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Reference guide for management of adult immune thrombocytopenia in Japan: 2019 Revision. Int J Hematol 2020; 111:329-351. [PMID: 31897887 PMCID: PMC7223085 DOI: 10.1007/s12185-019-02790-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/28/2019] [Accepted: 12/02/2019] [Indexed: 02/08/2023]
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2
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Tyrosyl-tRNA synthetase stimulates thrombopoietin-independent hematopoiesis accelerating recovery from thrombocytopenia. Proc Natl Acad Sci U S A 2018; 115:E8228-E8235. [PMID: 30104364 PMCID: PMC6126720 DOI: 10.1073/pnas.1807000115] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aminoacyl-tRNA synthetases (aaRSs) catalyze aminoacylation of tRNAs in the first step of protein synthesis in the cytoplasm. However, in higher eukaryotes, they acquired additional functions beyond translation. In the present study, we show that an activated form of tyrosyl-tRNA synthetase (YRSACT) functions to enhance megakaryopoiesis and platelet production in vitro and in vivo. These findings were confirmed with human megakaryocytes differentiated from peripheral blood CD34+ hematopoietic stem cells and with human induced pluripotent stem (iPS) cells. The activity of YRSACT is independent of thrombopoietin (TPO), as evidenced by expansion of the megakaryocytes from iPS cell-derived hematopoietic stem cells from a patient deficient in TPO signaling. These findings demonstrate a previously unrecognized function of an aaRS which may have implications for therapeutic interventions. New mechanisms behind blood cell formation continue to be uncovered, with therapeutic approaches for hematological diseases being of great interest. Here we report an enzyme in protein synthesis, known for cell-based activities beyond translation, is a factor inducing megakaryocyte-biased hematopoiesis, most likely under stress conditions. We show an activated form of tyrosyl-tRNA synthetase (YRSACT), prepared either by rationally designed mutagenesis or alternative splicing, induces expansion of a previously unrecognized high-ploidy Sca-1+ megakaryocyte population capable of accelerating platelet replenishment after depletion. Moreover, YRSACT targets monocytic cells to induce secretion of transacting cytokines that enhance megakaryocyte expansion stimulating the Toll-like receptor/MyD88 pathway. Platelet replenishment by YRSACT is independent of thrombopoietin (TPO), as evidenced by expansion of the megakaryocytes from induced pluripotent stem cell-derived hematopoietic stem cells from a patient deficient in TPO signaling. We suggest megakaryocyte-biased hematopoiesis induced by YRSACT offers new approaches for treating thrombocytopenia, boosting yields from cell-culture production of platelet concentrates for transfusion, and bridging therapy for hematopoietic stem cell transplantation.
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Balduini A, Raslova H, Di Buduo CA, Donada A, Ballmaier M, Germeshausen M, Balduini CL. Clinic, pathogenic mechanisms and drug testing of two inherited thrombocytopenias, ANKRD26-related Thrombocytopenia and MYH9-related diseases. Eur J Med Genet 2018; 61:715-722. [PMID: 29545013 DOI: 10.1016/j.ejmg.2018.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/08/2018] [Accepted: 01/27/2018] [Indexed: 12/21/2022]
Abstract
Inherited thrombocytopenias (ITs) are a heterogeneous group of disorders characterized by low platelet count resulting in impaired hemostasis. Patients can have spontaneous hemorrhages and/or excessive bleedings provoked by hemostatic challenges as trauma or surgery. To date, ITs encompass 32 different rare monogenic disorders caused by mutations of 30 genes. This review will focus on the major discoveries that have been made in the last years on the diagnosis, treatment and molecular mechanisms of ANKRD26-Related Thrombocytopenia and MYH9-Related Diseases. Furthermore, we will discuss the use a Thrombopoietin mimetic as a novel approach to treat the thrombocytopenia in these patients. We will propose the use of a new 3D bone marrow model to study the mechanisms of action of these drugs and to test their efficacy and safety in patients. The overall purpose of this review is to point out that important progresses have been made in understanding the pathogenesis of ANKRD26-Related Thrombocytopenia and MYH9-Related Diseases and new therapeutic approaches have been proposed and tested. Future advancement in this research will rely in the development of more physiological models to study the regulation of human platelet biogenesis, disease mechanisms and specific pharmacologic targets.
