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Hodroj MH, Taher A. Thalassemia and malignancies: Updates from the literature. Ann N Y Acad Sci 2023; 1529:14-20. [PMID: 37676814 DOI: 10.1111/nyas.15061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Thalassemia management has undergone significant development with the advancement in iron chelation therapy, which has led to a prolonged life expectancy. This has been accompanied by the emergence of several new morbidities and chronic diseases, including cancer. Over the years, multiple cases of solid and hematologic malignancies in thalassemia patients have been reported in the literature, with no clear mechanism for the development of cancer in these patients despite a number of potential mechanisms. However, the results of many studies have been contradictory regarding the risk of development of malignancies in thalassemia. The present review aims to discuss the available data on cancer and thalassemia in the literature, with the latest updates regarding possible malignancy development mechanisms, risks, and the most commonly reported types.
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Affiliation(s)
- Mohammad Hassan Hodroj
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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2
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Yu X, Peng Y, Nie T, Sun W, Zhou Y. Diabetes and two kinds of primary tumors in a patient with thalassemia: a case report and literature review. Front Oncol 2023; 13:1207336. [PMID: 37637036 PMCID: PMC10455928 DOI: 10.3389/fonc.2023.1207336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background Thalassemia is a group of common genetic hematologic disorders characterized by deficient synthesis of the hemoglobin chain. Due to effective blood transfusion and optimization of chelate therapy, the survival of thalassemia patients and their overall quality of life have improved noticeably in the past few decades. As a consequence, the longer life expectancy has led to the manifestation of several concomitant morbidities, including heart disease, infections, cirrhosis, endocrine abnormalities, various malignancies, and so on. In this context, the probability and updated literature about some malignancy cases in patients with thalassemia build new scenarios for the next few years. We describe the first report of a thalassemic patient developing diabetes and head and neck cancer and try to summarize the possible predisposing factors and mechanisms behind their phenomenon. Case presentation The current case report describes a 50-year-old Asian man who has been diagnosed with thalassemia since childhood. In early 2017, he was also diagnosed with diabetes and started on insulin-hypoglycemic treatment. The patient was then diagnosed with primary non-keratinizing undifferentiated carcinoma of the nasopharynx in late February 2013. A biopsy of the left tongue revealed squamous cell carcinoma (SCC) in late March 2019. Conclusions We report the first case of a thalassemic patient developing diabetes and squamous cell carcinoma of the head and neck and discuss the possibility of a link between the three diseases. This specific case should alert physicians to the possibility of endocrinopathy and malignancy in thalassemic patients.
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Affiliation(s)
- Xiaoyan Yu
- Department of Radiotherapy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Peng
- Department of Radiotherapy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tingting Nie
- Department of Radiotherapy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenjia Sun
- Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yajuan Zhou
- Department of Radiotherapy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Origa R, Gianesin B, Longo F, Di Maggio R, Cassinerio E, Gamberini MR, Pinto VM, Quarta A, Casale M, La Nasa G, Caocci G, Piroddi A, Piolatto A, Di Mauro A, Romano C, Gigante A, Barella S, Maggio A, Graziadei G, Perrotta S, Forni GL. Incidence of cancer and related deaths in hemoglobinopathies: A follow-up of 4631 patients between 1970 and 2021. Cancer 2023; 129:107-117. [PMID: 36321594 PMCID: PMC10092274 DOI: 10.1002/cncr.34509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/06/2022] [Accepted: 08/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The correlation between thalassemia and malignancies other than hepatocellular carcinoma (HCC) and the possible relationship between other hemoglobinopathies and tumor risk have been poorly evaluated. METHODS Eight Italian specialized centers evaluated the incidence of malignant neoplasms in hemoglobinopathies as well as their sites and features. The study cohort included 4631 patients followed between 1970 and 2021 (transfusion-dependent β-thalassemia, 55.6%; non-transfusion-dependent thalassemia, 17.7%; sickle cell disease, 17.6%; hemoglobin H disease, 8.3%). RESULTS A total of 197 diagnoses of cancer were reported (incidence rate, 442 cases per 100,000 person-years). The liver was the most frequent site of tumors in both sexes, with a higher incidence (190 cases per 100,000 person-years) in comparison with the general population found in all types of hemoglobinopathies (except hemoglobin H disease). In recent years, tumors have become the second cause of death in patients with transfusion-dependent thalassemia. A lower risk of breast and prostate cancer was observed in the whole group of patients with hemoglobinopathies. The first cancer diagnoses dated back to the 1980s, and the incidence rate sharply increased after the 2000s. However, although the incidence rate of cancers of all sites but the liver continued to show an increasing trend, the incidence of HCC showed stability. CONCLUSIONS These findings provide novel insights into the relationship between cancer and hemoglobinopathies and suggest that the overall risk is not increased in these patients. HCC has been confirmed as the most frequent tumor, but advances in chelation and the drugs that have led to the eradication of hepatitis C may explain the recent steadiness in the number of diagnoses that is reported here.
