101
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Myocardial infarction as a thrombotic complication of myeloproliferative disorders. Anatol J Cardiol 2016; 16:403-4. [PMID: 27282673 PMCID: PMC5331371 DOI: 10.14744/anatoljcardiol.2016.18293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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102
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Gillet B, Ianotto JC, Mingant F, Didier R, Gilard M, Ugo V, Lippert E, Galinat H. Multiple Electrode Aggregometry is an adequate method for aspirin response testing in myeloproliferative neoplasms and differentiates the mechanisms of aspirin resistance. Thromb Res 2016; 142:26-32. [DOI: 10.1016/j.thromres.2016.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 01/08/2023]
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103
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Charles M, Fontoura R, Sugalski G. Early recognition of intraventricular hemorrhage in the setting of thrombocytosis in the emergency department. Open Access Emerg Med 2016; 8:29-33. [PMID: 27307770 PMCID: PMC4886302 DOI: 10.2147/oaem.s98440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thrombocytosis is frequently encountered as an incidental laboratory finding since isolated thrombocytosis is often asymptomatic. Even though thrombocytosis is benign and self-limiting in most cases, it can at times result in thrombosis or hemorrhage. The most common type of thrombocytosis is reactive (secondary) thrombocytosis and can be due to infections, trauma, surgery, or occult malignancy. Since thrombocytosis is a known risk factor for thrombosis, it is commonly a concern for ischemic stroke and myocardial infarction. Much less common are hemorrhagic events associated with thrombocytosis. Studies have shown that when hemorrhage is present in patients with thrombocytosis, it is most often seen in the setting of chronic myelogenous leukemia and essential thrombocythemia. In essential thrombocythemia, the overall risk of bleeding and thrombosis is 0.33% per patient-year and 6.6% per patient-year, respectively. In the general population, the risk of bleeding and thrombosis is 0% and 1.2%, respectively. The present study is a case report of an 83-year-old man who presented to the emergency department with hypertension and headache, who was then found to have significant thrombocytosis (platelets >1,000×10(9)/L) and acute right intraventricular hemorrhage without any signs of neurological deficits, or evidence of vascular malformations or mass. We present this case report for review and discussion of some of the challenges and considerations associated with the management of such patients.
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Affiliation(s)
- Marvinia Charles
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Romy Fontoura
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory Sugalski
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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104
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Atilla E, Topcuoglu P, Ataca P, Pekcan G, Bozdag SC, Yuksel MK, Ozcan M, Gurman G, Toprak SK. A rare complication after allogeneic stem cell transplantation: post-transplant erythrocytosis. Clin Transplant 2016; 30:669-72. [PMID: 27028115 DOI: 10.1111/ctr.12741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/29/2022]
Abstract
Post-transplant erythrocytosis is an infrequent complication and has been reported after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in aplastic anemia, acute myeloid leukemia, and chronic myeloid leukemia. The pre-disposing factors and treatment are not clearly defined. We present 11 post-transplant erythrocytosis cases. More studies should be conducted to distinguish the pathogenesis and follow-up for this rare complication.
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Affiliation(s)
- Erden Atilla
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Pervin Topcuoglu
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Pinar Ataca
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Gultekin Pekcan
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Sinem Civriz Bozdag
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Meltem Kurt Yuksel
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Muhit Ozcan
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Gunhan Gurman
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Selami Kocak Toprak
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
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105
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Görtzen J, Hunka LM, Vonnahme M, Praktiknjo M, Kaifie A, Fimmers R, Jansen C, Heine A, Lehmann J, Goethert JR, Gattermann N, Goekkurt E, Platzbecker U, Brossart P, Strassburg CP, Brummendorf TH, Koschmieder S, Wolf D, Trebicka J. γ-Glutamyl Transferase Is an Independent Biomarker of Splanchnic Thrombosis in Patients With Myeloproliferative Neoplasm. Medicine (Baltimore) 2016; 95:e3355. [PMID: 27196445 PMCID: PMC4902387 DOI: 10.1097/md.0000000000003355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Myeloproliferative neoplasms (MPNs) are associated with an increased risk of thrombotic events and constitute the major risk factor of splanchnic venous thrombosis (SVT) in Western countries. Although timely anticoagulation resolves SVT, unrecognized SVT frequently leads to portal hypertension and, potentially, variceal bleeding, which may render anticoagulation difficult. Thus, early identification of SVT development is clinically relevant in MPN patients.In this retrospective analysis, we included 126 patients with MPN and/or SVT referred to our hospital between 2009 and 2014. A total of 86 patients diagnosed with MPN formed the first cohort (PV n = 18, ET n = 16, and MF n = 40), whereas 40 patients who had SVT without adjunct MPN formed a control cohort. Median follow-up period was 960 days. Clinical and laboratory data were collected and analyzed for the identification of potential biomarkers applying descriptive statistics, nonparametric testing, Kaplan-Meier, and logistic regression analysis. The relevance of the identified biomarkers was evaluated in an independent 2nd cohort of 181 patients from the MPN registry of the Study Alliance of Leukemia (SAL-MPN).Thirty-three MPN patients (38%) in the 1st cohort had SVT. Elevated levels of aspartate aminotransferase, alanine aminotransferase, serum bilirubin, or γ-GT were significantly correlated to the presence of SVT. In multivariate testing, CRP and aspartate aminotransferase were predictors for survival and γ-GT remained the only significant variable associated with SVT in MPN patients (P < 0.05). These findings were confirmed in the 2nd cohort comprising 42% of patients with MPN suffering from SVT.Elevated γ-GT levels indicate SVT in MPN patients, whereas CRP levels are independent predictors of patient survival.
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Affiliation(s)
- Jan Görtzen
- From the Department of Internal Medicine I (GJ, HLM, PM, JC, LJ, SC, TJ); Department of Medical Clinic III, University of Bonn, Bonn (VM, HA, BP, WD); Department of Hematology, Oncology, Hemostaseology, and SCT, Faculty of Medicine, University Hospital of the RWTH Aachen University, Aachen (KA, BTH, KS); Department of Biometrics, Informatics and Epidemiology, University of Bonn, Bonn (FR); Department for Hematology, University Hospital Essen, Essen (GJ); Department for Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Duesseldorf (GN); Practice for Hematology-Oncology Eppendorf, Hamburg (GE); and Department for Hematology, University Hospital Dresden, Dresden, Germany (PU)
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106
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Soyer N, Haznedaroğlu İC, Cömert M, Çekdemir D, Yılmaz M, Ünal A, Çağlıyan G, Bilgir O, İlhan O, Özdemirkıran F, Kaya E, Şahin F, Vural F, Saydam G. Multicenter Retrospective Analysis of Turkish Patients with Chronic Myeloproliferative Neoplasms. Turk J Haematol 2016; 34:27-33. [PMID: 27094252 PMCID: PMC5451685 DOI: 10.4274/tjh.2016.0005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: Chronic myeloproliferative neoplasms (CMPNs) that include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) are Philadelphia-negative malignancies characterized by a clonal proliferation of one or several lineages. The aim of this report was to determine the demographic features, disease characteristics, treatment strategies, and survival rates of patients with CMPNs in Turkey. Materials and Methods: Across all of Turkey, 9 centers were enrolled in the study. We retrospectively evaluated 708 CMPN patients’ results including 390 with ET, 213 with PV, and 105 with PMF. Results: The JAK2V617F mutation was found positive in 86% of patients with PV, in 51.5% of patients with ET, and in 50.4% of patients with PMF. Thrombosis and bleeding at diagnosis occurred in 20.6% and 7.5% of PV patients, 15.1% and 9% of ET patients, and 9.5% and 10.4% of PMF patients, respectively. Six hundred and eight patients (85.9%) received cytoreductive therapy. The most commonly used drug was hydroxyurea (89.6%). Leukemic and fibrotic transformations occurred at rates of 0.6% and 13.2%. The estimated overall survival in PV, ET, and PMF patients was 89.7%, 85%, and 82.5% at 10 years, respectively. There were no significant differences between survival in ET, PV, and PMF patients at 10 years. Conclusion: Our patients’ results are generally compatible with the literature findings, except for the relatively high survival rate in PMF patients. Hydroxyurea was the most commonly used cytoreductive therapy. Our study reflects the demographic features, patient characteristics, treatments, and survival rates of Turkish CMPN patients.
