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Matushita L, Valera ET, Aragon DC, Scridelli CA, Roxo-Junior P, de Carvalho LM. Chronic neutropenia in childhood: experience of a tertiary center. J Pediatr (Rio J) 2024; 100:311-317. [PMID: 38182128 PMCID: PMC11065660 DOI: 10.1016/j.jped.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE To assess the prevalence of chronic neutropenia (CN) and the clinical profile of patients with CN aged up to 18 years, followed in the pediatric hematology, rheumatology, or immunology outpatient clinic of a tertiary medical center from May 1, 2018, to 30 April 2019. METHODS Retrospective observational study carried out by collecting data from the patient's medical charts. CN was defined as absolute neutrophil count (ANC) below 1.5 × 109/L lasting over three months. Autoimmune neutropenia (AIN) was defined by clinical criteria and an over twofold increase in ANC after glucocorticoid stimulation. AIN was considered secondary when associated with autoimmune or immunoregulatory disorders. Wilcoxon and Fisher's exact tests were used to compare variables; the significance level was 5 %. RESULTS A total of 1,039 patients were evaluated; 217 (20 %) presented CN. Twenty-one (2 %) had AIN, classified as primary in 57 % of the cases. The average age at the onset of symptoms was 38.6 months. During follow-up, patients had 4.2 infections on average; frequency was higher among patients with secondary AIN (p = 003). Isolated neutropenia occurred in 43 % of the patients with AIN. Neutropenia resolved in eight (38 %) of the 21 patients with AIN within 19.6 months on average. Eight patients with secondary AIN met the criteria for Inborn Errors of Immunity. CONCLUSION AIN prevalence was 2 %. Most cases were first evaluated by a pediatric immunologist or rheumatologist rather than a pediatric hematologist. This study highlights the need for a multidisciplinary approach involving a pediatric immunologist, rheumatologist, and hematologist.
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Affiliation(s)
- Letícia Matushita
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Elvis Terci Valera
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Divisão de Oncologia e Hematologia, Ribeirão Preto, SP, Brazil
| | - Davi Casale Aragon
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Carlos Alberto Scridelli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Divisão de Oncologia e Hematologia, Ribeirão Preto, SP, Brazil
| | - Persio Roxo-Junior
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Divisão de Imunologia e Alergia, Ribeirão Preto, SP, Brazil
| | - Luciana Martins de Carvalho
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Divisão de Reumatologia Pediátrica, Ribeirão Preto, SP, Brazil.
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Sussman C, Liberatore RA, Drozdz MM. Delivery of DNA-Based Therapeutics for Treatment of Chronic Diseases. Pharmaceutics 2024; 16:535. [PMID: 38675196 PMCID: PMC11053842 DOI: 10.3390/pharmaceutics16040535] [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: 03/09/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Gene therapy and its role in the medical field have evolved drastically in recent decades. Studies aim to define DNA-based medicine as well as encourage innovation and the further development of novel approaches. Gene therapy has been established as an alternative approach to treat a variety of diseases. Its range of mechanistic applicability is wide; gene therapy has the capacity to address the symptoms of disease, the body's ability to fight disease, and in some cases has the ability to cure disease, making it a more attractive intervention than some traditional approaches to treatment (i.e., medicine and surgery). Such versatility also suggests gene therapy has the potential to address a greater number of indications than conventional treatments. Many DNA-based therapies have shown promise in clinical trials, and several have been approved for use in humans. Whereas current treatment regimens for chronic disease often require frequent dosing, DNA-based therapies can produce robust and durable expression of therapeutic genes with fewer treatments. This benefit encourages the application of DNA-based gene therapy to manage chronic diseases, an area where improving efficiency of current treatments is urgent. Here, we provide an overview of two DNA-based gene therapies as well as their delivery methods: adeno associated virus (AAV)-based gene therapy and plasmid DNA (pDNA)-based gene therapy. We will focus on how these therapies have already been utilized to improve treatment of chronic disease, as well as how current literature supports the expansion of these therapies to treat additional chronic indications in the future.
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Dobrewa W, Bielska M, Bąbol-Pokora K, Janczar S, Młynarski W. Congenital neutropenia: From lab bench to clinic bedside and back. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2024; 793:108476. [PMID: 37989463 DOI: 10.1016/j.mrrev.2023.108476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
Neutropenia is a hematological condition characterized by a decrease in absolute neutrophil count (ANC) in peripheral blood, typically classified in adults as mild (1-1.5 × 109/L), moderate (0.5-1 × 109/L), or severe (< 0.5 × 109/L). It can be categorized into two types: congenital and acquired. Congenital severe chronic neutropenia (SCN) arises from mutations in various genes, with different inheritance patterns, including autosomal recessive, autosomal dominant, and X-linked forms, often linked to mitochondrial diseases. The most common genetic cause is alterations in the ELANE gene. Some cases exist as non-syndromic neutropenia within the SCN spectrum, where genetic origins remain unidentified. The clinical consequences of congenital neutropenia depend on granulocyte levels and dysfunction. Infants with this condition often experience recurrent bacterial infections, with approximately half facing severe infections within their first six months of life. These infections commonly affect the respiratory system, digestive tract, and skin, resulting in symptoms like fever, abscesses, and even sepsis. The severity of these symptoms varies, and the specific organs and systems affected depend on the genetic defect. Congenital neutropenia elevates the risk of developing acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS), particularly with certain genetic variants. SCN patients may acquire CSF3R and RUNX1 mutations, which can predict the development of leukemia. It is important to note that high-dose granulocyte colony-stimulating factor (G-CSF) treatment may have the potential to promote leukemogenesis. Treatment for neutropenia involves antibiotics, drugs that boost neutrophil production, or bone marrow transplants. Immediate treatment is essential due to the heightened risk of severe infections. In severe congenital or cyclic neutropenia (CyN), the primary therapy is G-CSF, often combined with antibiotics. The G-CSF dosage is gradually increased to normalize neutrophil counts. Hematopoietic stem cell transplants are considered for non-responders or those at risk of AML/MDS. In cases of WHIM syndrome, CXCR4 inhibitors can be effective. Future treatments may involve gene editing and the use of the diabetes drug empagliflozin to alleviate neutropenia symptoms.
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Affiliation(s)
- Weronika Dobrewa
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland.
| | - Marta Bielska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland
| | - Katarzyna Bąbol-Pokora
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland
| | - Szymon Janczar
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland.
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Komvilaisak P, Yudhasompop N, Kanchanakamhaeng K, Hongeng S, Pakakasama S, Anurathapan U, Pongphitcha P, Songdej D, Sasanakul W, Sirachainan N. Screening for ELANE, HAX1 and GFI1 gene mutations in children with neutropenia and clinical characterization of two novel mutations in ELANE gene. BMC Pediatr 2023; 23:592. [PMID: 37993852 PMCID: PMC10666431 DOI: 10.1186/s12887-023-04428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Congenital neutropenia is a rare disease. Recurrent infections since young age are the presentation. The most common mutation causing severe congenital neutropenia (SCN) and cyclic neutropenia (CyN) is the ELANE gene. The objectives of this study were to screen the three common genetic mutations of ELANE, HAX1 and GFI1 in children with chronic neutropenia and to describe the clinical characteristics of children who had the mutations. METHODS Infants having ANC < 1,000/cu mm or children aged > 1 year having ANC < 1,500/cu mm at least 3 times in 3 months were enrolled in the study. Patients who had acquired neutropenia due to infection, immune deficiency, or drugs were excluded. The ELANE gene was first studied; and if mutations were not identified, the HAX1 and GFI1 genes were further examined. RESULTS A total of 60 patients were enrolled in the study. The median (range) age, ratio of female to male, ANC, and last follow-up age were 9.2 (0.5-45.2) months, 1:1.2, 248 (0-1,101) /cu mm, and 19.9 (3.5-202.3) months, respectively. Infections were noted in 67.3% of all patients. ELANE gene mutation was found in only four patients (6.7%), and the rest (56 patients) showed no mutations in the HAX1 and GFI1 genes. In patients without mutations, 66.0% had normal ANC during the follow-up, with a median (range) age for normal ANC of 19.8 (4.0-60.0) months. Two novel mutations p. Ala79del (c.234_236del) and p. Val197GlufsTer18 (c.589_590insAGGCCGGC) were identified, and they respectively cause SCN and CyN. Patients with the two novel mutations presented with several episodes of infection, including pneumonia, sepsis, abscess, otitis media, and gum infection. CONCLUSION The genetic screening for ELANE, HAX1, and GFI1 gene mutations in 60 patients with chronic neutropenia could identify four patients (6.7%) with ELANE gene mutation and two novel mutations, p. Ala79del in exon 3 and p. Val197GlufsTer18 in exon 4 causing SCN; and CyN, respectively.
