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Tse E, Kwong YL, Goh YT, Bee PC, Ng SC, Tan D, Caguioa P, Nghia H, Dumagay T, Norasetthada L, Chuncharunee S, Radhakrishnan V, Bagal B, Atmakusuma TD, Mulansari NA. Expert consensus on the management of chronic lymphocytic leukaemia in Asia. Clin Exp Med 2023; 23:2895-2907. [PMID: 36795237 PMCID: PMC10543526 DOI: 10.1007/s10238-023-01007-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023]
Abstract
In recent years, considerable progress has been made in the standard treatment for chronic lymphocytic leukaemia (CLL) due to the availability of new potent drugs. However, the majority of data on CLL were derived from Western populations, with limited studies and guidelines on the management of CLL from an Asian population perspective. This consensus guideline aims to understand treatment challenges and suggest appropriate management approaches for CLL in the Asian population and other countries with a similar socio-economic profile. The following recommendations are based on a consensus by experts and an extensive literature review and contribute towards uniform patient care in Asia.
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Affiliation(s)
- Eric Tse
- Division of Haematology, Medical Oncology and Haematopoietic Stem Cell Transplant, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China.
| | - Yok Lam Kwong
- 2.Division of Haematology, Medical Oncology and Haematopoietic Stem Cell Transplant, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Ping Chong Bee
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Chin Ng
- Subang Jaya Medical Centre (SJMC), Selangor, Malaysia
| | - Daryl Tan
- Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Priscilla Caguioa
- Section of Haematology, St Luke's Medical Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Huynh Nghia
- Blood Transfusion and Haematology Hospital (BTH), Ho Chi Minh, Vietnam
| | - Teresita Dumagay
- Division of Haematology, Department of Medicine, Philippine General Hospital, Manila, Philippines
| | - Lalita Norasetthada
- Division of Haematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suporn Chuncharunee
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Centre, Parel, India
| | - Tubagus Djumhana Atmakusuma
- Haematology-Medical Oncology Division, Dr. Cipto Mangunkusumo National General Hospital/ Universitas Indonesia, Jakarta, Indonesia
| | - Nadia Ayu Mulansari
- Haematology-Medical Oncology Division, Dr. Cipto Mangunkusumo National General Hospital/ Universitas Indonesia, Jakarta, Indonesia
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Purohit A, Satiza M, Somasundaram V, Sharma R, Mishra P, Seth T, Tyagi S, Mahapatra M, Pati HP, Saxena R. Evaluation of Diagnostic Usefulness of CD200 Expression in B-cell Chronic Lymphoproliferative Disorders. Indian J Hematol Blood Transfus 2023; 39:684-690. [PMID: 37786819 PMCID: PMC10542070 DOI: 10.1007/s12288-022-01622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
Immunophenotyping by flow cytometry (FCM) is a useful diagnostic tool for the evaluation of mature B-cell neoplasms (MBN). Here, CD200 expression may play a significant role and improve the distinction between various MBNs, but any potential as a prognostic marker is yet to be established. The present prospective study was conducted on all the suspected cases of MBNs. Immunophenotyping was done using a BD FACS Canto FCM using a panel of 4 to 6 color combinations of monoclonal antibodies; CD45, CD34, CD5, CD19, CD20, CD22, CD23, CD79b, FMC7, CD10, CD38, ZAP70, CD200, IgG, IgM, CD25, CD103, CD2, CD3, CD11c as well as κ and λ light chains. CD200 expression was compared in different subgroups. Of the total of 130 cases included in the study, CD200 was positive in 118 cases (90%). CD200 was expressed in 100% of the cases of CLL(86 cases), atypical CLL(06 cases), HCL(14 cases), FL(02 cases), SMZL(04 cases), LPL (01 case), and low-grade NHL (05 cases), with the highest intensity of fluorescence in HCL followed by CLL. All the cases of MCL and PLL were exclusively negative for CD200. In conclusion, the results of the present study support inclusion of this marker in the flow cytometric panels for the differential diagnosis of MBNs.
