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Tang X, Chen SQ, Huang JH, Deng CF, Zou JQ, Zuo J. Assessing the current situation and the influencing factors affecting perceived stigma among older patients after leukemia diagnosis. World J Psychiatry 2024; 14:812-821. [PMID: 38984333 PMCID: PMC11230094 DOI: 10.5498/wjp.v14.i6.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/13/2024] [Accepted: 04/25/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Psychological problems are becoming increasingly prominent among older patients with leukemia, with patients potentially facing stigmatization after diagnosis. However, there is limited research on the stigma experienced by these patients and the factors that may contribute to it. AIM To investigate the stigma faced by older patients after being diagnosed with leukemia and to analyze the potential influencing factors. METHODS A retrospective analysis was conducted using clinical data obtained from questionnaire surveys, interviews, and the medical records of older patients with leukemia admitted to the Hengyang Medical School from June 2020 to June 2023. The data obtained included participants' basic demographic information, medical history, leukemia type, family history of leukemia, average monthly family income, pension, and tendency to conceal illness. The Chinese versions of the Social Impact Scale (SIS), Perceived Social Support Scale (PSSS), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) were used to assess indicators related to stigma, social support, and mental health status. We used Pearson's correlation coefficient to analyze the strength and direction of the relationship between the scores of each scale, and regression analysis to explore the factors related to the stigma of older patients with leukemia after diagnosis. RESULTS Data from 120 patients with leukemia aged 65-80 years were analyzed. The total score on the SIS and PSSS was 43.60 ± 4.07 and 37.06 ± 2.87, respectively. The SAS score was 58.35 ± 8.32 and the SDS score was 60.58 ± 5.97. The stigma experienced by older leukemia patients was negatively correlated with social support (r = -0.691, P < 0.05) and positively correlated with anxiety and depression (r = 0.506, 0.382, P < 0.05). Age, education level, smoking status, average monthly family income, pension, and tendency to conceal illness were significantly associated with the participants' level of stigma (P < 0.05). Age, smoking status, social support, anxiety, and depression were predictive factors of stigmatization among older leukemia patients after diagnosis (all P < 0.05), with a coefficient of determination (R2) of 0.644 and an adjusted R2 of 0.607. CONCLUSION Older patients commonly experience stigmatization after being diagnosed with leukemia. Factors such as age, smoking status, social support, and psychological well-being may influence older patients' reported experience of stigma.
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Affiliation(s)
- Xuan Tang
- Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Shuang-Qin Chen
- Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Jiang-Hua Huang
- Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Cai-Feng Deng
- Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Jie-Qiong Zou
- Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Juan Zuo
- Department of Hematology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
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Egloff SA, Cao X, Lachs R, Martin C, Mattlin M, Fennell E, Rayburn D, Schlauch D, Kurbegov D, Ide S, Battiwalla M. Treatment patterns, resource utilization and clinical outcomes in patients with higher risk myelodysplastic syndromes (MDS) in United States community practices. Leuk Lymphoma 2023; 64:2101-2112. [PMID: 37680012 DOI: 10.1080/10428194.2023.2254429] [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: 01/04/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023]
Abstract
Management of higher-risk myelodysplastic syndromes (HR-MDS) is challenging in the real world. We studied 200 patients with HR-MDS within a large US community hospital network. We describe the clinical presentation, patient-related factors, prognostic characteristics, treatment patterns, clinical outcomes and resource utilization. Patients with HR-MDS, treated in our community setting, were elderly (median age 76 years) with a high comorbidity burden. First-line therapy was hypomethylating agent (HMA) monotherapy (20%), lenalidomide (2%), and venetoclax (2%), while the rest were treated with supportive care. Sixty-one percent of the 200, were subsequently hospitalized within 6 months of initial diagnosis. Overall survival was 11.8 months. Curative transplantation was infrequent, HMA-based therapy was underutilized, responses were not durable, most patients became transfusion-dependent or transformed to AML, and resource utilization was substantial and was highly correlated with total in-hospital days. There is a clear unmet need for tolerable treatments that can produce durable remissions in this population.
