1
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Krishnan N, Price R, Kotchetkov R. Case Report: Effects of multiple myeloma therapy on essential thrombocythemia and vice versa: a case of synchronous dual hematological malignancy. Front Oncol 2023; 13:1213942. [PMID: 37361582 PMCID: PMC10287112 DOI: 10.3389/fonc.2023.1213942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background Dual hematological malignancies, asynchronous or synchronous, are underrecognized entities and are usually suspected when clinical, hematological, or biochemical features cannot be explained by the primary malignancy alone. We present a case of synchronous dual hematological malignancies (SDHMs), where the patient was diagnosed with symptomatic multiple myeloma (MM) and essential thrombocythemia (ET), when excessive thrombocytosis occurred following initiation of MPV (melphalan-prednisone-bortezomib) antimyeloma therapy. Case description An 86-year-old woman presented to the emergency in May 2016 with confusion, hypercalcemia, and acute kidney injury. She was diagnosed with free light chain (FLC) lambda and Immunoglobulin G (IgG) lambda MM and started MPV (standard of care at that time) treatment with darbopoietin support. At diagnosis, she had normal platelet count since the ET was likely masked by bone marrow suppression due to active MM. After she reached stringent complete remission with no MP detected on serum protein electrophoresis or immunofixation, we noticed that her platelet counts increased to 1,518,000 × 109/L. She was tested positive for mutation in exon 9 of calreticulin (CALR). We concluded that she had concomitant CALR-positive ET. After bone marrow recovery from MM, the ET became clinically apparent. We started hydroxyurea for ET. Treatment for MM with MPV did not affect the course of ET. Presence of concomitant ET did not decrease the efficacy of sequential antimyeloma therapies in our elderly and frail patient. Conclusion The possible mechanism underlying the occurrence of SDHMs is unclear but is likely due to stem cell differentiation defects. SDHMs can be challenging to treat and warrant several considerations. In the absence of clear guidelines on how to manage SDHMs, management decisions depend on several factors including disease aggressiveness, age, frailty, and comorbidities.
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Affiliation(s)
- Nupur Krishnan
- Department of Medical Sciences, University of Western Ontario, London, ON, Canada
| | - Russell Price
- Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Rouslan Kotchetkov
- Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Centre, Barrie, ON, Canada
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2
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Hochman MJ, Smith BD, Karantanos T, Braunstein EM, Gojo I, Jain T, Streiff MB, Moliterno AR, DeZern AE. Chronic myeloid leukemia (CML) evolves from Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) with unexpected frequency. Int J Hematol 2023; 117:456-462. [PMID: 36181657 DOI: 10.1007/s12185-022-03463-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 10/06/2022]
Abstract
Myeloproliferative neoplasms (MPN) are chronic clonal disorders characterized by overproduction of myeloid-lineage blood cells and potential risk of evolution to acute myeloid leukemia (AML). Chronic myeloid leukemia (CML) is distinct from other MPNs in that its pathophysiology stems from the BCR-ABL fusion protein of the Philadelphia chromosome (Ph +). Though there are known cases of Ph- and Ph + MPNs coexisting in a single patient, overall prevalence has never been quantified in a prospective cohort. Here, we review our center's MPN registry, which shows 0.6% of Ph- MPN patients later developed CML. This development occurred no less than 10 and up to 36 years after Ph- MPN diagnosis. This rate of chronic transformation exceeds what is expected, as the incidence of CML in the United States is 2 per 100,000 people-years. The probability of this CML case rate in an average-risk population is less than 0.001%, suggesting there are shared risk factors between Ph- and Ph + MPNs. We speculate that these risk factors may include exposures, genetic predispositions, or be inherent to disease biology. Abrupt-onset leukocytosis heralded post-MPN CML in all cases here and suggests this salient clinical feature should trigger hematologists to consider this diagnosis and perform appropriate testing.
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Affiliation(s)
- Michael J Hochman
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRBI Room 3M87, Baltimore, MD, 21287-0013, USA.,Division of Hematology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - B Douglas Smith
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRBI Room 3M87, Baltimore, MD, 21287-0013, USA
| | - Theodoros Karantanos
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRBI Room 3M87, Baltimore, MD, 21287-0013, USA
| | - Evan M Braunstein
- Division of Hematology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ivana Gojo
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRBI Room 3M87, Baltimore, MD, 21287-0013, USA
| | - Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRBI Room 3M87, Baltimore, MD, 21287-0013, USA
| | - Michael B Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alison R Moliterno
- Division of Hematology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amy E DeZern
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRBI Room 3M87, Baltimore, MD, 21287-0013, USA.