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Affiliation(s)
- Alessandra Balduini
- University of Pavia, Pavia, Italy; IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Hana Raslova
- INSERM UMR 1170, Gustave Roussy Cancer Campus, Université Paris-Saclay, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Villejuif, France
| | - Christian A Di Buduo
- University of Pavia, Pavia, Italy; IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Alessandro Donada
- INSERM UMR 1170, Gustave Roussy Cancer Campus, Université Paris-Saclay, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Villejuif, France
| | | | | | - Carlo L Balduini
- University of Pavia, Pavia, Italy; IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
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Moulis G, Lapeyre-Mestre M, Adoue D, Sailler L. Épidémiologie et pharmacoépidémiologie du purpura thrombopénique immunologique. Rev Med Interne 2017; 38:444-449. [DOI: 10.1016/j.revmed.2016.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/04/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023]
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Di Buduo CA, Kaplan DL, Balduini A. In vitro generation of platelets: Where do we stand? Transfus Clin Biol 2017; 24:273-276. [PMID: 28669522 DOI: 10.1016/j.tracli.2017.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/06/2017] [Indexed: 12/30/2022]
Abstract
Millions of platelets, specialized cells that participate in haemostatic and inflammatory functions, are transfused each year worldwide, but their supply is limited. Platelets are produced by megakaryocytes by extending proplatelets, directly into the bloodstream. Bone marrow structure and extracellular matrix composition together with soluble factors (e.g. Thrombopoietin) are key regulators of megakaryopoiesis by supporting cell differentiation and platelet release. Despite this knowledge, the scarcity of clinical cures for life threatening platelet diseases is in a large part due to limited insight into the mechanisms that control the developmental process of megakaryocytes and the mechanisms that govern the production of platelets within the bone marrow. To overcome these limitations, functional human tissue models have been developed and studied to extrapolate ex vivo outcomes for new insight on bone marrow functions in vivo. There are many challenges that these models must overcome, from faithfully mimicking the physiological composition and functions of bone marrow, to the collection of the platelets generated and validation of their viability and function for human use. The overall goal is to identify innovative instruments to study mechanisms of platelet release, diseases related to platelet production and new therapeutic targets starting from human progenitor cells.
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Affiliation(s)
- C A Di Buduo
- Department of molecular medicine, university of Pavia, Pavia, Italy; Biotechnology, research laboratories, IRCCS San Matteo Foundation, Pavia, Italy
| | - D L Kaplan
- Department of biomedical engineering, Tufts university, Medford, MA, USA
| | - A Balduini
- Department of molecular medicine, university of Pavia, Pavia, Italy; Biotechnology, research laboratories, IRCCS San Matteo Foundation, Pavia, Italy; Department of biomedical engineering, Tufts university, Medford, MA, USA.
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Di Buduo CA, Currao M, Pecci A, Kaplan DL, Balduini CL, Balduini A. Revealing eltrombopag's promotion of human megakaryopoiesis through AKT/ERK-dependent pathway activation. Haematologica 2016; 101:1479-1488. [PMID: 27515246 DOI: 10.3324/haematol.2016.146746] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/04/2016] [Indexed: 12/21/2022] Open
Abstract
Eltrombopag is a small, non-peptide thrombopoietin mimetic that has been approved for increasing platelet count not only in immune thrombocytopenia and Hepatitis C virus-related thrombocytopenia, but also in aplastic anemia. Moreover, this drug is under investigation for increasing platelet counts in myelodysplastic syndromes. Despite current clinical practice, the mechanisms governing eltrombopag's impact on human hematopoiesis are largely unknown, in part due to the impossibility of using traditional in vivo models. To investigate eltrombopag's impact on megakaryocyte functions, we employed our established in vitro model for studying hematopoietic stem cell differentiation combined with our latest 3-dimensional silk-based bone marrow tissue model. Results demonstrated that eltrombopag favors human megakaryocyte differentiation and platelet production in a dose-dependent manner. These effects are accompanied by increased phosphorylation of AKT and ERK1/2 signaling molecules, which have been proven to be crucial in regulating physiologic thrombopoiesis. These data further clarify the different mechanisms of action of eltrombopag when compared to romiplostim, which, as we have shown, induces the proliferation of immature megakaryocytes rather than platelet production, due to the unbalanced activation of AKT and ERK1/2 signaling molecules. In conclusion, our research clarifies the underlying mechanisms that govern the action of eltrombopag on megakaryocyte functions and its relevance in clinical practice.