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Affiliation(s)
- Shanna Arnold Egloff
- Sarah Cannon Research Institute, HCA Healthcare, Nashville, TN, USA
- HCA Healthcare Research Institute, HCA Healthcare, Brentwood, TN, USA
| | - Xiting Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Rebecca Lachs
- Sarah Cannon Research Institute, HCA Healthcare, Nashville, TN, USA
- Genospace Inc, Boston, MA, USA
| | - Casey Martin
- Sarah Cannon Research Institute, HCA Healthcare, Nashville, TN, USA
- Genospace Inc, Boston, MA, USA
| | - Meredith Mattlin
- Sarah Cannon Research Institute, HCA Healthcare, Nashville, TN, USA
- Genospace Inc, Boston, MA, USA
| | - Emma Fennell
- HCA Healthcare Research Institute, HCA Healthcare, Brentwood, TN, USA
| | - Dillan Rayburn
- HCA Healthcare Research Institute, HCA Healthcare, Brentwood, TN, USA
| | - Daniel Schlauch
- Sarah Cannon Research Institute, HCA Healthcare, Nashville, TN, USA
- Genospace Inc, Boston, MA, USA
| | - Dax Kurbegov
- Sarah Cannon Research Institute, HCA Healthcare, Nashville, TN, USA
- Genospace Inc, Boston, MA, USA
| | - Susan Ide
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Minoo Battiwalla
- Sarah Cannon Research Institute, HCA Healthcare, Nashville, TN, USA
- HCA Healthcare Research Institute, HCA Healthcare, Brentwood, TN, USA
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Khani-Eshratabadi M, Mousavi SH, Zarrabi M, Motallebzadeh Khanmiri J, Zeinali Bardar Z. Human Umbilical Cord Mesenchymal Stem Cell-Derived Microvesicles Could Induce Apoptosis and Autophagy in Acute Myeloid Leukemia. IRANIAN BIOMEDICAL JOURNAL 2023; 27:247-56. [PMID: 37873637 PMCID: PMC10707811 DOI: 10.61186/ibj.27.5.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/31/2023] [Indexed: 12/17/2023]
Abstract
Background Microvesicles (MV) have been identified as candidate biomarkers for treating acute myeloid leukemia (AML). This study investigated the effects of human umbilical cord-derived mesenchymal stem cell (hUCMSC)-derived MVs on apoptosis and autophagy in the KG-1 leukemic cell line. Methods The hUCMSCs were cultured and characterized by flow cytometry. MVs were isolated by ultracentrifugation, and the concentration was determined using the Bradford method. The characteristics of MVs were confirmed using transmission electron microscopy, flow cytometry, and dynamic light scattering methods. KG-1 cells were treated with the desired concentrations of MVs for 24 h. The apoptosis induction and reactive oxygen species production were evaluated using flow cytometry. RT-PCR was performed to evaluate apoptosis- and autophagy-related genes expression. Results Following tretment of KG-1 cells with 25, 50, and 100 μg/ml concentrations of MVs, the apoptosis rates were 47.85%, 47.15%, and 51.35% (p < 0.0001), and the autophagy-induced ROS levels were 73.9% (p < 0.0002), 84.8% (p < 0.0001), and 85.4% (p < 0.0001), respectively. BAX and ATG7 gene expression increased significantly at all concentrations compared to the control, and this level was higher at 50 μg/ml than that of the other concentrations. In addition, LC3 and Beclin 1 expression increased significantly in a concentration-dependen manner. Conversely, BCL2 expression decreased compared to the control. Conclusion Our findings indicate that hUCMSC-MVs could induce cell death pathways of autophagy and apoptosis in the KG-1 cell lines and exert potent antiproliferative and proapoptotic effects on KG-1 cells in vitro. Therefore, hUCMSC-MVs may be a potential approach for cancer therapy as a novel cell-to-cell communication strategy.
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Affiliation(s)
- Mohammad Khani-Eshratabadi
- Department of Hematology and Blood Transfusion Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- Kashmar School of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Hadi Mousavi
- Department of Hematology and Blood Transfusion Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Zarrabi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Jamal Motallebzadeh Khanmiri
- Department of Hematology and Blood Transfusion Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Zeinali Bardar
- Kashmar School of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
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Mozessohn L, Li Q, Liu N, Leber B, Khalaf D, Sabloff M, Christou G, Yee K, Chodirker L, Parmentier A, Siddiqui M, Mamedov A, Zhang L, Liu Y, Earle CC, Cheung MC, Mittmann N, Buckstein R. Impact of Frailty on Health Care Resource Utilization and Costs of Care in Myelodysplastic Syndromes. JCO Oncol Pract 2023; 19:e559-e569. [PMID: 36763927 PMCID: PMC10101507 DOI: 10.1200/op.22.00668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/17/2022] [Accepted: 12/29/2022] [Indexed: 02/12/2023] Open
Abstract
PURPOSE The role of frailty in affecting survival in myelodysplastic syndromes (MDS) is increasingly recognized. Despite this, a paucity of data exists on the association between frailty and other clinically meaningful outcomes including health care resource utilization and costs of care. METHODS We linked the Ontario subset of the prospective Canadian MDS registry (including baseline patient/disease characteristics) to population-based health system administrative databases. Baseline frailty was calculated from the 15-item MDS-specific frailty scale (FS-15). Primary outcomes were public health care utilization and 30-day standardized costs of care (2019 Canadian dollars) determined for each phase of disease (initial, continuation, and terminal phases). Negative binomial regression was used to assess the association between frailty and health care costs with Poisson regression to explore predictors of hospitalization. RESULTS Among 461 patients with complete FS-15 scores, 374 (81.1%) had a hospitalization with a mean length of stay of 10.6 days. Controlling for age, comorbidities, Revised International Prognostic Scoring System, and transfusion dependence, the FS-15 was independently associated with hospitalization during the initial (P = .02) and continuation (P = .01) phases but not the terminal disease phase (P = .09). The mean 30-day standardized cost per patient was $8,499 (median, $6,295; interquartile range, $2,798-$11,996), largely driven by cancer clinic visits and hospitalization. On multivariable analysis, the FS-15 was independently associated with costs of care during the initial disease phase (P = .02). CONCLUSION We demonstrate an association between frailty and clinically meaningful outcomes including hospitalization and costs of care in patients with MDS. Our results suggest that baseline frailty may help to inform patients and physicians of expected outcomes.