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Affiliation(s)
- Abhishek Purohit
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Manali Satiza
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | | | - Rahul Sharma
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Pravas Mishra
- Hematology and Blood and Marrow Transplant, Max Hospitals Patparganj and Vaishali, New Delhi, India
| | - Tulika Seth
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Tyagi
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoranjan Mahapatra
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Hara Prasad Pati
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Saxena
- Department of Pathology and Lab Medicine and Head Hematopathology, Medanta, Medicity, Gurugram, India
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Santos AS, Andrade JPD, Freitas DA, Gonçalves ÉS, Borges DL, Carvalho LMDA, Noronha KVDS, Andrade MV. Cost-Effectiveness Analysis of Rituximab for Chronic Lymphocytic Leukemia Using A Semi-Markovian Model Approach in R. Value Health Reg Issues 2023; 36:10-17. [DOI: 10.1016/j.vhri.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/07/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
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Role of Sirtuins in the Pathobiology of Onco-Hematological Diseases: A PROSPERO-Registered Study and In Silico Analysis. Cancers (Basel) 2022; 14:cancers14194611. [PMID: 36230534 PMCID: PMC9561980 DOI: 10.3390/cancers14194611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The aging of the hematological system can cause physiological disorders such as anemia, reduced immunity, and the increased incidence of blood cancer. Patients diagnosed with hematologic malignancies comprise nearly 10% of all cancer deaths identified in international epidemiologic studies. Therefore, it is considered a public health problem worldwide. Scientific evidence demonstrates the important involvement of sirtuins (SIRTs) in the pathogenesis of several types of solid tumors. However, the role of SIRTs in the pathobiology of malignant hematological diseases has not yet been systematically reviewed. In this systematic review, we highlight the role of different SIRTs in the pathogenesis of acute and chronic leukemias, lymphoma and myeloma. Also, we performed a bioinformatic analysis to identify whether the expression of SIRTs is altered in onco-hematological diseases, such as lymphomas and leukemias. The advent of new applicability of SIRTs in the process of aging and hematological carcinogenesis may allow the development of new diagnostic and therapeutic approaches for these diseases. Abstract The sirtuins (SIRT) gene family (SIRT1 to SIRT7) contains the targets implicated in cellular and organismal aging. The role of SIRTs expression in the pathogenesis and overall survival of patients diagnosed with solid tumors has been widely discussed. However, studies that seek to explain the role of these pathways in the hematopoietic aging process and the consequences of their instability in the pathogenesis of different onco-hematological diseases are still scarce. Therefore, we performed a systematic review (registered in PROSPERO database #CRD42022310079) and in silico analysis (based on GEPIA database) to discuss the role of SIRTs in the advancement of pathogenesis and/or prognosis for different hematological cancer types. In summary, given recent available scientific evidence and in silico gene expression analysis that supports the role of SIRTs in pathobiology of hematological malignances, such as leukemias, lymphomas and myeloma, it is clear the need for further high-quality research and clinical trials that expands the SIRT inhibition knowledge and its effect on controlling clonal progression caused by genomic instability characteristics of these diseases. Finally, SIRTs represent potential molecular targets in the control of the effects caused by aging on the failures of the hematopoietic system that can lead to the involvement of hematological neoplasms.
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Pfister V, Marques FDM, Parra F, Yamamoto M, Gonçalves MV, Perobelli L, Buccheri V, Bandeira R, Fortier S, Azevedo A, Santucci R, Bellesso M, Fogliatto L, Ribeiro G, Lopes GS, Ikoma M, Figueiredo VP, Metze IGHL, Chiattone CS, Arrais‐Rodrigues C. Lower access to risk stratification tests and drugs, and worse survival of chronic lymphocytic leukaemia patients treated in public as compared to private hospitals in Brazil: A retrospective analysis of the Brazilian registry of chronic lymphocytic leukaemia. EJHAEM 2022; 3:698-706. [PMID: 36051063 PMCID: PMC9422035 DOI: 10.1002/jha2.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/22/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) has a highly variable clinical course. In addition to biological factors, socioeconomic factors and health system characteristics may influence CLL outcome. Data from the Brazilian Registry of CLL were analyzed to compare clinical and treatment-related characteristics in patients with CLL, from public or private institutions. A total of 3326 patients from 43 centres met the eligibility criteria, of whom 81% were followed up at public hospitals and 19% at private hospitals. The majority were male (57%), with a median age of 65 years. Comparing public and private hospitals, patients in public hospitals were older, had more advanced disease at diagnosis, and more frequently had elevated creatinine levels. All investigated prognostic markers were evaluated more often in private hospitals. First-line treatment was predominantly based on chlorambucil in 41% of the cases and fludarabine in 38%. Anti-CD20 monoclonal antibody was used in only 36% of cases. In public hospitals, significantly fewer patients received fludarabine-based regimens and anti-CD20 monoclonal antibodies. Patients from public hospitals had significantly worse overall survival (71% vs. 90% for private hospitals, p < 0.0001) and treatment-free survival (32% vs. 40%, for private hospitals, p < 0.0001) at seven years. Our data indicate striking differences between patients followed in public and private hospitals in Brazil. A worse clinical condition and lack of accessibility to basic laboratory tests and adequate therapies may explain the worse outcomes of patients treated in public institutions.