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Affiliation(s)
- Patcharee Komvilaisak
- Departments of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Najwa Yudhasompop
- Department of Pediatrics, Hatyai Hospital, Hatyai, Songkhla, Thailand
| | - Kittima Kanchanakamhaeng
- Departments of Pediatrics, Sawanpracharak Hospital, Sawanpracharak Hospital, Nakhon Sawan, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Samart Pakakasama
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Usanarat Anurathapan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Pongpak Pongphitcha
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Duantida Songdej
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Werasak Sasanakul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand.
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Martínez-Balsalobre E, García-Castillo J, García-Moreno D, Naranjo-Sánchez E, Fernández-Lajarín M, Blasco MA, Alcaraz-Pérez F, Mulero V, Cayuela ML. Telomerase RNA-based aptamers restore defective myelopoiesis in congenital neutropenic syndromes. Nat Commun 2023; 14:5912. [PMID: 37737237 PMCID: PMC10516865 DOI: 10.1038/s41467-023-41472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
Telomerase RNA (TERC) has a noncanonical function in myelopoiesis binding to a consensus DNA binding sequence and attracting RNA polymerase II (RNA Pol II), thus facilitating myeloid gene expression. The CR4/CR5 domain of TERC is known to play this role, since a mutation of this domain found in dyskeratosis congenita (DC) patients decreases its affinity for RNA Pol II, impairing its myelopoietic activity as a result. In this study, we report that two aptamers, short single-stranded oligonucleotides, based on the CR4/CR5 domain were able to increase myelopoiesis without affecting erythropoiesis in zebrafish. Mechanistically, the aptamers functioned as full terc; that is, they increased the expression of master myeloid genes, independently of endogenous terc, by interacting with RNA Pol II and with the terc-binding sequences of the regulatory regions of such genes, enforcing their transcription. Importantly, aptamers harboring the CR4/CR5 mutation that was found in DC patients failed to perform all these functions. The therapeutic potential of the aptamers for treating neutropenia was demonstrated in several preclinical models. The findings of this study have identified two potential therapeutic agents for DC and other neutropenic patients.
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Affiliation(s)
- Elena Martínez-Balsalobre
- Grupo de Telomerasa, Cáncer y Envejecimiento, Hospital Clínico Universitario Virgen de la Arrixaca, 30120, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, 30120, Murcia, Spain
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, 30100, Murcia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, 28029, Madrid, Spain
| | - Jesús García-Castillo
- Grupo de Telomerasa, Cáncer y Envejecimiento, Hospital Clínico Universitario Virgen de la Arrixaca, 30120, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, 30120, Murcia, Spain
| | - Diana García-Moreno
- Grupo de Telomerasa, Cáncer y Envejecimiento, Hospital Clínico Universitario Virgen de la Arrixaca, 30120, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, 30120, Murcia, Spain
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, 30100, Murcia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, 28029, Madrid, Spain
| | - Elena Naranjo-Sánchez
- Grupo de Telomerasa, Cáncer y Envejecimiento, Hospital Clínico Universitario Virgen de la Arrixaca, 30120, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, 30120, Murcia, Spain
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, 30100, Murcia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, 28029, Madrid, Spain
| | - Miriam Fernández-Lajarín
- Grupo de Telomerasa, Cáncer y Envejecimiento, Hospital Clínico Universitario Virgen de la Arrixaca, 30120, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, 30120, Murcia, Spain
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, 30100, Murcia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, 28029, Madrid, Spain
| | - María A Blasco
- Telomeres and Telomerase Group, Molecular Oncology Program, Spanish National Cancer Centre (CNIO), Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - Francisca Alcaraz-Pérez
- Grupo de Telomerasa, Cáncer y Envejecimiento, Hospital Clínico Universitario Virgen de la Arrixaca, 30120, Murcia, Spain.
- Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, 30120, Murcia, Spain.
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, 30100, Murcia, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, 28029, Madrid, Spain.
| | - Victoriano Mulero
- Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, 30120, Murcia, Spain.
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, 30100, Murcia, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, 28029, Madrid, Spain.
| | - María L Cayuela
- Grupo de Telomerasa, Cáncer y Envejecimiento, Hospital Clínico Universitario Virgen de la Arrixaca, 30120, Murcia, Spain.
- Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, 30120, Murcia, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, 28029, Madrid, Spain.
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Dale DC, Bolyard AA, Makaryan V. The promise of novel treatments for severe chronic neutropenia. Expert Rev Hematol 2023; 16:1025-1033. [PMID: 37978893 DOI: 10.1080/17474086.2023.2285987] [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: 07/25/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Severe chronic neutropenia, i.e. absolute neutrophil count (ANC) less than 0.5 × 109/L, is a serious health problem because it predisposes patients to recurrent bacterial infections. Management radically changed with the discovery that granulocyte colony-stimulating factor (G-CSF) could be used to effectively treat most patients; therapy required regular subcutaneous injections. In the early days of G-CSF therapy, there were concerns that it might somehow overstimulate the bone marrow and cause myelodysplasia (MDS) or acute myeloid leukemia (AML). Detailed research records from the Severe Chronic Neutropenia International Registry (SCNIR) indicate that this is a relatively low-risk event. The research records suggest that certain patient groups are primarily at risk. Presently, allogeneic hematopoietic stem cell therapy serves as an alternate form of therapy. AREAS COVERED Due to these concerns and the desire for an easy-to-take oral alternative, several new treatments are under investigation. These treatments include neutrophil elastase inhibitors, SGLT-2 inhibitors, mavorixafor - an oral CXCR4 inhibitor, gene therapy, and gene editing. EXPERT OPINION All of these alternatives to G-CSF are promising. The risks, relative benefits, and costs are yet to be determined.
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Affiliation(s)
- David C Dale
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Vahagn Makaryan
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Zhou J, Zhou N, Liu Q, Xie ZP, Xu Y, Dai SC, Lu J, Bao ZY, Wu LD. Prevalence of neutropenia in US residents: a population based analysis of NHANES 2011-2018. BMC Public Health 2023; 23:1254. [PMID: 37380948 DOI: 10.1186/s12889-023-16141-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/17/2023] [Indexed: 06/30/2023] Open
Abstract
AIMS Neutrophils play a pivotal in immunity and inflammation. We aim to investigate the prevalence of neutropenia in the United States. METHODS In this cross-sectional study, participants from the National Health and Nutrition Examination Survey (NHANES) (2011-2018) were enrolled. Demographic information, hematologic measurements, smoking status of all participants were collected for all participants. All statistical analyses were performed utilizing the NHANES survey weights. Covariate-adjusted linear regression was used to compare hematologic indices in different population grouped by age, sex, ethnicity, and smoking. We also employed multivariate-logistic regression to estimate the weighted odds ratio with a 95% confidence interval and predict the neutropenia risk among. RESULTS 32,102 participants from NHANES survey were included, represented 286.6 million multiracial population in the United States. Black participants had lower mean leukocyte count (mean difference (MD): 0.71 × 109/L; P < 0.001) and lower neutrophil count (MD: 0.83 × 109/L; P < 0.001) compared with white participants after adjusting for age and sex. Furthermore, t a notable observation was the significant downward shift in the distribution curves of leukocyte count and neutrophil count among black participants. Smokers had a higher mean leukocyte count (MD: 1.10 × 109 cells/L; P < 0.001) and a higher mean neutrophil count (MD: 0.75 × 109 cells/L; P < 0.001) comparing with nonsmokers. The estimated prevalence of neutropenia was 1.24% (95% CI: 1.11 - 1.37%), which corresponds to approximately 35.5 million individuals in the United States. The prevalence of neutropenia in black participants was significantly higher than other races. Results of logistic regression analysis showed that black individuals, male individuals, and children younger than 5 years had a higher risk of neutropenia. CONCLUSIONS Neutropenia is more common in the general population than we thought, especially in black individuals and children. More attention should be paid to neutropenia.
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Affiliation(s)
- Jing Zhou
- Department of Infectious Diseases, Affiliated Wuxi Fifth Hospital of Jiangnan University, The Fifth People's Hospital of Wuxi, Wuxi, 214065, China
| | - Nan Zhou
- Department of Nursing, Huadong Sanatorium, Wuxi, 214065, China
| | - Qing Liu
- Department of Nursing, Huadong Sanatorium, Wuxi, 214065, China
| | - Zhi-Ping Xie
- Department of Nursing, Huadong Sanatorium, Wuxi, 214065, China
| | - Yun Xu
- Department of Anesthesiology, Huadong Sanatorium, Wuxi, 214065, China
| | - Si-Cheng Dai
- Department of Nursing, Huadong Sanatorium, Wuxi, 214065, China
| | - Juan Lu
- Department of Nursing, Huadong Sanatorium, Wuxi, 214065, China.