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Affiliation(s)
- Raffaella Origa
- Università di Cagliari, SSD Talassemia, Ospedale Microcitemico 'A. Cao,' ASL8 Cagliari, Cagliari, Italy
| | | | - Filomena Longo
- Centro Microcitemie-Pediatria Azienda Ospedaliero Universitaria San Luigi Gonzaga, Turin, Italy
| | - Rosario Di Maggio
- Unità Operativa Complessa Ematologia per le Malattie Rare del Sangue e degli Organi Ematopoietici, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-V. Cervello, Palermo, Italy
| | - Elena Cassinerio
- Attività Diurne Malattie Rare Internistiche-Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Rita Gamberini
- Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Valeria Maria Pinto
- Struttura Semplice Dipartimentale Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Antonella Quarta
- Unità Operativa Semplice Centro Microcitemia, Unità Operativa Complessa Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale 'A. Perrino', Brindisi, Italy
| | - Maddalena Casale
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università̀ della Campania 'Luigi Vanvitelli,', Naples, Italy
| | - Giorgio La Nasa
- Università di Cagliari, Struttura Complessa Ematologia e Centro Trapianto di Midollo Osseo, Ospedale Businco, Cagliari, Italy
| | - Giovanni Caocci
- Università di Cagliari, Struttura Complessa Ematologia e Centro Trapianto di Midollo Osseo, Ospedale Businco, Cagliari, Italy
| | - Antonio Piroddi
- Centro Trapianti Cellule Staminali, Ospedale Microcitemico 'A. Cao', ASL8 Cagliari, Cagliari, Italy
| | - Andrea Piolatto
- Centro Microcitemie-Pediatria Azienda Ospedaliero Universitaria San Luigi Gonzaga, Turin, Italy
| | - Alessandra Di Mauro
- Attività Diurne Malattie Rare Internistiche-Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Romano
- Unità Operativa Semplice Centro Microcitemia, Unità Operativa Complessa Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale 'A. Perrino', Brindisi, Italy
| | | | - Susanna Barella
- Struttura Semplice Dipartimentale Talassemia, Ospedale Microcitemico 'A. Cao,' ASL8 Cagliari, Cagliari, Italy
| | - Aurelio Maggio
- Unità Operativa Complessa Ematologia per le Malattie Rare del Sangue e degli Organi Ematopoietici, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-V. Cervello, Palermo, Italy
| | - Giovanna Graziadei
- Attività Diurne Malattie Rare Internistiche-Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università̀ della Campania 'Luigi Vanvitelli,', Naples, Italy
| | - Gian Luca Forni
- Struttura Semplice Dipartimentale Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
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Belmokhtar I, Lhousni S, Elidrissi Errahhali M, Ghanam A, Elidrissi Errahhali M, Sidqi Z, Ouarzane M, Charif M, Bellaoui M, Boulouiz R, Benajiba N. Molecular heterogeneity of β-thalassemia variants in the Eastern region of Morocco. Mol Genet Genomic Med 2022; 10:e1970. [PMID: 35615994 PMCID: PMC9356555 DOI: 10.1002/mgg3.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/22/2022] [Accepted: 05/09/2022] [Indexed: 11/09/2022] Open
Abstract
