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Zhang Q, Huang M, Thomas ER, Wang L, Liu J, Li X, Luo J, Zou W, Wu J. The role of platelet desialylation as a biomarker in primary immune thrombocytopenia: mechanisms and therapeutic perspectives. Front Immunol 2024; 15:1409461. [PMID: 38979425 PMCID: PMC11228137 DOI: 10.3389/fimmu.2024.1409461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/03/2024] [Indexed: 07/10/2024] Open
Abstract
Primary immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by the destruction of platelets. Although it was long believed that the critical role of autoantibodies in platelet destruction, primarily through the Fc-dependent platelet clearance pathway, recent findings indicate that the significance of the Fc-independent platelet clearance pathway mediated by hepatocytes, thus shedding light on a previously obscure aspect of ITP pathogenesis. Within this context, the desialylation of platelets has emerged as a pivotal biochemical marker. Consequently, targeting platelet desialylation emerges as a novel therapeutic strategy in the pathogenesis of ITP. Notably, prevailing research has largely focused on antiplatelet antibodies and the glycosylation-associated mechanisms of platelet clearance, while comprehensive analysis of platelet desialylation remains scant. In response, we retrospectively discuss the historical progression, inducing factors, generation process, and molecular regulatory mechanisms underlying platelet desialylation in ITP pathogenesis. By systematically evaluating the most recent research findings, we contribute to a comprehensive understanding of the intricate processes involved. Moreover, our manuscript delves into the potential application of desialylation regulatory strategies in ITP therapy, heralding novel therapeutic avenues. In conclusion, this manuscript not only fills a critical void in existing literature but also paves the way for future research by establishing a systematic theoretical framework. By inspiring new research ideas and offering insights into the development of new therapeutic strategies and targeted drugs, our study is poised to significantly advance the clinical management of ITP.
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Affiliation(s)
- Qianhui Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Miao Huang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Elizabeth Rosalind Thomas
- Department of Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Lu Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jia Liu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Li
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Jiesi Luo
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Wenjun Zou
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jianming Wu
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
- Education Ministry Key Laboratory of Medical Electrophysiology, Medical Key Laboratory for Drug Discovery and Druggability Evaluation of Sichuan Province, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Luzhou, China
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2
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Mendoza A, Álvarez-Román MT, Monzón-Manzano E, Acuña P, Arias-Salgado EG, Rivas-Pollmar I, Martín-Salces M, Martínez de Miguel B, Martínez Montalbán E, Jiménez-Yuste V, Butta N. Study of platelet kinetics in immune thrombocytopenia to predict splenectomy response. Br J Haematol 2024; 204:315-323. [PMID: 37822168 DOI: 10.1111/bjh.19145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023]
Abstract
Despite the efficacy of splenectomy for chronic immune thrombocytopenia (ITP), its considerable failure rate and its possible related complications prove the need for further research into potential predictors of response. The platelet sequestration site determined by 111 In-labelled autologous platelet scintigraphy has been proposed to predict splenectomy outcome, but without standardisation in clinical practice. Here, we conducted a single-centre study by analysing a cohort of splenectomised patients with ITP in whom 111 In-scintigraphy was performed at La Paz University Hospital in Madrid to evaluate the predictive value of the platelet kinetic studies. We also studied other factors that could impact the splenectomy outcome, such as patient and platelet characteristics. A total of 51 patients were splenectomised, and 82.3% responded. The splenic sequestration pattern predicted a higher rate of complete response up to 12 months after splenectomy (p = 0.005), with 90% sensitivity and 77% specificity. Neither age, comorbidities, therapy lines nor previous response to them showed any association with response. Results from the platelet characteristics analysis revealed a significant loss of sialic acid in platelets from the non-responding patients compared with those who maintained a response (p = 0.0017). Our findings highlight the value of splenic sequestration as an independent predictor of splenectomy response.