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Affiliation(s)
- Verena Pfister
- Escola Paulista de Medicina /Universidade Federal de São Paulo, UNIFESPSão PauloBrazil
- Brazilian Registry of CLL – Associação Brasileira de Hematologia e HemoterapiaHemoterapiaBrazil
| | - Fernanda de Morais Marques
- Escola Paulista de Medicina /Universidade Federal de São Paulo, UNIFESPSão PauloBrazil
- Brazilian Registry of CLL – Associação Brasileira de Hematologia e HemoterapiaHemoterapiaBrazil
- Hospital BrigadeiroSão PauloBrazil
| | - Flavia Parra
- Brazilian Registry of CLL – Associação Brasileira de Hematologia e HemoterapiaHemoterapiaBrazil
| | - Mihoko Yamamoto
- Escola Paulista de Medicina /Universidade Federal de São Paulo, UNIFESPSão PauloBrazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Celso Arrais‐Rodrigues
- Escola Paulista de Medicina /Universidade Federal de São Paulo, UNIFESPSão PauloBrazil
- Brazilian Registry of CLL – Associação Brasileira de Hematologia e HemoterapiaHemoterapiaBrazil
- Hospital 9 de JulhoSão PauloBrazil
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Mkhwanazi ZA, Mfusi SA, Nkambule BB. Prognostic value of CD20 antigen mediated immune checkpoint inhibition in patients with acute or chronic lymphocytic leukemia: A protocol for systematic review. Medicine (Baltimore) 2022; 101:e28868. [PMID: 35363193 PMCID: PMC9282114 DOI: 10.1097/md.0000000000028868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The addition of rituximab to standard chemotherapy has been shown to improve response rates in patients with acute or chronic lymphocytic leukemia. However, the prognostic factors associated with progression-free survival in rituximab treated patients with lymphocytic leukemias remains unclear. We will perform a comprehensive systematic review and meta-analysis on available data on prognostic factors associated with the clinical outcomes of patients with acute and chronic lymphocytic leukemia. METHODS AND ANALYSIS This protocol for a systematic review and meta-analysis of prognostic factors has been prepared following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines. Electronic databases will be searched using keywords related to the objectives of this review. This systematic review and meta-analysis will include published randomized clinical trials, observational, prospective, and retrospective comparative cohorts. Two reviewers (ZAM and SAM) will independently screen studies, with a third reviewer consulted in cases of disagreements using a defined inclusion and exclusion criteria. Data items will be extracted using a predefined data extraction sheet. Moreover, the risk of bias and the quality of evidence were independently assessed using the quality in prognostic studies tool (QUIPS). The I2 and chi squared statistical tests will be used to analyze statistical heterogeneity across studies. An I2 values of > 50% will be considered substantial. All data analysis will be performed using STATA 16.0 (StataCorp LP, TX, USA). The outcomes examined will be progression-free and overall survival. ETHICS AND DISSEMINATION No ethical approval will be required and the findings of this meta-analysis will be published in a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION International prospective Register of Systematic Reviews (PROSERO) number: CRD42021218997.
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Affiliation(s)
- Zekhethelo A. Mkhwanazi
- School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Snenhlanhla A. Mfusi
- School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Braga TV, Evangelista FCG, Santiago MG, Ferrão ALM, Almeida TDD, Barbosa BLDF, Araujo SSDS, Ribeiro GN, Carvalho MDG, Sabino ADP. Evaluation of miR-15a, miR-16-1, ZAP-70, Ang-2, and Bcl-2 as potential prognostic biomarkers in chronic lymphocytic leukemia. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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8
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Khalifa MM, Zaki NE, Nazier AA, Moussa MA, Haleem RA, Rabie MA, Mansour AR. Prognostic significance of microRNA 17-92 cluster expression in Egyptian chronic lymphocytic leukemia patients. J Egypt Natl Canc Inst 2021; 33:37. [PMID: 34866170 DOI: 10.1186/s43046-021-00097-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Abnormal expression patterns of microRNAs (miRs) play an important role in the development and progression of malignancy. Identification of the clinical significance and prognostic value of these small molecules in chronic lymphocytic leukemia (CLL); a disease of heterogeneous biological landscape and clinical course, has always been of tremendous translational value. AIM To evaluate the prognostic value of microRNA17-92 cluster members in Egyptian CLL patients. METHODS The expression levels of miR17-92 cluster members were evaluated by qRT-PCR, including miR17, miR18a, miR19a, miR19b-1, miR20a, and miR92a-1. Other investigations included serum LDH, serum β2 microglobulin (β2M), CD38 and ZAP70 expression by flow cytometry, fluorescence in situ hybridization (FISH) for 17p deletion, and imaging studies (computerized tomography (CT) scans of neck, chest, abdomen, and pelvis or PET-CT scans). RESULTS Overexpression of all members of the miRNA17-92 cluster was detected in CLL patients compared to controls (p = < 0.001 for all miRs while p = 0.01 for miR19b-1). A significant positive correlation between Hb and miR17 and a significant negative correlation between Hb and miR19b-1 were observed (p = 0.041, 0.017 respectively). A statistically significant positive correlation between miR19b-1 expression and each of the WBCs and absolute lymphocytic count (ALC) was detected (p = 0.023, 0.022 respectively). Moreover, a statistically significant relation between miR19b-1 expression and advanced Binet stages was also found (p = 0.05). Regarding miR18a, a statistically significant positive correlation with LDH level was found (p = 0.003). We also found a significant positive correlation between miR92a-1 and β2M level (p = 0.005), as well as a significant relation between miR17 and negative CD38 expression (p = 0.034). However, no significant relationships between any of studied miRNA expression levels and 17p deletion or response to treatment were observed. Patients who expressed miR19b-1 were significantly indicated to start therapy at diagnosis (p = 0.05). The overall survival of CLL patients included in our study was 90.2% after 1 year from the time of diagnosis. Patients with high expression of miR19a had better OS than those with low expression (p = 0.04). CONCLUSIONS Overexpression of all members of the miR17-92 cluster was detected in Egyptian CLL patients. MiR18a, miR19b-1, and miR92a-1 also have an adverse prognostic value while miR17 can be considered a good prognostic marker. High expression of miR19a is associated with better OS.
