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Vassilakopoulos TP, Arapaki M, Diamantopoulos PT, Liaskas A, Panitsas F, Siakantaris MP, Dimou M, Kokoris SI, Sachanas S, Belia M, Chatzidimitriou C, Konstantinou EA, Asimakopoulos JV, Petevi K, Boutsikas G, Kanellopoulos A, Piperidou A, Lefaki ME, Georgopoulou A, Kopsaftopoulou A, Zerzi K, Drandakis I, Dimopoulou MN, Kyrtsonis MC, Tsaftaridis P, Plata E, Variamis E, Tsourouflis G, Kontopidou FN, Konstantopoulos K, Pangalis GA, Panayiotidis P, Angelopoulou MK. Prognostic Impact of Serum β 2-Microglobulin Levels in Hodgkin Lymphoma Treated with ABVD or Equivalent Regimens: A Comprehensive Analysis of 915 Patients. Cancers (Basel) 2024; 16:238. [PMID: 38254729 PMCID: PMC10813286 DOI: 10.3390/cancers16020238] [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: 12/04/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024] Open
Abstract
The significance of serum beta-2 microglobulin (sβ2m) in Hodgkin lymphoma (HL) is controversial. We analyzed 915 patients with HL, who were treated with ABVD or equivalent regimens with or without radiotherapy. Sβ2m levels were measured by a radioimmunoassay (upper normal limit 2.4 mg/L). Sequential cutoffs (1.8-3.0 by 0.1 mg/L increments, 3.5 and 4.0 mg/L) were tested along with ROC analysis. The median sβ2m levels were 2.20 mg/L and were elevated (>2.4 mg/L) in 383/915 patients (41.9%). Higher sβ2m was associated with inferior freedom from progression (FFP) at all tested cutoffs. The best cutoff was 2.0 mg/L (10-year FFP 83% vs. 70%, p = 0.001), which performed better than the 2.4 mg/L cutoff ("normal versus high"). In multivariate analysis, sβ2m > 2.0 mg/L was an independent adverse prognostic factor in the whole patient population. In multivariate overall survival analysis, sβ2m levels were predictive at 2.0 mg/L cutoff in the whole patient population and in advanced stages. Similarly, sβ2m > 2.0 mg/L independently predicted inferior HL-specific survival in the whole patient population. Our data suggest that higher sβ2m is an independent predictor of outcome in HL but the optimal cutoff lies within the normal limits (i.e., at 2.0 mg/L) in this predominantly young patient population, performing much better than a "normal versus high" cutoff set at 2.4 mg/L.
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Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Panagiotis T. Diamantopoulos
- First Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (P.T.D.)
| | - Athanasios Liaskas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Fotios Panitsas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Marina P. Siakantaris
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria Dimou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Styliani I. Kokoris
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Sotirios Sachanas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Marina Belia
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Elianna A. Konstantinou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Kyriaki Petevi
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - George Boutsikas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Alexandros Kanellopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Alexia Piperidou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria-Ekaterini Lefaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Angeliki Georgopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Anastasia Kopsaftopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Kalliopi Zerzi
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Ioannis Drandakis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria N. Dimopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Marie-Christine Kyrtsonis
- First Department of Internal Medicine Propedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece
| | - Panayiotis Tsaftaridis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Eleni Plata
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Eleni Variamis
- First Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (P.T.D.)
| | - Gerassimos Tsourouflis
- Second Department of Surgery Propedeutic, National and Kapodistrian University of Athens, Laikon General Hospital, 11527Athens, Greece
| | - Flora N. Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Ippokration General Hospital, 11527 Athens, Greece;
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Gerassimos A. Pangalis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Panayiotis Panayiotidis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., 11527 Athens, Greece; (M.A.); (M.D.); (M.B.); (C.C.); (E.A.K.); (J.V.A.); (A.K.); (P.T.); (M.K.A.)