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Affiliation(s)
- Christian A Di Buduo
- Department of Molecular Medicine, University of Pavia, Italy.,Biotechnology Research Laboratories, IRCCS San Matteo Foundation, Pavia, Italy
| | - Manuela Currao
- Department of Molecular Medicine, University of Pavia, Italy.,Biotechnology Research Laboratories, IRCCS San Matteo Foundation, Pavia, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Carlo L Balduini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - Alessandra Balduini
- Department of Molecular Medicine, University of Pavia, Italy .,Biotechnology Research Laboratories, IRCCS San Matteo Foundation, Pavia, Italy.,Department of Biomedical Engineering, Tufts University, Medford, MA, USA
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Tamamyan G, Danielyan S, Lambert MP. Chemotherapy induced thrombocytopenia in pediatric oncology. Crit Rev Oncol Hematol 2016; 99:299-307. [DOI: 10.1016/j.critrevonc.2016.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 10/06/2015] [Accepted: 01/12/2016] [Indexed: 01/19/2023] Open
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Balduini A, Di Buduo CA, Kaplan DL. Translational approaches to functional platelet production ex vivo. Thromb Haemost 2015; 115:250-6. [PMID: 26353819 DOI: 10.1160/th15-07-0570] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/11/2015] [Indexed: 12/13/2022]
Abstract
Platelets, which are released by megakaryocytes, play key roles in haemostasis, angiogenesis, immunity, tissue regeneration and wound healing. The scarcity of clinical cures for life threatening platelet diseases is in a large part due to limited insight into the mechanisms that control the developmental process of megakaryocytes and the mechanisms that govern the production of platelets within the bone marrow. To overcome these limitations, functional human tissue models have been developed and studied to extrapolate ex vivo outcomes for new insight on bone marrow functions in vivo. There are many challenges that these models must overcome, from faithfully mimicking the physiological composition and functions of bone marrow, to the collection of the platelets generated and validation of their viability and function for human use. The overall goal is to identify innovative instruments to study mechanisms of platelet release, diseases related to platelet production and new therapeutic targets starting from human progenitor cells.
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Affiliation(s)
- Alessandra Balduini
- Alessandra Balduini, Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA 02155, USA, Tel.: +1 617 627 2580, Fax: +1 617 627 3231, E-mail:
| | | | - David L Kaplan
- David L. Kaplan, Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA 02155, USA, Tel.: +1 617 627 2580, Fax: +1 617 627 3231, E-mail:
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Kühne T. Treatment of pediatric primary immune thrombocytopenia with thrombopoietin receptor agonists. Semin Hematol 2014; 52:25-30. [PMID: 25578416 DOI: 10.1053/j.seminhematol.2014.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Chronic immune thrombocytopenia (ITP) occurs in approximately one fifth of children with primary ITP and is characterized by a significant lack of clinical data. A minority of these children exhibit bleeding and need treatment. Often standard therapy used for patients with newly diagnosed ITP is administered to stop bleeding and to increase the platelet count. These drugs are associated with adverse effects, which is particularly evident when used during long time. In adult patients with chronic ITP, thrombopoietin receptor agonists (TPO-RAs) demonstrated efficacy in approximately 80% of patients. These drugs have been studied intensely for registration purposes; however, for children and adolescents they are not yet approved and studies are ongoing. First experiences with these drugs show similar effects and safety as in adults, though based on very small numbers of children. These drugs have the potential to be used during long time, in order to increase platelets, to stop or prevent bleeding and to augment quality of life, making long-term safety an important issue.
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Affiliation(s)
- Thomas Kühne
- Division of Oncology/Hematology, University Children's Hospital, Basel, Switzerland.