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Affiliation(s)
- M M Khalifa
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - N E Zaki
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - A A Nazier
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - M A Moussa
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - R Abdel Haleem
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - M A Rabie
- Department of Medical Laboratory Technology, Pharos University, Alexandria, Egypt
| | - A R Mansour
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Management of Chronic Lymphocytic Leukemia in Less-Resourced Countries. ACTA ACUST UNITED AC 2021; 27:314-319. [PMID: 34398558 DOI: 10.1097/ppo.0000000000000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Despite the practice-changing advances achieved in the prognostic stratification and treatment of chronic lymphocytic leukemia (CLL), a large fraction of the world population resides in countries where access to many of these advances remains unavailable or subject to severe constraints. Although some of these countries display incidence rates of CLL that are lower than those of developed Western countries, a large number of patients are expected to be diagnosed with CLL in these regions every year. In this article, we review issues regarding management of CLL in some less-resourced countries, with a focus on the evidence basis for epidemiological and clinical information on this disease, the availability of diagnostic and therapeutic resources, and participation in clinical trials. Going forward, challenges that still need to be addressed include the development of unified countrywide registries, guidelines for management applicable to each country, wider availability of prognostic tools, access to new drugs, and policies that ensure these drugs are affordable to all patients worldwide.
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Musanhu E, Sharma RK, Attygalle A, Wotherspoon A, Chau I, Cunningham D, Dearden C, El-Sharkawi D, Iyengar S, Sharma B. Chronic lymphocytic leukaemia and Richter's transformation: multimodal review and new imaging paradigms. Clin Radiol 2021; 76:789-800. [PMID: 34217434 DOI: 10.1016/j.crad.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/01/2021] [Indexed: 12/15/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in adults. It is a malignancy of CD5 B-cells characterised by small, mature-appearing lymphocytes accumulating in the blood, bone marrow, and lymphoid tissues. Richer transformation (RT) is an important adverse complication. Detection of RT is critical to allow initiation of appropriate therapy. CLL staging and response evaluation is complicated and nuanced. From our extensive tertiary centre experience of several hundred CLL cases over the last decade, we detail key computed tomography (CT) and positron-emission tomography (PET) imaging features of the natural history of CLL. The authors present an original imaging-based patient-management paradigm for the investigation of potential RT, which will inform global practice. Potential applications of whole-body diffusion weighted imaging, novel PET radiotracers, minimal residual disease, and ct-DNA are addressed.
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Affiliation(s)
- E Musanhu
- Radiology Department, Royal Marsden Hospital, London, UK
| | - R K Sharma
- University of Exeter Medical School, Exeter, UK
| | - A Attygalle
- Pathology Department, Royal Marsden Hospital, UK
| | - A Wotherspoon
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - I Chau
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - D Cunningham
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - C Dearden
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - D El-Sharkawi
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - S Iyengar
- The Institute of Cancer Research, London, UK
| | - B Sharma
- Radiology Department, Royal Marsden Hospital, London, UK.
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Gamaleldin MA, Ghallab OM, Nadwan EA, Abo Elwafa RA. PD-1 and PD-L1 gene expressions and their association with Epstein-Barr virus infection in chronic lymphocytic leukemia. Clin Transl Oncol 2021; 23:2309-2322. [PMID: 34120295 DOI: 10.1007/s12094-021-02657-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The PD-1 (programmed cell death-1) receptor is expressed on the surface of activated T cells. Its ligand, programmed cell death ligand-1 (PD-L1), is expressed on the surface of dendritic cells or macrophages. The PD-1/PD-L1 interaction ensures prevention of autoimmunity by activating the immune system only when needed. In cancers, PD-L1 expressed on the tumour cells binds to PD-1 receptors on the activated T cells, leading to inhibition of the cytotoxic T cells and immunosuppression. PD-1/PD-L1 pathway is upregulated in EBV infection that is known to worsen the CLL prognosis. Therefore, we aimed to study the association between PD-1 and PD-L1 expressions, EBV status and the CLL prognosis. METHODS AND PATIENTS The study was conducted on 80 newly diagnosed CLL patients and 80 controls. We analyzed PD-1 and PD-L1 expressions and EBV-DNA load by real-time PCR. The cytogenetic abnormalities and expression of ZAP70 and CD38 were detected by FISH and Flow cytometry, respectively. RESULTS PD-1/PD-L1 expressions were significantly upregulated in CLL patients compared to controls. In addition, their mRNA levels were significantly higher in EBV( +) versus EBV( -) patients. High expression of PD-1/PD-L1 was associated with poor prognostic markers (RAI stages of CLL, del 17p13, ZAP70, and CD38 expression), failure of complete remission, shorter progression-free survival, and overall survival. CONCLUSION High expression of PD-1 and PD-L1, together with high EBD-DNA load were linked to worse prognosis in CLL. In addition, PD-1 and PD-L1 might represent suitable therapeutic targets for patients suffering from aggressive CLL.