- Department of Anesthesiology, Huadong Sanatorium, Wuxi, 214065, China.
| | - Zheng-Yang Bao
- Department of Internal Medicine, Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University, Jiangnan University, Wuxi, 214002, China.
| | - Li-Da Wu
- Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China.
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Villarreal M. Neutropenia: A Brief Review. Pediatr Ann 2023; 52:e238-e241. [PMID: 37280003 DOI: 10.3928/19382359-20230411-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Neutropenia is one of the most common abnormalities on complete blood count encountered in pediatric clinical practice. It causes anxiety in the pediatric clinician as well as in the patient and their family. Neutropenia can be inherited or acquired. Acquired neutropenia is much more common than inherited neutropenia. Acquired neutropenia self-resolves after the offending cause is removed, and therefore, most acquired neutropenia can be managed by primary care physicians, unless they are associated with severe infections. In contrast, inherited neutropenia needs to be managed in collaboration with the hematologist. [Pediatr Ann. 2023;52(6):e238-e241.].
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Fioredda F, Skokowa J, Tamary H, Spanoudakis M, Farruggia P, Almeida A, Guardo D, Höglund P, Newburger PE, Palmblad J, Touw IP, Zeidler C, Warren AJ, Dale DC, Welte K, Dufour C, Papadaki HA. The European Guidelines on Diagnosis and Management of Neutropenia in Adults and Children: A Consensus Between the European Hematology Association and the EuNet-INNOCHRON COST Action. Hemasphere 2023; 7:e872. [PMID: 37008163 PMCID: PMC10065839 DOI: 10.1097/hs9.0000000000000872] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
Neutropenia, as an isolated blood cell deficiency, is a feature of a wide spectrum of acquired or congenital, benign or premalignant disorders with a predisposition to develop myelodysplastic neoplasms/acute myeloid leukemia that may arise at any age. In recent years, advances in diagnostic methodologies, particularly in the field of genomics, have revealed novel genes and mechanisms responsible for etiology and disease evolution and opened new perspectives for tailored treatment. Despite the research and diagnostic advances in the field, real world evidence, arising from international neutropenia patient registries and scientific networks, has shown that the diagnosis and management of neutropenic patients is mostly based on the physicians' experience and local practices. Therefore, experts participating in the European Network for the Innovative Diagnosis and Treatment of Chronic Neutropenias have collaborated under the auspices of the European Hematology Association to produce recommendations for the diagnosis and management of patients across the whole spectrum of chronic neutropenias. In the present article, we describe evidence- and consensus-based guidelines for the definition and classification, diagnosis, and follow-up of patients with chronic neutropenias including special entities such as pregnancy and the neonatal period. We particularly emphasize the importance of combining the clinical findings with classical and novel laboratory testing, and advanced germline and/or somatic mutational analyses, for the characterization, risk stratification, and monitoring of the entire spectrum of neutropenia patients. We believe that the wide clinical use of these practical recommendations will be particularly beneficial for patients, families, and treating physicians.
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Affiliation(s)
| | - Julia Skokowa
- Department of Oncology, Hematology, Immunology, Rheumatology, and Clinical Immunology, University Hospital Tübingen, Germany
| | - Hannah Tamary
- The Rina Zaizov Hematology/Oncology Division, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Michail Spanoudakis
- Department of Hematology, Warrington and Halton Teaching Hospitals NHS foundation Trust, Warrington, United Kingdom
| | - Piero Farruggia
- Pediatric Onco-Hematology, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Antonio Almeida
- Department of Hematology, Hospital da Luz Lisboa, Portugal
- Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Daniela Guardo
- Unit of Hematology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Petter Höglund
- Clinical Immunology and Transfusion Medicine Clinic, Karolinska University Hospital, Stockholm, Sweden
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan Palmblad
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivo P. Touw
- Department of Hematology and Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Cornelia Zeidler
- Department of Oncology, Hematology, Immunology and Bone Marrow Transplantation, Hannover Medical School, Hannover, Germany
| | - Alan J. Warren
- Department of Hematology, University of Cambridge, United Kingdom
- Cambridge Institute for Medical Research, University of Cambridge, United Kingdom
- Wellcome Trust–Medical Research Council Stem Cell Institute, University of Cambridge, United Kingdom
| | | | - Karl Welte
- University Children’s Hospital Tübingen, Germany
| | - Carlo Dufour
- Unit of Hematology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Helen A. Papadaki
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, Heraklion, Greece
- Department of Hematology, University Hospital of Heraklion, Crete, Greece
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10
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Nepesov S, Yaman Y, Elli M, Bayram N, Ozdilli K, Ayaz A, Anak S. Chronic Neutropenia in Childhood: Laboratory and Clinical Features. Indian J Pediatr 2022; 89:894-898. [PMID: 35267133 DOI: 10.1007/s12098-022-04104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of patients with chronic neutropenia. METHODS Data of 36 patients with chronic neutropenia, who were followed up in the authors' clinic between May 2013 and May 2020, were analyzed retrospectively. Patients were diagnosed based on their clinical and laboratory characteristics. RESULTS A total of 36 patients (23 females, 13 males) were included in the study. The mean age at diagnosis was 9.85 ± 9.17 mo while the mean follow-up time was 21.83 ± 20.03 mo. The mean absolute neutrophil count (ANC) at admission was 462.5 ± 388.8 cells/mm3 (median = 375 cells/mm3), and the lowest and highest ANC mean was 241.2 ± 262.1 cells/mm3 (median = 125 cells/mm3), and 1362.9 ± 1127.9 cells/mm3 (median = 925 cells/mm3), respectively. Idiopathic neutropenia was found in 28 (77.8%) patients, autoimmune neutropenia in 6 (16.7%) patients, and congenital neutropenia in 2 (5.6%) patients. Neutrophil normalization was observed in 19 (52.8%) of the patients. CONCLUSIONS Chronic neutropenia is a heterogeneous picture that presents with different clinical symptoms in childhood. The cause of neutropoenia in children is usually benign and resolves spontaneously but especially in those with severe neutropoenia genetic examination should be performed.
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Affiliation(s)
- Serdar Nepesov
- Department of Pediatric Allergy and Immunology, İstanbul Medipol University, İstanbul, 34214, Turkey.
| | - Yontem Yaman
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Murat Elli
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Nihan Bayram
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Kursat Ozdilli
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Akif Ayaz
- Department of Medical Genetics, İstanbul Medipol University, İstanbul, Turkey
| | - Sema Anak
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
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11
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Chok R, Price V, Steele M, Corriveau-Bourque C, Bruce A. Pediatric Benign Neutropenia: Assessing Practice Preferences in Canada. J Pediatr Hematol Oncol 2022; 44:318-322. [PMID: 35129142 DOI: 10.1097/mph.0000000000002427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
Pediatric benign neutropenia is a self-limited condition with a benign clinical course. An approach to this condition is not well-defined in the literature. Our objective was to use a case-based survey to elucidate trends in the diagnosis and management of benign neutropenia among pediatric hematology/oncology practitioners in Canada. We received 46 completed surveys (response rate 66%). At initial presentation with fever and neutropenia, 67% of respondents recommended partial septic workup but 11% recommended no investigations. Nearly 70% recommended admission for empiric intravenous antibiotics, while 24% would discharge home without antibiotics. In a patient with fever and known neutropenia, respondents were more likely to pursue outpatient antibiotic therapy. For investigation of chronic neutropenia, most respondents (60%) do not use antineutrophil antibody testing. Common indications for bone marrow biopsy were severe infection, prolonged neutropenia, or before initiating granulocyte colony stimulating factor. Indications for granulocyte colony stimulating factor were based on severity and frequency of infection. Most respondents (84%) would not recommend antibiotic prophylaxis. Results demonstrate the considerable variability in management of benign neutropenia among pediatric hematology/oncology practitioners in Canada and highlight the need for prospective studies to establish diagnostic criteria for benign neutropenia and evaluate management of fever in this population.
