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Alfraih F, Absi A, Abuhaleeqa M, Alghamdi K, Alhuraiji A, Al‐Khabori M, Al‐Shaibani Z, Alzahrani M, Cherif H, Eldadah S, Hanbali A, Motabi IH, Salama H. Management of adult acute lymphoblastic leukemia in the Gulf Cooperation Council (GCC) countries: A consensus report from the GCC Adult ALL Working Group. Cancer Rep (Hoboken) 2024; 7:e1931. [PMID: 38083985 PMCID: PMC10849924 DOI: 10.1002/cnr2.1931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/22/2023] [Accepted: 11/05/2023] [Indexed: 02/12/2024] Open
Abstract
Leukemia burden is growing in the Gulf Council Cooperation (GCC) countries. Nonetheless, there is no unified protocol for managing adult acute lymphoblastic leukemia (ALL) patients in the GCC-countries. Therefore, the GCC Adult-ALL Treaters working group developed this consensus to address the adult-ALL treatment protocols in the GCC-countries and related toxicities' management. Besides, the consensus aimed to highlight the current unmet needs and treatment gaps and provide recommendations to optimize adult-ALL care and patient-centered communication. A three-step modified Delphi method to develop evidence-based recommendations through two-voting rounds and in-between virtual meetings are used in the manuscript development. A 12 experts' panel from five GCC-countries and two international experts were invited to participate in this consensus. This consensus consisted of 35-statements that highlighted the experts' recommendations to optimize ALL adults' care in the first line setting and manage pediatric or pediatric-inspired regimens-related toxicities. Besides, guidance was provided for future research direction and improve patient-centered communication. In conclusion, the adult-ALL management landscape is evolving, and the current evidence highlights better response and survival outcomes with pediatric or pediatric-inspired regiments. Therefore, protocols are needed to optimize the adult-ALL management in the GCC and tailored clinical-trials findings according to the GCC patients' characteristics and local-healthcare infrastructure.
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Affiliation(s)
- Feras Alfraih
- King Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
- Al Faisal UniversityRiyadhSaudi Arabia
| | - Ahmed Absi
- Princess Noorah Oncology CenterKing Abdulaziz Medical City, Ministry of National Guard Health AffairsJeddahSaudi Arabia
| | | | | | - Ahmad Alhuraiji
- Department of HematologyKuwait Cancer Control CenterKuwait CityKuwait
| | - Murtadha Al‐Khabori
- Department of Hematology, College of Medicine and Health SciencesSultan Qaboos UniversityMuscatOman
| | - Zeyad Al‐Shaibani
- King Faisal Specialist Hospital and Research CentreMadinahSaudi Arabia
| | - Musa Alzahrani
- Department of Medicine, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Honar Cherif
- National Center for Cancer Care and ResearchHamad Medical CooperationDohaQatar
| | - Saleem Eldadah
- Princess Noorah Oncology CenterKing Abdulaziz Medical City, Ministry of National Guard Health AffairsJeddahSaudi Arabia
| | - Amr Hanbali
- King Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | | | - Hind Salama
- King Abdulaziz‐Medical CityRiyadhSaudi Arabia
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Salama H, Eldadah S, Omer MH, Alhejazi A, Bin Dayil L, Almozaini A, Khalil RR, Mugairi AA, Snnallah M, Damlaj M, Alaskar A, Alsaeed A, Bakkar MM, Alahmari B, Alzahrani M, Elhemaidi I, Alahmadi M, Alamoudi S, Rajkhan W, Khalil M, Kanfar SS, Saleh ASA, Raizah AA, Ibrahim A, Absi A. Comparison of a modified pediatric protocol versus a hyper-CVAD protocol in adolescents and young adults with Philadelphia-negative acute lymphoblastic leukemia: A multicenter retrospective analysis. Leuk Res 2023; 130:107316. [PMID: 37245332 DOI: 10.1016/j.leukres.2023.107316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The outcomes of Pediatric acute lymphoblastic leukemia (ALL) have improved dramatically whereas outcomes for ALL amongst adolescents and young adults (AYA) have lagged behind. The introduction of pediatric-like regimens to manage adult ALL has shown promising outcomes across several analyses. MATERIALS AND METHODS In this analysis, we aimed to retrospectively compare the differences in outcomes among patients aged 14-40 years with Philadelphia-negative ALL treated with a Hyper-CVAD protocol versus a modified pediatric protocol. RESULTS A total of 103 patients were identified with 58 (56.3%) in the modified ABFM group and 45 (43.7%) in the hyper-CVAD group. The median duration of follow-up for the cohort was 39 months (range 1-93). There were significantly lower rates of MRD persistence after consolidation (10.3% vs. 26.7%, P = 0.031) and transplantation (15.5% vs. 46.6%, P < 0.001) in the modified ABFM group. 5-year OS rates (83.9% vs. 65.3%, P = 0.036) and DFS rates (67.4% vs. 44%, P = 0.014) were higher in the modified ABFM groups. The incidence of grade 3 and 4 hepatotoxicity (24.1% vs. 13.3%, P < 0.001) and osteonecrosis (20.6% vs. 2.2%, P = 0.005) were higher in the modified ABFM group. CONCLUSION Our analysis demonstrates that the use of a pediatric modified ABFM protocol demonstrated superior outcomes compared to the hyper-CVAD regimen in the treatment of Philadelphia-negative ALL amongst AYA patients. However, the modified ABFM protocol was associated with an increased risk of certain toxicities including high grade liver toxicity and osteonecrosis.
