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Claudiani S, Chughtai F, Khan A, Hayden C, Fernando F, Khorashad J, Orovboni V, Scandura G, Innes A, Apperley JF, Milojkovic D. Long-term outcomes after upfront second-generation tyrosine kinase inhibitors for chronic myeloid leukemia: managing intolerance and resistance. Leukemia 2024; 38:796-802. [PMID: 38424138 PMCID: PMC10997507 DOI: 10.1038/s41375-024-02187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Second-generation tyrosine kinase inhibitors (2GTKI) are more effective in inducing rapid molecular responses than imatinib when used first-line in patients with chronic myeloid leukemia in chronic phase (CML-CP). However, failure of first line-2GTKI (1L-2GTKI) still occurs and there is no consensus regarding subsequent management. We retrospectively analyzed the outcome of 106 CML-CP patients treated with 1L-2GTKI and with a median follow-up of 91 months. 45 patients (42.4%) switched to an alternative TKI, 28 for intolerance (26.4%) and 17 (16%) for resistance. Most patients who remained on 1L-2GTKI achieved deep molecular responses (DMR) and 15 (14.1%) are in treatment-free remission (TFR). Intolerant patients also obtained DMR, although most required multiple TKI changes and were slower to respond, particularly if treated with 2L-imatinib. Inferior outcomes were observed in resistant patients, who failed alternative 2L-2GTKI and required 3/4GTKI and/or allogeneic hematopoietic stem cell transplant (alloSCT). 7yr-OS was significantly lower for these individuals (66.1%) than for intolerant patients and those who remained on 1L-2GTKI (100% and 97.9%, respectively; p = 0.001). It is apparent that failure of 1L-2GTKI is a challenging problem in modern CML therapy. Intolerance can be effectively managed by switching to an alternative 2GTKI, but resistance requires early consideration of 3/4GTKI.
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Affiliation(s)
- Simone Claudiani
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK.
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Farhan Chughtai
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Afzal Khan
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Chloe Hayden
- Imperial Molecular Pathology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Fiona Fernando
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jamshid Khorashad
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Victoria Orovboni
- Imperial Molecular Pathology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Glenda Scandura
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Andrew Innes
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jane F Apperley
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Dragana Milojkovic
- Centre for Haematology, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Kim MS, Lee SH. Reply: Atrial fibrillation surgery concomitant with mitral valve surgery: Much more than gilding the lily. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00181-8. [PMID: 38493373 DOI: 10.1016/j.jtcvs.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Min-Seok Kim
- Division of Cardiovascular Surgery, Cardiovascular Center, Myongji Hospital, Gyeonggi-do, South Korea
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Liouta E, Kalyvas AV, Komaitis S, Drosos E, Koutsarnakis C, García-Gómez JM, Juan-Albarracín J, Katsaros V, Kalamatianos T, Argyrakos T, Stranjalis G. Response to letter regarding "Assessing the association between preoperative neurocognitive status and IDH1 mutation status in high-grade gliomas: A deeper look into potential confounding variables.". Neurooncol Pract 2023; 10:597-598. [PMID: 38009118 PMCID: PMC10666807 DOI: 10.1093/nop/npad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Affiliation(s)
- Evangelia Liouta
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Athens Microneurosurgery Laboratory
- Hellenic Center for Neurosurgical Research “Prof. Petros Kokkalis”, Athens, Greece
| | - Aristotelis V Kalyvas
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Spyridon Komaitis
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Athens Microneurosurgery Laboratory
| | - Evangelos Drosos
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Athens Microneurosurgery Laboratory
| | - Christos Koutsarnakis
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Athens Microneurosurgery Laboratory
| | - Juan M García-Gómez
- Grupo de Informática Biomédica (IBIME), Instituto de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Valencia, Spain
| | - Javier Juan-Albarracín
- Grupo de Informática Biomédica (IBIME), Instituto de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Valencia, Spain
| | - Vasileios Katsaros
- Department of Radiology, General Anti-Cancer and Oncological Hospital of Athens “St. Savvas,”Athens, Greece
| | - Theodosis Kalamatianos
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Hellenic Center for Neurosurgical Research “Prof. Petros Kokkalis”, Athens, Greece
| | | | - George Stranjalis
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Athens Microneurosurgery Laboratory
- Hellenic Center for Neurosurgical Research “Prof. Petros Kokkalis”, Athens, Greece