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Affiliation(s)
| | - Victoria Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - MacGregor Steele
- Department of Pediatrics, Section of Pediatric Hematology, Alberta Children's Hospital and University of Calgary, Calgary, Alberta
| | - Catherine Corriveau-Bourque
- Division of Hematology/Oncology, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton
| | - Aisha Bruce
- Division of Hematology/Oncology, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton
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12
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Roganovic J, Ricci E, Polychronopoulou S, Fioredda F. Isolated neutropenia preceding acute lymphoblastic leukemia in children. Pediatr Blood Cancer 2022; 69:e29518. [PMID: 34913255 DOI: 10.1002/pbc.29518] [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: 10/24/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Jelena Roganovic
- Division of Hematology, Oncology and Clinical Genetics, Department of Pediatrics, University Hospital Center Rijeka, Rijeka, Croatia
| | - Erica Ricci
- Hematology Unit, Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Istituto Giannina Gaslini, Genoa, Italy
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology and Oncology, Aghia Sophia Childrens' Hospital, Athens, Greece
| | - Francesca Fioredda
- Hematology Unit, Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Istituto Giannina Gaslini, Genoa, Italy
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13
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Fioredda F, Onofrillo D, Farruggia P, Barone A, Veltroni M, Notarangelo LD, Menna G, Russo G, Martire B, Finocchi A, Verzegnassi F, Bonanomi S, Ramenghi U, Pillon M, Dufour C. Diagnosis and management of neutropenia in children: The approach of the Study Group on Neutropenia and Marrow Failure Syndromes of the Pediatric Italian Hemato-Oncology Association (Associazione Italiana Emato-Oncologia Pediatrica - AIEOP). Pediatr Blood Cancer 2022; 69:e29599. [PMID: 35253359 DOI: 10.1002/pbc.29599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/09/2022]
Abstract
Neutropenia refers to a group of diseases characterized by a reduction in neutrophil levels below the recommended age threshold. The present study aimed to review the diagnosis and management of neutropenia, including a diagnostic toolkit and candidate underlying genes. This study also aimed to review the progress toward the definition of autoimmune and idiopathic neutropenia rising in infancy or in late childhood but without remission, and provide suggestions for efficient diagnostics, including indications for the bone marrow and genetic testing. The management and treatment protocols for common and unique presentations are also reviewed, providing evidence tailored to a single patient.
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Affiliation(s)
| | - Daniela Onofrillo
- Pediatric Hematology and Oncology Unit, Department of Hematology, Spirito Santo Hospital, Pescara, Italy
| | - Piero Farruggia
- Department of Pediatric Onco-Hematology, University Hospital, Parma, Italy
| | - Angelica Barone
- Pediatric Hematology and Oncology Unit, ARNAS (Azienda di Rilievo Nazionale ad Alta Specializzazione) Ospedale Civico, Palermo, Italy
| | - Marinella Veltroni
- Department of Pediatric Onco-Hematology, Meyer Children's Hospital, Florence, Italy
| | - Lucia Dora Notarangelo
- Oncology-Haematology and Bone Marrow Transplantation Unit, Children's Hospital, Brescia, Italy
| | - Giuseppe Menna
- AORN (Azienda Ospedaliera Rilievo Nazionale), Santobono Pausillipon, Naples, Italy
| | - Giovanna Russo
- Pediatric Ematologi and Oncology Unit, Azienda Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Baldassarre Martire
- Unit of Pediatrics and Neonatology, "Monsignor Dimiccoli" Hospital, Barletta, Italy
| | - Andrea Finocchi
- Unit of Immune and Infectious Disease, University Department of Pediatrics DPUO, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Federico Verzegnassi
- Institute of Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy.,Department of Pediatric Hematology, San Gerardo Hospital, Monza, Italy
| | - Sonia Bonanomi
- MBBM (Monza e Brianza per Bambino e Mamma) Foundation, Department of Pediatrics, University of Milano - Bicocca, Monza, Italy
| | - Ugo Ramenghi
- Department of Pediatric and Public Health Sciences, University of Torino, Turin, Italy
| | - Marta Pillon
- Pediatric Onco-Hematology Unit, University Hospital of Padua, Padua, Italy
| | - Carlo Dufour
- Unit of Haematology, IRCCS - Istituto Giannina Gaslini, Genoa, Italy
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14
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Outcomes for patients with severe chronic neutropenia treated with granulocyte colony-stimulating factor. Blood Adv 2022; 6:3861-3869. [PMID: 35476051 PMCID: PMC9278291 DOI: 10.1182/bloodadvances.2021005684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
Severe chronic neutropenia (SCN), defined as blood neutrophils < 0.5 x 109/L for more than 3 months, is an uncommon hematological condition associated with recurrent and severe bacterial infections. After short-term clinical trials showed the benefits of granulocyte colony-stimulating factor (G-CSF) treatment for SCN, the Severe Chronic Neutropenia International Registry (SCNIR) opened to determine the long-term benefits and safety of this treatment. This report summarizes findings from more than 16 000 patient-years of prospective observations for patients with congenital and acquired SCN. We observed that adverse outcomes depend on the underlying etiology. MDS and AML occur infrequently and largely in patients with congenital neutropenias. Having cyclic or chronic autoimmune/idiopathic neutropenia portends a favorable prognosis. A few patients with idiopathic neutropenia evolve to develop lymphoid malignancies, but they do not appear to be at increased risk of myeloid malignancies, even with very long-term G-CSF therapy. Progression to systemic autoimmune diseases, bone marrow failure, aplastic anemia, or non-myeloid malignancies are not expected consequences of SCN or treatment with G-CSF.
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15
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Gkoufa A, Sklapani P, Trakas N, Georgakopoulou VE. A Challenging Cutaneous Lesion in a Patient With Chronic Idiopathic Neutropenia. Cureus 2022; 14:e21225. [PMID: 35186525 PMCID: PMC8844289 DOI: 10.7759/cureus.21225] [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] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
Ecthyma gangrenosum (EG) is an uncommon necrotizing vasculitis that affects mainly immunocompromised and burn patients, and it is frequently associated with Pseudomonas aeruginosa bacteremia. However, cases of EG with other related pathogens and cases of EG affecting immunocompetent hosts have also been described in the literature. Besides, less common cases of EG without bacteremia have been reported. Herein, we describe a rare case of EG due to Pseudomonas aeruginosa without bacteremia in a patient with chronic idiopathic neutropenia (CIN). Considering the high mortality rate associated with EG, early diagnosis and appropriate effective treatment are crucial.
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16
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Kim KB, An JH, Lee JH, Park SM, Chae HK, Song WJ, Youn HY. Transient thrombocytopenia in a cat following G-CSF treatment. Vet Med Sci 2021; 8:421-424. [PMID: 34967142 PMCID: PMC8959317 DOI: 10.1002/vms3.706] [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] [Indexed: 11/18/2022] Open
Abstract
A 4‐year‐old, castrated male, Russian blue cat with idiopathic epilepsy was diagnosed with neutropenia. The neutropenia was classified as idiopathic after blood tests and abdominal imaging did not reveal an infectious, inflammatory or neoplastic aetiology. As a treatment trial for idiopathic neutropenia, the cat was administered granulocyte colony‐stimulating factor by subcutaneous injection once daily for 3 days. Two weeks after completion of granulocyte colony‐stimulating factor therapy, the cat developed severe thrombocytopenia, with the granulocyte colony‐stimulating factor therapy considered to be the most likely cause. No treatment was initiated, and the thrombocytopenia had resolved spontaneously by 2 weeks after diagnosis. This is the first reported case of transient severe thrombocytopenia in a cat following granulocyte colony‐stimulating factor treatment.
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Affiliation(s)
- Kyeong-Bo Kim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Ju-Hyun An
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Jeong-Hwa Lee
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Su-Min Park
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Hyung Kyu Chae
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Woo-Jin Song
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and Research Institute of Veterinary Research, Jeju National University, Jeju, Korea
| | - Hwa-Young Youn
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
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17
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Connelly JA. Diagnosis and therapeutic decision-making for the neutropenic patient. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:492-503. [PMID: 34889413 PMCID: PMC8791128 DOI: 10.1182/hematology.2021000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Determining the cause of a low neutrophil count in a pediatric or adult patient is essential for the hematologist's clinical decision-making. Fundamental to this diagnostic process is establishing the presence or lack of a mature neutrophil storage pool, as absence places the patient at higher risk for infection and the need for supportive care measures. Many diagnostic tests, eg, a peripheral blood smear and bone marrow biopsy, remain important tools, but greater understanding of the diversity of neutropenic disorders has added new emphasis on evaluating for immune disorders and genetic testing. In this article, a structure is provided to assess patients based on the mechanism of neutropenia and to prioritize testing based on patient age and hypothesized pathophysiology. Common medical quandaries including fever management, need for growth factor support, risk of malignant transformation, and curative options in congenital neutropenia are reviewed to guide medical decision-making in neutropenic patients.