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Affiliation(s)
- Hind Salama
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia.
| | - Saleem Eldadah
- Department of Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Mohamed H Omer
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ayman Alhejazi
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Luluh Bin Dayil
- Department of Adult Nursing, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ayman Almozaini
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Roaa Reda Khalil
- Department of Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Areej Al Mugairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Snnallah
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Moussab Damlaj
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia; Department of Hematology Oncology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ahmed Alaskar
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Ahmad Alsaeed
- Department of Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Mohammed Mosa Bakkar
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Bader Alahmari
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Mohsen Alzahrani
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Ihab Elhemaidi
- Department of Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Majed Alahmadi
- Department of Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Sameer Alamoudi
- Department of Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Walaa Rajkhan
- Department of Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Manar Khalil
- Department of Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Solaf Sami Kanfar
- Department of Adult Hematology and Stem Cell Transplantation, King Faisal Specialist Hospital, Dammam, Saudi Arabia
| | - Abdullah S Al Saleh
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Abdulrahman Al Raizah
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Ayman Ibrahim
- Department of Oncology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
| | - Ahmed Absi
- Department of Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Medical Research Center, Saudi Arabia; Saudi Society of Blood and Bone Marrow Transplantation (SSBMT), Saudi Arabia
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Al-Mansour M, Saif SA, Alharbi Z, Alhwaity AS, Almasrahi A, Alnejadi W, Hussain S, Aga SS, Khan MA, Almufti R, Absi A. The Outcomes of Diffuse Large B-cell Lymphoma Patients with Synchronous and Early Central Nervous System Involvement: A Single-Center Experience. Asian Pac J Cancer Prev 2023; 24:623-631. [PMID: 36853313 PMCID: PMC10162608 DOI: 10.31557/apjcp.2023.24.2.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Diffuse large B cell lymphoma (DLBCL) is the most commonly diagnosed subtype of non-Hodgkin's lymphoma (NHL). R-CHOP has significantly improved clinical outcomes in patients with DLBCL, however, its indication in the prevention of CNS relapse and recurrence is still inconsistent. Moreover, prophylactic methotrexate and/or cytarabine have been used prophylactically for DLBCL patients is at high risk of CNS relapse and to treat CNS DLBCL, however, their efficacy remains unclear. METHODS The aim of our retrospective study was to determine the incidence of CNS in-volvement in patients with DLBCL and to describe its risk factors and survival outcomes. RESULTS A total of 406 patients with DLBCL were identified, and 17 (4.2%) of DLBCL patients had CNS involvement i.e. 9 (2.2 %) at diagnosis and 8 (~2%) at relapse. The patients were younger, had advanced stage, high CNS-IPI, and had extra nodal involvement. Seven out of the 17 patients who survived received chemotherapy and a prophylactic methotrexate. Considering the CNS-IPI, of the 146 patients with high CNS-IPI at presentation, 18 received the prophylactic HDMTX and 3 (16.7%) of them had CNS relapse. Two (1.6%) out of 128 who did not receive the prophylactic HDMTX had CNS relapse. On the other hand, of the 223 patients with intermediate CNS-IPI, 25 received the prophylactic HDMTX and 2 (8%) of them had CNS relapse and in 198 patients who did not receive the prophylactic HDMTX, 2 (1.01%) had CNS relapse. The 5-year progression-free survival and overall survival rates for the entire cohort were 73% and 84%, respectively. The median OS for those who had CNS involvement was 17 months and the 2-year OS was 40%. CONCLUSION CNS involvement in DLBCL has a poor prognosis, thus, aggressive CNS-directed therapy should be considered, especially in young patients.