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Affiliation(s)
- Nur Soyer
- Ege University Faculty of Medicine, Department of Hematology, İzmir, Turkey Phone: +90 232 390 42 87 E-mail:
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107
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Andıç N, Ünübol M, Yağcı E, Akay OM, Yavaşoğlu İ, Kadıköylü VG, Bolaman AZ. Clinical Features of 294 Turkish Patients with Chronic Myeloproliferative Neoplasms. Turk J Haematol 2016; 33:187-95. [PMID: 27094255 PMCID: PMC5111463 DOI: 10.4274/tjh.2015.0041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: Myeloproliferative neoplasms (MPNs) share common clonal stem cells but show significant differences in their clinical courses. The aim of this retrospective study was to evaluate thrombotic and hemorrhagic complications, JAK2 status, gastrointestinal and cardiac changes, treatment modalities, and survival in MPNs in Turkish patients. Materials and Methods: Medical files of 294 patients [112 essential thrombocythemia (ET), 117 polycythemia vera (PV), 46 primary myelofibrosis, and 19 unclassified MPN cases] from 2 different universities in Turkey were examined. Results: Older age, higher leukocyte count at diagnosis, and JAK2 mutation positivity were risk factors for thrombosis. Platelet count over 1000x109/L was a risk factor for hemorrhagic episodes. Hydroxyurea treatment was not related to leukemic transformation. Median follow-up time was 50 months (quartiles: 22.2-81.75) in these patients. Patients with primary myelofibrosis had the shortest survival of 137 months when compared with 179 months for ET and 231 months for PV. Leukemic transformation, thromboembolic events, age over 60 years, and anemia were found to be the factors affecting survival. Conclusion: Thromboembolic complications are the most important preventable risk factors for morbidity and mortality in MPNs. Drug management in MPNs is done according to hemoglobin and platelet counts. Based on the current study population our results support the idea that leukocytosis and JAK2 positivity are more important risk factors for thrombosis than hemoglobin and platelet values.
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Affiliation(s)
- Neslihan Andıç
- Osmangazi University Faculty of Medicine, Department of Hematology, Eskişehir, Turkey, Phone: +90 532 518 22 63, E-mail:
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108
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Kaifie A, Kirschner M, Wolf D, Maintz C, Hänel M, Gattermann N, Gökkurt E, Platzbecker U, Hollburg W, Göthert JR, Parmentier S, Lang F, Hansen R, Isfort S, Schmitt K, Jost E, Serve H, Ehninger G, Berdel WE, Brümmendorf TH, Koschmieder S. Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry. J Hematol Oncol 2016; 9:18. [PMID: 26944254 PMCID: PMC4779229 DOI: 10.1186/s13045-016-0242-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 02/10/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients with Ph-negative myeloproliferative neoplasms (MPN), such as polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are at increased risk for thrombosis/thromboembolism and major bleeding. Due to the morbidity and mortality of these events, antiplatelet and/or anticoagulant agents are commonly employed as primary and/or secondary prophylaxis. On the other hand, disease-related bleeding complications (i.e., from esophageal varices) are common in patients with MPN. This analysis was performed to define the frequency of such events, identify risk factors, and assess antiplatelet/anticoagulant therapy in a cohort of patients with MPN. METHODS The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008). For statistical analysis, descriptive methods and tests for significant differences as well as contingency tables were used to identify the odds of potential risk factors for vascular events. RESULTS MPN subgroups significantly differed in sex distribution, age at diagnosis, blood counts, LDH levels, JAK2V617F positivity, and spleen size (length). While most thromboembolic events occurred around the time of MPN diagnosis, one third of these events occurred after that date. Splanchnic vein thrombosis was most frequent in post-PV-MF and MPN-U patients. The chance of developing a thromboembolic event was significantly elevated if patients suffered from post-PV-MF (OR 3.43; 95% CI = 1.39-8.48) and splenomegaly (OR 1.76; 95% CI = 1.15-2.71). Significant odds for major bleeding were previous thromboembolic events (OR = 2.71; 95% CI = 1.36-5.40), splenomegaly (OR = 2.22; 95% CI 1.01-4.89), and the administration of heparin (OR = 5.64; 95% CI = 1.84-17.34). Major bleeding episodes were significantly less frequent in ET patients compared to other MPN subgroups. CONCLUSIONS Together, this report on an unselected "real-world" cohort of German MPN patients reveals important data on the prevalence, diagnosis, and treatment of thromboembolic and major bleeding complications of MPN.
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Affiliation(s)
- A. Kaifie
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - M. Kirschner
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - D. Wolf
- Internal Medicine 3, Oncology, Hematology and Rheumatology, University Clinic Bonn (UKB), Bonn, Germany
| | - C. Maintz
- Practice for Hematology and Oncology, Wuerselen, Germany
| | - M. Hänel
- Department for Hematology, Oncology, Stem Cell Transplantation, Hospital Chemnitz, Chemnitz, Germany
| | - N. Gattermann
- Department for Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - E. Gökkurt
- Practice for Hematology-Oncology Eppendorf, Hamburg, Germany
| | - U. Platzbecker
- Department for Hematology, University Hospital Dresden, Dresden, Germany
| | - W. Hollburg
- Practice for Hematology and Oncology Altona, Hamburg, Germany
| | - J. R. Göthert
- Department for Hematology, University Hospital Essen, Essen, Germany
| | - S. Parmentier
- Department for Hematology, Oncology and Palliative Care, Rems-Murr-Hospitals, Winnenden, Germany
| | - F. Lang
- Department for Hematology and Oncology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - R. Hansen
- Practice for Hematology and Oncology, Kaiserslautern, Germany
| | - S. Isfort
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - K. Schmitt
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - E. Jost
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - H. Serve
- Department for Hematology and Oncology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - G. Ehninger
- Department for Hematology, University Hospital Dresden, Dresden, Germany
| | - W. E. Berdel
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - T. H. Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - S. Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
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109
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Andriani A, Latagliata R, Anaclerico B, Spadea A, Rago A, Di Veroli A, Spirito F, Porrini R, De Muro M, Crescenzi Leonetti S, Villivà N, De Gregoris C, Montefusco E, Polverelli N, Santoro C, Breccia M, Cimino G, Majolino I, Mazzucconi MG, Vianelli N, Alimena G, Montanaro M, Palandri F. Spleen enlargement is a risk factor for thrombosis in essential thrombocythemia: Evaluation on 1,297 patients. Am J Hematol 2016; 91:318-21. [PMID: 26748894 DOI: 10.1002/ajh.24269] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 12/31/2022]
Abstract
Spleen enlargement, present in 10-20% of Essential Thrombocythemia (ET) patients at diagnosis, is a feature clinically easy to assess, confirmable by echography with a very low chance of misinterpretation. Nonetheless, the clinical and prognostic role of splenomegaly has been seldom evaluated. From 1979 to 2013, 1297 ET patients retrospectively collected in the database of the Lazio Cooperative Group and Bologna University Hospital were evaluable for spleen enlargement at diagnosis and included in the analysis. On the whole, spleen was enlarged in 172/1297 (13.0%) patients; in most cases (94.8%) splenomegaly was mild (≤5 cm). Patients with splenomegaly were younger, predominantly male, presented higher platelet count and JAK2V617F allele burden and had a lower incidence of concomitant cardiovascular risk factors. At least one thrombotic event during follow-up occurred in 97/1,125 (8.6%) patients without spleen enlargement compared to 27/172 (15.7%) patients with spleen enlargement (P = 0.003). Despite comparable use of cytoreductive/antiplatelet therapies in the two groups, the cumulative risk of thrombosis at 5 years was significantly higher in patients with baseline splenomegaly (9.8% versus 4.4% in patients without splenomegaly, P = 0.012). In multivariate analysis exploring risk factors for thrombosis, splenomegaly retained its negative prognostic role, together with previous thrombosis, leucocyte count and male gender. Baseline splenomegaly seems to be an independent additional risk factor for thrombosis in nonstrictly WHO-defined ET patients. This data could be useful in the real-life clinical management of these patients.
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Affiliation(s)
| | - Roberto Latagliata
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Rome
| | | | - Antonio Spadea
- Hematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute, Rome
| | - Angela Rago
- Division of Hematology, Polo Universitario Pontino, Latina
| | | | - Francesca Spirito
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliera San Camillo-Forlanini, Rome
| | | | | | | | | | | | | | - Nicola Polverelli
- Institute of Hematology "L. And a. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Italy
| | - Cristina Santoro
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Rome
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Rome
| | | | - Ignazio Majolino
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliera San Camillo-Forlanini, Rome
| | | | - Nicola Vianelli
- Institute of Hematology "L. And a. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Italy
| | - Giuliana Alimena
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Rome
| | | | - Francesca Palandri
- Institute of Hematology "L. And a. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Italy
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110
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Assessment of rotation thromboelastometry parameters in patients with essential thrombocythemia at diagnosis and after hydroxyurea therapy. Blood Coagul Fibrinolysis 2016; 27:205-9. [DOI: 10.1097/mbc.0000000000000421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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111
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Sørensen AL, Hasselbalch HC. Antecedent cardiovascular disease and autoimmunity in Philadelphia-negative chronic myeloproliferative neoplasms. Leuk Res 2016; 41:27-35. [DOI: 10.1016/j.leukres.2015.11.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/14/2015] [Accepted: 11/28/2015] [Indexed: 01/07/2023]
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112
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Lucewicz A, Fisher K, Henry A, Welsh AW. Review of the correlation between blood flow velocity and polycythemia in the fetus, neonate and adult: appropriate diagnostic levels need to be determined for twin anemia-polycythemia sequence. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:152-157. [PMID: 25580896 DOI: 10.1002/uog.14782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/01/2014] [Accepted: 01/02/2015] [Indexed: 06/04/2023]
Abstract
Twin anemia-polycythemia sequence (TAPS) is recognized increasingly antenatally by the demonstration of an anemic twin and a polycythemic cotwin using the middle cerebral artery peak systolic velocity (MCA-PSV). While the MCA-PSV has been shown to correlate well with anemia in singleton fetuses, the evidence to support its use to diagnose fetal polycythemia appears to be less clear-cut. We aimed to evaluate fetal, neonatal and adult literature used to support the use of MCA-PSV for the diagnosis of polycythemia. Comprehensive literature searches were performed for ultrasound evidence of polycythemia in the human fetus, neonate and adult using key search terms. Only manuscripts in the English language with an abstract were considered for the review, performed in June 2014. Fifteen manuscripts were found for the human fetus, including 38 cases of TAPS. Nine of these defined fetal polycythemia as MCA-PSV < 0.8 multiples of the median (MoM), five used < 1.0 MoM and one used 0.8-1.0 MoM. Only two studies, involving a total of 15 cases, proposed a diagnostic level, acknowledging false-positive and -negative cases, though neither reported sensitivities or specificities. Six neonatal studies (96 neonates) demonstrated evidence of decreased cerebral velocities in polycythemia and a consequent increase with hemodilution. In the adult, five studies (57 polycythemic adults) demonstrated increased flow or velocity with hemodilution. Neither neonatal nor adult studies conclusively defined levels for screening for polycythemia. Despite widespread adoption of a cut-off of < 0.8 MoM in the published literature for the polycythemic fetus in TAPS, this is based upon minimal evidence, with unknown sensitivity and specificity. We recommend caution in excluding TAPS based purely upon the absence of a reduced MCA-PSV.
