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Zhao LJ, Wang ZY, Liu WT, Yu LL, Qi HN, Ren J, Zhang CG. Aspirin suppresses hepatocellular carcinoma progression by inhibiting platelet activity. World J Gastrointest Oncol 2024; 16:2742-2756. [PMID: 38994144 PMCID: PMC11236245 DOI: 10.4251/wjgo.v16.i6.2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most common malignant liver disease in the world. Platelets (PLTs) are known to play a key role in the maintenance of liver homeostasis and the pathophysiological processes of a variety of liver diseases. Aspirin is the most classic antiplatelet agent. However, the molecular mechanism of platelet action and whether aspirin can affect HCC progression by inhibiting platelet activity need further study. AIM To explore the impact of the antiplatelet effect of aspirin on the development of HCC. METHODS Platelet-rich plasma, platelet plasma, pure platelet, and platelet lysate were prepared, and a coculture model of PLTs and HCC cells was established. CCK-8 analysis, apoptosis analysis, Transwell analysis, and real-time polymerase chain reaction (RT-PCR) were used to analyze the effects of PLTs on the growth, metastasis, and inflammatory microenvironment of HCC. RT-PCR and Western blot were used to detect the effects of platelet activation on tumor-related signaling pathways. Aspirin was used to block the activation and aggregation of PLTs both in vitro and in vivo, and the effect of PLTs on the progression of HCC was detected. RESULTS PLTs significantly promoted the growth, invasion, epithelial-mesenchymal transition, and formation of an inflammatory microenvironment in HCC cells. Activated PLTs promoted HCC progression by activating the mitogen-activated protein kinase/protein kinase B/signal transducer and activator of transcription three (MAPK/ AKT/STAT3) signaling axis. Additionally, aspirin inhibited HCC progression in vitro and in vivo by inhibiting platelet activation. CONCLUSION PLTs play an important role in the pathogenesis of HCC, and aspirin can affect HCC progression by inhibiting platelet activity. These results suggest that antiplatelet therapy has promising application prospects in the treatment and combined treatment of HCC.
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Affiliation(s)
- Li-Jun Zhao
- Hematology Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, Henan Province, China
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Zhi-Yin Wang
- Hematology Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, Henan Province, China
| | - Wei-Ting Liu
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Li-Li Yu
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Hao-Nan Qi
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Jie Ren
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Chen-Guang Zhang
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
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Zhao LJ, Wang ZY, Liu WT, Yu LL, Qi HN, Ren J, Zhang CG. Aspirin suppresses hepatocellular carcinoma progression by inhibiting platelet activity. World J Gastrointest Oncol 2024; 16:2730-2744. [DOI: 10.4251/wjgo.v16.i6.2730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most common malignant liver disease in the world. Platelets (PLTs) are known to play a key role in the maintenance of liver homeostasis and the pathophysiological processes of a variety of liver diseases. Aspirin is the most classic antiplatelet agent. However, the molecular mechanism of platelet action and whether aspirin can affect HCC progression by inhibiting platelet activity need further study.
AIM To explore the impact of the antiplatelet effect of aspirin on the development of HCC.
METHODS Platelet-rich plasma, platelet plasma, pure platelet, and platelet lysate were prepared, and a coculture model of PLTs and HCC cells was established. CCK-8 analysis, apoptosis analysis, Transwell analysis, and real-time polymerase chain reaction (RT-PCR) were used to analyze the effects of PLTs on the growth, metastasis, and inflammatory microenvironment of HCC. RT-PCR and Western blot were used to detect the effects of platelet activation on tumor-related signaling pathways. Aspirin was used to block the activation and aggregation of PLTs both in vitro and in vivo, and the effect of PLTs on the progression of HCC was detected.
RESULTS PLTs significantly promoted the growth, invasion, epithelial-mesenchymal transition, and formation of an inflammatory microenvironment in HCC cells. Activated PLTs promoted HCC progression by activating the mitogen-activated protein kinase/protein kinase B/signal transducer and activator of transcription three (MAPK/ AKT/STAT3) signaling axis. Additionally, aspirin inhibited HCC progression in vitro and in vivo by inhibiting platelet activation.
CONCLUSION PLTs play an important role in the pathogenesis of HCC, and aspirin can affect HCC progression by inhibiting platelet activity. These results suggest that antiplatelet therapy has promising application prospects in the treatment and combined treatment of HCC.