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Zijtregtop EAM, Zeal J, Metzger ML, Kelly KM, Mauz-Koerholz C, Voss SD, McCarten K, Flerlage JE, Beishuizen A. Significance of E-lesions in Hodgkin lymphoma and the creation of a new consensus definition: a report from SEARCH. Blood Adv 2023; 7:6303-6319. [PMID: 37522740 PMCID: PMC10589789 DOI: 10.1182/bloodadvances.2023010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/05/2023] [Accepted: 05/25/2023] [Indexed: 08/01/2023] Open
Abstract
The International Staging Evaluation and Response Criteria Harmonization for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (SEARCH for CAYAHL) seeks to provide an appropriate, universal differentiation between E-lesions and stage IV extranodal disease in Hodgkin lymphoma (HL). A literature search was performed through the PubMed and Google Scholar databases using the terms "Hodgkin disease," and "extranodal," "extralymphatic," "E lesions," "E stage," or "E disease." Publications were reviewed for the number of participants; median age and age range; diagnostic modalities used for staging; and the definition, incidence, and prognostic significance of E-lesions. Thirty-six articles describing 12 640 patients met the inclusion criteria. Most articles reported staging per the Ann Arbor (72%, 26/36) or Cotswolds modification of the Ann Arbor staging criteria (25%, 9/36), and articles rarely defined E-lesions or disambiguated "extranodal disease." The overall incidence of E-lesions for patients with stage I-III HL was 11.5% (1330/11 602 unique patients). Available stage-specific incidence analysis of 3888 patients showed a similar incidence of E-lesions in stage II (21.2%) and stage III (21.9%), with E-lesions rarely seen with stage I disease (1.1%). E-lesions likely remain predictive, but we cannot unequivocally conclude that identifying E-lesions in HL imparts prognostic value in the modern era of the more selective use of targeted radiation therapy. A harmonized E-lesion definition was reached based on the available evidence and the consensus of the SEARCH working group. We recommend that this definition of E-lesion be applied in future clinical trials with explicit reporting to confirm the prognostic value of E-lesions.
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Affiliation(s)
- Eline A. M. Zijtregtop
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jamie Zeal
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - Monika L. Metzger
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kara M. Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Christine Mauz-Koerholz
- Department of Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Giessen, Giessen, Germany
- Medical Faculty, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Stephan D. Voss
- Department of Radiology, Boston Children’s Hospital Dana-Farber Cancer Institute, Boston, MA
| | | | - Jamie E. Flerlage
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Auke Beishuizen
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Karakatsanis S, Panitsas F, Arapaki M, Galopoulos D, Asimakopoulos JV, Liaskas A, Chatzidimitriou C, Belia M, Konstantinou E, Vassilopoulos I, Papadatos SS, Sachanas S, Efstathopoulou M, Yiakoumis X, Pardalis V, Iliakis T, Giannakopoulou N, Dimou M, Chatzidavid S, Boutsikas G, Petevi K, Kanellopoulos A, Gainaru G, Variamis E, Siakantaris MP, Kyrtsonis MC, Plata E, Tsaftaridis P, Dimopoulou MN, Viniou NA, Syrigos KN, Pangalis GA, Panayiotidis P, Konstantopoulos K, Angelopoulou MK, Vassilakopoulos TP. Serum ferritin levels in previously untreated classical Hodgkin lymphoma: correlations and prognostic significance. Leuk Lymphoma 2022; 63:799-812. [DOI: 10.1080/10428194.2021.2010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Stamatios Karakatsanis
- Third Department of Internal Medicine and Laboratory, National and Kapoditrian University of Athens, School of Medicine, “Sotiria” General Hospital, Athens, Greece
| | - Fotios Panitsas
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Galopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athanassios Liaskas
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Marina Belia
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Elianna Konstantinou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Vassilopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Stamatis S. Papadatos
- Third Department of Internal Medicine and Laboratory, National and Kapoditrian University of Athens, School of Medicine, “Sotiria” General Hospital, Athens, Greece
| | - Sotirios Sachanas
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Maria Efstathopoulou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Xanthoula Yiakoumis
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Vassilios Pardalis
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Theodoros Iliakis
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Nefeli Giannakopoulou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Sevastianos Chatzidavid
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Boutsikas
