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Gross SA, Paustenbach DJ. Shanghai Health Study (2001-2009): What was learned about benzene health effects? Crit Rev Toxicol 2017; 48:217-251. [PMID: 29243948 DOI: 10.1080/10408444.2017.1401581] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Shanghai Health Study (SHS) was a large epidemiology study conducted as a joint effort between the University of Colorado and Fudan University in Shanghai, China. The study was funded by members of the American Petroleum Institute between 2001 and 2009 and was designed to evaluate the human health effects associated with benzene exposure. Two arms of the SHS included: an occupational-based molecular epidemiology study and several hospital-based case control studies. Consistent with historical literature, following sufficient exposure to relatively high airborne concentrations and years of exposure, the SHS concluded that exposure to benzene resulted in an increased risk of various blood and bone marrow abnormalities such as benzene poisoning, aplastic anemia (AA), myelodysplastic syndrome (MDS), and acute myeloid leukemia (AML). Non-Hodgkin lymphoma (NHL) was not significantly increased for the exposures examined in this study. Perhaps the most important contribution of the SHS was furthering our understanding of the mechanism of benzene-induced bone marrow toxicity and the importance of identifying the proper subset of MDS relevant to benzene. Investigators found that benzene-exposed workers exhibited bone marrow morphology consistent with an immune-mediated inflammatory response. Contrary to historic reports, no consistent pattern of cytogenetic abnormalities was identified in these workers. Taken together, findings from SHS provided evidence that the mechanism for benzene-induced bone marrow damage was not initiated by chromosome abnormalities. Instead, chronic inflammation, followed by an immune-mediated response, is likely to play a more significant role in benzene-induced disease initiation and progression than previously thought.
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Acquired myelodysplasia or myelodysplastic syndrome: clearing the fog. Adv Hematol 2013; 2013:309637. [PMID: 24194760 PMCID: PMC3806348 DOI: 10.1155/2013/309637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/28/2013] [Indexed: 12/20/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are clonal myeloid disorders characterized by progressive peripheral blood cytopenias associated with ineffective myelopoiesis. They are typically considered neoplasms because of frequent genetic aberrations and patient-limited survival with progression to acute myeloid leukemia (AML) or death related to the consequences of bone marrow failure including infection, hemorrhage, and iron overload. A progression to AML has always been recognized among the myeloproliferative disorders (MPD) but occurs only rarely among those with essential thrombocythemia (ET). Yet, the World Health Organization (WHO) has chosen to apply the designation myeloproliferative neoplasms (MPN), for all MPD but has not similarly recommended that all MDS become the myelodysplastic neoplasms (MDN). This apparent dichotomy may reflect the extremely diverse nature of MDS. Moreover, the term MDS is occasionally inappropriately applied to hematologic disorders associated with acquired morphologic myelodysplastic features which may rather represent potentially reversible hematological responses to immune-mediated factors, nutritional deficiency states, and disordered myelopoietic responses to various pharmaceutical, herbal, or other potentially myelotoxic compounds. We emphasize the clinical settings, and the histopathologic features, of such AMD that should trigger a search for a reversible underlying condition that may be nonneoplastic and not MDS.
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Ok CY, Medeiros LJ, Hu Y, Bueso-Ramos CE, Wang SA. Transient/reversible ring sideroblasts in bone marrow of patients post cytotoxic therapies for primary malignancies. Leuk Res 2011; 35:1605-10. [PMID: 21596435 DOI: 10.1016/j.leukres.2011.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 04/19/2011] [Accepted: 04/21/2011] [Indexed: 02/03/2023]
Abstract
The diagnosis of therapy-related myelodysplastic syndrome (t-MDS) in the absence of increased myeloblasts or cytogenetic abnormalities is challenging. The presence of ring sideroblasts (RS) in this setting is often used to support the diagnosis of t-MDS. In this study, we reviewed 843 patients initially classified as therapy-related myeloid neoplasm in our hospital over 10 years. Nineteen (2.3%) patients had a normal karyotype, <5% bone marrow (BM) blasts, and ≥15% RS (17-70%), forming this study group. After reviewing clinical charts and follow-up BM specimens, we confirmed the diagnosis of MDS in 13 patients, but in 6 patients the blood counts returned to normal and RS and associated dyserythropoiesis disappeared in the follow-up BM biopsy. With a median follow-up of 21 months, none of these 6 patients died of BM causes. Compared with t-MDS cases, the 6 patients with transient/reversible RS showed comparable numbers of RS and BM blasts, but infrequent dysplasia involving non-erythroid lineages. We conclude that the presence of ≥15% RS in the post-therapy setting is not necessarily indicative of a clonal stem cell neoplasm. Four patients with transient/reversible RS received α-interferon therapy which may contribute to RS formation in this setting.