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Affiliation(s)
- Mubarak Al-Mansour
- Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Saif Ahmed Saif
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Ziyad Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Abdulrhman Salem Alhwaity
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Ahmed Almasrahi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Waleed Alnejadi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Sarah Hussain
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Syed Sameer Aga
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Muhammad Anwar Khan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Roula Almufti
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Ahmed Absi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
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Al‑Μansour M, Absi A, Al‑Μufti R, Alahmadi M, El‑Ηemaidi I, Alamoudi S, Eldadah S, Aga S, Khan M, Alsaeed A. Outcomes of high‑dose methotrexate for CNS prophylaxis in diffuse large B‑cell lymphoma with an intermediate or high CNS‑International Prognostic Index: A single‑center retrospective cohort study. Mol Clin Oncol 2022; 17:159. [DOI: 10.3892/mco.2022.2592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mubarak Al‑Μansour
- Department of Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
| | - Ahmed Absi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
| | - Roula Al‑Μufti
- Department of Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
| | - Majed Alahmadi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
| | - Ihab El‑Ηemaidi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
| | - Sameer Alamoudi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
| | - Saleem Eldadah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
| | - Syed Aga
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
| | - Muhammed Khan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
| | - Ahmed Alsaeed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs‑Western Region, Jeddah 21423, Saudi Arabia
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Alsharif AT, Aldawsari M, Babateen EM, Kouther MA, Aljahdali FF, Absi A, Aldosary T, Ahmed ME. The Impact of Obesity on Hodgkin’s Lymphoma Patients Treated With Uniform Chemotherapy Protocol at Princess Noorah Oncology Center, National Guard Health Affairs, Jeddah, Saudi Arabia: Retrospective Matched Cohort. Cureus 2022; 14:e25002. [PMID: 35719750 PMCID: PMC9198289 DOI: 10.7759/cureus.25002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/05/2022] Open
Abstract
Background Hodgkin's lymphoma (HL) is a disease that affects lymphocytes, mostly B cells, and it is commonly diagnosed by the presence of Reed-Sternberg cells. The influence of obesity on the disease course of HL is still controversial. This study’s aim was to investigate the treatment outcomes in obese patients suffering from HL and compare them to the outcomes of non-obese patients. Methods This study is a single-center retrospective cohort study that included 280 patients admitted between 2009 and 2020 with different subtypes of HL who received the chemotherapy regimen of Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) at Princess Norah Oncology Center, National Guard Hospital, Jeddah, Saudi Arabia. Based on WHO criteria, the participants were divided into two groups (obese with a BMI that exceeds 30 kg/m2 versus non-obese with any BMI less than 29,9 kg/m2). All demographic data including age, gender, BMI, body surface area (BSA), and HL subtype (nodular sclerosis, mixed cellularity, lymphocyte depletion) were recorded. In addition, the presence of diabetes mellitus (DM), previous cancer, smoking, staging of HL, number of cycles of ABVD, dose intensity of ABVD, and outcomes (emergency visits, death during therapy, primary resistance, relapse) were collected from the participant files. Results Regarding therapy outcomes, 24.1% of obese patients were admitted to the hospital after receiving the first cycle of ABVD as compared to 75.9% of non-obese patients. However, there was no significant statistical difference between obese and non-obese patients in their hospital admission (p value=0.500). In addition, non-obese patients had a higher chance of being admitted to the hospital after receiving the chemotherapy dose with an odds ratio of 1.22 compared to obese patients. For the emergency visits, 20.8% of obese patients were admitted to ER as a complication of the chemotherapy regimen, whereas 79.3% of non-obese patients were admitted to ER after receiving the chemotherapy. The P-value was statistically not significant (0.396), but the odds of ER admissions after ABVD cycles were 1.28 times higher in non-obese patients compared to obese. Conclusion The study outcomes showed a higher odds of hospital admission and ER admission as complications of the chemotherapy regimen in non-obese HL patients as compared to obese patients.