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Affiliation(s)
- James A. Connelly
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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18
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"Oral Manifestations of Patients with Inherited Defect in Phagocyte Number or Function" a systematic review. Clin Immunol 2021; 229:108796. [PMID: 34271191 DOI: 10.1016/j.clim.2021.108796] [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: 05/14/2021] [Revised: 07/10/2021] [Accepted: 07/11/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Inherited phagocyte defects are one of the subgroups of primary immunodeficiency diseases (PIDs) with various clinical manifestations. As oral manifestations are common at the early ages, oral practitioners can have a special role in the early diagnosis. MATERIALS AND METHODS A comprehensive search was conducted in this systematic review study and data of included studies were categorized into four subgroups of phagocyte defects, including congenital neutropenia, defects of motility, defects of respiratory burst, and other non-lymphoid defects. RESULTS Among all phagocyte defects, 12 disorders had reported data for oral manifestations in published articles. A total of 987 cases were included in this study. Periodontitis is one of the most common oral manifestations. CONCLUSION There is a need to organize better collaboration between medical doctors and dentists to diagnose and treat patients with phagocyte defects. Regular dental visits and professional oral health care are recommended from the time of the first primary teeth eruption in newborns.
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19
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Incidence and Prognosis of Clonal Hematopoiesis in patients with Chronic Idiopathic Neutropenia. Blood 2021; 138:1249-1257. [PMID: 34166485 DOI: 10.1182/blood.2021010815] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/05/2021] [Indexed: 11/20/2022] Open
Abstract
The incidence and prognosis of clonal hematopoiesis in patients with isolated neutropenia among patients with idiopathic cytopenia of undetermined significance (ICUS), known as ICUS-N or chronic idiopathic neutropenia (CIN) patients, is poorly defined. In the present study we sought to investigate the frequency and clinical significance of mutations of genes implicated in myeloid malignancies using next generation sequencing, in CIN patients (n=185) with a long follow-up. We found that 21/185 patients (11.35%) carried totally 25 somatic mutations in 6 genes with median variant allele frequency (VAF) 12.75%. The most frequently mutated genes were DNMT3A and TET2 involving more than 80% of patients followed by IDH1/2, SRSF2 and ZRSR2. The frequency of transformation to a myeloid malignancy was low in the total group of patients (5/185 patients; 2.70%). However, from the transformed patients four belonged to the clonal (4/21; 19.05%) and one to the non-clonal (1/164; 0.61%) group, indicating that the presence of mutation(s) confers a relative risk for transformation 31.24 (P = 0.0017). The VAF of the mutant clones in the transformed patients was higher than 10% in all cases and the genes most frequently associated with malignant transformation were the SRSF2 and IDH1. No significant differences were identified between clonal and non-clonal groups in the severity of neutropenia. Patients with clonal disease were older compared to non-clonal patients. These data contribute to the better understanding of the heterogeneous entities underlying ICUS and highlight the importance of the mutation analysis for the diagnosis and prognosis of patients with unexplained neutropenias.
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20
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Adachi Y, Yamazoe-Ishiguri Y, Iwata S, Murase A, Kihara R, Watamoto K. Two Cases of Autoimmune Neutropenia Complicated with Other Lineages of Autoimmune Cytopenia, Successfully Treated with Prednisolone. Intern Med 2021; 60:1271-1277. [PMID: 33162482 PMCID: PMC8112969 DOI: 10.2169/internalmedicine.6032-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Though adult-onset primary autoimmune pancytopenia (AIP) rarely follows a self-limited course, a standard treatment strategy has not yet been established. We herein report two cases, each involving primary autoimmune neutropenia complicated with autoimmune thrombocytopenia or Evans syndrome. They were refractory to granulocyte-colony stimulating factor, but all lineages of cytopenia promptly recovered with prednisolone (PSL). In case 1, PSL was tapered and discontinued six months after its initiation without AIP relapse. In case 2, PSL has been tapered for five months without relapse. To establish an optimal treatment strategy for AIP, it is necessary to accumulate more cases.
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Affiliation(s)
| | | | - Satoshi Iwata
- Department of Hematology, Komaki City Hospital, Japan
| | | | - Rika Kihara
- Department of Hematology, Komaki City Hospital, Japan
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21
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Mörtberg A, Pütsep K, Höglund P. The blood protein hCAP-18 in neutropenia: An 18-month experience of a new ELISA for clinical use. Scand J Immunol 2021; 94:e13037. [PMID: 33662157 DOI: 10.1111/sji.13037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/18/2022]
Abstract
Neutropenia as an isolated clinical finding may include aetiologies ranging from severe disease to a transient condition, and differential diagnosis may be challenging. Previous data and clinical experience suggest that low levels of the neutrophil-derived protein human 18 kDa cathelicidin antimicrobial protein (hCAP-18) in the blood are predictive of more severe forms of neutropenia. The objective of this study was to present the results from a newly developed ELISA method that has been used in clinical routine in Sweden since 2018 for quantification of hCAP-18 in blood plasma. Using this method, we report that patients with severe disease analysed during the study period presented with low or undetectable levels of blood plasma hCAP-18, validating its use as screening tool for severe neutropenia. Furthermore, neutropenic patients as a group displayed lower levels of hCAP-18 as compared to blood donors. Within the group of neutropenic patients, those with neutrophil antibodies displayed significantly higher hCAP-18 levels compared to patients with idiopathic neutropenia. By including an analysis of hCAP-18 in the primary investigation of neutropenia, an increased accuracy in differential diagnosis is achieved, thus contributing to reduced costs of neutropenia management.
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Affiliation(s)
- Anette Mörtberg
- Medical Unit Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Katrin Pütsep
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Petter Höglund
- Medical Unit Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.,Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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22
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Kang EM. Disease Presentation, Treatment Options, and Outcomes for Myeloid Immunodeficiencies. Curr Allergy Asthma Rep 2021; 21:14. [PMID: 33666780 DOI: 10.1007/s11882-020-00984-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Up-to-date review on various types of immunodeficiencies with a significant myeloid component including some more recently described congenital disorders. RECENT FINDINGS While a number of disorders have been described in the past, genetic sequencing has led to the identification of the specific disorders and clarified their pathophysiology. Advances in genetic therapies including genetic editing should provide future treatments beyond hematopoietic stem cell transplant for patients with these rare disorders. Neutrophils (or granulocytes) are a major contributor to infection surveillance and clearance, and defective neutrophils characteristically lead to pyogenic infections. Deficiency in numbers, either iatrogenic or congenital; functional defects; and/or inability to target to the sites of infection can all lead to serious morbidity and mortality; however, myeloid-based immunodeficiencies are not all the same. Having absent neutrophils, that is, neutropenia, has implications different to those of having dysfunctional neutrophils as will become evident as the various disorders are reviewed.
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Affiliation(s)
- Elizabeth M Kang
- National Institutes of Allergy and Infectious Disease/National Institutes of Health, 10 Center Drive, Room 6-3752, Bethesda, MD, 20892, USA.
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23
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Alotaibi FA, Albarkheel AI. Periodontal Disease in Two Siblings with VPS45-associated Severe Congenital Neutropenia Type V: A Case Report. Int J Clin Pediatr Dent 2021; 13:572-575. [PMID: 33623350 PMCID: PMC7887162 DOI: 10.5005/jp-journals-10005-1841] [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] [Indexed: 11/23/2022] Open
Abstract
VPS45-associated severe congenital neutropenia type V (VPS45-associated SCN5) is an autosomal recessive disorder caused by defective endosomal intracellular protein trafficking due to mutations in VPS45 underlies a reduced absolute neutrophil count >500 cells/mm3 and impaired neutrophil function. VPS45-associated SCN5 is a very rare condition with only 19 patients previously reported in the literature. Patients suffering from this disorder having profound neutropenia in the first months of life, fever, pneumonitis, skin infections, oral ulcerations, and gingivitis. This paper reports the first two cases of VPS45-associated SCN5 in Saudi Arabia and describes the treatment approaches for periodontal disease as a manifestation of that disorder since the existing dental literature is lacking sufficient information on the management of those kinds of patients. The present two cases reflect the importance of early diagnosis of periodontal disease as a possible indicator of underlying systemic disease.
