1
|
Xing L, Zhao M, Wang Y, Feng Y, Qu Y, Duan N, Wang Y, Wang H, Liu C, Qu W, Wu Y, Guan J, Wang G, Song J, Li L, Wang X, Fu R, Shao Z. Characteristics of patients with autoimmune haemolytic anaemia secondary to lymphoproliferative disorder: A single-centre retrospective analysis. Sci Rep 2019; 9:19716. [PMID: 31873137 PMCID: PMC6928151 DOI: 10.1038/s41598-019-56162-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023] Open
Abstract
Autoimmune haemolytic anaemia (AIHA) is a kind of autoimmune diseases characterized by autoantibodies which produced and secreted by abnormal activated B lymphocytes directed against red blood cells (RBC). Study reveals that about 50% AIHA mainly occurs secondary to lymphoproliferative disorders (LPD) and autoimmune diseases. In this study, we aim to explore the characteristics of patients with AIHA secondary to LPD. Fifteen patients with AIHA secondary to LPD (secondary group) and 60 with primary AIHA (primary group) were retrospectively included. Patients in the secondary group [(59.40 ± 4.74) y] were older than those in the primary group [(47.53 ± 2.30) y] (p = 0.024). Reticulocyte counts were lower for the secondary group [(134.55 ± 20.67) × 109/L] than for the primary group [(193.88 ± 27.32) × 109/L] (p = 0.09). Haptoglobin was higher in the secondary (0.75 ± 0.19) g/L than in the primary group (0.34 ± 0.05) g/L (p = 0.004). The ratio of CD3+CD4+/CD3+CD8+ was higher in the secondary (1.81 ± 0.41) than in the primary (1.05 ± 0.12) group (p = 0.025). Duration of remission was shorter in the secondary [(23.52 ± 5.20) months] than in the primary [(40.87 ± 3.92) months] group (p = 0.013). Relapse rate was higher for the secondary (33.3%) than for the primary (8.3%) group (p = 0.003). Mortality rate was higher in the secondary (33.3%) than in the primary (8.3%) group (p = 0.003). Progression-free survival was shorter in the secondary than in the primary group (p = 0.021). In conclusion, patients with AIHA secondary to LPD showed higher age at diagnosis, shorter remission time, and higher recurrence and mortality rates than did those with primary AIHA.
Collapse
Affiliation(s)
- Limin Xing
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China.
| | - Manjun Zhao
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Yi Wang
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Yingying Feng
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Yingying Qu
- Doppler Ultrasonic Department of Tianjin Third Centre Hospital, Tianjin, 300170, China
| | - Ningning Duan
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Yihao Wang
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Huaquan Wang
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Chunyan Liu
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Wen Qu
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Yuhong Wu
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Jing Guan
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Guojin Wang
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Jia Song
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Lijuan Li
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Xiaoming Wang
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Rong Fu
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Zonghong Shao
- Haematology Department of General Hospital, Tianjin Medical University, Tianjin, 300052, China.
| |
Collapse
|
3
|
Kalpadakis C, Pangalis GA, Angelopoulou MK, Sachanas S, Vassilakopoulos TP. Should rituximab replace splenectomy in the management of splenic marginal zone lymphoma? Best Pract Res Clin Haematol 2018; 31:65-72. [DOI: 10.1016/j.beha.2017.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 02/07/2023]
|
4
|
Kalpadakis C, Pangalis GA, Angelopoulou MK, Vassilakopoulos TP. Treatment of splenic marginal zone lymphoma. Best Pract Res Clin Haematol 2016; 30:139-148. [PMID: 28288709 DOI: 10.1016/j.beha.2016.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/06/2023]
Abstract
Splenic marginal zone lymphoma (SMZL) is a distinct lymphoma entity characterized by an indolent clinical course and prolonged survival. Treatment is not standardized, since there are no prospective randomized trials in large series of SMZL patients. Splenectomy and rituximab represent the most effective treatment strategies used so far. The addition of chemotherapy to rituximab has not further improved the outcome, although this issue requires further investigation. Rituximab monotherapy has been associated with high response rates (∼90%), with approximately half of these responses being complete, even at the molecular level. More importantly, many of these responses are long-lasting, with a reported 7-year progression-free survival (PFS) at the rate of 69%. Maintenance rituximab treatment has been associated with further improvement of the quality of response as well as longer response duration in studies derived from one group of investigators. Based on its high efficacy and the good safety profile, rituximab represent one of the best treatment options for SMZL patients. Moreover, rituximab retains its efficacy in the relapse setting in most cases. Splenectomy is a meaningful alternative to rituximab in patients with bulky splenomegaly and cytopenias, without extensive bone marrow infiltration, who are fit for surgery. However splenectomy cannot completely eradicate the disease and it is also associated with greater morbidity or even mortality compared to rituximab. The choice of one of these two treatment approaches (rituximab or splenectomy) should mainly be based on patient's characteristics and on the disease burden. Novel agents are currently testing in low grade lymphomas including a small number of SMZL patients with promising results.
Collapse
Affiliation(s)
- Christina Kalpadakis
- Department of Haematology, Heraklion University Hospital, 71001, University of Crete, Heraklion, Crete, Greece.
| | - Gerassimos A Pangalis
- Department of Haematology, Athens Medical Center-Psychikon Branch, 11525, Athens, Greece.
| | - Maria K Angelopoulou
- Department of Haematology, National and Kapodistrian University, Laikon General Hospital, Athens, Greece.
| | | |
Collapse
|
5
|
Kalpadakis C, Pangalis GA, Angelopoulou MK, Sachanas S, Vassilakopoulos TP. Current and emerging treatment approaches for splenic marginal zone lymphoma. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1198255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Christina Kalpadakis
- Department of Haematology, Heraklion University Hospital, University of Crete, Heraklion, Crete, Greece
| | | | - Maria K. Angelopoulou
- Department of Haematology, National and Kapodistrian University, Laikon General Hospital, Athens, Greece
| | - Sotirios Sachanas
- Department of Haematology, Athens Medical Center- Psychikon Branch, Athens, Greece
| | | |
Collapse
|