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Affiliation(s)
- A Lucewicz
- Department of Obstetrics & Gynaecology, Westmead Hospital, Westmead, NSW, Australia
| | - K Fisher
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - A Henry
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW, Australia
- Department of Obstetrics and Gynaecology, St George Hospital, Kogarah, NSW, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Randwick, NSW, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia
| | - A W Welsh
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Randwick, NSW, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia
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113
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Okabe M, Yamaguchi H, Usuki K, Kobayashi Y, Kawata E, Kuroda J, Kimura S, Tajika K, Gomi S, Arima N, Mori S, Ito S, Koizumi M, Ito Y, Wakita S, Arai K, Kitano T, Kosaka F, Dan K, Inokuchi K. Clinical features of Japanese polycythemia vera and essential thrombocythemia patients harboring CALR, JAK2V617F, JAK2Ex12del, and MPLW515L/K mutations. Leuk Res 2015; 40:68-76. [PMID: 26614694 DOI: 10.1016/j.leukres.2015.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 10/03/2015] [Accepted: 11/02/2015] [Indexed: 01/17/2023]
Abstract
The risk of complication of polycythemia vera (PV) and essential thrombocythemia (ET) by thrombosis in Japanese patients is clearly lower than in western populations, suggesting that genetic background such as race may influence the clinical features. This study aimed to clarify the relationship between genetic mutations and haplotypes and clinical features in Japanese patients with PV and ET. Clinical features were assessed prospectively among 74 PV and 303 ET patients. There were no clinical differences, including JAK2V617F allele burden, between PV patients harboring the various genetic mutations. However, CALR mutation-positive ET patients had a significantly lower WBC count, Hb value, Ht value, and neutrophil alkaline phosphatase score (NAP), and significantly more platelets, relative to JAK2V617F-positive ET patients and ET patients with no mutations. Compared to normal controls, the frequency of the JAK246/1 haplotype was significantly higher among patients with JAK2V617F, JAK2Ex12del, or MPL mutations, whereas no significant difference was found among CALR mutation-positive patients. CALR mutation-positive patients had a lower incidence of thrombosis relative to JAK2V617F-positive patients. Our findings suggest that JAK2V617F-positive ET patients and CALR mutation-positive patients have different mechanisms of occurrence and clinical features of ET, suggesting the potential need for therapy stratification in the future.
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Affiliation(s)
| | | | - Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Japan
| | - Yutaka Kobayashi
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Japan
| | - Eri Kawata
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Kyoto Prefectural University of Medicine, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Kenji Tajika
- Department of Hematology, Yokohama Minami Kyousai Hospital, Japan
| | - Seiji Gomi
- Department of Hematology, Yokohama Minami Kyousai Hospital, Japan
| | | | - Sinichiro Mori
- Hemato-Oncology Department, St Luke's International Hospital, Japan
| | - Shigeki Ito
- Department of Hematology, Iwate Medical University, Japan
| | | | - Yoshikazu Ito
- Department of Hematology, Tokyo Medical University, Japan
| | | | - Kunihito Arai
- Department of Hematology, Nippon Medical School, Japan
| | | | - Fumiko Kosaka
- Department of Hematology, Nippon Medical School, Japan
| | - Kazuo Dan
- Department of Hematology, Nippon Medical School, Japan
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114
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Tortorella G, Calzolari M, Tieghi A, Muià N, Piccin A, Gugliotta L. Acute coronary syndrome (ACS) in patients with essential thrombocytemia (ET). What is the best treatment? Int J Cardiol 2015; 203:225-7. [PMID: 26512843 DOI: 10.1016/j.ijcard.2015.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- G Tortorella
- Cardiology Unit, Azienda Ospedaliera Santa Maria Nuova-IRCCS Reggio Emilia, Italy
| | - M Calzolari
- Cardiology Unit, Azienda Ospedaliera Santa Maria Nuova-IRCCS Reggio Emilia, Italy.
| | - A Tieghi
- Hematology Unit, Azienda Ospedaliera Santa Maria Nuova-IRCCS Reggio Emilia, Italy
| | - N Muià
- Cardiology Unit, Azienda Ospedaliera Santa Maria Nuova-IRCCS Reggio Emilia, Italy
| | - A Piccin
- Hematology Unit, San MaurizioRregional Hospital, Bolzano, South Tyrol, Italy
| | - L Gugliotta
- Hematology Institute L.e A. Serignoli S.Orsola Malpighi University Hospital, Bologna, Italy
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115
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Bleeding complications in BCR-ABL negative myeloproliferative neoplasms: prevalence, type, and risk factors in a single-center cohort. Int J Hematol 2015; 102:587-93. [PMID: 26440973 DOI: 10.1007/s12185-015-1871-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/09/2015] [Accepted: 09/18/2015] [Indexed: 12/29/2022]
Abstract
The BCR-ABL1-negative myeloproliferative neoplasms (MPN) share an increased risk of thrombotic and hemorrhagic complications. Risk factors for hemorrhage are less well defined than those for thrombosis. Because patients with CALR mutations have higher platelet counts compared to JAK2 V617F-mutated patients, bleeding rates may be increased in this group. Our aim was to retrospectively evaluate whether acquired von Willebrand disease (AvWD), thrombocytosis, mutational status, or treatment history are associated with bleeding in a cohort of MPN patients. Using an electronic database, MPN patients seen between 2005 and 2013 were retrospectively identified using ICD-9 codes and billing records. A bleeding event was defined as one that was identified in the medical record and graded based on the Common Terminology Criteria for Adverse Event (CTCAE) version 4.0. Among 351 MPN patients, 15.6 % experienced 64 bleeding event types. There was no association of bleeding with mutational status, gender, MPN subtype, aspirin use, prior thrombosis, or platelet count at presentation. There was an association between bleeding and older age at diagnosis. aVWD was identified in six patients. In this single-center retrospective study, bleeding events were identified in 15 % of patients, and associated with older age at diagnosis. aVWD was rarely tested for in this cohort.
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116
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Rajasekaran A, Ngo TT, Abdelrahim M, Glass W, Podoll A, Verstovsek S, Abudayyeh A. Primary myelofibrosis associated glomerulopathy: significant improvement after therapy with ruxolitinib. BMC Nephrol 2015; 16:121. [PMID: 26232031 PMCID: PMC4521341 DOI: 10.1186/s12882-015-0121-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary myelofibrosis (PMF) is a type of myeloproliferative neoplasm (MPN) characterized by the predominant proliferation of megakaryocytes and granulocytes in the bone marrow, leading to the deposition of fibrous tissue, and by a propensity toward extramedullary hematopoiesis. Renal involvement in PMF is rare, but kidney tissue samples from these patients reveal MPN-related glomerulopathy, a recently discovered condition, in the late stages of the disease. CASE PRESENTATION We present the first case described in the medical literature of a patient with early renal glomerular involvement in PMF/MPN. A 60-year-old man with stage 4 chronic kidney disease and a recent diagnosis of PMF (within 4 weeks of presentation at our renal division) presented with generalized body swelling, acute kidney injury, and massive nephrotic-range proteinuria. Kidney biopsy was performed to determine the etiology of the patient's renal dysfunction and revealed early renal glomerular involvement that was histologically characteristic of MPN-related glomerulopathy. Early diagnosis and prompt medical management returned the patient's kidney functionality to the levels seen on initial presentation at our hospital. CONCLUSION Large studies with long follow-up durations are necessary to identify and categorize the risk factors for the development of MPN-related glomerulopathy, to standardize therapeutic regimens, and to determine whether aggressive management of the myelofibrosis slows the progression of kidney disease.
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Affiliation(s)
- Arun Rajasekaran
- Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Thuy-Trang Ngo
- Department of Nephrology, The University of Texas Medical School at Houston, Houston, TX, USA.
| | - Maen Abdelrahim
- Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA.
| | - William Glass
- Department of Renal Pathology, The University of Texas Medical School at Houston, Houston, TX, USA.
| | - Amber Podoll
- Department of Nephrology, The University of Texas Medical School at Houston, Houston, TX, USA.