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Affiliation(s)
- Chi Young Ok
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Lv L, Lin G, Lin G, Gao X, Wu C, Dai J, Yang Y, Zou H, Sun H, Gu M, Chen X, Fu H, Bao L. Case-control study of risk factors of myelodysplastic syndromes according to World Health Organization classification in a Chinese population. Am J Hematol 2011; 86:163-9. [PMID: 21264898 DOI: 10.1002/ajh.21941] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Risk factors of mydelodysplastic syndromes (MDS) remain largely unknown. We conducted a hospital-based case-control study consisting of 403 newly diagnosed MDS patients according to World Health Organization classification and 806 individually gender and age-matched patient controls from 27 major hospitals in Shanghai, China, to examine relation of lifestyle, environmental, and occupational factors to risk of MDS. The study showed that all MDS (all subtypes combined) risk factors included anti tuberculosis drugs [odds ratio (OR)(adj) = 3.15; 95% confidence interval (CI) = 1.22-8.12] as an independent risk factor, benzene (OR(adj) = 3.73; 95% CI = 1.32-10.51), hair dye use (OR = 1.46; 95% CI = 1.03-2.07), new building and renovations (OR = 1.69; 95% CI = 1.11-2.00), pesticides (OR = 2.16; 95% CI = 1.22-3.82), and herbicides (OR = 5.33; 95% CI = 1.41-20.10) as relative risk factors. Risk factors of MDS subtype refractory cytopenia with multiple dysplasia (RCMD) were benzene (OR(adj) = 5.99; 95% CI = 1.19-30.16) and gasoline (OR(adj) = 11.44; 95% CI = 1.31-100.03) as independent risk factors, and traditional Chinese medicines (OR = 2.17; 95% CI = 1.15-4.07), pesticides (OR = 2.92; 95% CI = 1.37-6.25), and herbicides (OR = 12.00; 95% CI = 1.44-99.67) as relative risk factors. Smoking tobacco was significantly associated with refractory anemia with excess of blasts (RAEB) (OR(adj) = 2.43; 95% CI = 1.02-5.77). Education is shown as an independent protective factor against all MDS (OR(adj) = 0.90; 95% CI = 0.83-0.99) and RCMD (OR(adj) = 0.89; 95% CI = 0.79-0.99). These findings suggest that multiple modifiable behavioral, environmental, and occupational factors play a role in MDS etiology, and various MDS subtypes may have different susceptibility.
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Affiliation(s)
- Ling Lv
- Departments of Occupational Medicine and Clinical Epidemiology, Huashan Hospital, Fudan University, Shanghai, China
- Departments of Hematology and Clinical Epidemiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Guowei Lin
- Departments of Occupational Medicine and Clinical Epidemiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Guowei Lin
- Departments of Hematology and Clinical Epidemiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiang Gao
- Departments of Occupational Medicine and Clinical Epidemiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Cuie Wu
- Department of Occupational Health, School of Public Health, Fudan University, Shanghai, China
| | - Junmin Dai
- Department of Occupational Health, School of Public Health, Fudan University, Shanghai, China
| | - Yongchen Yang
- Shanghai Children's Hospital, Shanghai Jiaotong University Affiliated Children's Hospital, Shanghai, China
| | - Hejian Zou
- Departments of Occupational Medicine and Clinical Epidemiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hengjuan Sun
- Shanghai Children's Hospital, Shanghai Jiaotong University Affiliated Children's Hospital, Shanghai, China
| | - Minghua Gu
- Departments of Occupational Medicine and Clinical Epidemiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xi Chen
- Center for Clinical Molecular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Fu
- Department of Occupational Health, School of Public Health, Fudan University, Shanghai, China
| | - Liming Bao
- Shanghai Children's Hospital, Shanghai Jiaotong University Affiliated Children's Hospital, Shanghai, China
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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