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Kyriaki Petevi
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandros Kanellopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Gabriella Gainaru
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina P. Siakantaris
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Eleni Plata
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panayiotis Tsaftaridis
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria N. Dimopoulou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos N. Syrigos
- Third Department of Internal Medicine and Laboratory, National and Kapoditrian University of Athens, School of Medicine, “Sotiria” General Hospital, Athens, Greece
| | | | - Panayiotis Panayiotidis
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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P Vassilakopoulos T, Levidou G, Milionis V, Hartmann S, Lakiotaki E, Sepsa A, Thymara I, Ntailiani P, Spanou K, K Angelopoulou M, P Siakantaris M, Moschogiannis M, A Pangalis G, Panayiotidis P, Konstantopoulos K, Patsouris E, Hansmann ML, Korkolopoulou P. Thioredoxin-1, chemokine (C-X-C motif) ligand-9 and interferon-γ expression in the neoplastic cells and macrophages of Hodgkin lymphoma: clinicopathologic correlations and potential prognostic implications. Leuk Lymphoma 2017; 58:1-13. [PMID: 28571489 DOI: 10.1080/10428194.2017.1289520] [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] [Indexed: 10/19/2022]
Abstract
Expression of thioredoxin-1 (TXN) and CXCL9 is not restricted to THRLBCL macrophages, but may be observed in histiocytes and neoplastic (HRS) cells of EBV + mixed cellularity (MC) classical Hodgkin lymphoma (cHL) and nodular lymphocyte predominant HL. We aimed to validate and extend the above observations in 174 cHL patients evaluating the immunohistochemical expression of TXN, CXCL9 and IFN-γ. HRS-cell CXCL9 expression was higher in latent membrane protein-1 (LMP1)+, MC and Stage IV. TXN and CXCL9 expression by cHL histiocytes was more frequent in LMP1+, MC and older patients (only for CXCL9). TXN expression by HRS cells (≥80%) was independently associated with better failure-free survival. In conclusion, markers of TCHRLBCL histiocytes (TXN, CXCL9), as well as IFN-γ are also expressed by histiocyte subsets and neoplastic cells of cHL. The expression of some of them is more prominent in EBV + MC, but not restricted to this subtype. The prognostic implication of TXN needs further evaluation.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- a Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Levidou
- b Department of Pathology , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Vassilis Milionis
- b Department of Pathology , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Sylvia Hartmann
- c Dr Senckenberg Institute of Pathology, Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Eleftheria Lakiotaki
- b Department of Pathology , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Athanasia Sepsa
- b Department of Pathology , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Irene Thymara
- b Department of Pathology , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Panagiota Ntailiani
- b Department of Pathology , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Kallirroi Spanou
- b Department of Pathology , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Maria K Angelopoulou
- a Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina P Siakantaris
- a Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Moschogiannis
- d Department of Haematology , Athens Medical Center , Psychikon , Athens , Greece
| | | | - Panayiotis Panayiotidis
- c Dr Senckenberg Institute of Pathology, Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Kostas Konstantopoulos
- c Dr Senckenberg Institute of Pathology, Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Efstratios Patsouris
- b Department of Pathology , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Martin-Leo Hansmann
- c Dr Senckenberg Institute of Pathology, Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Penelope Korkolopoulou
- b Department of Pathology , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
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Bröckelmann PJ, Angelopoulou MK, Vassilakopoulos TP. Prognostic factors in Hodgkin lymphoma. Semin Hematol 2016; 53:155-64. [DOI: 10.1053/j.seminhematol.2016.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vassilakopoulos TP, Dimopoulou MN, Angelopoulou MK, Petevi K, Pangalis GA, Moschogiannis M, Dimou M, Boutsikas G, Kanellopoulos A, Gainaru G, Plata E, Flevari P, Koutsi K, Papageorgiou L, Telonis V, Tsaftaridis P, Sachanas S, Yiakoumis X, Tsirkinidis P, Viniou NA, Siakantaris MP, Variami E, Kyrtsonis MC, Meletis J, Panayiotidis P, Konstantopoulos K. Prognostic Implication of the Absolute Lymphocyte to Absolute Monocyte Count Ratio in Patients With Classical Hodgkin Lymphoma Treated With Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine or Equivalent Regimens. Oncologist 2016; 21:343-53. [PMID: 26921291 DOI: 10.1634/theoncologist.2015-0251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/24/2015] [Indexed: 01/02/2023] Open