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Affiliation(s)
- Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Qing Li
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Ning Liu
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Brian Leber
- Division of Hematology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - Dina Khalaf
- Division of Hematology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Grace Christou
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Karen Yee
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lisa Chodirker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Anne Parmentier
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mohammed Siddiqui
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexandre Mamedov
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Liying Zhang
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ying Liu
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Craig C. Earle
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Matthew C. Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacology and Toxicology and Institute for Health, Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rena Buckstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Zhang L, Khadka B, Wu J, Feng Y, Long B, Xiao R, Liu J. Bone Marrow Mesenchymal Stem Cells-Derived Exosomal miR-425-5p Inhibits Acute Myeloid Leukemia Cell Proliferation, Apoptosis, Invasion and Migration by Targeting WTAP. Onco Targets Ther 2021; 14:4901-4914. [PMID: 34594112 PMCID: PMC8478487 DOI: 10.2147/ott.s286326] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Acute myeloid leukemia (AML) is a predominant blood malignancy with high mortality and severe morbidity. AML is affected by microRNAs (miRNAs) loaded in exosomes derived from bone marrow mesenchymal stem cells (BM-MSCs). MiR-425-5p has been reported to participate in different cancer models. However, the function of BM-MSCs-derived exosomal miR-425-5p in AML is unclear. Methods The expression of miR-425-5p was measured by qRT-PCR in clinical AML samples. The immunophenotype of BM-MSCs was analyzed using antibodies against CD44, CD90, and CD105. The exosome was isolated from BM-MSCs. The effect of BM-MSCs-derived exosomal miR-425-5p on AML was analyzed by CCK-8 assay, Edu assay, transwell assay, flow cytometry in AML cells. qRT-PCR, luciferase reporter gene assay and Western blot analysis were also conducted in AML cells. Results The expression levels of miR-425-5p were decreased in CD34 + CD38-AML cells from primary AML patients compared to that from the bone marrow of healthy cases, and were reduced in exosomes from AML patients compared that from healthy cases. Similarly, miR-425-5p was also down-regulated in AML cell lines compared with BM-MSCs. MiR-425-5p was able to express in exosomes from BM-MSCs. CCK-8, Edu, transwell assay and flow cytometry analysis revealed that BM-MSCs-derived exosomal miR-425-5p significantly inhibited cell viability, Edu positive cells, invasion and migration, and induced apoptosis of AML cells. Meanwhile, the expression levels of cleaved PARP and cleaved caspase3 were increased by BM-MSCs-derived exosomal miR-425-5p in cells. MiR-425-5p inhibited the expression of Wilms tumor 1-associated protein (WTAP). Moreover, overexpression of WTAP could reverse the miR-425-5p-induced inhibition effect on AML cell proliferation, apoptosis, migration and invasion. Conclusion BM-MSCs-derived exosomal miR-425-5p inhibits proliferation, invasion and migration of AML cells and induced apoptosis of AML cells by targeting WTAP. Therapeutically, BM-MSCs-derived exosomal miR-425-5p may serve as a potential target for AML therapy.
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Affiliation(s)
- Ling Zhang
- Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangdong Province, 510630, People's Republic of China
| | - Bijay Khadka
- Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangdong Province, 510630, People's Republic of China
| | - Jieying Wu
- Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangdong Province, 510630, People's Republic of China
| | - Yashu Feng
- Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangdong Province, 510630, People's Republic of China
| | - Bing Long
- Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangdong Province, 510630, People's Republic of China
| | - Ruozhi Xiao
- Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangdong Province, 510630, People's Republic of China
| | - Jiajun Liu
- Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangdong Province, 510630, People's Republic of China
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