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Affiliation(s)
- Ana Mendoza
- Department of Haematology, La Paz University Hospital, Madrid, Spain
| | - María Teresa Álvarez-Román
- Department of Haematology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | - Elena Monzón-Manzano
- Department of Haematology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - Paula Acuña
- Department of Haematology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - Elena G Arias-Salgado
- Department of Haematology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - Isabel Rivas-Pollmar
- Department of Haematology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - Mónica Martín-Salces
- Department of Haematology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | | | | | - Víctor Jiménez-Yuste
- Department of Haematology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | - Nora Butta
- Department of Haematology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
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3
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Ding B, Liu L, Li M, Song X, Zhang Y, Xia A, Liu J, Zhou H. Anti-GPIb/IX autoantibodies are associated with poor response to dexamethasone combined with rituximab therapy in primary immune thrombocytopenia patients. Platelets 2023; 34:2258988. [PMID: 37722393 DOI: 10.1080/09537104.2023.2258988] [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: 06/29/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
This retrospective study aimed to evaluate whether anti-glycoproteins (GPs) autoantibodies can be used as predictors of response to high-dose dexamethasone combined with rituximab (DXM-RTX) in the treatment of primary immune thrombocytopenia (ITP) patients. One-hundred twenty-six ITP patients were included and retrospectively analyzed, 66.7% of anti-GPIb/IX and 65.9% of anti-GPIIb/IIIa autoantibodies. Results showed that overall response (OR) and complete response (CR) rates of patients without anti-GPIb/IX autoantibodies to DXM-RTX were significantly higher than those with anti-GPIb/IX autoantibodies at 4 weeks (OR: 73.8% vs. 47.6%, CR: 50.0% vs. 26.2%; P < 0.05) and 6 months (OR: 71.4% vs. 45.2%, CR: 42.9% vs. 25.0%; P < .05). Furthermore, patients with anti-GPIb/IX single-positivity exhibited higher resistance to DXM-RTX than patients with anti-GPIIb/IIIa single-positivity at 4 weeks (OR: 37.5% vs. 78.3%; P < .05) and 6 months (OR: 29.2% vs. 78.3%; P < .05). Multivariable logistic regression analysis revealed that anti-GPIb/IX autoantibodies and megakaryocytes were associated with the OR rate of patients at both 4 weeks and 6 months, and anti-GPIb/IX autoantibodies at 4 weeks represented the only significant factor affecting OR rate with DXM-RTX (F = 9.128, P = .003). Therefore, platelet anti-GPIb/IX autoantibodies might predict poor response to DXM-RTX in ITP patients.
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Affiliation(s)
- Bingjie Ding
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, China
| | - Liu Liu
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengjuan Li
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, China
| | - Xuewen Song
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, China
| | - Yuanyuan Zhang
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, China
| | - Ao Xia
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, China
| | - Jingyuan Liu
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, China
| | - Hu Zhou
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, China
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Szittner Z, Bentlage AEH, Temming AR, Schmidt DE, Visser R, Lissenberg-Thunnissen S, Mok JY, van Esch WJE, Sonneveld ME, de Graaf EL, Wuhrer M, Porcelijn L, de Haas M, van der Schoot CE, Vidarsson G. Cellular surface plasmon resonance-based detection of anti-HPA-1a antibody glycosylation in fetal and neonatal alloimmune thrombocytopenia. Front Immunol 2023; 14:1225603. [PMID: 37868955 PMCID: PMC10585714 DOI: 10.3389/fimmu.2023.1225603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/06/2023] [Indexed: 10/24/2023] Open
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) can occur due to maternal IgG antibodies targeting platelet antigens, causing life-threatening bleeding in the neonate. However, the disease manifests itself in only a fraction of pregnancies, most commonly with anti-HPA-1a antibodies. We found that in particular, the core fucosylation in the IgG-Fc tail is highly variable in anti-HPA-1a IgG, which strongly influences the binding to leukocyte IgG-Fc receptors IIIa/b (FcγRIIIa/b). Currently, gold-standard IgG-glycoanalytics rely on complicated methods (e.g., mass spectrometry (MS)) that are not suited for diagnostic purposes. Our aim was to provide a simplified method to quantify the biological activity of IgG antibodies targeting cells. We developed a cellular surface plasmon resonance imaging (cSPRi) technique based on FcγRIII-binding to IgG-opsonized cells and compared the results with MS. The strength of platelet binding to FcγR was monitored under flow using both WT FcγRIIIa (sensitive to Fc glycosylation status) and mutant FcγRIIIa-N162A (insensitive to Fc glycosylation status). The quality of the anti-HPA-1a glycosylation was monitored as the ratio of binding signals from the WT versus FcγRIIIa-N162A, using glycoengineered recombinant anti-platelet HPA-1a as a standard. The method was validated with 143 plasma samples with anti-HPA-1a antibodies analyzed by MS with known clinical outcomes and tested for validation of the method. The ratio of patient signal from the WT versus FcγRIIIa-N162A correlated with the fucosylation of the HPA-1a antibodies measured by MS (r=-0.52). Significantly, FNAIT disease severity based on Buchanan bleeding score was similarly discriminated against by MS and cSPRi. In conclusion, the use of IgG receptors, in this case, FcγRIIIa, on SPR chips can yield quantitative and qualitative information on platelet-bound anti-HPA-1a antibodies. Using opsonized cells in this manner circumvents the need for purification of specific antibodies and laborious MS analysis to obtain qualitative antibody traits such as IgG fucosylation, for which no clinical test is currently available.