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Affiliation(s)
- M A Gamaleldin
- Clinical Pathology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
| | - O M Ghallab
- Internal Medicine Department (Hematology Unit), Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - E A Nadwan
- Internal Medicine Department (Hematology Unit), Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - R A Abo Elwafa
- Clinical Pathology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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12
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Gupta R, Garg N, Singh A. Anti-globulin test positivity indicates advanced disease in Indian CLL patients. AMERICAN JOURNAL OF BLOOD RESEARCH 2021; 11:157-162. [PMID: 34079629 PMCID: PMC8165719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
Autoimmune Hemolytic Anemia (AIHA) occurs in 10% to 25% of Chronic Lymphocytic Leukemia (CLL) while Direct Antiglobulin Test (DAT) positivity seen in 35% of cases. The prevalence and prognostic significance of DAT positivity is not well documented especially in Indian population. The present study was undertaken to know prevalence and prognostic significance of DAT positivity in CLL in India by associating it with stage and CD 38 expression. The study included fifty-eight newly diagnosed and untreated cases of CLL staged according to Binet and Rai system. Complete hemogram, DAT and immuno-phenotyping by flow cytometry was done to diagnose CLL and to assess CD 38 expression. Student's t test and Chi square test was used to calculate difference between means. p value ≤0.05 was considered significant. Results-DAT positivity was found in 27.58% cases. A positive association was seen between DAT and advanced Rai and Binet stage (P = 0.024 and P = 0.014 respectively). A positive association was also seen between DAT and CD 38 (P = 0.008). The study concluded that DAT positivity in Indian CLL patients is high as compared to West. As DAT correlated with advanced Rai/Binet stage, as well as CD 38 positivity, it can be considered as a surrogate marker for advanced disease and used to select patients needing close follow up especially at places where molecular and flow cytometric set up for prognostication is not available.
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Affiliation(s)
- Richa Gupta
- Department of Pathology, University College of Medical SciencesDelhi, India
| | - Neha Garg
- Department of Pathology, University College of Medical SciencesDelhi, India
| | - Abha Singh
- Department of Pathology, Dr Ram Manohar Lohia Hospital and PG InstituteNew Delhi, India
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Extracellular vesicles (EVs): What we know of the mesmerizing roles of these tiny vesicles in hematological malignancies? Life Sci 2021; 271:119177. [PMID: 33577843 DOI: 10.1016/j.lfs.2021.119177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
Cancer is a complex disease in which a bidirectional collaboration between malignant cells and surrounding microenvironment creates an appropriate platform which ultimately facilitates the progression of the disease. The discovery of extracellular vesicles (EVs) was a turning point in the modern era of cancer biology, as their importance in human malignancies has set the stage to widen research interest in the field of cell-to-cell communication. The implication in short- and long-distance interaction via horizontally transfer of cellular components, ranging from non-coding RNAs to functional proteins, as well as stimulating target cells receptors by the means of ligands anchored on their membrane endows these "tiny vesicles with giant impacts" with incredible potential to re-educate normal tissues, and thus, to re-shape the surrounding niche. In this review, we highlight the pathogenic roles of EVs in human cancers, with an extensive focus on the recent advances in hematological malignancies.
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Bagheri M, Khansarinejad B, Mosayebi G, Moradabadi A, Mondanizadeh M. Diagnostic Value of Plasma miR-145 and miR-185 as Targeting of the APRIL Oncogene in the B-cell Chronic Lymphocytic Leukemia. Asian Pac J Cancer Prev 2021; 22:111-117. [PMID: 33507687 PMCID: PMC8184163 DOI: 10.31557/apjcp.2021.22.1.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/31/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is one of the most common hematologic malignancy in adults worldwide. This cancer has a poor prognosis at different stages. So, the identification of new biomarkers is important for diagnosis of B-CLL. Considering the oncogenic role of APRIL molecule in this leukemia as well as the regulatory role of miRNAs in different signaling pathways, the present study evaluated the miRNAs targeting APRIL gene in B-CLL. METHODS The miRNAs were predicted and selected using bioinformatics algorithms. A total of 80 plasma samples were subjected to RNA extraction and synthesis of cDNA. The expressions levels of predicted miRNAs and APRIL gene in plasma of B-CLL patients and healthy individuals were assessed by Real time PCR analysis. ROC analysis was performed to investigate the role predicted miRNAs as novel biomarkers in diagnosis of B-CLL. RESULTS The results of the prediction showed that miR-145-5p and miR-185-5p target the APRIL gene. The expression level of APRIL gene was strikingly higher in plasma of B-CLL patients than in the healthy individuals (102, P= 0.001). On the other hand, expression levels of miR-145-5p and miR-185-5p were strikingly lower in B-CLL patients than in the healthy individuals (0.07, P= 0.001) (0.29, P= 0.001). Also, ROC curve analyses demonstrated that miR-145-5p and miR-185-5p are specific and sensitive and may serve as new biomarkers for the detection of B-CLL. (AUC; 0.95, sensitivity; %90) (AUC; 0.87, sensitivity; %63). CONCLUSION These data suggest that miR-145-5p and miR-185-5p target the APRIL gene and might have a role in diagnosis of B-CLL. Therefore, these two miRNAs can be served as a novel and potential biomarker for detection of B-CLL.
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MESH Headings
- Aged
- Biomarkers, Tumor/blood
- Case-Control Studies
- Computational Biology
- Female
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Male
- MicroRNAs/blood
- MicroRNAs/genetics
- Middle Aged
- Oncogenes
- Prognosis
- Tumor Necrosis Factor Ligand Superfamily Member 13/genetics
- Tumor Necrosis Factor Ligand Superfamily Member 13/metabolism
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Affiliation(s)
- Malihe Bagheri
- Department of Biotechnology and Molecular Medicine, Arak University of Medical Sciences, Arak, Iran.
| | - Behzad Khansarinejad
- Department of Microbiology and Immunology, Arak University of Medical Sciences, Arak, Iran.
| | - Ghasem Mosayebi
- Department of Microbiology and Immunology, Arak University of Medical Sciences, Arak, Iran.
| | - Alireza Moradabadi
- Department of Hematology and Blood Banking, Arak University of Medical Sciences, Arak, Iran.
| | - Mahdieh Mondanizadeh
- Department of Biotechnology and Molecular Medicine, Arak University of Medical Sciences, Arak, Iran.
- Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, Iran.
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15
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Chauffaille MDLLF, Zalcberg I, Barreto WG, Bendit I. Detection of somatic TP53 mutations and 17p deletions in patients with chronic lymphocytic leukemia: a review of the current methods. Hematol Transfus Cell Ther 2020; 42:261-268. [PMID: 32660851 PMCID: PMC7417461 DOI: 10.1016/j.htct.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 01/09/2023] Open
Abstract
Chronic lymphocytic leukemia is the most common hematologic malignancy among adults in Western countries. Several studies show that somatic mutations in the TP53 gene are present in up to 50% of patients with relapsed or refractory chronic lymphocytic leukemia. This study aims to review and compare the methods used to detect somatic TP53 mutations and/or 17p deletions and analyze their importance in the chronic lymphocytic leukemia diagnosis and follow-up. In chronic lymphocytic leukemia patients with refractory or recurrent disease, the probability of clonal expansion of cells with the TP53 mutation and/or 17p deletion is very high. The studies assessed showed several methodologies able to detect these changes. For the 17p deletion, the chromosome G-banding (karyotype) and interphase fluorescence in situ hybridization are the most sensitive. For somatic mutations involving the TP53 gene, moderate or high-coverage read next-generation sequencing and Sanger sequencing are the most recommended ones. The TP53 gene mutations represent a strong adverse prognostic factor for patient survival and treatment resistance in chronic lymphocytic leukemia. Patients carrying low-proportion TP53 mutation (less than 20–25% of all alleles) remain a challenge to these tests. Thus, for any of the methods employed, it is essential that the laboratory conduct its analytical validation, documenting its accuracy, precision and sensitivity/limit of detection.
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Affiliation(s)
| | - Ilana Zalcberg
- Centro de Transplante de Medula Óssea, Instituto Nacional do Cancer (CEMO-INCA), Rio de Janeiro, RJ, Brazil; GeneOne, DASA, São Paulo, SP, Brazil
| | | | - Israel Bendit
- Laboratório de Biologia do Tumor do Serviço de Hematologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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16
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Abo Elwafa R, Abd Elrahman A, Ghallab O. Long intergenic non-coding RNA-p21 is associated with poor prognosis in chronic lymphocytic leukemia. Clin Transl Oncol 2020; 23:92-99. [PMID: 32468342 DOI: 10.1007/s12094-020-02398-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/12/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Long non-coding RNAs (LncRNAs) are RNA transcripts longer than 200 nucleotides. They are new players in transcriptional regulation and cancer research. LincRNA-p21 is a p53-regulated lncRNA involved in the p53 transcriptional network. It has an important role in regulating cellular proliferation and apoptosis. Chronic lymphocytic leukemia is derived by a typical defect in apoptosis and characterized by clonal proliferation and accumulation of mature B cells. The aim of the present study was to assess the expression pattern of the lincRNA-p21 and investigate its potential role as a new prognostic marker in CLL. METHODS The study was conducted on 80 newly diagnosed CLL patients and 80 age- and sex-matched controls. The analysis of LincRNA-p21 and the p53 downstream proapoptotic target genes (MDM2, PUMA, BAX, and NOXA) was performed by real-time PCR. The cytogenetic abrasions and expression of ZAP70 and CD38 were detected by FISH and Flow cytometry, respectively. RESULTS LincRNA-p21 was significantly downregulated in CLL patients compared to controls. The downstream proapoptotic targets were significantly downregulated in CLL patients and positively correlated with lincRNA-p21. Low expression of lincRNA-p21 was associated with poor prognostic markers (advanced stages of CLL, del 17p13, ZAP70, and CD38 expression), failure of complete remission, shorter progression free survival, and overall survival. Low lincRNA-p21 expression was independently prognostic for shorter time to treatment. CONCLUSION Low expression of lincRNA-p21 demarcates a more aggressive form of CLL with poor prognosis. Therefore, it could be considered as a new prognostic marker to predict disease outcome in CLL.