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Affiliation(s)
- Faris A Alotaibi
- Department of Pediatric Dentistry, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah I Albarkheel
- Department of Pediatric Dentistry, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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24
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Boggs NA, Rao VK. The Role of Bone Marrow Evaluation in Clinical Allergy and Immunology Practice: When and Why. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:3356-3362. [PMID: 32531483 PMCID: PMC10996386 DOI: 10.1016/j.jaip.2020.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 11/21/2022]
Abstract
Allergists and immunologists rely on other specialists for higher risk procedures such as biopsies of the lung or gastrointestinal tract. However, we perform and interpret a handful of procedures ourselves. Training programs have historically required competency for prescribing immunoglobulin infusions, patch testing, rhino laryngoscopy, lung function testing, and provocation testing for airway hyperreactivity even though other specialists often perform them. Bone marrow aspirations and biopsies are not included in fellowship training assessments despite a significant number of marrow evaluations being requested by allergists and immunologists. For example, nearly 1 marrow assessment per month has been requested over 2 years for patients in the Allergy Immunology Clinic at Walter Reed National Military Medical Center. Marrow assessments are often required for diagnosis, monitoring, and treatment-related toxicities. Interpretive and procedural competency would benefit the field given the range of diseases in clinical immunology practice that require marrow assessment. We have generated a comprehensive list of the major conditions that might require bone marrow assessments in any Allergy and Immunology practice. We then summarize the specific tests that must be ordered and show how to determine sample quality. Finally, some providers may desire procedural competency and for those individuals we discuss tips for the procedure.
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Affiliation(s)
- Nathan A Boggs
- Uniformed Services University of the Health Sciences, Bethesda, Md.
| | - V Koneti Rao
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md
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Incidence of Severe Chronic Neutropenia in South Korea and Related Clinical Manifestations: A National Health Insurance Database Study. ACTA ACUST UNITED AC 2020; 56:medicina56060262. [PMID: 32471206 PMCID: PMC7353846 DOI: 10.3390/medicina56060262] [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: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/08/2022]
Abstract
Background and objectives: Severe chronic neutropenia (SCN) is a condition in which absolute neutrophil counts remain at a low level (under 500/µL) over months or years. Because of the rare onset of SCN, its epidemiology, prognosis, and clinical manifestations have not yet been fully understood. In particular, large-cohort studies in Asian countries are still insufficient. Therefore, in this study, national health insurance data was used to investigate the epidemiologic features and prognosis of SCN in South Korea. Materials and Methods: The data from the Health Insurance Review and Assessment database recorded between 1 January 2011 and 31 December 2015 were explored. SCN was defined based on the ICD-10 code, registry of benefit extension policy, and inclusion criteria of the study. After identifying patients with SCN, annual incidence and their co-morbidities were analyzed. Results: Among the initially identified patients with severe neutropenia (N = 2145), a total of 367 patients had SCN and were enrolled. The annual incidence rate of SCN ranged from 0.12 to 0.17 per 100,000 person-year (PY) during the study period. The highest incidence was observed in pediatric patients aged between 0 to 9 years (N = 156), followed by women in their fifties (N = 43). The total incidence rate was 0.17 in females and 0.12 in males (Relative risk (RR): 1.43, 95%, CI: 1.16–1.76). The most common accompanying condition was mild respiratory infection, but about 3.2% of patients progressed to hematologic malignancy after an average of 2.4 years. Conclusions: This nationwide population-based epidemiological study showed that incidence of SCN is higher in pediatrics and middle-aged women. As progression to hematologic malignancy was significantly higher in the age of in 45–49 years old, careful follow-up is necessary in this group. However, since this study lacks the molecular information, these finding need to be interpreted with great caution.
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Kirk SE, Grimes AB, Shelke S, Despotovic JM, Powers JM. The cost of a "benign" condition: Healthcare utilization and infectious outcomes in young children with primary autoimmune neutropenia. Pediatr Blood Cancer 2020; 67:e28146. [PMID: 31886613 DOI: 10.1002/pbc.28146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Autoimmune neutropenia (AIN) is a common cause of chronic neutropenia in childhood. Despite an expected benign clinical course, many patients undergo extensive evaluation. Data on healthcare utilization and rates of bloodstream infections in young patients with AIN are limited. METHODS All patients with a diagnosis code of leukopenia, neutropenia, or AIN followed within the outpatient hematology clinic of a single institution from 2014 to 2016 were identified. Patients aged ≤5 years with absolute neutrophil count (ANC) ≤500/µL persisting for ≥3 months, a clinical diagnosis of AIN, and documented resolution of neutropenia were included. Data on clinical management, including infectious outcomes and emergency center (EC) encounters, were collected. RESULTS Forty-three patients with AIN (18 male [42%], median age at diagnosis 12 months) met eligibility criteria. Children were followed by hematology for a median duration of 18 (range, 2-85) months. Diagnostic evaluations were variable. Thirty patients (70%) had ≥ 1 EC encounters for evaluation of isolated fever with a total of 113 EC encounters for the overall cohort. Patients with ANC < 500/µL and isolated fever were admitted for observation, which resulted in 24 hospitalizations in 16 patients. Of 138 blood cultures drawn, two were positive, both later determined to be contaminants. CONCLUSION At a large tertiary care center, no bloodstream infections were identified in a cohort of 43 children with AIN presenting to the EC for assessment of fever. A less-intensive, more cost-effective management paradigm, which continues to prioritize patient safety, among young children with AIN is needed.
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Affiliation(s)
- Susan E Kirk
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| | - Amanda Bell Grimes
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| | | | - Jenny M Despotovic
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| | - Jacquelyn M Powers
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
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Neutropenia in glycogen storage disease Ib: outcomes for patients treated with granulocyte colony-stimulating factor. Curr Opin Hematol 2020; 26:16-21. [PMID: 30451720 DOI: 10.1097/moh.0000000000000474] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Glycogen storage disease Ib (GSD Ib) is characterized by hepatomegaly, hypoglycemia, neutropenia, enterocolitis and recurrent bacterial infections. It is attributable to mutations in G6PT1, the gene for the glucose-6-phosphate transporter responsible for transport of glucose into the endoplasmic reticulum. Neutropenia in GSD Ib is now frequently treated with granulocyte colony-stimulating factor (G-CSF). We formed a cooperative group to review outcomes of the long-term treatment of GSD Ib patients treated with G-CSF. RECENT FINDINGS The study enrolled 103 patients (48 men and 55 women), including 47 currently adult patients. All of these patients were treated with G-CSF, starting at a median age of 3.8 years (range 0.04-33.9 years) with a median dose of 3.0 mcg/kg/day (range 0.01-93.1 mcg/kg/day) for a median of 10.3 years (range 0.01-29.3 years). Neutrophils increased in response to G-CSF in all patients (median values before G-CSF 0.2 × 10/l, on G-CSF 1.20 x 10/l). Treatment increased spleen size (before G-CSF, 47%, on treatment on G-CSF 76%), and splenomegaly was the dose-limiting adverse effect of treatment (pain and early satiety). Clinical observations and records attest to reduce frequency of infectious events and the severity of inflammatory bowel symptoms, but fever and recurrent infections remain a significant problem. In the cohort of patients followed carefully through the Severe Chronic Neutropenia International Registry, four patients have developed myelodysplasia or acute myeloid leukemia and we are aware of four other cases, (altogether seven on G-CSF, one never treated with G-CSF). Liver transplantation in five patients did not correct neutropenia. Four patients had hematopoietic stem cell transplantation; two adults and two children were transplanted; one adult and one child survived. SUMMARY GSD Ib is a complex disorder of glucose metabolism causing severe chronic neutropenia. G-CSF is effective to raise blood neutrophil counts and reduce fevers and infections in most patients. In conjunction with other therapies (salicylates, mesalamine sulfasalazine and prednisone), G-CSF ameliorates inflammatory bowel symptoms, but doses must be limited because it increases spleen size associated with abdominal pain.
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Raj SC, Mahapatra A, Agrawal P, Patnaik K, Pradhan SS. Chronic idiopathic neutropenia: A periodontist's diagnosis. J Indian Soc Periodontol 2020; 24:173-177. [PMID: 32189847 PMCID: PMC7069110 DOI: 10.4103/jisp.jisp_149_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 11/23/2022] Open
Abstract
Our aim is to report the periodontal findings of a 10-year-old boy who visited the outpatient department of periodontology, with the chief complaint of swelling in the right cheek region for the last 2 months, increasing mobility of the teeth, and frequent bleeding from the gums. Since the age of 4 years, he suffered from recurrent febrile episodes, with boils and furuncles on the face. After several hematological and immunological investigations, he was diagnosed with chronic idiopathic neutropenia. He was prescribed a 150 μg subcutaneous injection of recombinant granulocyte colony-stimulating factor, once daily for 8 days. For reducing oral inflammation, he was advised an oral rinse of 15 ml of chlorhexidine gluconate (0.12%) twice daily and advised for a routine periodontal checkup, every 3–4 weeks for evaluation, maintenance, and avoiding any acute inflammatory flare-ups.