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3
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Ohlsen TJD, Scanlon S, Perez FA, Ermoian RP, Paulson VA, Hauptman JS, Crotty EE, Ting MA. Synchronous rare tumors in a pediatric patient with a de novo cancer predisposition syndrome. Pediatr Blood Cancer 2022; 69:e29746. [PMID: 35484874 DOI: 10.1002/pbc.29746] [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: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Timothy J D Ohlsen
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Samantha Scanlon
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Francisco A Perez
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Ralph P Ermoian
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Vera A Paulson
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA.,Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Erin E Crotty
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Michelle A Ting
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
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4
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Muacevic A, Adler JR. Coexistence of Post-essential Thrombocythemia Myelofibrosis With Monoclonal Gammopathy of Undetermined Significance: A Case Report. Cureus 2022; 14:e29948. [PMID: 36348874 PMCID: PMC9635405 DOI: 10.7759/cureus.29948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
Synchronous dual haematological neoplasms are always challenging in both diagnosis and treatment. Here, we report the case of a 73-year-old African American female patient with the coexistence of post-essential thrombocythemia myelofibrosis with MPL positive mutation and monoclonal gammopathy of undetermined significance (MGUS). Our management plan focuses on her anaemia and regular monitoring for observing MGUS transforming into an aggressive multiple myeloma.
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5
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Ansar S, Malcolmson J, Farncombe KM, Yee K, Kim RH, Sibai H. Clinical implementation of genetic testing in adults for hereditary hematologic malignancy syndromes. Genet Med 2022; 24:2367-2379. [PMID: 36112138 DOI: 10.1016/j.gim.2022.08.010] [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: 05/20/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE As research on hereditary hematologic malignancy syndromes (HHMS) are accumulating, cancer genetics clinics are identifying more adult hematology patients with an inherited component to their disease. However, investigations for HHMS are complex, and there is no formal consensus on genetic testing criteria. METHODS We developed genetic testing criteria for adult hematology patients through a comprehensive literature review and our experience at the Princess Margaret Cancer Centre. We validated our criteria by applying them retrospectively to patients referred to our clinic for HHMS assessment. RESULTS Our genetic testing criteria are comprehensive of myeloid malignancies, lymphoid malignancies, and bone marrow failure, including age at diagnosis, family history, and genetic test results in blood and bone marrow. Of the 104 patients who met the criteria, 26% had at least 1 actionable variant in any gene associated with an increased risk of cancer and 13% had an actionable variant resulting in an HHMS diagnosis. A total of 15 patients had incidental findings, including 11 patients with a pathogenic variant associated with carrier status for an autosomal recessive disorder and 4 patients with a mosaic result. CONCLUSION Our high gene positivity rate shows the utility of a broad approach to germline testing in an adult hematology population.
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Affiliation(s)
- Safa Ansar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Janet Malcolmson
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Kirsten M Farncombe
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Karen Yee
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raymond H Kim
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada; Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada; Sinai Health System, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Hassan Sibai
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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6
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Giuliano FD, Perretta T, Pitocchi F, Pucci N, Serio ML, Caliandro A, Picchi E, Ferrazzoli V, Pistolese CA, Garaci F, Floris R. Coexistence of primary central nervous system lymphoma and primary breast lymphoma: Clinical presentation, imaging features, and treatment management. Radiol Case Rep 2022; 17:2470-2476. [PMID: 35586158 PMCID: PMC9108739 DOI: 10.1016/j.radcr.2022.04.005] [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: 03/05/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022] Open
Abstract
The presence of synchronous dual hematological diseases is an uncommon finding. We report an unusual case of coexistence of primary central nervous system lymphoma and primary breast lymphoma without systemic involvement in an immunocompetent patient. To our knowledge a similar case has not yet been reported in the literature. We especially focus on presenting the imaging features, the associated clinical findings and treatment management of each entity, with the aim of raising awareness on these two rare types of lymphomas and the possibility of their coexistence.
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Affiliation(s)
- Francesca Di Giuliano
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Tommaso Perretta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Francesca Pitocchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Noemi Pucci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
- Corresponding author.
| | - Maria Lina Serio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Aurelia Caliandro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Eliseo Picchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Valentina Ferrazzoli
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Chiara Adriana Pistolese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
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7
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Ismail OM, Amer A, Ibrahim FA, Abu-Tineh M, Yassin MA. Coexistence of Prefibrotic Myelofibrosis with Monoclonal Gammopathy of Undetermined Significance: A Case Report. Case Rep Oncol 2021; 14:1435-1440. [PMID: 34899233 PMCID: PMC8613572 DOI: 10.1159/000516746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
The coexistence of dual hematological neoplasms is an unusual and challenging presentation due to the different combination of etiopathology. The presentation of synchronous dual hematological malignancies can be one of the 3 types: myeloid + lymphoid or dual lymphoid or dual myeloid. Here, we are reporting a case of a 53-year-old male with simultaneous presence of JAK2 V617F-positive myeloproliferative neoplasm with features favoring prefibrotic phase of primary myelofibrosis (pre-PMF) in combination with monoclonal gammopathy of undetermined significance (MGUS). In such cases of simultaneous existence of dual hematological neoplasm management, it is recommended to treat the more aggressive one. Currently, our management plan is focusing on treating the pre-PMF and observation of MGUS with regular monitoring for transformation to MM.