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Ala Abudayyeh
- Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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117
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Fujino A, Hao H, Kajimoto N, Kawakami R, Imanaka T, Fujii K, Abe T, Ishihara M, Hirota S. Restenosis After Drug-Eluting Stent Implantation in a Patient With Polycythemia Vera. JACC Cardiovasc Interv 2015; 8:e111-2. [DOI: 10.1016/j.jcin.2015.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/29/2015] [Indexed: 10/23/2022]
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118
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Howell C, Douglas K, Cho G, El-Ghariani K, Taylor P, Potok D, Rintala T, Watkins S. Guideline on the clinical use of apheresis procedures for the treatment of patients and collection of cellular therapy products. Transfus Med 2015; 25:57-78. [PMID: 26013470 DOI: 10.1111/tme.12205] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 01/19/2023]
Affiliation(s)
- C. Howell
- Diagnostic & Therapeutic Services; NHS Blood and Transplant; Bristol UK
| | - K. Douglas
- Beatson West of Scotland Cancer Centre; Glasgow UK
- Scottish National Blood Transfusion Service; Glasgow UK
| | - G. Cho
- London North West Healthcare NHS Trust; Harrow UK
| | - K. El-Ghariani
- Therapeutics & Tissue Services; NHS Blood and Transplant; Sheffield UK
| | - P. Taylor
- The Rotherham NHS Foundation Trust; Rotherham UK
| | - D. Potok
- Diagnostic & Therapeutic Services; NHS Blood and Transplant; Leeds UK
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119
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Essential thrombocythemia-related stroke and improvement with tissue plasminogen activator. Am J Med Sci 2015; 350:152. [PMID: 26002850 DOI: 10.1097/maj.0000000000000497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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120
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Gorukmez O, Sag ŞO, Gorukmez Ö, Ture M, Topak A, Sahinturk S, Ozkaya G, Gulten T, Ali R, Yakut T. Association of the ACE I/D gene polymorphisms with JAK2V617F-positive polycythemia vera and essential thrombocythemia. Genet Test Mol Biomarkers 2015; 19:303-8. [PMID: 25955555 DOI: 10.1089/gtmb.2014.0334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The renin-angiotensin system contributes to cell growth, proliferation, and differentiation in the bone marrow. We investigated the role of the ACE I/D gene polymorphism in 108 polycythemia vera (PV) and essential thrombocytosis (ET) patients who were positive for the JAK2V617F mutation, with a thrombosis group (TG) of 95 patients who had a history of vascular events, but did not have a history of myeloproliferative neoplasms and compared these to a healthy control group (CG) of 72 subjects. In the patients, II genotype and I allele frequency (p=0.009, odds ratio [OR]=9.716, 95% confidence interval [CI]=1.242-76.00, p=0.004, OR=2.019, 95% CI=1.243-3.280, respectively) were found to be higher than those in the controls. The DD genotype (p=0.021, OR=0.491, 95% CI=0.268-0.899) and D allele (p=0.004, OR=0.495, 95% CI=0.305-0.805) were found to be correlated with a decreased risk of a myeloproliferative neoplasm. These findings support the hypothesis that the ACE II genotype and I allele may be related to increased risk of ET and PV. Conversely, the DD genotype and D allele may be related to decreased risk of ET and PV. The results also indicated that the ACE I/D gene polymorphism was independent of thrombosis formation.
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Affiliation(s)
- Orhan Gorukmez
- 1 Şevket Yılmaz Training and Research Hospital , Medical Genetics Unit, Bursa, Turkey
| | - Şebnem Ozemri Sag
- 2 Department of Medical Genetics, School of Medicine, Uludag University , Bursa, Turkey
| | - Özlem Gorukmez
- 2 Department of Medical Genetics, School of Medicine, Uludag University , Bursa, Turkey
| | - Mehmet Ture
- 2 Department of Medical Genetics, School of Medicine, Uludag University , Bursa, Turkey
| | - Ali Topak
- 2 Department of Medical Genetics, School of Medicine, Uludag University , Bursa, Turkey
| | - Serdar Sahinturk
- 2 Department of Medical Genetics, School of Medicine, Uludag University , Bursa, Turkey
| | - Güven Ozkaya
- 3 Department of Biostatistics, School of Medicine, Uludag University , Bursa, Turkey
| | - Tuna Gulten
- 2 Department of Medical Genetics, School of Medicine, Uludag University , Bursa, Turkey
| | - Rıdvan Ali
- 4 Division of Hematology, Department of Internal Medicine, School of Medicine, Uludag University , Bursa
| | - Tahsin Yakut
- 2 Department of Medical Genetics, School of Medicine, Uludag University , Bursa, Turkey
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121
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Bhandary SP, Papadimos TJ, Essandoh MK, Apostolakis J. Massive intracardiac thrombosis during coronary artery bypass grafting surgery. Int J Crit Illn Inj Sci 2015; 5:56-8. [PMID: 25810967 PMCID: PMC4366831 DOI: 10.4103/2229-5151.152347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Thrombosis is a potential life-threatening complication in patients undergoing cardiac surgery. Various clinical and heritable conditions, like cancer, trauma, immobilization, the presence of factor V Leiden or prothrombin 20210A, deficiency of or resistance to the inhibitor proteins C, S, or antithrombin, elevated levels of coagulation proteins, antiphospholipid antibody syndrome, pregnancy, and the use of exogenous hormones, may contribute to catastrophic thrombosis. Massive thrombi with cerebrovascular and cardiovascular events develop in patients with polycythemia vera (PV). However, thrombus formation in the cardiac chambers is extremely rare. We report a case of massive intracardiac thrombosis in a patient undergoing coronary artery bypass grafting.
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Affiliation(s)
- Sujatha P Bhandary
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael K Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John Apostolakis
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Main Campus, Cleveland, Ohio, USA
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122
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Szumowska A, Galar M, Bolkun L, Kloczko J. Plasma Concentrations of Protein Z and Protein Z-Dependent Protease Inhibitor in Patients With Essential Thrombocythemia. Clin Appl Thromb Hemost 2015; 22:679-84. [PMID: 25783867 DOI: 10.1177/1076029615576741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The pathological consequences of decreased protein Z (PZ) and/or Z-dependent protease inhibitor (ZPI) levels remain as yet unclear, despite a growing body of evidence which supports their involvement in an increased thrombotic risk. The purpose of the present study was 2-fold: to evaluate plasma concentrations of protein Z and ZPI in patients with essential thrombocythemia (ET) and to determine their significance in thrombotic complications. The median (range) plasma concentrations of PZ in our patients with ET were lower, but not significantly, than in healthy individuals: PZ (1.42 µg/mL, 0.36-3.14 µg/mL vs 1.6 µg/mL, 0.75-2.56 µg/mL, P = .08). On the other hand, the median (range) plasma concentrations of ZPI in the said patients with ET were meaningfully lower than in the reference group: ZPI (3.22 µg/mL, 0.85-6.97 µg/mL vs 4.41 µg/mL, 1.63-7.83 µg/mL, P = .0004). More importantly, the study revealed a statistically significant lower concentration of PZ and ZPI in patients with the presence of the JAK2V617F mutation relative to patients without the mutation, for PZ: 1.38 µg/mL, 0.36-2.6 µg/mL versus 1.63 µg/mL, 0.88-3.14 µg/mL, P = .03, and ZPI 2.89 µg/mL, 0.85-5.91 µg/mL versus 3.61 µg/mL, 1.53-6.97 µg/mL, P = .002. Additionally, significant differences between the concentrations of PZ and ZPI were found in patients with venous thrombotic episodes compared to healthy individuals, for PZ: 1.23 µg/mL, 0.82-1.99 µg/mL versus 1.6 µg/mL, 0.75-2.56 µg/mL, P = .043, and ZPI: 2.42 µg/mL, 0.85-4.21 µg/mL versus 4.41 µg/mL, 1.63-7.83 µg/mL, P < .0001. To recapitulate, our results suggest that the deficiency of PZ may increase tendency to thrombosis in patients with ET.