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Affiliation(s)
- R Abo Elwafa
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - A Abd Elrahman
- Internal Medicine Department (Hematology Unit), Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - O Ghallab
- Internal Medicine Department (Hematology Unit), Faculty of Medicine, Alexandria University, Alexandria, Egypt
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17
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El Din Fouad NB, Ibrahim NY, Abdel Aziz RS, Ibrahim SK. CD200 Expression in Diagnostic and Prognostic Assessment of Mature B Cell Lymphophoproliferative Neoplasms. Asian Pac J Cancer Prev 2018; 19:3383-3392. [PMID: 30583344 PMCID: PMC6428547 DOI: 10.31557/apjcp.2018.19.12.3383] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/04/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Multiparameter flow cytometry is a useful tool for diagnostic evaluation of mature B-cell neoplasms (MBN). Recently, it has been shown that assessment of CD200 expression may improve the distinction between chronic lymphocytic leukemia (CLL; CD200 positive) and mantle cell lymphoma (MCL; CD200 negative), but any potential as a prognostic marker for CLL remains to be established. Materials and methods: This cross sectional study was conducted on sixty-seven patients newly diagnosed as having mature B-cell lymphoproliferative disorders Levels of CD 200 in lymphoma cells were assessed. Results: CD200 was consistently expressed in CLL and hairy cell leukemia B cells, but not in MCL cells. Heterogeneous expression was noted in other CD5 positive Non-Hodgkin lymphomas. High CD200 expression (≥50%) was associated with a higher CD5, 19 and CD23 expression, older age, higher TLC and absolute lymphocyte count, hepatomegaly, splenomegaly and a higher Rai stage. There were no significant correlations between CD200 expression and response to treatment. Conclusion: CD200 could be of high value in distinguishing CLL, MCL, and atypical CLL. CD200 expression can also be of prognostic and therapeutic value in CLL cases.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD/metabolism
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Biomarkers, Tumor/metabolism
- Cross-Sectional Studies
- Diagnosis, Differential
- Female
- Humans
- Immunophenotyping/methods
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/metabolism
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/metabolism
- Lymphoma, Non-Hodgkin/pathology
- Lymphoproliferative Disorders/diagnosis
- Lymphoproliferative Disorders/metabolism
- Lymphoproliferative Disorders/pathology
- Male
- Middle Aged
- Prognosis
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18
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Fonseca ICCFE, da Luz FAC, Uehara IA, Silva MJB. Cell-adhesion molecules and their soluble forms: Promising predictors of "tumor progression" and relapse in leukemia. Tumour Biol 2018; 40:1010428318811525. [PMID: 30486756 DOI: 10.1177/1010428318811525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Some surface markers are used to discriminate certain leukemic subpopulations that retain a greater oncogenic potential than others, and, for this reason, they were termed as leukemic stem cells, similar to the concept of cancer stem cells in carcinoma. Among these surface markers are proteins involved in cell-cell adhesion or cell-matrix adhesion, and they may play a role in the relapse of leukemia, similar to metastasis in carcinomas. The most important are epithelial cadherin, neural cadherin, epithelial cell-adhesion molecule, and CD44, which can be cleaved and released, and their soluble forms were found increased in serum levels of cancer patients, being implicated, in some cases, with progression, metastases, and relapse. In this review, we highlighted the role of these four adhesion molecules in carcinomas and hematological malignancies, mainly leukemia, and discuss if the serum levels of soluble forms can be correlated with the surface protein status on the leukemic cells. Accession of the soluble forms looks attractive, but their use as markers in cancer must be studied in association with other parameters, as there are significant changes in levels in other pathological conditions besides cancer. Studies correlating the levels of the forms with the status of the membrane-bound proteins in leukemic (stem) cells and correlating those parameters with relapse in leukemia may afford important knowledge and applicability of those serum markers in clinical practice. For instance, the expression of the membrane-bound forms of these adhesion proteins may have promising clinical use in leukemia and other hematological malignancies.
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Affiliation(s)
| | - Felipe Andrés Cordero da Luz
- 1 Laboratory of Tumor Biomarkers and Osteoimmunology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
- 2 Nucleus of Cancer Prevention and Research, Cancer Hospital, Federal University of Uberlândia, Uberlândia, Brazil
| | - Isadora Akemi Uehara
- 1 Laboratory of Tumor Biomarkers and Osteoimmunology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - Marcelo José Barbosa Silva
- 1 Laboratory of Tumor Biomarkers and Osteoimmunology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
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19
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Hasan KM. Clinical Aspects, Immunophenotypic Analysis and Survival Rate of Chronic Lymphocytic Leukaemia Patients in Erbil City, Iraq. Sultan Qaboos Univ Med J 2018; 18:e461-e467. [PMID: 30988964 PMCID: PMC6443287 DOI: 10.18295/squmj.2018.18.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/27/2018] [Accepted: 10/18/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Chronic lymphocytic leukaemia (CLL) is characterised by an accumulation of clonal B cells in the blood, bone marrow and lymphatic tissue. This study aimed to evaluate the clinical and immunophenotypic characteristics and survival rate of CLL patients. METHODS This retrospective study was conducted at the Nanakaly Hospital for Blood Diseases & Oncology in Erbil, Iraq, between January 2011 and December 2017. A total of 105 CLL patients were assessed to determine clinical presentation and staging, immunophenotype and survival rate. RESULTS The median age of the patients was 65 years and 63.8% were male. The main clinical presentations were splenomegaly (64.8%), pallor (61.9%) and lymphadenopathy (60%). More than half of the patients presented at an advanced clinical stage according to the Rai and Binet staging systems (59.1% and 55.2%, respectively). All CLL cases expressed both cluster of differentiation (CD)19 and CD5, 67.6% had monoclonal kappa light chains and 21% expressed CD38. The five-year overall survival (OS) rate was 61.3%. The mean duration of five-year survival was 41.3 months (95% confidence interval: 36.4-46.3 months). There were no correlations between survival and sociodemographic, clinical or laboratory characteristics. CONCLUSION In comparison to the existing Western literature, Iraqi CLL patients more frequently presented with hepatosplenomegaly and at a more advanced clinical stage. In addition, the five-year OS rate was much lower.