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Affiliation(s)
- Zoltán Szittner
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Arthur E. H. Bentlage
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Department of Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences and Bijvoet Center for Biomolecular Research, Utrecht University, Utrecht, Netherlands
| | - A. Robin Temming
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - David E. Schmidt
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Remco Visser
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Suzanne Lissenberg-Thunnissen
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Myrthe E. Sonneveld
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Erik L. de Graaf
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, Netherlands
- Translational Immunohematology, Research, Amsterdam, Netherlands
- Department of Hematology, Leiden University Medical Centre, Leiden, Netherlands
| | - C. Ellen van der Schoot
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Gestur Vidarsson
- Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
- Department of Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences and Bijvoet Center for Biomolecular Research, Utrecht University, Utrecht, Netherlands
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5
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Godeau B. Is splenectomy a good strategy for refractory immune thrombocytopenia in adults? Br J Haematol 2023; 203:86-95. [PMID: 37735555 DOI: 10.1111/bjh.19077] [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: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 09/23/2023]
Abstract
Rituximab and thrombopoietin receptor agonists (TPO-RAs) have profoundly changed the management of immune thrombocytopenia (ITP) over the last 20 years. Even if most current guidelines put splenectomy, rituximab and TPO-RAs on the same treatment level, most clinicians and patients clearly prefer to postpone splenectomy and to multiply the lines of medical treatment before considering surgery. The management of ITP refractory to rituximab and TPO-RAs is challenging. Splenectomy is currently performed much less frequently because of a better knowledge of its complications, particularly severe late infections and deep vein thrombosis, and the inability to reliably predict its effectiveness. Furthermore, there is a reluctance to propose splenectomy when other treatments have been ineffective, based on the not well-documented risk that splenectomy could not be effective in such a case. The objective of this update was to review the most recent published data on the long-term tolerability and side effects of splenectomy and the predictors of response and efficacy, especially for patients exposed to multiple medical lines. This update can help physicians and patients with failure of multiple lines of therapy make an informed decision on the indication for splenectomy with the help of up-to-date data.
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Affiliation(s)
- Bertrand Godeau
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
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6
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Zheng SS, Ahmadi Z, Leung HHL, Wong R, Yan F, Perdomo JS, Chong BH. Antiplatelet antibody predicts platelet desialylation and apoptosis in immune thrombocytopenia. Haematologica 2022; 107:2195-2205. [PMID: 35199503 PMCID: PMC9425302 DOI: 10.3324/haematol.2021.279751] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/18/2021] [Indexed: 11/09/2022] Open
Abstract
Immune thrombocytopenia (ITP) is a bleeding disorder caused by dysregulated B- and T- cell functions, which lead to platelet destruction. A well-recognized mechanism of ITP pathogenesis involves anti-platelet and anti-megakaryocyte antibodies recognizing membrane glycoprotein (GP) complexes, mainly GPIb/IX and GPIIb/IIIa. In addition to the current view of phagocytosis of the opsonised platelets by splenic and hepatic macrophages via their Fc γ receptors, antibodyinduced platelet desialylation and apoptosis have also been reported to contribute to ITP pathogenesis. Nevertheless, the relationship between the specific thrombocytopenic mechanisms and various types of anti-platelet antibodies has not been established. In order to ascertain such association, we used sera from 61 ITP patients and assessed the capacity of anti-platelet antibodies to induce neuraminidase 1 (NEU1) surface expression, RCA-1 lectin binding and loss of mitochondrial inner membrane potential on donors' platelets. Sera from ITP patients with detectable antibodies caused significant platelet desialylation and apoptosis. Anti-GPIIb/IIIa antibodies appeared more capable of causing NEU1 surface translocation while anti-GPIb/IX complex antibodies resulted in a higher degree of platelet apoptosis. In ITP patients with anti-GPIIb/IIIa antibodies, both desialylation and apoptosis were dependent on FcγRIIa signaling rather than platelet activation. Finally, we confirmed in a murine model of ITP that destruction of human platelets induced by anti-GPIIb/IIIa antibodies can be prevented with the NEU1 inhibitor oseltamivir. A collaborative clinical trial is warranted to investigate the utility of oseltamivir in the treatment of ITP.
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Affiliation(s)
- Shiying Silvia Zheng
- Haematology Research Unit, St. George and Sutherland Clinical School, University of New South Wales, Sydney, Australia; Department of Haematology, St. George Hospital, Kogarah, New South Wales.
| | - Zohra Ahmadi
- Haematology Research Unit, St. George and Sutherland Clinical School, University of New South Wales, Sydney
| | - Halina Hoi Laam Leung
- Haematology Research Unit, St. George and Sutherland Clinical School, University of New South Wales, Sydney
| | - Rose Wong
- Haematology Research Unit, St. George and Sutherland Clinical School, University of New South Wales, Sydney, Australia; Department of Haematology, St. George Hospital, Kogarah, New South Wales
| | - Feng Yan
- Haematology Research Unit, St. George and Sutherland Clinical School, University of New South Wales, Sydney, Australia; Department of Haematology, St. George Hospital, Kogarah, New South Wales
| | - Jose Sail Perdomo
- Haematology Research Unit, St. George and Sutherland Clinical School, University of New South Wales, Sydney
| | - Beng Hock Chong
- Haematology Research Unit, St. George and Sutherland Clinical School, University of New South Wales, Sydney, Australia; Department of Haematology, St. George Hospital, Kogarah, New South Wales
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Enhanced hepatic clearance of hyposialylated platelets explains thrombocytopenia in GNE-related macrothrombocytopenia. Blood Adv 2022; 6:3347-3351. [PMID: 35255501 PMCID: PMC9198933 DOI: 10.1182/bloodadvances.2021006830] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
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