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Affiliation(s)
- Li-Jun Zhao
- Hematology Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, Henan Province, China
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Zhi-Yin Wang
- Hematology Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, Henan Province, China
| | - Wei-Ting Liu
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Li-Li Yu
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Hao-Nan Qi
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Jie Ren
- Xinxiang Key Laboratory of Tumor Microenvironment and Immunotherapy, School of Medical Technology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
| | - Chen-Guang Zhang
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
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Virdee PS, Collins KK, Friedemann Smith C, Yang X, Zhu S, Roberts SE, Roberts N, Oke JL, Bankhead C, Perera R, Hobbs FDR, Nicholson BD. The Association between Blood Test Trends and Undiagnosed Cancer: A Systematic Review and Critical Appraisal. Cancers (Basel) 2024; 16:1692. [PMID: 38730644 PMCID: PMC11083147 DOI: 10.3390/cancers16091692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Clinical guidelines include monitoring blood test abnormalities to identify patients at increased risk of undiagnosed cancer. Noting blood test changes over time may improve cancer risk stratification by considering a patient's individual baseline and important changes within the normal range. We aimed to review the published literature to understand the association between blood test trends and undiagnosed cancer. MEDLINE and EMBASE were searched until 15 May 2023 for studies assessing the association between blood test trends and undiagnosed cancer. We used descriptive summaries and narratively synthesised studies. We included 29 articles. Common blood tests were haemoglobin (24%, n = 7), C-reactive protein (17%, n = 5), and fasting blood glucose (17%, n = 5), and common cancers were pancreatic (29%, n = 8) and colorectal (17%, n = 5). Of the 30 blood tests studied, an increasing trend in eight (27%) was associated with eight cancer types, and a decreasing trend in 17 (57%) with 10 cancer types. No association was reported between trends in 11 (37%) tests and breast, bile duct, glioma, haematological combined, liver, prostate, or thyroid cancers. Our review highlights trends in blood tests that could facilitate the identification of individuals at increased risk of undiagnosed cancer. For most possible combinations of tests and cancers, there was limited or no evidence.
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Affiliation(s)
- Pradeep S. Virdee
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (K.K.C.); (C.F.S.); (S.Z.); (J.L.O.); (C.B.); (R.P.); (F.R.H.); (B.D.N.)
| | - Kiana K. Collins
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (K.K.C.); (C.F.S.); (S.Z.); (J.L.O.); (C.B.); (R.P.); (F.R.H.); (B.D.N.)
| | - Claire Friedemann Smith
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (K.K.C.); (C.F.S.); (S.Z.); (J.L.O.); (C.B.); (R.P.); (F.R.H.); (B.D.N.)
| | - Xin Yang
- St Edmund Hall, University of Oxford, Oxford OX1 4AR, UK;
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (K.K.C.); (C.F.S.); (S.Z.); (J.L.O.); (C.B.); (R.P.); (F.R.H.); (B.D.N.)
| | - Sophie E. Roberts
- Medical Sciences Division, St Peters College, University of Oxford, Oxford OX1 2DL, UK;
| | - Nia Roberts
- Bodleian Health Care Libraries, Oxford OX3 7DQ, UK;
| | - Jason L. Oke
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (K.K.C.); (C.F.S.); (S.Z.); (J.L.O.); (C.B.); (R.P.); (F.R.H.); (B.D.N.)
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (K.K.C.); (C.F.S.); (S.Z.); (J.L.O.); (C.B.); (R.P.); (F.R.H.); (B.D.N.)
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (K.K.C.); (C.F.S.); (S.Z.); (J.L.O.); (C.B.); (R.P.); (F.R.H.); (B.D.N.)
| | - FD Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (K.K.C.); (C.F.S.); (S.Z.); (J.L.O.); (C.B.); (R.P.); (F.R.H.); (B.D.N.)
| | - Brian D. Nicholson
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (K.K.C.); (C.F.S.); (S.Z.); (J.L.O.); (C.B.); (R.P.); (F.R.H.); (B.D.N.)
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Garcia J, Mankin P, Gnanamony M, de Alarcon PA. Evaluation of angiogenic signaling molecules associated with reactive thrombocytosis in an iron-deficient rat model. Pediatr Res 2021; 90:341-346. [PMID: 33469189 DOI: 10.1038/s41390-020-01318-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/02/2020] [Accepted: 11/24/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Iron deficiency anemia (IDA)-induced reactive thrombocytosis can occur in children and adults. The underlying mechanism for this phenomenon is indeterminate. Traditional cytokines such as thrombopoietin (TPO), interleukin-6 (IL-6), and IL-11 involved in megakaryopoiesis have not been shown to be the cause. Recent studies suggest that growth factors and signaling molecules involved with angiogenesis influence the proliferation and differentiation of megakaryocytes. METHODS We investigated the possible association between angiogenic cytokines with reactive thrombocytosis due to IDA in an iron-deficient (ID) rat model. Complete blood count, iron panels, and TPO levels were measured at baseline and 5 weeks later in both control (C) and ID rats. Angiogenic cytokines were evaluated in the bone marrow in all rats. RESULTS We successfully induced IDA in our rats by phlebotomy and reduced iron diet. We did not find an increase of TPO in ID rats. A review of the bone marrow showed an increase in the number of megakaryocytes, vascular structures, as well as increased intensity of stain for vascular endothelial growth factor (VEGF), and CXC chemokine receptor 4 (CXCR4) in rats with IDA compared to controls. CONCLUSIONS Our results of histological bone marrow data suggest an important role for angiogenesis in the development of IDA-induced thrombocytosis. IMPACT Thrombocytosis is common with IDA in both children and adults, but the mechanism is unclear. We confirmed that TPO is not the major driver of iron deficiency-associated thrombocytosis. We confirmed the increase in the number of megakaryocytes in the bone marrow despite stable TPO levels. We provided evidence supporting an important role of angiogenesis in megakaryocytopoiesis/thrombopoiesis with increased vascular structures and angiogenic cytokines in the bone marrow of iron-deficient rats. The demonstration that angiogenesis may play an important role in secondary thrombocytosis could lead to a new approach in treating symptomatic reactive thrombocytosis by targeting angiogenesis.