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Affiliation(s)
- Omar M Ismail
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Aliaa Amer
- Hematopathology Division, Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Feryal A Ibrahim
- Hematopathology Division, Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Abu-Tineh
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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8
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Chalopin T, Vallet N, Arbion F, Barin C, Rault E, Villate A, Eloit M, La Rochelle LD, Foucault A, Ertault M, Dartigeas C, Benboubker L, Estienne MH, Domenech J, Hérault O, Gyan E. Characteristics, combinations, treatments, and survival of second primary hematological neoplasm: a retrospective single-center cohort of 49 patients (Hemo 2study). Ann Hematol 2019; 98:2367-2377. [PMID: 31455988 DOI: 10.1007/s00277-019-03778-9] [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: 02/15/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
The coexistence of dual hematological neoplasms is very rare. Sequential or synchronous neoplasms in hematology are an uncommon and complex clinical situation. The aim of the Hemo2 study was to describe the clinical characteristics and analyze the outcome of these patients. We performed a retrospective review of all patients diagnosed with sequential or synchronous hematological malignancies in the university hospital of Tours, between 2007 and 2018. We identified 49 patients in our study, with a prevalence of 0.89%. Sequential and synchronous combinations were found in 36 (73%) and 13 (27%) patients, respectively. One patient presented three sequential neoplasms. The median cumulative incidence was 6 years (95% CI 3-7). Among all neoplasms diagnosed (n = 99), we found 79 lymphoid neoplasms (LNs) (80%) and 20 myeloid neoplasms (MNs) (20%). Sex ratio was 1.88 with 65% of males and 35% of females. The most common LNs were Hodgkin lymphoma (n = 16; 16%) and multiple myeloma (n = 11; 11%). The most frequent MN was essential thrombocythemia (n = 5; 5%). The most common combination was Hodgkin lymphoma and follicular lymphoma in five (10%) patients. The overall survival from the first diagnosis (OS1) at 5 years was 82.4% (95% CI 72.1-94.3). The median overall survival from the second diagnosis (OS2) was 98 months (95% CI 44-NR) and 5-year OS2 was 58.7% (95% CI 45.5-75.7). Median progression-free survival from the second diagnosis (PFS) was 47 months (95% CI 27-NR) with 5-year PFS of 49% (95% CI 35.9-67). OS and PFS did not statistically differ between synchronous and sequential dual neoplasms. In this cohort, that the death relative risk (RR) was significantly lower if the second neoplasm appeared after more than 4 years following the first diagnosis (OR 0.37 (95% CI 0.16-0.90)). The Hemo2study confirmed the rarity of dual hematological neoplasms. In this cohort, HL and FL were the most frequent combinations. Our results may support that synchronous and sequential dual neoplasms bear the same prognosis. Further studies are needed to better characterize these uncommon clinical situations.
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Affiliation(s)
- Thomas Chalopin
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Nicolas Vallet
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Flavie Arbion
- Department of Pathology, University Hospital of Tours, Tours, France
| | - Carole Barin
- Department of Cytogenetics, University Hospital of Tours, Tours, France
| | - Emmanuelle Rault
- Department of Biological Hematology, University Hospital of Tours, Tours, France
| | - Alban Villate
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Martin Eloit
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Laurianne Drieu La Rochelle
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Amélie Foucault
- Department of Biological Hematology, University Hospital of Tours, Tours, France
| | - Marjan Ertault
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Caroline Dartigeas
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Lotfi Benboubker
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | | | - Jorge Domenech
- Department of Biological Hematology, University Hospital of Tours, Tours, France.,University of Tours, CNRS ERL 7001 LNOx and EA 7501, Tours, France
| | - Olivier Hérault
- Department of Biological Hematology, University Hospital of Tours, Tours, France.,University of Tours, CNRS ERL 7001 LNOx and EA 7501, Tours, France
| | - Emmanuel Gyan
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France. .,University of Tours, CNRS ERL 7001 LNOx and EA 7501, Tours, France. .,Clinical Investigation Center, University Hospital of Tours, INSERM U1415, Tours, France.
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