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Kamidani R, Chiba N, Kuroda A, Uchida A, Okada H. Successful Therapeutic Leukapheresis for Chronic Myeloid Leukemia Identified by Persistent Erection: A Case Report. Cureus 2024; 16:e61351. [PMID: 38947668 PMCID: PMC11214657 DOI: 10.7759/cureus.61351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
Cytoreduction in leukostasis can be achieved using leukapheresis. We report a case of chronic myeloid leukemia (CML) identified by a persistent erection, which was successfully treated using the Spectra Optia®︎ apheresis system. A 29-year-old male presented with an erection for 12 hours without identified triggers and no improvement despite penile corpus cavernosum puncture. His white blood cell count was 458,930/μL. A diagnosis of CML-induced persistent erection with secondary hyperleukocytosis was established. Following an emergency bilateral penile corpus cavernosum incision (distal shunting), he received hydroxyurea and febuxostat. Persistent erection resolved after leukapheresis for two consecutive days. Rapid leukocyte count reduction can effectively address leukostasis in CML without major complications.
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Affiliation(s)
- Ryo Kamidani
- Department of Emergency and Disaster Medicine, Gifu University, Gifu, JPN
| | - Naokazu Chiba
- Department of Emergency and Disaster Medicine, Gifu University, Gifu, JPN
| | - Ayumi Kuroda
- Department of Emergency and Disaster Medicine, Gifu University, Gifu, JPN
| | - Akihiro Uchida
- Department of Emergency and Disaster Medicine, Gifu University, Gifu, JPN
| | - Hideshi Okada
- Department of Emergency and Disaster Medicine, Gifu University, Gifu, JPN
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Wang C, Nistala R, Cao M, Pan Y, Behrens M, Doll D, Hammer RD, Nistala P, Chang HM, Yeh ETH, Kang X. Dipeptidylpeptidase 4 promotes survival and stemness of acute myeloid leukemia stem cells. Cell Rep 2023; 42:112105. [PMID: 36807138 PMCID: PMC10432577 DOI: 10.1016/j.celrep.2023.112105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 11/11/2022] [Accepted: 01/29/2023] [Indexed: 02/19/2023] Open
Abstract
Leukemic-stem-cell-specific targeting may improve the survival of patients with acute myeloid leukemia (AML) by avoiding the ablative effects of standard regimens on normal hematopoiesis. Herein, we perform an unbiased screening of compounds targeting cell surface proteins and identify clinically used DPP4 inhibitors as strong suppressors of AML development in both murine AML models and primary human AML cells xenograft model. We find in retrovirus-induced AML mouse models that DPP4-deficient AML cell-transplanted mice exhibit delay and reversal of AML development, whereas deletion of DPP4 has no significant effect on normal hematopoiesis. DPP4 activates and sustains survival of AML stem cells that are critical for AML development in both human and animal models via binding with Src kinase and activation of nuclear factor κB (NF-κB) signaling. Thus, inhibition of DPP4 is a potential therapeutic strategy against AML development through suppression of survival and stemness of AML cells.
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Affiliation(s)
- Chen Wang
- Center for Precision Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Ravi Nistala
- Center for Precision Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA; Division of Nephrology, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Min Cao
- Center for Precision Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Yi Pan
- Center for Precision Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Madelaine Behrens
- Center for Precision Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Donald Doll
- Division of Hematology and Oncology, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Richard D Hammer
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Puja Nistala
- Division of Hematology and Oncology, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Hui-Ming Chang
- Department of Pharmacology and Toxicology, The University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Department of Internal Medicine, The University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Edward T H Yeh
- Department of Internal Medicine, The University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - XunLei Kang
- Center for Precision Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA; Division of Hematology and Oncology, Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA.
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Coffe C, Pouthier F, Barisien C, Slimane M, Sheytanova A. Therapeutic leukapheresis and thrombapheresis in medical emergencies. Transfus Apher Sci 2020; 59:102997. [PMID: 33189569 DOI: 10.1016/j.transci.2020.102997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The management of hyperleukocytosis or thrombocytosis by therapeutic cytapheresis in the early 21 st century is far from codified (universal). Therapeutic cytapheresis have been proposed to achieve more rapid cytoreduction in peripheral blood than old universal support in order to quickly prevent potential complications. But, there are no randomized studies demonstrating the superiority of cytapheresis over other treatments alone. In this short review, based on our own experience (since 1980), we will give the indications and the role of cytapheresis procedures and we will try to answer the questions: when is therapeutic cytapheresis appropriate and do they still have a place in 2020, especially as a medical emergency?