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Affiliation(s)
- Anna Szumowska
- Department of Haematology, Medical University, Bialystok, Poland
| | - Marzenna Galar
- Department of Haematology, Medical University, Bialystok, Poland
| | - Lukasz Bolkun
- Department of Haematology, Medical University, Bialystok, Poland
| | - Janusz Kloczko
- Department of Haematology, Medical University, Bialystok, Poland
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123
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Weingarten TN, Hofer RE, Ahle BJ, Kemp KM, Nkwonta JA, Narr BJ, Pardanani A, Schroeder DR, Sprung J. Perioperative blood product administration and thromboembolic events in patients with treated polycythemia vera: a case-control study. Transfusion 2015; 55:1090-7. [PMID: 25727411 DOI: 10.1111/trf.13006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/13/2014] [Accepted: 10/17/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Patients with polycythemia vera (PV) have historically been considered to be at high risk for perioperative hemorrhagic and thromboembolic complications. However, no recent studies have compared these outcomes between treated PV patients and patients without PV undergoing similar procedures. STUDY DESIGN AND METHODS Patients with PV who underwent surgery with anesthesia from June 1, 2006, to May 31, 2011, were randomly matched (sex, age, type of surgical procedure, surgical year) at a ratio of 1:4 with control patients without PV. Conditional logistic regression analysis adjusting for surgical duration, preoperative hemoglobin, platelet count, and cardiovascular disease was used to assess the association between PV and blood product transfusions, thromboembolism, and other major cardiovascular and pulmonary complications. RESULTS Fifty-six PV patients who underwent 79 surgeries were matched with 312 controls. During hospitalization, 35 (44.3%) and 82 (25.9%) PV and control patients, respectively, were transfused with blood products. PV patients were at increased risk for transfusion intraoperatively (odds ratio [OR], 4.35; 95% confidence interval [CI], 1.79-10.57; p = 0.001) and during hospitalization (OR, 4.35; 95% CI, 1.84-10.31; p < 0.001). The likelihood of thromboembolic complications and/or other major complications did not differ between the two study groups (thromboembolic-OR 1.53, 95% CI 0.39-6.02, p = 0.540; other major complications-OR 2.15, 95% CI 0.93-4.96, p = 0.073). CONCLUSIONS Medically managed PV patients had an increased likelihood of receiving blood products perioperatively. Given the low number of observed thromboembolic events, we cannot make definitive conclusions regarding the association between PV and thromboembolism.
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Affiliation(s)
| | | | | | | | | | | | | | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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124
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Lim Y, Lee JO, Kim SH, Kim JW, Kim YJ, Lee KW, Lee JS, Bang SM. Prediction of thrombotic and hemorrhagic events during polycythemia vera or essential thrombocythemia based on leukocyte burden. Thromb Res 2015; 135:846-51. [PMID: 25743883 DOI: 10.1016/j.thromres.2015.02.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/21/2015] [Accepted: 02/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidences suggest an association between leukocytosis and thrombotic or hemorrhagic complication in polycythemia vera (PV) and essential thrombocythemia (ET), but clinical implication is not well known. OBJECTIVE To evaluate whether leukocyte burden during follow-up is related to thrombotic or hemorrhagic events in PV and ET. PATIENTS/METHODS We retrospectively analyzed patients with PV or ET treated at Seoul National University Bundang Hospital, Korea. Time-weighted averages of leukocytes during the follow-up period were defined as leukocyte burden and were calculated for each patient and compared between patient subgroups. In each patient with events, leukocyte burden for the 3-month period before the event was compared with that for the entire follow-up period. RESULTS In 102 patients with PV or ET, 35 events (16 thrombotic, 19 hemorrhagic) occurred in 29 patients (median follow-up, 54months). Leukocyte burden were significantly higher in patients with events than in event-free patients (12,015×10(3) /μL vs. 9,567×10(3)/μL, P=0.003). The difference was more prominent in ET patients than in PV patients, and in patients with hemorrhagic events than in those with thrombotic events. In patients with events, the leukocyte burden in the pre-event period was higher than in the entire follow-up period (16,767×10(3)/μL vs. 12,015×10(3)/μL, P=0.002). In all patients, leukocyte burden during entire follow-up period of 11,000×10(3)/μL or higher was an independent risk factor for vascular events. CONCLUSION In PV or ET patients, leukocyte burden during disease course is related to increased incidence of thrombotic or hemorrhagic events.
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Affiliation(s)
- Yoojoo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong Seok Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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125
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Hernández-Boluda JC, Arellano-Rodrigo E, Cervantes F, Alvarez-Larrán A, Gómez M, Barba P, Mata MI, González-Porras JR, Ferrer-Marín F, García-Gutiérrez V, Magro E, Moreno M, Kerguelen A, Pérez-Encinas M, Estrada N, Ayala R, Besses C, Pereira A. Oral anticoagulation to prevent thrombosis recurrence in polycythemia vera and essential thrombocythemia. Ann Hematol 2015; 94:911-8. [PMID: 25680896 DOI: 10.1007/s00277-015-2330-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/01/2015] [Indexed: 12/20/2022]
Abstract
It is unclear whether anticoagulation guidelines intended for the general population are applicable to patients with polycythemia vera (PV) and essential thrombocythemia (ET). In the present study, the risk of thrombotic recurrence was analyzed in 150 patients with PV and ET treated with vitamin K antagonists (VKA) because of an arterial or venous thrombosis. After an observation period of 963 patient-years, the incidence of re-thrombosis was 4.5 and 12 per 100 patient-years under VKA therapy and after stopping it, respectively (P < 0.0005). After a multivariate adjustment for other prognostic factors, VKA treatment was associated with a 2.8-fold reduction in the risk of thrombotic recurrence. Notably, VKA therapy offset the increased risk of re-thrombosis associated with a prior history of remote thrombosis. Both the protective effect of VKA therapy and the predisposing factors for recurrence were independent of the anatomical site involved in the index thrombosis. Treatment periods with VKA did not result in a higher incidence of major bleeding as compared with those without VKA. These findings support the use of long-term anticoagulation for the secondary prevention of thrombosis in patients with PV and ET, particularly in those with history of remote thrombosis.
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Affiliation(s)
- Juan-Carlos Hernández-Boluda
- Hematology and Medical Oncology Department, Hospital Clínico Universitario, Avd. Blasco Ibáñez 17, 46010, Valencia, Spain,
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126
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Tefferi A, Barbui T. Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management. Am J Hematol 2015; 90:162-73. [PMID: 25611051 DOI: 10.1002/ajh.23895] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Polycythemia vera (PV) and essential thrombocythemia (ET) are myeloproliferative neoplasms, respectively characterized by erythrocytosis and thrombocytosis. Other disease features include leukocytosis, splenomegaly, thrombosis, bleeding, microcirculatory symptoms, pruritus, and risk of leukemic or fibrotic transformation. DIAGNOSIS PV is defined by a JAK2 mutation, whose absence, combined with normal or increased serum erythropoietin level, makes the diagnosis unlikely. Differential diagnosis in ET includes reactive thrombocytosis, chronic myeloid leukemia, and prefibrotic myelofibrosis. Janus kinase 2 (JAK2), calreticulin (CALR), or myeloproliferative leukemia virus oncogene (MPL) mutations occur in approximately 55%, 25%, and 3% of ET patients, respectively. The same molecular markers are also present in prefibrotic myelofibrosis, which needs to be morphologically distinguished from ET. Survival and leukemic/fibrotic transformation: Median survivals are ∼14 years for PV and 20 years for ET; the corresponding values for younger patients are 24 and 33 years. Life-expectancy in ET is inferior to the control population. JAK2/CALR mutational status does not affect survival in ET. Risk factors for survival in ET and PV include advanced age, leukocytosis, and thrombosis. Leukemic transformation rates at 20 years are estimated at <10% for PV and 5% for ET; fibrotic transformation rates are slightly higher. Thrombosis risk stratification: Current risk stratification in PV and ET is designed to estimate the likelihood of recurrent thrombosis: high-risk is defined by the presence of age >60 years or presence of thrombosis history; low-risk is defined by the absence of both of these two risk factors. Recent data consider JAK2V617F and cardiovascular risk factors as additional risk factors. Presence of extreme thrombocytosis might be associated with acquired von Willebrand syndrome (AvWS) and, therefore, risk of bleeding. RISK-ADAPTED THERAPY The main goal of therapy in PV and ET is to prevent thrombohemorrhagic complications. In low risk patients, this is accomplished by the use of low-dose aspirin and phlebotomy (hematocrit target <45%) in PV. In high risk (for thrombosis) patients, treatment with hydroxyurea is additionally recommended. Treatment with busulfan or interferon-α is usually effective in hydroxyurea failures and the additional value of JAK inhibitor therapy in such cases is limited. Screening for AvWS is recommended before administrating aspirin, in the presence of extreme thrombocytosis.
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - Tiziano Barbui
- Research Foundation; Papa Giovanni XXIII Hospital; Bergamo Italy
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127
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Connelly-Smith LS, Linenberger ML. Therapeutic Apheresis for Patients with Cancer. Cancer Control 2015; 22:60-78. [DOI: 10.1177/107327481502200109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Laura S. Connelly-Smith
- Seattle Cancer Care Alliance, School of Medicine, University of Washington, Seattle, Washington
- Division of Hematology, School of Medicine, University of Washington, Seattle, Washington
| | - Michael L. Linenberger
- Seattle Cancer Care Alliance, School of Medicine, University of Washington, Seattle, Washington
- Division of Hematology, School of Medicine, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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128
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Tseng WL, Chen TH, Huang CC, Huang YH, Yeh CF, Tsai HJ, Lee HY, Kao CY, Lin SW, Liao HR, Cheng JC, Tseng CP. Impaired thrombin generation in Reelin-deficient mice: a potential role of plasma Reelin in hemostasis. J Thromb Haemost 2014; 12:2054-64. [PMID: 25255925 DOI: 10.1111/jth.12736] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/25/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Reelin is a large extracellular glycoprotein that is present in the peripheral blood. That Reelin interacts with the coagulation components and elicits a functional role in hemostasis has not yet been elucidated. OBJECTIVES The hemostatic activity of Reelin is investigated and defined in this study. METHODS The interplay of Reelin with coagulation components was elucidated by far-Western and liposome/platelet binding assays. In vivo and ex vivo hemostasis-related analyses of Reelin-deficient mice and plasma were also performed. RESULTS Reelin interacted with the liposomes containing phosphatidylserine (PS) or phosphatidylcholine. Instead of interacting with known Reelin receptors (ApoE receptor 2, very low density lipoprotein receptor and integrin β1), Reelin interacted with PS of the activated platelets. The interaction between Reelin and the coagulation factors of thrombin and FXa was also demonstrated with the Kd of 11.7 and 21.2 nm, respectively. Reelin-deficient mice displayed a prolonged bleeding time and an increase in rebleeding rate. Despite the fact that Reelin deficiency had no significant effect on the clotting time of prothrombin and activated partial thromboplastin time, the fibrin clot formation was abnormal and the fibrin clot structure was relatively loosened with reduced clot strength. Abnormal fibrinogen expression did not account for the hemostatic defects associated with Reelin deficiency. Instead, thrombin generation was impaired concomitant with an altered prothrombin cleavage pattern. CONCLUSIONS By interacting with platelet phospholipids and the coagulation factors, thrombin and FXa, Reelin plays a selective role in coagulation activation, leading to thrombin generation and formation of a normal fibrin clot.