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El-Haddad H, Khan E, El-Hemaidi I, Absi A. Transfusion-dependent anemia, and cytopenia secondary to parvovirus B19 infection as the first manifestation of X-linked hyper immunoglobulin M immunodeficiency syndrome in two male patients in their third decade of life. J Appl Hematol 2022. [DOI: 10.4103/joah.joah_179_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Algahtani H, Absi A, Shirah B, Al-Maghraby H, Algarni H. Hyperferritinemia with iron deposition in the basal ganglia and tremor as the initial manifestation of follicular lymphoma. Int J Neurosci 2021:1-5. [PMID: 34846223 DOI: 10.1080/00207454.2021.2012470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Iron is an essential element for brain cells that is required for the transport of oxygen, energy generation, myelin synthesis, and production of neurotransmitters. Disturbances in the homeostatic mechanisms of iron metabolism may cause iron accumulation with subsequent oxidative stress and cellular damage. It is important to consider the possibility of both a genetic and acquired iron overload syndrome in patients with neurological symptoms and hyperferritinemia. In this article, we are reporting a unique case characterized by hyperferritinemia with widespread deposition of iron in more than one bodily organ, movement disorder, and hidden malignancy. We stress on the importance of early diagnosis using a systematic approach since early treatment with iron chelators is warranted to prevent the progression of neurological symptoms. Even those patients who have no neurological symptoms with high iron should be monitored closely and treated early to avoid the deposition of iron in the brain. Whether brain damage and MRI changes are reversible completely or partially is a subject for further research.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City/King Saud, Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmed Absi
- King Abdulaziz Medical City/King Saud, Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bader Shirah
- King Abdullah International Medical Research Center/King Saud, Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hatim Al-Maghraby
- Department of Pathology and Lab Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hussam Algarni
- King Saud, Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Salama HA, Jazieh AR, Alhejazi AY, Absi A, Alshieban S, Alzahrani M, Alaskar A, Gmati G, Damlaj M, Abuelgasim KA, Alghamdi A, Alahmari B, Almugairi A, Alzahrani H, Bazarbachi A, Musa MOH, Goyal G. Highlights of the Management of Adult Histiocytic Disorders: Langerhans Cell Histiocytosis, Erdheim-Chester Disease, Rosai-Dorfman Disease, and Hemophagocytic Lymphohistiocytosis. Clin Lymphoma Myeloma Leuk 2021; 21:e66-e75. [PMID: 32943371 PMCID: PMC7434330 DOI: 10.1016/j.clml.2020.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022]
Abstract
Histiocytic disorders are an exceptionally rare group of diseases with diverse manifestations and a paucity of approved treatments, thereby leading to various challenges in their diagnosis and management. With the discovery of novel molecular targets and the incorporation of targeted agents in the management of various adult histiocytic disorders, their management has become increasingly complex. In an attempt to improve the understanding of the clinical features and management of common adult histiocytic disorders (Langerhans cell histiocytosis, Erdheim-Chester disease, Rosai-Dorfman disease, and hemophagocytic lymphohistiocytosis), we created this document based on existing literature and expert opinion.