Abstract
Low absolute lymphocyte count (ALC) to absolute monocyte count (AMC) ratio (ALC/AMC) is an independent prognostic factor in Hodgkin lymphoma (HL), but different cutoffs (1.1, 1.5, and 2.9) have been applied. We aimed to validate the prognostic significance of ALC/AMC in 537 homogenously treated (doxorubicin, bleomycin, vinblastine, and dacarbazine or equivalents ± radiotherapy) classical HL patients at various cutoffs. The median ALC/AMC was 2.24 (0.44-20.50). The median AMC was 0.653 × 10(9)/L (0.050-2.070). Lower ALC/AMC was associated with established markers of adverse prognosis. In total, 477 (89%), 418 (78%), and 189 (35%) patients had an ALC/AMC ratio of ≥1.1, ≥1.5, and ≥2.9; respectively; 20% had monocytosis (≥0.9 × 10(9)/L). Ten-year time to progression (TTP) was 77% versus 55% for patients with ALC/AMC ≥1.1 and <1.1 (p = .0002), 76% versus 68% for ALC/AMC ≥1.5 and <1.5 (p = .049), 77% versus 73% for ALC/AMC ≥2.9 and <2.9 (p = .35), and 79% versus 70% for ALC/AMC ≥2.24 and <2.24 (p = .08), respectively. In stages ΙΑ/ΙΙΑ and in patients ≥60 years old, ALC/AMC had no significant effect on TTP. In advanced stages, ALC/AMC was significant only at the cutoff of 1.1 (10-year TTP 67% vs. 48%; p = .016). In younger, advanced-stage patients, the differences were more pronounced. In multivariate analysis of TTP, ALC/AMC < 1.1 (p = .007) and stage IV (p < .001) were independent prognostic factors; ALC/AMC was independent of International Prognostic Score in another model. ALC/AMC was more predictive of overall survival than TTP. At the cutoff of 1.1, ALC/AMC had independent prognostic value in multivariate analysis. However, the prognostically inferior group comprised only 11% of patients. Further research is needed prior to the widespread use of this promising marker.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria N Dimopoulou
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriaki Petevi
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Maria Dimou
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Boutsikas
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Kanellopoulos
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriella Gainaru
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Plata
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Pagona Flevari
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Koutsi
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Loula Papageorgiou
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Telonis
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Tsaftaridis
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Nora-Athina Viniou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina P Siakantaris
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Variami
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Meletis
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Georgiadi EC, Dimtsas GS, Vassilakopoulos TP, Pangalis GA, Kittas C, Doussis-Anagnostopoulou IA. Functional p53 can modulate the relationship between E2F-1 expression and tumor kinetics in Hodgkin lymphoma. Leuk Lymphoma 2014; 56:748-54. [DOI: 10.3109/10428194.2014.930850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Dimtsas GS, Georgiadi EC, Karakitsos P, Vassilakopoulos TP, Thymara I, Korkolopoulou P, Patsouris E, Kittas C, Doussis-Anagnostopoulou IA. Prognostic significance of immunohistochemical expression of the angiogenic molecules vascular endothelial growth factor-A, vascular endothelial growth factor receptor-1 and vascular endothelial growth factor receptor-2 in patients with classical Hodgkin lymphoma. Leuk Lymphoma 2013; 55:558-64. [PMID: 23772669 DOI: 10.3109/10428194.2013.813629] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Angiogenesis leads to new blood vessel formation and is implicated in both physiological and pathological situations. The vascular endothelial growth factor (VEGF) family is the major mediator of this process. The aim of our study was to evaluate the expression of VEGF-A, vascular endothelial growth factor receptor-1 (VEGFR-1) and VEGFR-2 and their correlation with clinicopathological parameters and prognosis in patients with classical Hodgkin lymphoma (cHL), since the role of angiogenesis in this tumor still remains unclear. The immunohistochemical expression of VEGF-A, VEGFR-1 and VEGFR-2 was examined in 194 patients with cHL. The neoplastic Hodgkin Reed-Sternberg (HRS) cells expressed VEGF-A, VEGFR-1 and VEGFR-2 in 90.3%, 97.2% and 94.1% of cases, respectively. Only the expression of VEGFR-2 was positively correlated with serum albumin levels ≥ 4 g/dL. No correlation with patient outcome was observed. All three molecules were statistically correlated with ramifications of blood vessels. Summarizing, our results are not sufficient to consider VEGF-A and/or VEGF receptors as prognosticators in cHL.