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Affiliation(s)
- Subash Chandra Raj
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Annuroopa Mahapatra
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Poonam Agrawal
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Kaushik Patnaik
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Shib Shankar Pradhan
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
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Dale DC, Bolyard AA, Steele LA, Zeidler C, Welte K. Registries for study of nonmalignant hematological diseases: the example of the Severe Chronic Neutropenia International Registry. Curr Opin Hematol 2020; 27:18-26. [PMID: 31764167 PMCID: PMC7236759 DOI: 10.1097/moh.0000000000000558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Registries provide 'real world' perspectives on the natural history and outcomes for many clinical conditions. The purpose of this review is to identify registries for nonmalignant hematological disease and to describe the operation of a successful long-term registry for patients with severe chronic neutropenia. RECENT FINDINGS There was an upswing in registries about 20 years ago, based on optimism about their utility to improve patient care. To show value, registries must define outcomes for populations of patients with specific medical conditions and the effects of treatment. This is challenging for many reasons. The Severe Chronic Neutropenia International Registry is an example of a successful registry. This report describes underlying reasons for its success. SUMMARY Registries are important to organize and analyze clinical information across geographic, ethnic and social boundaries. They are also challenging to organize, administer and support.
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Affiliation(s)
- David C. Dale
- University of Washington, Department of Medicine, Seattle, WA
| | - Audrey Anna Bolyard
- University of Washington, Severe Chronic Neutropenia International Registry, Seattle, WA
| | | | - Cornelia Zeidler
- Hannover Medical School, Department of Molecular Hematopoiesis, Hannover, Germany
| | - Karl Welte
- University Hospital Tübingen, Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Tübingen, Germany
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Steensma DP. The Clinical Challenge of Idiopathic Cytopenias of Undetermined Significance (ICUS) and Clonal Cytopenias of Undetermined Significance (CCUS). Curr Hematol Malig Rep 2019; 14:536-542. [DOI: 10.1007/s11899-019-00547-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nisly SA, McClain DL, Fillius AG, Davis KA. Oral antibiotics for the treatment of Gram-negative bloodstream infections: A retrospective comparison of three antibiotic classes. J Glob Antimicrob Resist 2019; 20:74-77. [PMID: 31390537 DOI: 10.1016/j.jgar.2019.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/13/2019] [Accepted: 07/29/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Treatment of bacteraemia with oral antibiotics has the potential to reduce hospital length of stay, treatment costs and line-related complications. To date, small trials have supported the use of specific classes of antibiotics, primarily fluoroquinolones (FQs), in the treatment of Gram-negative bloodstream infections (GNBSIs). Currently, limited data exist evaluating treatment with β-lactams (BLs) or trimethoprim/sulfamethoxazole (SXT). The purpose of this study was to compare treatment of GNBSIs across three different oral antibiotic classes. METHODS A retrospective cohort of hospitalised patients with GNBSI receiving initial intravenous (i.v.) antibiotic therapy followed by step-down oral therapy was conducted. Patients were divided into one of three oral antibiotic treatment groups: FQ; BL; or SXT. The composite primary endpoint was treatment failure, including 30-day mortality, recurrent bacteraemia or transition back to i.v. antibiotics. Additional endpoints included secondary infections and individual components within the primary endpoint. Categorical endpoints were analysed using χ2 test or Fisher's exact test, whilst continuous variables were assessed by one-way ANOVA. RESULTS A total of 204 patients were included in the analysis. The majority of patients received a FQ (136; 66.7%), followed by a BL (46; 22.5%) and SXT (22; 10.8%). Treatment failure occurred in 15 patients (7.4%), with no statistically significant differences between groups. Likewise, individual composite outcomes and secondary outcomes demonstrated no statistically significant differences. CONCLUSION Transitioning to oral antibiotics to complete GNBSI treatment can offer many advantages. As FQ resistance increases, data supporting the use of a BL or SXT in GNBSI treatment will become essential.
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Affiliation(s)
- Sarah A Nisly
- School of Pharmacy, Wingate University, 515 N. Main St., Wingate, NC 28174, USA; School of Pharmacy Alumna, Wingate University, 515 N. Main St., Wingate, NC 28174, USA.
| | - Dominique L McClain
- School of Pharmacy Alumna, Wingate University, 515 N. Main St., Wingate, NC 28174, USA
| | - Amy G Fillius
- School of Pharmacy Alumna, Wingate University, 515 N. Main St., Wingate, NC 28174, USA
| | - Kyle A Davis
- Internal Medicine, Department of Pharmacy, Wake Forest Baptist Medical Center, 1 Medical Center Blvd., Winston Salem, NC 27157, USA
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Iberl S, Meyer AL, Müller G, Peters S, Johannesen S, Kobor I, Beier F, Brümmendorf TH, Hart C, Schelker R, Herr W, Bogdahn U, Grassinger J. Effects of continuous high-dose G-CSF administration on hematopoietic stem cell mobilization and telomere length in patients with amyotrophic lateral sclerosis - a pilot study. Cytokine 2019; 120:192-201. [PMID: 31100684 DOI: 10.1016/j.cyto.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/23/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of complex and still poorly understood etiology. Loss of upper and lower motoneurons results in death within few years after diagnosis. Recent studies have proposed neuroprotective and disease-slowing effects of granulocyte-colony stimulating factor (G-CSF) treatment in ALS mouse models as well as humans. In this study, six ALS patients were monitored up to 3.5 years during continuous high-dose G-CSF administration. Repetitive analyses were performed including blood count parameters, CD34+ hematopoietic stem and progenitor cell (HSPC) and colony forming cell (CFC) counts, serum cytokine levels and leukocyte telomere length. We demonstrate that continuous G-CSF therapy was well tolerated and safe resulting in only mild adverse events during the observation period. However, no mobilization of CD34+ HSPC was detected as compared to baseline values. CFC mobilization was equally low and even a decrease of myeloid precursors was observed in some patients. Assessment of telomere length within ALS patients' leukocytes revealed that G-CSF did not significantly shorten telomeres, while those of ALS patients were shorter compared to age-matched healthy controls, irrespective of G-CSF treatment. During G-CSF stimulation, TNF-alpha, CRP, IL-16, sVCAM-1, sICAM-1, Tie-2 and VEGF were significantly increased in serum whereas MCP-1 levels decreased. In conclusion, our data show that continuous G-CSF treatment fails to increase circulating CD34+ HSPC in ALS patients. Cytokine profiles revealed G-CSF-mediated immunomodulatory and proteolytic effects. Interestingly, despite intense G-CSF stimulation, telomere length was not significantly shortened.
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Affiliation(s)
- Sabine Iberl
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.
| | - Anne-Louise Meyer
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Gunnar Müller
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Peters
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Ines Kobor
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Fabian Beier
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University Medical School, Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University Medical School, Aachen, Germany
| | - Christina Hart
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Roland Schelker
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Jochen Grassinger
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany; Department of Oncology and Hematology, St. Elisabeth Hospital, Straubing, Germany
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Seguier J, Barlogis V, Croisille L, Audrain M, Ebbo M, Beaupain B, Meunier B, Vallentin B, Jean R, Harle JR, Donadieu J, Schleinitz N. Severe Transitory Neonatal Neutropenia Associated with Maternal Autoimmune or Idiopathic Neutropenia. J Clin Immunol 2019; 39:200-206. [PMID: 30900095 DOI: 10.1007/s10875-019-00608-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Neonatal immune neutropenia is observed in rare cases in newborns from mothers with idiopathic or autoimmune neutropenia, secondary to passive transfer of maternal granulocyte auto-antibodies. METHODS We performed a literature review and report four supplementary cases from the French registry of neutropenia. RESULTS Only 14 cases (11 mothers, 14 newborns) have been reported. Granulocyte aggregation (GAT) and granulocyte indirect immunofluorescence test (GIFT) are the recommended laboratory procedures for antibody detection. Monoclonal antibody-specific immobilization of granulocyte antigens (MAIGA)-confirmed antibody specificity. Antibody detection in newborns is not generally possible owing to extreme neutropenia. In half of the cases autoantibodies against neutrophils (AAN) were positive in maternal sera (7 out of 11). In some newborns tested, IgG+ AAN were also positive, with disappearance in parallel of spontaneous neutrophil count improvement. No correlation between maternal type of AAN and titer and neonatal neutropenia can be established. Neutropenia resolved spontaneously between 2 weeks and 4 months. Infections in newborns were observed in 43% of cases, with no deaths reported. Granulocyte colony-stimulating factor (G-CSF) was administered to some newborns (5 out of 14) in the case of infections. Low-dose G-CSF administered to childbearing women during pregnancy could be proposed to prevent neutropenia in newborns. CONCLUSIONS From the few cases reported so far it is impossible to draw any conclusions regarding frequency, risk factors, and outcome, but the overall prognosis for newborns seems good. Because it can be associated with potentially severe neonatal infections, autoimmune neutropenia in childbearing mothers should be closely monitored in collaboration with gynecologists and pediatricians.