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Affiliation(s)
- Hind Abdin Salama
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia.
| | - Abdul Rahman Jazieh
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Ayman Yahya Alhejazi
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Ahmed Absi
- Section of Adult Hematology and Hematopoietic Stem Cell Transplant, Princess Nora Oncology Centre, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
| | - Saeed Alshieban
- King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia; Departments of Pathology and Clinical Laboratory, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Giamal Gmati
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Moussab Damlaj
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Khadega A Abuelgasim
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Abdulrahman Alghamdi
- King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia; Department of Clinical Pharmacy, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Bader Alahmari
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Areej Almugairi
- King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia; Departments of Pathology and Clinical Laboratory, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Hazza Alzahrani
- Section of Adult Hematology and Stem Cell Transplant, Department of Oncology, King Faisal Specialist and Research Centre, Riyadh, Saudi Arabia
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine American University of Beirut, Medical Center, Beirut, Lebanon
| | - M O H Musa
- Department of Hematology, Fedail Hospital, Khartoum, Sudan
| | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL.
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Almalki H, Absi A, Alghamdi A, Alsalmi M, Khan M. Analysis of Patient-Physician Concordance in the Understanding of Chemotherapy Treatment Plans Among Patients With Cancer. JAMA Netw Open 2020; 3:e200341. [PMID: 32125427 PMCID: PMC7054829 DOI: 10.1001/jamanetworkopen.2020.0341] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The treatment plans of patients with cancer involve multiple modalities that oncologists need to explain to patients. One such modality is chemotherapy, in which information about the goals, duration, and expected complications of therapy are considered fundamental to achieving optimal patient understanding. Therefore, effective communication between patients and their treating physicians is important to ensure patient adherence to treatment and achieve better outcomes. OBJECTIVE To investigate the concordance in the understanding of chemotherapy treatment plans between patients and their treating oncologists and to identify the potential factors associated with concordance. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study was conducted among adult patients (aged >18 years) with cancer who consented to receive chemotherapy between October 4, 2017, and November 8, 2018. The study also included the treating oncologists of patients receiving chemotherapy. An interview-based structured questionnaire was administered in both inpatient and outpatient settings at the Princess Noorah Oncology Center in Jeddah, Saudi Arabia. The demographic data of patients and physicians were obtained from the ARIA Oncology Information System, a chemotherapy-prescribing software database used at the center. Patients who had a personal history of cancer or were unwilling to be involved in the decision-making process were excluded. Data were analyzed from November 15 to December 20, 2018. EXPOSURES Patients' comprehension and concordance with their treating physicians regarding the aspects of the intended treatment plan. MAIN OUTCOMES AND MEASURES The main outcomes measured were the patient-physician concordance level in the understanding of treatment plans and the identification of patient-related and physician-related factors associated with the level of concordance. RESULTS A total of 151 adult patients (77 men [51.0%] and 74 women [49.0%]) were interviewed. Of those, 144 patients (75.5%) were younger than 60 years, and 52 patients (34.4%) had a college or advanced degree. A total of 20 treating oncologists were interviewed, of whom 14 (70.0%) were men and 6 (30.0%) were women. Arabic was the primary language of 19 oncologists (95.0%), and 19 oncologists (95.0%) had medical practice experience outside of Saudi Arabia. Only 20 patients (13.7%) had full concordance with their physicians regarding the aspects of their treatment plans. The remaining 131 patients (86.2%) had discordance with 1 or more aspect of their treatment plans. The most common aspect of discordance was the planned duration of the chemotherapy regimen, with 104 patients (68.4%) having full discordance. Full patient-physician concordance was more likely among patients with college or advanced degrees (χ21 = 17.73; P < .001) and patients with a family history of cancer (χ21 = 15.88; P < .001). In addition, older physicians (>40 years) compared with younger physicians (aged 30-40 years) were more likely to achieve higher rates of full patient-physician concordance, whereas older patients (>60 years) were associated with only partial concordance compared with patients younger than 60 years (χ21 = 5.84; P = .008), with an AR of 2.7. CONCLUSIONS AND RELEVANCE Most patients showed suboptimal understanding of aspects of their chemotherapy treatment plans. More effort and time should be dedicated to enhancing the understanding of chemotherapy plans among patients with lower educational levels. In addition, self-report surveys that evaluate patients' understanding of their chemotherapy treatment plans should be developed and added to the informed consent process to objectively assess how much a patient understands and to develop a stepwise patient education program that targets patients with the lowest levels of understanding.