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Affiliation(s)
- W-L Tseng
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
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Abstract
Geriatric patients are at higher risk for hemorrhagic complications after surgery and traumatic injuries. The geriatric population is more likely to take anticoagulant or antiplatelet medications. Chronic disease, autoimmune disease, and nutritional deficiencies can lead to coagulation factor and platelet disorders. One must be familiar with the current anticoagulant and antiplatelet medications, their mechanism of action, and reversal agents to properly care for this group of patients. The new oral anticoagulants do not have Food and Drug Administration (FDA) approved reversal agents, but known procoagulant agents with other FDA indications may be effective.
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Affiliation(s)
- Philbert Y Van
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L-611, Portland, OR 97239-3098, USA
| | - Martin A Schreiber
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L-611, Portland, OR 97239-3098, USA.
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130
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Kreher S, Ochsenreither S, Trappe RU, Pabinger I, Bergmann F, Petrides PE, Koschmieder S, Matzdorff A, Tiede A, Griesshammer M, Riess H. Prophylaxis and management of venous thromboembolism in patients with myeloproliferative neoplasms: consensus statement of the Haemostasis Working Party of the German Society of Hematology and Oncology (DGHO), the Austrian Society of Hematology and Oncology (ÖGHO) and Society of Thrombosis and Haemostasis Research (GTH e.V.). Ann Hematol 2014; 93:1953-63. [PMID: 25307456 DOI: 10.1007/s00277-014-2224-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/25/2014] [Indexed: 01/28/2023]
Abstract
Patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) like polycythemia vera and essential thrombocythemia are at increased risk of arterial and venous thrombosis. Strategies of prevention may consist of platelet aggregation inhibitors and/or cytoreductive agents depending on the underlying disease and the individual risk. Clinical evidence for management of acute venous thromboembolic events in MPN patients is limited. Modality and duration of therapeutic anticoagulation after venous thrombosis has to be evaluated critically with special regard to the increased risk for spontaneous bleeding events associated with the underlying diseases. Both for therapy of the acute event and for secondary prophylaxis, low-molecular-weight heparins should preferentially be used. A prolongation of the therapeutic anticoagulation beyond the usual 3 to 6 months can only be recommended in high-risk settings and after careful evaluation of potential risks and benefits for the individual patient. New direct oral anticoagulants (NOAC) should not preferentially be used due to lack of clinical experience in patients with MPN and potential drug interactions (e.g. with JAK inhibitors). Consequent treatment of the underlying myeloproliferative disease and periodical evaluation of the response to therapy is crucial for optimal secondary prophylaxis of thromboembolic events in those patients.
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Affiliation(s)
- Stephan Kreher
- Department of Hematology and Oncology, Charite Berlin, Berlin, Hindenburgdamm 30, 12200, Berlin, Germany,
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Hasselbalch HC. The platelet–cancer loop in myeloproliferative cancer. Is thrombocythemia an enhancer of cancer invasiveness and metastasis in essential thrombocythemia, polycythemia vera and myelofibrosis? Leuk Res 2014; 38:1230-6. [DOI: 10.1016/j.leukres.2014.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/26/2014] [Accepted: 07/14/2014] [Indexed: 02/08/2023]
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Kissova J, Bulikova A, Ovesna P, Bourkova L, Penka M. Increased mean platelet volume and immature platelet fraction as potential predictors of thrombotic complications in BCR/ABL-negative myeloproliferative neoplasms. Int J Hematol 2014; 100:429-36. [PMID: 25227185 DOI: 10.1007/s12185-014-1673-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/04/2014] [Accepted: 09/08/2014] [Indexed: 01/14/2023]
Abstract
BCR/ABL-negative myeloproliferative neoplasms (MPNs) are considered to be acquired thrombophilic conditions. Persistently enhanced platelet activation has been described in polycythaemia vera and essential thrombocythaemia (ET), and shown to contribute to a higher risk of arterial and venous thrombotic complications. Recent studies have shown that mean platelet volume (MPV) and immature platelet fraction (IPF) can serve as useful markers of platelet activation and increased risk of thrombosis. The aim of the present study was to investigate the relationship between these parameters and thrombotic events in BCR/ABL-negative MPN. MPV values in patients with BCR/ABL-negative MPN were significantly higher than MPV values of healthy individuals (P < 0.001). No significant difference in MPV or IPF was observed between groups of patients with and without thrombotic complications (P = 0.441; P = 0.110); the difference in IPF values was close to the significance level for patients with ET (P = 0.073). Higher values of IPF were more frequently detected in patients with JAK2 V617F positivity (P = 0.030). These patients had higher MPV more frequently than others, and this difference was close to the significance level (P = 0.056). Further studies should validate the use of platelet parameters to identify patients at high risk.
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Affiliation(s)
- Jarmila Kissova
- Department of Haematology, University Hospital Brno, Jihlavska 20, 625 00, Brno, Czech Republic,
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133
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Angona A, Alvarez-Larrán A, Bellosillo B, Martínez-Avilés L, Garcia-Pallarols F, Longarón R, Ancochea À, Besses C. [Essential thrombocythemia: baseline characteristics and risk factors for survival and thrombosis in a series of 214 patients]. Med Clin (Barc) 2014; 144:247-53. [PMID: 25192581 DOI: 10.1016/j.medcli.2014.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/22/2014] [Accepted: 04/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Two prognostic models to predict overall survival and thrombosis-free survival have been proposed: International Prognostic Score for Essential Thrombocythemia (IPSET) and IPSET-Thrombosis, respectively, based on age, leukocytes count, history of previous thrombosis, the presence of cardiovascular risk factors and the JAK2 mutational status. The aim of the present study was to assess the clinical and biological characteristics at diagnosis and during evolution in essential thrombocythemia (ET) patients as well as the factors associated with survival and thrombosis and the usefulness of these new prognostic models. PATIENTS AND METHODS We have evaluated the clinical data and the mutation status of JAK2, MPL and calreticulin of 214 ET patients diagnosed in a single center between 1985 and 2012, classified according to classical risk stratification, IPSET and IPSET-Thrombosis. RESULTS With a median follow-up of 6.9 years, overall survival was not associated with any variable by multivariate analysis. Thrombotic history and leukocytes>10×10(9)/l were associated with thrombosis-free survival (TFS). In our series, IPSET prognostic systems of survival and thrombosis did not provide more clinically relevant information regarding the classic risk of thrombosis stratification. CONCLUSION Thrombotic history and leukocytosis>10×10(9)/l were significantly associated with lower TFS, while the prognostic IPSET-Thrombosis system did not provide more information than classical thrombotic risk assessment.
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Affiliation(s)
- Anna Angona
- Servicio de Hematología, Hospital del Mar-IMIM, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar-IMIM, Barcelona, España
| | - Alberto Alvarez-Larrán
- Servicio de Hematología, Hospital del Mar-IMIM, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar-IMIM, Barcelona, España
| | - Beatriz Bellosillo
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar-IMIM, Barcelona, España; Servicio de Patología, Hospital del Mar-IMIM, Barcelona, España; Universitat Pompeu Fabra, Barcelona, España
| | - Luz Martínez-Avilés
- Universitat Autònoma de Barcelona, Barcelona, España; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar-IMIM, Barcelona, España; Servicio de Patología, Hospital del Mar-IMIM, Barcelona, España
| | - Francesc Garcia-Pallarols
- Servicio de Hematología, Hospital del Mar-IMIM, Barcelona, España; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar-IMIM, Barcelona, España
| | - Raquel Longarón
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar-IMIM, Barcelona, España; Servicio de Patología, Hospital del Mar-IMIM, Barcelona, España
| | - Àgueda Ancochea
- Servicio de Hematología, Hospital del Mar-IMIM, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar-IMIM, Barcelona, España
| | - Carles Besses
- Servicio de Hematología, Hospital del Mar-IMIM, Barcelona, España; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar-IMIM, Barcelona, España.