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Affiliation(s)
- Jessica Garcia
- Department of Pediatrics, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Peggy Mankin
- Department of Pediatrics, Division of Hematology/Oncology, University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Manu Gnanamony
- Department of Pediatrics, Division of Hematology/Oncology, University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Pedro A de Alarcon
- Department of Pediatrics, Division of Hematology/Oncology, University of Illinois College of Medicine Peoria, Peoria, IL, USA
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Loscocco GG, Antonioli E, Romano I, Vergoni F, Rotunno G, Mannelli F, Guglielmelli P, Vannucchi AM. Lenalidomide: A double-edged sword for concomitant multiple myeloma and post-essential thrombocythemia myelofibrosis. Am J Hematol 2021; 96:749-754. [PMID: 33719069 DOI: 10.1002/ajh.26153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe G. Loscocco
- Department of Experimental and Clinical Medicine University of Florence Florence Italy
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative Azienda Ospedaliero‐Universitaria Careggi Florence Italy
- Hematology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | | | - Ilaria Romano
- Department of Experimental and Clinical Medicine University of Florence Florence Italy
- Hematology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Federica Vergoni
- Division of Pathology, Department of Surgery and Translational Medicine University of Florence Florence Italy
| | - Giada Rotunno
- Department of Experimental and Clinical Medicine University of Florence Florence Italy
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Francesco Mannelli
- Department of Experimental and Clinical Medicine University of Florence Florence Italy
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative Azienda Ospedaliero‐Universitaria Careggi Florence Italy
- Hematology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine University of Florence Florence Italy
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative Azienda Ospedaliero‐Universitaria Careggi Florence Italy
- Hematology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Alessandro M. Vannucchi
- Department of Experimental and Clinical Medicine University of Florence Florence Italy
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative Azienda Ospedaliero‐Universitaria Careggi Florence Italy
- Hematology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
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Thom CS, Echevarria E, Osborne AD, Carr L, Rubey K, Salazar E, Callaway D, Pawlowski T, Devine M, Kleinman S, Witmer C, Flibotte J, Lambert MP. Extreme thrombocytosis is associated with critical illness and young age, but not increased thrombotic risk, in hospitalized pediatric patients. J Thromb Haemost 2020; 18:3352-3358. [PMID: 32979018 PMCID: PMC7855272 DOI: 10.1111/jth.15103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/01/2020] [Accepted: 09/11/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Extreme thrombocytosis (EXT, platelet count > 1000 × 103 /μL) is an uncommon but potentially clinically significant finding. Primary EXT in the setting of myeloproliferative disorders is linked to thrombotic and/or bleeding complications more frequently than secondary EXT, which typically occurs in reaction to infection, inflammation, or iron deficiency. However, comorbidities have been reported in adults with secondary EXT. Clinical implications of EXT in children are not well defined, as prior studies targeted small and/or specialized pediatric populations. OBJECTIVES Our objectives were to determine etiologies and sequelae of EXT in a hospitalized general pediatric patient population. PATIENTS AND METHODS We retrospectively analyzed EXT cases from a single-center pediatric cohort of ~80 000 patients over 8 years. RESULTS Virtually all cases (99.8%) were secondary in nature, and most were multifactorial. Many cases of EXT occurred in children under 2 years old (47%) and/or during critical illness (55%). No thrombotic or bleeding events directly resulted from EXT, confirming a paucity of clinical complications associated with EXT in pediatric patients. There were indications that neonatal hematopoiesis and individual genetic variation influenced some cases, in addition to certain diagnoses (eg, sickle cell anemia) and clinical contexts (eg, asplenia). CONCLUSION Our findings confirm that thrombotic events related to EXT are rare in pediatric patients, which can inform the use of empiric anti-platelet therapy.
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Affiliation(s)
- Christopher S Thom
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Emily Echevarria
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Ashley D Osborne
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Leah Carr
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Kathryn Rubey
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Salazar
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Danielle Callaway
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Thomas Pawlowski
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Matthew Devine
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Stacey Kleinman
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Char Witmer
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Hematology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - John Flibotte
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
| | - Michele P Lambert
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Division of Hematology, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
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Affiliation(s)
- Ayalew Tefferi
- From the Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Animesh Pardanani
- From the Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
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