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Interobserver variability of clinical target volume delineation in supra-diaphragmatic Hodgkin's disease: a multi-institutional experience. Strahlenther Onkol 2011; 187:357-66. [PMID: 21603989 DOI: 10.1007/s00066-011-2221-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND To determine interobserver variability in clinical target volume (CTV) of supra-diaphragmatic Hodgkin's lymphoma. MATERIALS AND METHODS At the 2008 AIRO (Italian Society of Radiation Oncology) Meeting, the Radiation Oncology Department of Chieti proposed a multi-institutional contouring dummy-run of two cases of early stage supra-diaphragmatic Hodgkin's lymphoma after chemotherapy. Clinical history, diagnostics, and planning CT imaging were available on Chieti's radiotherapy website (www.radioterapia.unich.it). Participating centers were requested to delineate the CTV and submit it to the coordinating center. To quantify interobserver variability of CTV delineations, the total volume, craniocaudal, laterolateral, and anteroposterior diameters were calculated. RESULTS A total of 18 institutions for case A and 15 institutions for case B submitted the targets. Case A presented significant variability in total volume (range: 74.1-1,157.1 cc), craniocaudal (range: 6.5-22.5 cm; median: 16.25 cm), anteroposterior (range: 5.04-14.82 cm; median: 10.28 cm), and laterolateral diameters (range: 8.23-22.88 cm; median: 15.5 cm). Mean CTV was 464.8 cc (standard deviation: 280.5 cc). Case B presented significant variability in total volume (range: 341.8-1,662 cc), cranio-caudal (range: 8.0-28.5 cm; median: 23 cm), anteroposterior (range: 7.9-1.8 cm; median: 11.1 cm), and laterolateral diameters (range: 12.9-24.0 cm; median: 18.8 cm). Mean CTV was 926.0 cc (standard deviation: 445.7 cc). CONCLUSION This significant variability confirms the need to apply specific guidelines to improve contouring uniformity in Hodgkin's lymphoma.
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Vassilakopoulos TP, Angelopoulou MK, Pangalis GA. Treatment strategies for pediatric nodular lymphocyte predominant Hodgkin's lymphoma. Leuk Lymphoma 2009; 47:1450-1. [PMID: 16966251 DOI: 10.1080/10428190600709507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Theodoros P Vassilakopoulos
- First Department of Internal Medicine and Department of Haematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Pavone V, Ricardi U, Luminari S, Gobbi P, Federico M, Baldini L, Iannitto E, Ucci G, Marcheselli L, Orsucci L, Angelucci E, Liberati M, Gavarotti P, Levis A. ABVD plus radiotherapy versus EVE plus radiotherapy in unfavorable stage IA and IIA Hodgkin's lymphoma: results from an Intergruppo Italiano Linfomi randomized study. Ann Oncol 2008; 19:763-8. [PMID: 18180244 DOI: 10.1093/annonc/mdm575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In 1997, the Intergruppo Italiano Linfomi started a randomized trial to evaluate, in unfavorable stage IA and IIA Hodgkin's lymphoma (HL) patients, the efficacy and toxicity of the low toxic epirubicin, vinblastine and etoposide (EVE) regimen followed by involved field radiotherapy in comparison to the gold standard doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) regimen followed by the same radiotherapy program. PATIENTS AND METHODS Patients should be younger than 65 years with unfavorable stage IA and IIA HL (i.e. stage IA or IIA with bulky disease and/or subdiaphragmatic disease, erythrocyte sedimentation rate higher than 40, extranodal (E) involvement, hilar involvement and more than three involved lymph node areas). RESULTS Ninety-two patients were allocated to the ABVD arm and 89 to the EVE arm. Complete remission (CR) rates at the end of treatment program [chemotherapy (CT) + RT] were 93% and 92% for ABVD and EVE arms, respectively (P = NS). The 5-year relapse-free survival (RFS) rate was 95% for ABVD and 78% for EVE (P < 0.05). As a consequence of the different relapse rate, the 5-year failure-free survival (FFS) rate was significantly better for ABVD (90%) than for EVE (73%) arm (P < 0.05). No differences in terms of overall survival (OS) were observed for the two study arms. CONCLUSIONS In unfavorable stage IA and IIA HL patients, no differences were observed between ABVD and EVE arms in terms of CR rate and OS. EVE CT, however, was significantly worse than ABVD in terms of RFS and FFS and cannot be recommended as initial treatment for HL.
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Affiliation(s)
- V Pavone
- Division of Haematology, Ospedale G. Panico, Tricase, Lecce, Italy.