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134
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Bhat T, Ahmed M, Baydoun H, Ghandour Z, Bhat A, McCord D. Acute ST-segment elevation myocardial infarction in a young patient with essential thrombocythemia: a case with long-term follow-up report. J Blood Med 2014; 5:123-7. [PMID: 25093003 PMCID: PMC4114920 DOI: 10.2147/jbm.s53539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Essential thrombocythemia (ET) is a neoplastic proliferation of mature myeloid cells – in particular, megakaryocytes – leading to persistently elevated platelet count. Usual clinical presentation is related to an increase in the risk of hemorrhage and/or thrombosis. Management of ET consists of antiplatelet therapies – mainly aspirin and cytoreductive therapies. Coronary involvement in patients with ET is rare. The optimal treatment strategies for ET patients presenting with acute myocardial infarction remains unclear. Acute interventions like intracoronary thrombolytic therapy, angioplasty, and coronary-artery bypass grafting have been reported in such patients. However, several questions remain unanswered about the acute and long-term management of these patients. Herein, we report the case of a 47-year-old female who presented with acute myocardial infarction as the first clinical sign of ET, and also present the long-term follow-up of this patient.
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Affiliation(s)
- Tariq Bhat
- Division of Cardiology, Staten Island University Hospital, Staten Island, NY, USA
| | - Mohammed Ahmed
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Hassan Baydoun
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Zahraa Ghandour
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Alina Bhat
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Donald McCord
- Division of Cardiology, Staten Island University Hospital, Staten Island, NY, USA
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135
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Atalay F, Toprak SK, Koca E, Karakuş S. sEPCR Levels in Chronic Myeloproliferative Diseases and Their Association with Thromboembolic Events: A Case-Control Study. Turk J Haematol 2014; 31:121-7. [PMID: 25035668 PMCID: PMC4102038 DOI: 10.4274/tjh.2012.0150] [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: 01/10/2012] [Accepted: 08/22/2013] [Indexed: 12/01/2022] Open
Abstract
Objective: Venous, arterial, and microcirculatory events are frequently encountered in the clinical course of essential thrombocytosis and polycythemia vera. We aimed to investigate the levels of soluble endothelial protein C receptor (sEPCR) in myeloproliferative diseases to see whether there was a difference between the patients with and without history of thromboembolism. Materials and Methods: The study included patients with polycythemia vera (n=12), patients with essential thrombocytosis (n=13), and controls (n=29). In all groups, we measured proteins C and S, antithrombin and sEPCR levels, and plasma concentrations of thrombin-antithrombin complex, prothrombin fragments 1+2, and D-dimer. Results: Comparing the patients with and without history of thromboembolic attack, statistically significant differences were not observed in terms of sEPCR, D-dimer, thrombin-antithrombin complex, prothrombin fragments 1+2, and hematocrit levels (p=0.318, 0.722, 0.743, 0.324, and 0.065, respectively). Conclusion: Significant increase in the parameters that reflect activation of coagulation, such as sEPCR, thrombin-antithrombin complex, prothrombin fragments 1+2, and D-dimer, reflects the presence of a basal condition that leads to a tendency toward thrombosis development in ET and PV when compared to healthy controls.
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Affiliation(s)
- Figen Atalay
- Başkent University Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Selami Koçak Toprak
- Başkent University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Ebru Koca
- Başkent University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Sema Karakuş
- Başkent University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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136
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Cetin G, Ozkan T, Turgut S, Ali Cikrikcioglu M, Cem Ar M, Ayer M, Unlu A, Celik SR, Sekin Y, Karatoprak C. Evaluation of clinical and laboratory findings with JAK2 V617F mutation as an independent variable in essential thrombocytosis. Mol Biol Rep 2014; 41:6737-42. [DOI: 10.1007/s11033-014-3559-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 06/20/2014] [Indexed: 10/25/2022]
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137
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Abstract
Thrombosis is common in patients suffering from myeloproliferative neoplasm (MPN), whereas bleeding is less frequent. JAK2(V617F), the main mutation involved in MPN, is considered as a risk factor for thrombosis, although the direct link between the mutation and hemostatic disorders is not strictly established. We investigated this question using conditional JAK2(V617F) knock-in mice with constitutive and inducible expression of JAK2(V617F) in hematopoietic cells, which develop a polycythemia vera (PV)-like disorder evolving into myelofibrosis. In vitro, thrombosis was markedly impaired with an 80% decrease in platelet-covered surface, when JAK2(V617F) blood was perfused at arterial shear over collagen. JAK2(V617F) platelets presented only a moderate glycoprotein (GP) VI deficiency not responsible for the defective platelet accumulation. In contrast, a decreased proportion of high-molecular-weight von Willebrand factor multimers could reduce platelet adhesion. Accordingly, the tail bleeding time was prolonged. In the FeCl3-induced thrombosis model, platelet aggregates formed rapidly but were highly unstable. Interestingly, vessels were considerably dilated. Thus, mice developing PV secondary to constitutive JAK2(V617F) expression exhibit a bleeding tendency combined with the accelerated formation of unstable clots, reminiscent of observations made in patients. Hemostatic defects were not concomitant with the induction of JAK2(V617F) expression, suggesting they were not directly caused by the mutation but were rather the consequence of perturbations in blood and vessel homeostasis.
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138
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Changes in response to antiaggregatory treatment in patients with myeloproliferative neoplasms: a sequential study using multiple electrode aggregometry. Blood Coagul Fibrinolysis 2014; 24:869-73. [PMID: 24176950 DOI: 10.1097/mbc.0b013e328364713a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the present study, we used multiple electrode aggregometry (MEA) to investigate the response to aspirin and clopidogrel treatment, and its potential changes over a long-time disease course in patients with myeloproliferative neoplasms (MPNs). arachidonic acid (ASPI), ADP, and thrombin receptor activating peptide (TRAP) tests were performed at two timepoints between 32-50 months in 21 patients with MPN and 1-46 months in 29 controls. We further checked the medical records of the participants to identify a potential correlation of changes in the treatment response with clinical events. In MPN, four out of 13 patients treated with 100 mg of aspirin, no patients receiving 50 mg of aspirin, and one out of five clopidogrel-treated patients showed a therapeutic antiplatelet effect. In the subsequent examinations, five patients changed from response to nonresponse or vice versa. Initial nonresponse and changes from an initial response to nonresponse were observed in six patients with thrombotic events. In the controls, 25 out of 26 aspirin-treated patients and two out of three clopidogrel-treated patients showed an initially adequate in-vitro response. Except from one patient changing from initial aspirin nonresponse to response, all controls showed a stable response state. One control with two ischemic strokes showed a nonresponse to clopidogrel. In conclusion, MEA detects the response to antiaggregatory treatment, as well as its changes during the disease course in patients with MPN. An initial or subsequent nonresponse was observed in patients with thrombotic events.
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139
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Hernández-Boluda JC, Gómez M. Target hematologic values in the management of essential thrombocythemia and polycythemia vera. Eur J Haematol 2014; 94:4-11. [PMID: 24814134 DOI: 10.1111/ejh.12381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 12/24/2022]
Abstract
Treatment of essential thrombocythemia (ET) and polycythemia vera (PV) is aimed at preventing vascular complications, which are the main cause of morbidity and mortality in these diseases. Over the years, clinical trials have demonstrated that the incidence of thrombosis and bleeding can be reduced by controlling the blood cell counts, but the target hematological levels have varied across the studies. In this article, we review the evidence supporting the use of predefined target hematologic values for the management of ET and PV in routine clinical practice. At present, the recommended target hematocrit in PV is below 45%, regardless of the patients' risk profile. Concerning platelet counts, no direct correlation has been demonstrated with thrombotic risk in either ET or PV. Thus, although cytoreductive treatment reduces the rate of vascular complications in high-risk patients, no particular threshold of the platelet counts has been shown to be more protective against thrombosis. Extreme thrombocytosis is a risk factor for bleeding, particularly when aspirin or anagrelide are given. Leukocytosis at baseline or during follow-up appears to be a risk factor for thrombosis, mostly in high-risk patients. However, the clinical benefit of strictly controlling this parameter is not yet established. Finally, standardized definitions of response to cytoreductive treatment in ET and PV have recently been published. Nevertheless, they have been produced to compare the efficacy of new therapies in clinical trials, whereas its relevance in clinical practice has been questioned in retrospective studies showing that such response definitions do not correlate with the patients' clinical outcome.