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Affiliation(s)
- Julie Seguier
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France.
| | - Vincent Barlogis
- Aix-Marseille University, APHM, Pédiatrie et hématologie pédiatrique Hôpital de la Timone, Marseille, France
| | | | - Marie Audrain
- Laboratoire d'immunologie, Institut de biologie, CHU de Nantes, Nantes, France
| | - Mikael Ebbo
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France
| | - Blandine Beaupain
- Service d'hématologie pédiatrique, Hôpital Trousseau, APHP, Paris, France
| | - Benoit Meunier
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France
| | - Blandine Vallentin
- Aix-Marseille University, APHM, Pédiatrie et hématologie pédiatrique Hôpital de la Timone, Marseille, France
| | - Rodolphe Jean
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Conception, Marseille, France
| | - Jean-Robert Harle
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France
| | - Jean Donadieu
- Service d'hématologie pédiatrique, Hôpital Trousseau, APHP, Paris, France
| | - Nicolas Schleinitz
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France
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Farruggia P, Fioredda F, Puccio G, Onofrillo D, Russo G, Barone A, Bonanomi S, Boscarol G, Finocchi A, Ghilardi R, Giordano P, Ladogana S, Lassandro G, Luti L, Lanza T, Mandaglio R, Marra N, Martire B, Mastrodicasa E, Motta M, Notarangelo LD, Pillon M, Porretti L, Serafinelli J, Trizzino A, Tucci F, Veltroni M, Verzegnassi F, Ramenghi U, Dufour C. Idiopathic neutropenia of infancy: Data from the Italian Neutropenia Registry. Am J Hematol 2019; 94:216-222. [PMID: 30456824 DOI: 10.1002/ajh.25353] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/27/2018] [Accepted: 11/12/2018] [Indexed: 01/13/2023]
Abstract
Autoimmune neutropenia of infancy (AIN) is characterized by low risk of severe infection, tendency to spontaneously resolve and typically onset at ≤4-5 years of age; it is due to auto-antibodies whose detection is often difficult. In case of negativity of 4 antineutrophils autoantibody tests, after having excluded ethnic, postinfection, drug induced, or congenital neutropenia, according to the Italian guidelines the patients will be defined as affected by "idiopathic neutropenia" (IN). We describe the characteristics of 85 IN patients enrolled in the Italian neutropenia registry: they were compared with 336 children affected by AIN. The 2 groups were clinically very similar and the main differences were detection age (later in IN), length of disease (longer in IN) and, among recovered patients, age of spontaneous recovery: the median age at resolution was 2.13 years in AINs and 3.03 years in INs (P = .00002). At bivariate analysis among AIN patients earlier detection age (P = .00013), male sex (P = .000748), absence of leucopenia (P = .0045), and absence of monocytosis (P = .0419) were significantly associated with earlier recovery; in the IN group only detection age (P = .013) and absence of monocytosis (P = .0333) were significant. At multivariate analysis detection age and absence of monocytosis were independently significant (P = 6.7e-05 and 4.4e-03, respectively) in the AIN group, whereas in the IN group only detection age stayed significant (P = .013).
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Affiliation(s)
- Piero Farruggia
- Pediatric Hematology and Oncology Unit; A.R.N.A.S. Ospedale Civico; Palermo Italy
| | - Francesca Fioredda
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
| | - Giuseppe Puccio
- Department of Sciences for Health Promotion; University of Palermo; Palermo Italy
| | - Daniela Onofrillo
- Pediatric Hematology and Oncology Unit, Department of Hematology; Spirito Santo Hospital; Pescara Italy
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Azienda Policlinico-Vittorio Emanuele; University of Catania; Catania Italy
| | - Angelica Barone
- Department of Pediatric Onco-Hematology; University Hospital; Parma Italy
| | - Sonia Bonanomi
- MBBM Foundation, Department of Pediatrics; University of Milano - Bicocca; Monza Italy
| | - Gianluca Boscarol
- Department of Pediatrics; Central Teaching Hospital Bolzano; Bolzano Italy
| | | | - Roberta Ghilardi
- Department of Pediatrics; Ospedale Maggiore Policlinico IRCCS; Milan Italy
| | - Paola Giordano
- Department of Biomedical Sciences and Human Oncology; Pediatric Section, University "A. Moro" of Bari; Bari Italy
| | - Saverio Ladogana
- Department of Hematology; IRCCS Casa Sollievo della Sofferenza; San Giovanni Rotondo Italy
| | - Giuseppe Lassandro
- Department of Biomedical Sciences and Human Oncology; Pediatric Section, University "A. Moro" of Bari; Bari Italy
| | - Laura Luti
- Pediatric Hematology Oncology; Bone Marrow Transplant, Azienda Ospedaliero Universitaria Pisana, S. Chiara Hospital; Pisa Italy
| | - Tiziana Lanza
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
| | | | | | - Baldassare Martire
- Pediatric Science and Surgery Department; Pediatric Onco-Hematology Unit, Hospital Policlinico- Giovanni XXIII; Bari Italy
| | - Elena Mastrodicasa
- Pediatric Oncology Hematology Unit; S. Maria Della Misericordia Hospital; Perugia Italy
| | - Milena Motta
- Pediatric Hematology and Oncology Unit, Azienda Policlinico-Vittorio Emanuele; University of Catania; Catania Italy
| | - Lucia Dora Notarangelo
- Onco-Haematology and Bone Marrow Transplantation Unit; Children's Hospital; Brescia Italy
| | - Marta Pillon
- Pediatric Onco-Hematology Department; University of Padova; Padova
| | - Laura Porretti
- Flow Cytometry Service; Laboratory of Clinical Chemistry and Microbiology, IRCCS “Ca‘ Granda” Foundation, Maggiore Hospital Policlinico; Milan Italy
| | | | - Angela Trizzino
- Pediatric Hematology and Oncology Unit; A.R.N.A.S. Ospedale Civico; Palermo Italy
| | - Fabio Tucci
- Department of Pediatric Onco-Hematology; Meyer Children's Hospital; Florence Italy
| | - Marinella Veltroni
- Department of Pediatric Onco-Hematology; Meyer Children's Hospital; Florence Italy
| | - Federico Verzegnassi
- Institute for Maternal and Child Health (I.R.C.C.S) Burlo Garofolo; Trieste Italy
| | - Ugo Ramenghi
- Department of Pediatric and Public Health Sciences; University of Torino; Italy
| | - Carlo Dufour
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
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How can we define low disease activity in systemic lupus erythematosus? Semin Arthritis Rheum 2018; 48:1035-1040. [PMID: 30415943 DOI: 10.1016/j.semarthrit.2018.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/04/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND In recent years, low disease activity emerged as a state that is associated with improved long-term outcomes in systemic lupus erythematosus (SLE). Our aim was to review the current concepts for low disease activity in SLE in order to serve as the basis of a future consensus for standardization. METHODS The PubMed database was searched for relevant articles from inception up to July 2018. Medical Subject Headings (MeSH terms) included "lupus" AND "low disease activity" OR "minimal disease activity". RESULTS Three different definitions of low disease activity in lupus have been proposed. Minimal disease activity (MDA) is defined as a clinical SLE Disease Activity Index 2000 (SLEDAI-2K)≤1 on antimalarials, immunosuppressives in standard doses and prednisone ≤5 mg/day. Low disease activity (LDA) allows for a clinical SLEDAI-2K≤2 maintained on antimalarials only. Lupus Low Disease Activity State (LLDAS) accepts a SLEDAI-2K≤4 with no activity from major organ systems, a Physician's Global Assessment of ≤1 with no new activity, prednisone dose ≤7.5 mg/day and standard doses of antimalarials, immunosuppressives and biologics. Active serology (anti-dsDNA and complement C3/C4) is not included in the MDA and LDA but counts towards disease activity in the LLDAS definition. All definitions were associated with less damage-accrual and mortality in the long-term that were comparable to those of clinical remission. CONCLUSIONS There is solid evidence that low disease activity is associated with improved outcomes in SLE and could serve as a therapeutic target in daily practice and clinical trials. Future research should focus on advancing a consensus for the best possible definition.
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