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Koontz BF, Kirkpatrick JP, Clough RW, Prosnitz RG, Gockerman JP, Moore JO, Prosnitz LR. Combined-Modality Therapy Versus Radiotherapy Alone for Treatment of Early-Stage Hodgkin's Disease: Cure Balanced Against Complications. J Clin Oncol 2006; 24:605-11. [PMID: 16446333 DOI: 10.1200/jco.2005.02.9850] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The treatment of early-stage Hodgkin's disease (HD) has evolved from radiotherapy alone (RT) to combined-modality therapy (CMT) because of concerns about late adverse effects from high-dose subtotal nodal irradiation (STNI). However, there is little information regarding the long-term results of CMT programs that substantially reduce the dose and extent of radiation. In addition, lowering the total radiation dose may reduce the complication rate without compromising cure. This retrospective study compares the long-term results of STNI with CMT using modestly reduced RT dose in the treatment of early-stage HD. Patients and Methods Between 1982 and 2002, 111 patients with stage IA and IIA HD were treated definitively with RT (mean dose, 37.9 Gy); 70 patients were treated with CMT with low-dose involved-field radiotherapy (LDIFRT; mean dose, 25.5 Gy). Median follow-up was 11.7 years for RT patients and 8.1 years for the CMT group. Results There was a trend toward improved 20-year overall survival with CMT (83% v 70%; P = .405). No second cancers were observed in the CMT group; in the RT group the actuarial frequency of a second cancer was 16% at 20 years. There was no difference in the frequency of cardiac complications (9% v 6%, RT v CMT). Conclusion In this retrospective review, CMT with LDIFRT was effective in curing early-stage HD and was not associated with an increase in second malignancies. For RT alone, a moderate dose seemed to reduce cardiac complications but did not lessen second malignancies compared with higher doses used historically.
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Affiliation(s)
- Bridget F Koontz
- Department of Radiation Oncology, Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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Abstract
Hematologic malignancies complicating pregnancy are uncommon, but a delay in diagnosis or treatment can mean the difference between life and death. It is the responsibility of the obstetrician, nurse-midwife, or nurse practitioner to maintain a high index of suspicion when patients present with unexplained lymphadenopathy or protracted constitutional symptoms. Management of these patients requires a multifaceted team from the oncology, pediatrics, and obstetrics services. With most hematologic cancers now requiring multiagent chemotherapy for optimal survival, the patient, her family, and her physicians are often faced with what seems to be a Faustian dilemma. Most infants exposed in utero to multiagent chemotherapy, however, seem to suffer no long-term detrimental consequences.
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Affiliation(s)
- Timothy J Hurley
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico Health Science Center, 2211 Lomas Boulevard, Albuquerque, NM 87131, USA.
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Korkolopoulou P, Thymara I, Kavantzas N, Vassilakopoulos TP, Angelopoulou MK, Kokoris SI, Dimitriadou EM, Siakantaris MP, Anargyrou K, Panayiotidis P, Tsenga A, Androulaki A, Doussis-Anagnostopoulou IA, Patsouris E, Pangalis GA. Angiogenesis in Hodgkin's lymphoma: a morphometric approach in 286 patients with prognostic implications. Leukemia 2005; 19:894-900. [PMID: 15800675 DOI: 10.1038/sj.leu.2403690] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The significance of angiogenesis in Hodgkin's lymphoma (HL) is not well defined. The aim of this study was to evaluate various morphometric characteristics of microvessels in lymph node sections of 286 patients with HL at diagnosis and investigate their relationship with clinicopathologic parameters and prognosis. Microvessel density (MVD), total vascular area (TVA) and several size- and shape-related microvascular parameters were quantitated--after anti-CD34 immunohistochemical staining--in the region of most intense vascularization, using image analysis. An increase in microvessel caliber parameters (area, perimeter, major and minor axis length) and a decrease in MVD were noted with increasing stage. An inverse relationship was recorded between MVD and the number of involved sites (NIS) and LDH. In univariate analysis, overall disease-specific survival was adversely affected by MVD and TVA, whereas inferior failure-free survival (FFS) was associated with the presence of more flattened vessel sections. Multivariate analysis disclosed that the extent of angiogenesis (MVD/TVA), age and the NIS independently affected overall survival. Accordingly, FFS was independently linked to the shape of microvessels and albumin levels or the NIS. In conclusion, our data support the view that angiogenesis in HL provides independent prognostic information, requiring the concomitant evaluation of quantitative and qualitative aspects of microvascular network.
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Affiliation(s)
- P Korkolopoulou
- Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece.
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Baxendale IR, Ley SV. Formation of 4-Aminopyrimidines via the Trimerization of Nitriles Using Focused Microwave Heating. ACTA ACUST UNITED AC 2005; 7:483-9. [PMID: 15877477 DOI: 10.1021/cc049826d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A series of substituted aliphatic nitriles have been trimerized to their corresponding pyrimidine structures under solvent-free conditions in the presence of catalytic quantities of potassium tert-butoxide using a focused microwave reactor. Multigram quantities of the corresponding 4-aminopyrimidines have been prepared in high yields and purity following a simple and scaleable protocol.
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Affiliation(s)
- Ian R Baxendale
- Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
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