Background β‐thalassemia syndromes are the most common hereditary blood disorders in the world and are recognized as a major health problem in Morocco. They are characterized by the reduction or the absence of β‐globin chain synthesis. The severity of the disease depends on the nature of the variants affecting the β‐globin gene (HBB), and each ethnic group has its own mutation spectrum. Hereby, we present, for the first time, the molecular profile of β‐thalassemia in the Eastern region of Morocco. Methods This study concerns 39 cases from 33 families who were enrolled in the BRO Biobank. Nineteen were diagnosed with β‐thalassemia major and 20 with β‐thalassemia minor. To detect mutations of the β‐globin gene, we have used RFLP‐PCR and Sanger sequencing. Results Nine known β‐thalassemia variants have been identified. Among these, we reported, for the first time in the Moroccan population, the Czechoslovakian variant C38/39(‐C) at homozygous state. The C39(C > T) was the most frequent variant (72.54%), followed by FSC5(‐CT) (5.88%), FSC6(−A), IVS‐1‐110(G > A), −29(A > G), C38/39(‐C) (3.92% each), and finally by IVS‐I‐1(G > A), IVS‐II‐1(G > A), and −56(G > C) (1.96%). Of particular interest this mutational spectrum of β‐thalassemia is very different from that found in previous studies in Morocco or in other North African countries. Conclusion This study is the first contribution to the description of the molecular profile of β‐thalassemia in the Eastern region of Morocco. It shows the high molecular heterogeneity of β‐thalassemia in our country. Therefore, these results can be valuable for the implementation of carrier screening, genetic counseling, and prenatal diagnosis programs.
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Affiliation(s)
- Ihab Belmokhtar
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Saida Lhousni
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Mounia Elidrissi Errahhali
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Ayad Ghanam
- Department of PediatricsMohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed PremierOujdaMorocco
| | - Manal Elidrissi Errahhali
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | | | - Meryem Ouarzane
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Majida Charif
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Mohammed Bellaoui
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Redouane Boulouiz
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Noufissa Benajiba
- Department of PediatricsMohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed PremierOujdaMorocco
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Eisele AS, Cosgrove J, Magniez A, Tubeuf E, Tenreira Bento S, Conrad C, Cayrac F, Tak T, Lyne AM, Urbanus J, Perié L. Erythropoietin directly remodels the clonal composition of murine hematopoietic multipotent progenitor cells. eLife 2022; 11:66922. [PMID: 35166672 PMCID: PMC8884727 DOI: 10.7554/elife.66922] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
The cytokine erythropoietin (EPO) is a potent inducer of erythrocyte development and one of the most prescribed biopharmaceuticals. The action of EPO on erythroid progenitor cells is well established, but its direct action on hematopoietic stem and progenitor cells (HSPCs) is still debated. Here, using cellular barcoding, we traced the differentiation of hundreds of single murine HSPCs, after ex vivo EPO-exposure and transplantation, in five different hematopoietic cell lineages, and observed the transient occurrence of high-output Myeloid-Erythroid-megaKaryocyte (MEK)-biased and Myeloid-B-cell-Dendritic cell (MBDC)-biased clones. Single-cell RNA sequencing (ScRNAseq) analysis of ex vivo EPO-exposed HSPCs revealed that EPO induced the upregulation of erythroid associated genes in a subset of HSPCs, overlapping with multipotent progenitor (MPP) 1 and MPP2. Transplantation of Barcoded EPO-exposed-MPP2 confirmed their enrichment in Myeloid-Erythroid-biased clones. Collectively, our data show that EPO does act directly on MPP independent of the niche, and modulates fate by remodeling the clonal composition of the MPP pool.