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Affiliation(s)
- Kawa M Hasan
- Department of Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
- Department of Clinical Haematology, Nanakaly Hospital for Blood Diseases & Oncology, Erbil, Iraq
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20
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Buccheri V, Barreto WG, Fogliatto LM, Capra M, Marchiani M, Rocha V. Prognostic and therapeutic stratification in CLL: focus on 17p deletion and p53 mutation. Ann Hematol 2018; 97:2269-2278. [DOI: 10.1007/s00277-018-3503-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/23/2018] [Indexed: 01/15/2023]
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21
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Gomes LC, Ferrão ALM, Evangelista FCG, de Almeida TD, Barbosa RC, Carvalho MDG, de Paula Sabino A. Advances in chronic lymphocytic leukemia pharmacotherapy. Biomed Pharmacother 2017; 97:349-358. [PMID: 29091884 DOI: 10.1016/j.biopha.2017.10.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 12/14/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a lymphoproliferative disease that affects B lymphocytes in most cases. Leukemic lymphocytes have prolonged longevity, defined by resistance to apoptosis. These cells can accumulate in peripheral blood, bone marrow, and solid lymphoid organs. CLL may be indolent or aggressive and has a range of prognostic factors such as expression of CD38 and ZAP-70, immunophenotypic and cytogenetic changes, imbalanced apoptosis proteins, and others. Although CLL has a low mortality rate, this disease is generally not considered curable until today. CLL treatment involves alkylating agents and glucocorticoids, purine analogs, monoclonal antibody therapies, and bone marrow transplantation. In recent decades, new drugs have appeared focusing on new targets and specific molecules, such as the BCR receptor, Bruton's tyrosine kinase, phosphatidylinositol 3-kinase, spleen tyrosine kinase, apoptosis proteins and microRNAs. The most appropriate treatment for CLL is one that involves in its protocol a combination of drugs according to the prognostic factors presented by each patient. In this sense, treatment individualization is essential. This article examines standard treatments for CLL and explores new treatments and potential new targets, as well as schematic protocols to understand where we are, how the treatment has evolved, and the advantages and disadvantages of new targets for CLL therapy.
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Affiliation(s)
- Lorena Caixeta Gomes
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Address: 6627, Presidente Antônio Carlos Ave, Pampulha, Zip Code 31270-901, Belo Horizonte, MG, Brazil
| | - Aline Lúcia Menezes Ferrão
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Address: 6627, Presidente Antônio Carlos Ave, Pampulha, Zip Code 31270-901, Belo Horizonte, MG, Brazil
| | - Fernanda Cristina Gontijo Evangelista
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Address: 6627, Presidente Antônio Carlos Ave, Pampulha, Zip Code 31270-901, Belo Horizonte, MG, Brazil
| | - Tâmara Dauare de Almeida
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Address: 6627, Presidente Antônio Carlos Ave, Pampulha, Zip Code 31270-901, Belo Horizonte, MG, Brazil
| | - Rayson Carvalho Barbosa
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Address: 6627, Presidente Antônio Carlos Ave, Pampulha, Zip Code 31270-901, Belo Horizonte, MG, Brazil
| | - Maria das Graças Carvalho
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Address: 6627, Presidente Antônio Carlos Ave, Pampulha, Zip Code 31270-901, Belo Horizonte, MG, Brazil
| | - Adriano de Paula Sabino
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Address: 6627, Presidente Antônio Carlos Ave, Pampulha, Zip Code 31270-901, Belo Horizonte, MG, Brazil.
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22
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Gonçalves MV, Rodrigues CA, Lorand Metze IGH, Lacerda MP, de Lourdes Lopes Ferrari Chauffaill M, Azevedo A, Machado C, Chiattone CS, Fortier S, Perobelli L, Ikoma MRV, Clementino N, Hamerschlak N, Sthel VM, Ommati LVM, de Farias DLC, Duarte FB, Buccheri V, de Azambuja AP, de Almeida DR, Figueiredo VLP, Yamamoto M. Chronic lymphocytic leukemia in Brazil: A retrospective analysis of 1903 cases. Am J Hematol 2017; 92:E171-E173. [PMID: 28474845 DOI: 10.1002/ajh.24779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | - Celso Arrais Rodrigues
- Universidade Federal de São Paulo (UNIFESP/EPM); São Paulo Brazil
- Hospital Sírio Libanês; São Paulo Brazil
| | | | | | | | | | | | - Carlos Sérgio Chiattone
- Santa Casa de Misericórdia de São Paulo; São Paulo Brazil
- Hospital Samaritano; São Paulo Brazil
| | - Sérgio Fortier
- Santa Casa de Misericórdia de São Paulo; São Paulo Brazil
| | - Leila Perobelli
- Hospital de Transplantes Euryclides de Jesus Zerbini/Hospital Brigadeiro; São Paulo Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Mihoko Yamamoto
- Universidade Federal de São Paulo (UNIFESP/EPM); São Paulo Brazil
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23
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Evaluation of MiR-15a and MiR-16-1 as prognostic biomarkers in chronic lymphocytic leukemia. Biomed Pharmacother 2017; 92:864-869. [DOI: 10.1016/j.biopha.2017.05.144] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 12/22/2022] Open
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