- Department of HematologyBeijing HospitalBeijingChina
| | - Xiu‐hua Sun
- Department of Medical OncologyThe Second Hospital of Dalian Medical UniversityDalianChina
| | - Yu‐jun Dong
- Department of HematologyPeking University First HospitalBeijingChina
| | - Xiu‐bin Xiao
- Senior Department of HematologyThe 5th Medical Center of PLA General HospitalBeijingChina
| | - Jing‐wen Wang
- Department of HematologyBeijing Tongren HospitalBeijingChina
| | - Zhen‐ling Li
- Department of HematologyChina‐Japan Friendship HospitalBeijingChina
| | - Wen‐rong Huang
- Senior Department of HematologyThe 5th Medical Center of PLA General HospitalBeijingChina
| | - Li‐hong Li
- Department of HematologyBeijing Tsinghua Changgung HospitalBeijingChina
| | - Hui‐zheng Bao
- Department of Medical OncologyJilin Cancer HospitalChangchunChina
| | - Wei Yang
- Department of HematologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Ya‐lan Wang
- Department of Medical OncologyBaotou Cancer HospitalBaotouChina
| | - Shu‐ye Wang
- Department of HematologyThe First Hospital of Harbin Medical UniversityHarbinChina
| | - Juan He
- Department of HematologyThe First Hospital of China Medical UniversityShenyangChina
| | - Xiao‐ling Li
- Department of Medical OncologyLiaoning Cancer Hospital & InstituteShenyangChina
| | - Ai‐chun Liu
- Department of Hematology and Lymphatic MedicineHarbin Medical University Cancer HospitalHarbinChina
| | - Hong‐mei Jing
- Department of HematologyPeking University Third HospitalBeijingChina
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50
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Rattanathammethee T, Norasetthada L, Bunworasate U, Wudhikarn K, Julamanee J, Noiperm P, Lanamtieng T, Phiphitaporn P, Navinpipat M, Kanya P, Jit-Ueakul D, Wongkhantee S, Suwannathen T, Chaloemwong J, Wong P, Makruasi N, Khuhapinant A, Prayongratana K, Niparuck P, Kanitsap N, Suwanban T, Intragumtornchai T. Outcomes of polatuzumab vedotin-containing regimens in real-world setting of relapsed and or refractory diffuse large B-cell lymphoma patients: a matched-control analysis from the Thai Lymphoma Study Group (TLSG). Ann Hematol 2023:10.1007/s00277-023-05273-8. [PMID: 37202499 DOI: 10.1007/s00277-023-05273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
Relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) is a challenging condition to treat, and there is an unmet clinical need for effective therapies. Recently, polatuzumab vedotin (Pola), an anti-CD79b antibody-drug-conjugate (ADC), combined with bendamustine-rituximab (BR), has been approved for R/R DLBCL patients. However, real-world data on Pola-based regimens in R/R DLBCL patients, especially in Thailand, are limited. This study aimed to evaluate the efficacy and safety of Pola-based salvage treatment in R/R DLBCL patients in Thailand. Thirty-five patients who received Pola-based treatment were included in the study, and their data were compared to 180 matched patients who received non-Pola-based therapy. The overall response rate (ORR) in the Pola group was 62.8%, with complete remission and partial remission rates of 17.1% and 45.7%, respectively. The median progression-free survival (PFS) and overall survival (OS) were 10.6 months and 12.8 months, respectively. The study found a significantly higher ORR in Pola-based salvage treatments compared to non-Pola-based therapy (62.8% vs. 33.3%). The survival outcomes were also significantly superior in the Pola group, with longer median PFS and OS than the control group. Grades 3-4 adverse events (AEs) were mainly hematological, and they were tolerable. In conclusion, this study provides real-world evidence of the efficacy and safety of Pola-based salvage treatment in R/R DLBCL patients in Thailand. The results of this study are promising and suggest that Pola-based salvage treatment could be a viable option for R/R DLBCL patients who have limited treatment options.
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Affiliation(s)
- Thanawat Rattanathammethee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Udomsak Bunworasate
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kitsada Wudhikarn
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakrawadee Julamanee
- Hematology Unit, Division of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Panarat Noiperm
- Hematology Unit, Division of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Theerin Lanamtieng
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pisa Phiphitaporn
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Manassamon Navinpipat
- Division of Hematology, Department of Medicine, Chulabhorn Hospital, Bangkok, Thailand
| | - Piyapong Kanya
- Division of Hematology, Department of Internal Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Dusit Jit-Ueakul
- Division of Hematology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Somchai Wongkhantee
- Division of Hematology, Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand
| | | | - Juthatip Chaloemwong
- Division of Hematology, Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand
| | - Peerapon Wong
- Division of Hematology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Nisa Makruasi
- Division of Hematology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Archrob Khuhapinant
- Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kannadit Prayongratana
- Division of Hematology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nonglak Kanitsap
- Division of Hematology, Department of Medicine, Thammasat University, Pathumthani, Thailand
| | - Tawatchai Suwanban
- Division of Hematology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Tanin Intragumtornchai
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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