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Affiliation(s)
- Almut S Eisele
- CNRS UMR168, Physico-chimie, Institut Curie, Paris, France
| | - Jason Cosgrove
- CNRS UMR168, Physico-chimie, Institut Curie, Paris, France
| | | | - Emilie Tubeuf
- CNRS UMR168, Physico-chimie, Institut Curie, Paris, France
| | | | - Cecile Conrad
- CNRS UMR168, Physico-chimie, Institut Curie, Paris, France
| | - Fanny Cayrac
- CNRS UMR168, Physico-chimie, Institut Curie, Paris, France
| | - Tamar Tak
- CNRS UMR168, Physico-chimie, Institut Curie, Paris, France
| | | | - Jos Urbanus
- Immunology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Leïla Perié
- CNRS UMR168, Physico-chimie, Institut Curie, Paris, France
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Sherief LM, Goneim E, Kamal NM, Ibraheim A, Alsofiani F, Alawur A. Acute lymphoblastic leukemia in a β-thalassemia intermedia child: A case report. World J Clin Pediatr 2020; 9:1-6. [PMID: 32844089 PMCID: PMC7416358 DOI: 10.5409/wjcp.v9.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/09/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND β-thalassemia intermedia (βTI) is one of the hemoglobinopathies. It constitutes 10% of β-thalassemia cases and is associated with better quality of life than β-thalassemia major (βTM).
CASE SUMMARY We recently reported the first case of acute lymphoblastic leukemia (ALL) from Egypt in a child with βTM, and we herein report the first case of ALL from Egypt in a child with βTI. In this report, literature was reviewed for cases of malignancies associated with βTI and the possible factors underling the relationship between the two entities.
CONCLUSIO We stress that physicians should have a high index of suspicion of malignancies in thalassemia patients if they present with any suggestive symptoms or signs.
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Affiliation(s)
- Laila M Sherief
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Zagazig University, Zagazig 44511, Egypt
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig 44511, Egypt
| | - Esmael Goneim
- Department of Pediatric Oncology, Tanta Cancer Institute, Tanta 00202, Egypt
| | - Naglaa M Kamal
- Department of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo 21121, Egypt
- Department of Pediatrics, Alhada Armed Forces Hospital, Taif 00966, Saudi Arabia
| | - Amr Ibraheim
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig 44511, Egypt
| | - Fuad Alsofiani
- Department of Pediatrics, Alhada Armed Forces Hospital, Taif 00966, Saudi Arabia
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Motta I, Mancarella M, Marcon A, Vicenzi M, Cappellini MD. Management of age-associated medical complications in patients with β-thalassemia. Expert Rev Hematol 2019; 13:85-94. [DOI: 10.1080/17474086.2020.1686354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Irene Motta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Mancarella
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Marcon
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Vicenzi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Hodroj MH, Bou-Fakhredin R, Nour-Eldine W, Noureldine HA, Noureldine MHA, Taher AT. Thalassemia and malignancy: An emerging concern? Blood Rev 2019; 37:100585. [DOI: 10.1016/j.blre.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/05/2019] [Accepted: 06/20/2019] [Indexed: 01/29/2023]
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How I manage medical complications of β-thalassemia in adults. Blood 2018; 132:1781-1791. [PMID: 30206117 DOI: 10.1182/blood-2018-06-818187] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/09/2018] [Indexed: 02/06/2023] Open
Abstract
The complex pathophysiology in β-thalassemia can translate to multiple morbidities that affect every organ system. Improved survival due to advances in management means that patients are exposed to the harmful effects of ineffective erythropoiesis, anemia, and iron overload for a longer duration, and we started seeing new or more frequent complications in adult compared with younger patients. In this article, we highlight particular aspects of managing adult patients with β-thalassemia, using our own experience in treating such patients. We cover both transfusion-dependent and nontransfusion-dependent forms of the disease and tackle specific morbidities of highest interest.
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