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Villa A, Bougouin W, Urbina T, Bonny V, Gabarre P, Missri L, Baudel JL, Buzzi JC, Guidet B, Ait-Oufella H, Maury E, Joffre J. Impact of immunosuppressive regimen on ICU acquired pneumonia in critically ill COVID-19. Minerva Anestesiol 2023; 89:783-791. [PMID: 37166347 DOI: 10.23736/s0375-9393.23.17196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Immunosuppressors (IS) such as Dexamethasone (DXM), Tocilizumab, and high-dose methylprednisolone boli (HDMB), are used in COVID-19-related acute respiratory distress syndrome (ARDS). This study aimed to determine whether COVID-19 ARDS-related combined IS therapy was associated with an increased incidence of ICU-acquired pneumonia (IAP). METHODS We retrospectively analyzed COVID-19-ARDS admitted to ICU from March 2020 to April 2022. Patients' and IAP characteristics were analyzed according to five IS regimens: No IS, DXM alone, DXM+HDMB, DXM+tocilizumab, and DXM+tocilizumab+HDMB. To investigate the role of IS on IAP incidence, we performed a multivariate logistic regression and built a propensity score. Ultimately, we used a conditional logistic regression after pairing on the propensity score. RESULTS The study included 496 COVID-19-ARDS. Regarding the IS therapy, 12.7% received no IS, 43% DXM alone, 21.6% DXM+HDMB, 15.5% DXM+tocilizumab and 5.4% DXM+tocilizumab+HDMB. 37% presented at least one IAP, and the IAP incidence was higher with DXM+HDMB (66.4%) compared to no IS (P<0.0001), DXM (P<0.0001) and DXM+tocilizumab (P<0.0001). HDMB and probabilistic antibiotherapy at admission were independent IAP predictors after adjustment on the propensity score (respectively OR:2.44; P<0.0001 and OR:2.85; P<0.001). CONCLUSIONS In critically ill COVID-19, HDMB significantly increases the risk of IAP whereas DXM alone, nor in combination with tocilizumab, did not.
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Affiliation(s)
- Antoine Villa
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
| | - Wulfran Bougouin
- Intensive Care Unit, Ramsay Générale de Santé - Jacques Cartier Hospital, Massy, France
- Paris Cardiovascular Research Center, Paris Sudden Death Expertise Center, INSERM Unit 970, Paris, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
| | - Vincent Bonny
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Faculty of Medicine, Sorbonne University, Paris, France
| | - Paul Gabarre
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Faculty of Medicine, Sorbonne University, Paris, France
| | - Louai Missri
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
| | - Jean-Claude Buzzi
- Medical Information Department, Saint Antoine Hospital, Paris, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Faculty of Medicine, Sorbonne University, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, INSERM U1136, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Paris Cardiovascular Research Center, Paris Sudden Death Expertise Center, INSERM Unit 970, Paris, France
- Paris Cardiovascular Research Center, Paris University, INSERM U970, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Faculty of Medicine, Sorbonne University, Paris, France
| | - Jérémie Joffre
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France -
- Faculty of Medicine, Sorbonne University, Paris, France
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR-S938, Paris, France
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Idrovo AJ. Multilevel analyses of the cardiometabolic health of Indigenous Brazilian peoples. Lancet 2023; 401:2039-2040. [PMID: 37330742 DOI: 10.1016/s0140-6736(23)00664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Alvaro J Idrovo
- Public Health Department, Universidad Industrial de Santander, Bucaramanga 680006, Colombia.
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Konar NM, Karaismailoglu S, Karaismailoglu E. Status and trends of personalized medicine research from 2000 to 2020: a bibliometric analysis. Curr Med Res Opin 2022; 38:837-846. [PMID: 35274582 DOI: 10.1080/03007995.2022.2052515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Personalized medicine (PM), as a rapidly growing research area, provides treatments, practices, and interventions being adapted to an individual patient based on his own risk of disease. This study aims to analyze the productivity of countries, institutions, and authors in this field, to determine the existing research trends worldwide, and to forecast future research activity for specific countries. METHODS Documents published between 2000 and 2020 were retrieved from the Web of Science (WoS) database. Bibliometric analysis was performed to assess the outputs, correlation analysis was applied to analyze the relationship between Gross Domestic Product per capita (GDP-PP) and the number of publications, and an extrapolation method was used for predicting the future productivity trends for certain countries. RESULTS A total of 7,772 documents were published globally on PM between 2000 and 2020. The most productive country, journal, and institution are the USA, Personalized Medicine, and Harvard Medical School, respectively. The USA is also first in line in terms of total citations. Netherlands, Denmark, and the USA are listed at the top in terms of the total number of papers and citations, after adjusting for GDP-PP and population size. Also, as predictions suggest, the USA will maintain its predominant role in the PM field in the next 5 years. CONCLUSIONS Owing to its both interdisciplinary and multidisciplinary nature, PM bestows researchers' numerous sources to benefit and enables them a field that they can be productive of for the future. Therefore, this field is expected to progress and be the lead area in medicine in the upcoming years.
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Affiliation(s)
- Naime Meric Konar
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | | | - Eda Karaismailoglu
- Department of Medical Informatics, Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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