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Affiliation(s)
| | - Fabienne Pouthier
- Department of Cellular and Tissue Engineering, Etablissement Français du sang Bourgogne, Franche Comté, Besançon, France
| | - Christophe Barisien
- Department of Blood Donations, Etablissement Français du sang Bourgogne, Franche Comté, Besançon, France
| | - Mohamed Slimane
- Etablissement Français du sang Bourgogne, Franche Comté, Dijon, France
| | - Antoaneta Sheytanova
- Department of Therapeutic Apheresis, Etablissement Français du sang Bourgogne, Franche Comté, Besançon, France
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Piccirillo N, Putzulu R, Massini G, Di Giovanni A, Chiusolo P, Sica S, Zini G. Inline extracorporeal photopheresis: evaluation of cell collection efficiency. Transfusion 2019; 59:3714-3720. [PMID: 31682286 DOI: 10.1111/trf.15570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) therapy has proved to be an effective and safe treatment for graft-versus-host-disease (GvHD), an important complication after hematopoietic stem cell transplantation. In 2016, we acquired Therakos CellEx, a dedicated inline ECP device to accomplish a significant increase in ECP activity. In literature, we found few data reporting CellEx performance evaluated in terms of collection efficiency to qualify the device. Hence, we decided to collect and analyze our data in order to build a reference in terms of expected results of the procedure. Here we report our data of ECP performed using CellEx in a 12-month period focusing on collection efficiency assessment, as well as procedural and apheretic product characteristics. STUDY DESIGN AND METHODS We collected data of patients undergoing ECP from April 2018 to March 2019 using CellEx in order to evaluate collection efficiency. RESULTS Between April 2018 and March 2019 we treated 28 adult patients affected by GvHD performing 319 ECP using CellEx. CellEx mononuclear cell product was characterized by high mononuclear cell percentage and low percentage of granulocytes, resulting particularly suitable for ECP treatments. Median collection efficiency for total nucleated cells and for mononuclear cells was 31.2% and 62.3%, respectively. CONCLUSION Collection efficiency of CellEx was comparable to that usually obtained by cell separators designed for cell collection and was comparable to that of offline systems. Our results provide a detailed performance evaluation for inline ECP system users.
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Affiliation(s)
- Nicola Piccirillo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Transfusion Medicine Department, Roma, Italy
| | - Rossana Putzulu
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Transfusion Medicine Department, Roma, Italy
| | - Giuseppina Massini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Transfusion Medicine Department, Roma, Italy
| | - Alessia Di Giovanni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Hematology Department, Roma, Italy
| | - Patrizia Chiusolo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Hematology Department, Roma, Italy
| | - Simona Sica
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Hematology Department, Roma, Italy
| | - Gina Zini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Transfusion Medicine Department, Roma, Italy
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Cates NC, Oakley DJ, Onwuemene OA. Therapeutic white blood cell and platelet depletions using the spectra OPTIA system continuous mononuclear cell protocol. J Clin Apher 2018; 33:580-585. [PMID: 30325054 DOI: 10.1002/jca.21644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/09/2022]
Abstract
The Spectra Optia apheresis system has only recently been approved by the Food and Drug Administration (FDA) for therapeutic white blood cell (WBC) depletions and is not yet approved for platelet depletions. Prior to FDA-approval of the WBC depletion protocol, when our available COBE Spectra apheresis systems were out of service, we successfully performed WBC depletion using a modified Spectra Optia apheresis system Continuous Mononuclear Cell (CMNC) protocol. Using this modified Spectra Optia CMNC protocol, we created institutional protocols for WBC and platelet depletions. We performed 10 WBC depletions in 9 patients and 2 platelet depletions in 2 patients. We compared pre- and post-procedure WBC, platelet count, and hemoglobin to the same data from patients previously treated on the COBE Spectra and found no difference in % WBC and platelet reduction. We also found no significant difference in post-procedural hematocrit decline. Additionally, adverse reactions were not increased. Therefore, we conclude that the Spectra Optia CMNC protocol can be successfully modified for effective WBC and platelet depletions without increase in adverse reactions.
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Affiliation(s)
- Nancy C Cates
- Therapeutic Apheresis Service, Duke University Medical Center, Durham, North Carolina
| | - Darlene J Oakley
- Therapeutic Apheresis Service, Duke University Medical Center, Durham, North Carolina
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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