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Moulis G, Bagheri H, Sailler L, Jonville-Bera AP, Weber E, Guy C, Petitpain N, Laroche ML, Favrelière S, Béné J, Baldin B, Villeval-Federici L, Tebacher-Alt M, Bres V, Veyrac G, Grandvuillemin A, Mauprivez C, Lapeyre-Mestre M, Montastruc JL. Are adverse drug reaction patterns different between romiplostim and eltrombopag? 2009-2013 French PharmacoVigilance assessment. Eur J Intern Med 2014; 25:777-80. [PMID: 25242516 DOI: 10.1016/j.ejim.2014.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Romiplostim and eltrombopag, the two marketed thrombopoietin receptor agonists (TPO-RAs), have distinct binding sites and might have distinct pharmacodynamic mechanisms. The aim of this study was to compare their adverse drug reaction (ADR) patterns. METHODS We selected in the French PharmacoVigilance Database all ADRs associated with TPO-RAs from TPO-RA marketing until the 31st of December 2013. Medical charts were reviewed. We conducted disproportionality analyses comparing romiplostim exposure in the reports of a given ADR pattern (thrombosis, neurological, cutaneous, gastrointestinal or hematological) to romiplostim exposure in all other TPO-RA-related ADR reports. Reporting Odds Ratios (RORs) were adjusted for age and gender. We also compared the number of reports of a given ADR pattern per million daily defined doses (DDDs) dispensed in France during the study period. RESULTS We described 45 reports (53 ADRs) with romiplostim and 26 reports (37 ADRs) with eltrombopag. There were 19 venous thromboses. At least one other risk factor was present in 83.3% of the cases. Ten (55.6%) patients had been splenectomized previously. There were eight arterial thromboses. Another risk factor was noticed in all cases. There was no signal for an excess risk of thrombosis with romiplostim versus eltrombopag (ROR: 1.45, 95% CI [0.48-4.45]). There was a signal for a higher risk of gastrointestinal ADRs with eltrombopag (ROR: 30.28, 95% CI [3.23-383.86]) and of hematological ADRs with romiplostim (ROR: 14.36, 95% CI [1.73-119.08]). Dispensing data-adjusted comparisons led to similar results. CONCLUSIONS This study suggests different ADR patterns between romiplostim and eltrombopag.
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Affiliation(s)
- Guillaume Moulis
- Laboratoire de Pharmacologie Médicale et Clinique, Université Paul Sabatier, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France; Equipe de Pharmacoépidémiologie de l'INSERM U 1027, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France; Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Place du Dr Baylac, TSA 40031, 31059 Toulouse Cedex 9, France.
| | - Haleh Bagheri
- Laboratoire de Pharmacologie Médicale et Clinique, Université Paul Sabatier, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France; Equipe de Pharmacoépidémiologie de l'INSERM U 1027, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France; Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France
| | - Laurent Sailler
- Equipe de Pharmacoépidémiologie de l'INSERM U 1027, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France; Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Place du Dr Baylac, TSA 40031, 31059 Toulouse Cedex 9, France
| | - Annie-Pierre Jonville-Bera
- Service de Pharmacologie Clinique, Centre Régional de Pharmacovigilance, Centre Hospitalier Universitaire de Tours, 2 bd Tonnellé, 37044 Tours Cedex 9, France
| | - Emmanuelle Weber
- Service de Médecine Interne, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, 42055 Saint-Étienne Cedex 02, France
| | - Claire Guy
- Centre Régional de Pharmacovigilance et de Renseignements sur le Médicament, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, 42055 Saint-Étienne Cedex 02, France
| | - Nadine Petitpain
- Service de Pharmacologie Clinique, Centre Régional de Pharmacovigilance de Lorraine, Centre Hospitalier Universitaire de Nancy, 29 Avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex, France
| | - Marie-Laure Laroche
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d'Information sur les Médicaments, Centre Hospitalier Universitaire de Limoges, 2 Avenue Martin-Luther-King, 87042 Limoges Cedex, France
| | - Sylvie Favrelière
- Centre Régional de Pharmacovigilance, Centre Hospitalier Universitaire de Poitiers, BP 577, 86021 Poitiers Cedex, France
| | - Johana Béné
- Centre Régional de Pharmacovigilance, Centre Hospitalier Universitaire de Lille, 1 Place de Verdun, 59045 Lille Cedex, France