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140
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Adam R, Priglinger M, Harrington T, Gottlieb D, Krause M. An Unusual Cause of Cerebellar Hemorrhage in a Young Patient: Essential Thrombocythemia. J Stroke Cerebrovasc Dis 2014; 23:e373-4. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/05/2013] [Accepted: 12/09/2013] [Indexed: 12/14/2022] Open
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Montanaro M, Latagliata R, Cedrone M, Spadea A, Rago A, Di Giandomenico J, Spirito F, Porrini R, De Muro M, Leonetti SC, Villivà N, De Gregoris C, Breccia M, Montefusco E, Santoro C, Cimino G, Majolino I, Mazzucconi MG, Alimena G, Andriani A. Thrombosis and survival in essential thrombocythemia: a regional study of 1,144 patients. Am J Hematol 2014; 89:542-6. [PMID: 24481665 DOI: 10.1002/ajh.23685] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 01/26/2014] [Accepted: 01/27/2014] [Indexed: 01/21/2023]
Abstract
To identify prognostic factors affecting thrombosis-free survival (TFS) and overall survival (OS), we report the experience of a Regional cooperative group in a real-life cohort of 1,144 patients with essential thrombocythemia (ET) diagnosed from January 1979 to December 2010. There were 107 thrombotic events (9.4%) during follow-up [60 (5.3%) arterial and 47 (4.1%) venous thromboses]. At univariate analysis, risk factors for a shorter TFS were: age >60 years (P < 0.0054, 95% CI 1.18-2.6), previous thrombosis (P < 0.0001, 95% CI 1.58-4.52) and the presence of at least one cardiovascular risk factor (P = 0.036, 95% CI 1.15-3.13). Patients with a previous thrombosis occurred ≥24 months before ET diagnosis had a shorter TFS compared to patients with a previous thrombosis occurred <24 months (P = 0.0029, 95% CI 1.5-6.1); furthermore, patients with previous thrombosis occurred <24 months did not show a shorter TFS compared with patients without previous thrombosis (P = 0.303, 95% CI 0.64-3.21). At multivariate analysis for TFS, only the occurrence of a previous thrombosis maintained its prognostic impact (P = 0.0004, 95% CI 1.48-3.79, RR 2.36). The 10-year OS was 89.9% (95% CI 87.3-92.5): at multivariate analysis for OS, age >60 years (P < 0.0001), anemia (P < 0.0001), male gender (P = 0.0019), previous thromboses (P = 0.0344), and white blood cell >15 × 10(9) /l (P = 0.0370) were independent risk factors. Previous thrombotic events in ET patients are crucial for TFS but their importance seems related not to the occurrence per se but mainly to the interval between the event and the diagnosis.
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Affiliation(s)
| | - Roberto Latagliata
- Department of Cellular Biotechnologies and Hematology; University “La Sapienza,”; Rome Italy
| | - Michele Cedrone
- Department of Hematology; San Giovanni Hospital,; Rome Italy
| | - Antonio Spadea
- Unit of Hematology; Regina Elena National Cancer Institute; Rome Italy
| | - Angela Rago
- Department of Hematology; Polo Universitario Pontino; Latina Italy
| | | | | | | | - Marianna De Muro
- Department of Hematology; University “Campus Biomedico,”; Rome Italy
| | | | - Nicoletta Villivà
- Department of Hematology; Nuovo Regina Margherita Hospital; Rome Italy
| | | | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology; University “La Sapienza,”; Rome Italy
| | | | - Cristina Santoro
- Department of Cellular Biotechnologies and Hematology; University “La Sapienza,”; Rome Italy
| | - Giuseppe Cimino
- Department of Hematology; Polo Universitario Pontino; Latina Italy
| | | | | | - Giuliana Alimena
- Department of Cellular Biotechnologies and Hematology; University “La Sapienza,”; Rome Italy
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142
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Cytokine profiles in polycythemia vera and essential thrombocythemia patients: Clinical implications. Exp Hematol 2014; 42:360-8. [DOI: 10.1016/j.exphem.2014.01.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 01/10/2014] [Accepted: 01/17/2014] [Indexed: 01/18/2023]
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143
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Les glomérulopathies associées aux néoplasies myéloprolifératives. Rev Med Interne 2014; 35:222-30. [DOI: 10.1016/j.revmed.2013.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 02/25/2013] [Accepted: 04/25/2013] [Indexed: 11/20/2022]
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144
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Hasselbalch HC. Perspectives on the impact of JAK-inhibitor therapy upon inflammation-mediated comorbidities in myelofibrosis and related neoplasms. Expert Rev Hematol 2014; 7:203-16. [PMID: 24524202 DOI: 10.1586/17474086.2013.876356] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic inflammation is suggested to contribute to the Philadelphia-chromosome-negative myeloproliferative neoplasm (MPN) disease initiation and progression, as well as the development of premature atherosclerosis and may drive the development of other cancers in MPNs, both nonhematologic and hematologic. The MPN population has a substantial comorbidity burden, including cerebral, cardiovascular, pulmonary, abdominal, renal, metabolic, skeletal, autoimmune, and chronic inflammatory diseases. This review describes the comorbidities associated with MPNs and the potential impact of early intervention with anti-inflammatory and/or immunomodulatory agents such as JAK-inhibitors, statins, and IFN-α to inhibit cancer progression and reduce MPN-associated comorbidity impact. Early intervention may yield a subset of patients who achieve minimal residual disease, thereby likely reducing the comorbidity burden and improving the cost-effective socioeconomic profile.
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Affiliation(s)
- Hans C Hasselbalch
- Department of Hematology, Roskilde Hospital University of Copenhagen, Køgevej 7-13, 4000 Roskilde, Denmark
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145
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Christensen AS, Møller JB, Hasselbalch HC. Chronic kidney disease in patients with the Philadelphia-negative chronic myeloproliferative neoplasms. Leuk Res 2014; 38:490-5. [PMID: 24630365 DOI: 10.1016/j.leukres.2014.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/17/2014] [Accepted: 01/28/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The progression of kidney function and frequency of chronic kidney disease (CKD) in patients with the Philadelphia-negative myeloproliferative neoplasms (MPN) is unknown, although CKD is linked to increased mortality. METHODS This longitudinal retrospective study evaluates the estimated glomerular filtration rate (eGFR) in 143 MPN patients over a period of 9 years. RESULTS 29% of patients had CKD stage 3 or 4 at time of diagnosis. 20% of patients had a rapid annual loss of eGFR (>3mL/min/1.73m(2)) and eGFR was negatively correlated to monocyte and neutrophil counts. CONCLUSION Kidney impairment might contribute to the increased mortality observed in MPN patients.
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Affiliation(s)
| | - Jonas Bech Møller
- Quantitative Clinical Pharmacology, Novo Nordisk A/S, Søborg, Denmark
| | - Hans Carl Hasselbalch
- Department of Hematology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
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146
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147
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Vannucchi AM, Guglielmelli P, Pieri L, Antonioli E, Bosi A. Treatment options for essential thrombocythemia and polycythemia vera. Expert Rev Hematol 2014; 2:41-55. [DOI: 10.1586/17474086.2.1.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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148
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Andriani A, Zullo A, Recine U, Barbara A, Minucci S, Cao P. Splenic artery thrombosis and rupture of left gastric artery aneurysm: an unusual cause of acute abdominal pain. Indian J Gastroenterol 2014; 33:87-8. [PMID: 23292794 DOI: 10.1007/s12664-012-0290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Alessandro Andriani
- UOS of Hematology, S. Spirito in Sassia Hospital, Lungotevere in Sassia 3, 00100, Rome, Italy,
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149
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de Lacerda JF, Oliveira SN, Ferro JM. Chronic myeloproliferative diseases. HANDBOOK OF CLINICAL NEUROLOGY 2014; 120:1073-81. [PMID: 24365372 DOI: 10.1016/b978-0-7020-4087-0.00072-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The chronic myeloproliferative disorders are a group of diseases in which there is an increased proliferation of one or more subtypes of myeloid cells; they include essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF). In ET and PV the main neurologic manifestations are headaches, dizziness and macro- and microvascular, both venous and arterial, thrombosis and intracranial hemorrhages. Paresthesias and chorea also occur in PV. In PMF neurologic complications are very rare and consist predominantly of spinal cord compression by extramedullary hematopoiesis tissue.
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Affiliation(s)
- João Forjaz de Lacerda
- Department of Hematology and Bone Marrow Transplantation, Hospital de Santa Maria, Lisbon, Portugal
| | | | - José M Ferro
- Neurology Service, Department of Neurosciences, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.
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150
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Cardin F, Randi ML, Mosele M, Terranova C, Militello C. Severe delayed postpolypectomy bleeding in elder patient with post-polycythemia myelofibrosis. BMC Surg 2013; 13 Suppl 2:S18. [PMID: 24267952 PMCID: PMC3851144 DOI: 10.1186/1471-2482-13-s2-s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The interest of the case lies in an unexpected delayed bleeding following an endoscopic procedure in a patient with post-polycythemia myelofibrosis. The case gives the opportunity to discuss the medical management and monitoring of patients with myeloproliferative disorders undergoing minimally invasive surgery interventions. CASE PRESENTATION A 75 years old woman affected by post-polycythemia myelofibrosis underwent endoscopy polypectomy followed by a delayed major local bleeding. At the time of the endoscopy followed by bleeding, the platelet count was 837 × 109/L, haemoglobin 113 g/L, PCV 35,2% and WBC 20.22 × 106/L. No antithrombotic prophylaxis with low molecular weight heparin was used. Antiplatelet drug was withdraw seven days before endoscopy and restarted one week after the procedure. Polyp size was 11 x 19 mm and it was located on right side of the colon. CONCLUSION There are some patients in whom current guidelines do not apply and our case stress the importance of myeloproliferative neoplasms as a risk factor for complications of endoscopic polypectomy. The delayed haemorrhage we observed suggest to strictly control the patient for a period longer than only one week also in case of antithrombotic treatment with antiplatelet drugs.
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