| | - Bernadette Baldin
- Centre Régional de Pharmacovigilance, Centre Hospitalier Universitaire de Nice, 4 Avenue Reine Victoria, BP 1179, 06003 Nice Cedex 1, France
| | - Laure Villeval-Federici
- Service de Médecine Interne, Clinique Adassa, 13 Place de Haguenau, 67000 Strasbourg, France
| | - Martine Tebacher-Alt
- Centre Régional de Pharmacovigilance, Centre Hospitalier Universitaire de Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France
| | - Virginie Bres
- Département de Pharmacologie Médicale et Toxicologie, Centre Régional de Pharmacovigilance de Languedoc-Roussillon, Centre Hospitalier Universitaire de Montpellier, 371 Avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France
| | - Gwenaëlle Veyrac
- Service de Pharmacologie Clinique, UF de Pharmacovigilance, Institut de Biologie, Centre Hospitalier Universitaire de Nantes, 9 Quai Moncousu, 44093 Nantes Cedex 01, France
| | - Aurélie Grandvuillemin
- Centre Régional de Pharmacovigilance de Bourgogne, EA 4184, Centre Hospitalier Universitaire de Dijon, 14 rue Paul-Gaffarel, BP 77908, 21079 Dijon Cedex, France
| | - Cédric Mauprivez
- Centre Régional de Pharmacovigilance de Paris-Cochin, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Maryse Lapeyre-Mestre
- Laboratoire de Pharmacologie Médicale et Clinique, Université Paul Sabatier, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France; Equipe de Pharmacoépidémiologie de l'INSERM U 1027, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France; Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Université Paul Sabatier, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France; Equipe de Pharmacoépidémiologie de l'INSERM U 1027, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France; Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, Faculté de Médecine, 37 Allées Jules-Guesde, 31000 Toulouse, France
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Moulis G, Sailler L, Adoue D, Lapeyre-Mestre M. Pharmacoepidemiology of Immune Thrombocytopenia: Protocols of FAITH and CARMEN Studies. Therapie 2014; 69:437-48. [DOI: 10.2515/therapie/2014056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/26/2014] [Indexed: 01/19/2023]
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12
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Prica A, Sholzberg M, Buckstein R. Safety and efficacy of thrombopoietin-receptor agonists in myelodysplastic syndromes: a systematic review and meta-analysis of randomized controlled trials. Br J Haematol 2014; 167:626-38. [DOI: 10.1111/bjh.13088] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/02/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Anca Prica
- Division of Medical Oncology and Haematology; Princess Margaret Cancer Centre/Mount Sinai Hospital; University of Toronto; Toronto ON Canada
| | - Michelle Sholzberg
- Division of Haematology; St. Michael's Hospital; University of Toronto; Toronto ON Canada
| | - Rena Buckstein
- Division of Medical Oncology and Haematology; Odette Cancer Centre/Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
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Chronic myelomonocytic leukemia prognostic classification and management: evidence base and current practice. Curr Hematol Malig Rep 2014; 9:301-10. [PMID: 25142910 DOI: 10.1007/s11899-014-0225-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Chronic myelomonocytic leukemia is a clonal malignancy of the ageing hematopoietic stem cell characterized by a biased differentiation leading to persistent monocytosis and inconstant hypersensitivity of myeloid progenitors to granulo-monocyte colony-stimulating factor (GM-CSF). Cytogenetic abnormalities identified in 30-40 % of patients and gene mutations detected in every patient can be used to stratify patients into risk groups that guide the therapeutic choices. TET2, SRSF2, ASXL1, and genes of the Ras pathway are the most frequently mutated genes, with ASXL1 mutations negatively affecting the disease outcome. Allogeneic stem cell transplantation is the first option to consider, especially in younger patients with poor prognostic factors. There is no firm clinical guideline in transplant-ineligible patients, but hypomethylating agents might be an interesting option. A consensus prognostic scoring system and specific response criteria are now required to facilitate the evaluation of new therapeutic strategies in clinical trials specifically dedicated to this disease.
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