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Affiliation(s)
- Hani Almalki
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Absi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of the National Guard–Health Affairs, Jeddah, Saudi Arabia
| | - Abdulrahman Alghamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed Alsalmi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Muhammad Khan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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Salama H, Alhejazi A, Absi A, Alshieban S, Alzahrani M, Alaskar A, Gmati G, Damlaj M, Abuelgasim K, Ali O, Alghamdi A, Alahmari B, Almugairi A, Alzahrani H, ALhashmi H, Jazieh A. Guide lines for management of adult histiocytic disease. J Appl Hematol 2018. [DOI: 10.4103/joah.joah_48_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alsobhi E, Abrar MB, Abdelaal M, Alsaeed A, Absi A, Alzahrani Z, El-Hemaidi I, Alshehri MA, Warsi A, Bayashoot S, Hashem H, Merdad A, Radi S, Shiekhi H, Al-Amri A. Response to imatinib therapy in adult patients with chronic myeloid leukemia in Saudi population: a single-center study. Leuk Lymphoma 2014; 56:882-6. [PMID: 24956142 DOI: 10.3109/10428194.2014.935365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
No study has been published yet in the Arab world regarding response and outcome of imatinib in patients with chronic myeloid leukemia (CML). This study evaluated a total of 122 patients with CML treated with imatinib between 2001 and 2012. Survival, hematologic, cytogenetic and molecular responses and adverse events were assessed. The 5-year overall survival (OS), event free survival (EFS) and progression-free survival (PFS) rates were: 95.4 ± 2.3%, 81.4 ± 4.6% and 90.8 ± 3.2%, respectively. Significant differences in OS (p = 0.001), EFS (p = 0.001) and PFS (p = 0.001) were noted when patients were stratified by cytogenetic response. Survival by Sokal risk groups was not significant (p = 0.293). Complete hematologic response was achieved in 94 patients (93.1%), cytogenetic response in 84 (83.2%), major molecular response in 62 (61.4%) and complete molecular response in 34 (33.7%). This article presents the first evidence on the effectiveness of imatinib in patients with CML from Saudi Arabia and highlights similarities and differences in response patterns in published studies.
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Kelley T, Beck R, Absi A, Jin T, Pohlman B, Hsi E. Biologic predictors in follicular lymphoma: Importance of markers of immune response. Leuk Lymphoma 2009; 48:2403-11. [DOI: 10.1080/10428190701665954] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Prolymphocytic leukemia is a rare chronic lymphoproliferative disorder that includes two subtypes, B cell and T cell, each with its own distinct clinical, laboratory and pathological features. T-cell prolymphocytic leukemia has an aggressive course with short median survival and poor response to chemotherapy. With the use of the purine analogue pentostatin more than half of patients will have a major response and a minority will have a complete remission, usually lasting months. With the introduction of alemtuzumab, most patients who progressed despite treatment with pentostatin had a major response with a complete remission rate higher than that obtained with pentostatin when used as a first line. Unfortunately, progression still follows shortly. We recommend alemtuzumab as initial therapy and offer stem cell transplant (SCT) to selected young, healthy patients who respond. Although B-cell prolymphocytic leukemia is also a progressive disease, some patients can achieve a prolonged progression-free-survival with fludarabine. Patients presenting with massive splenomegaly may be effectively palliated with splenic irradiation or splenectomy. Rituximab is a promising agent and further investigations are warranted to better define its role in treatment of this disorder.
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MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal, Murine-Derived
- Antibodies, Neoplasm/administration & dosage
- Antineoplastic Agents/therapeutic use
- Female
- Humans
- Leukemia, B-Cell/therapy
- Leukemia, Prolymphocytic/therapy
- Leukemia, T-Cell/therapy
- Male
- Pentostatin/administration & dosage
- Rituximab
- Stem Cell Transplantation
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Affiliation(s)
- Ahmed Absi
- Taussig Cancer Cancer, The Cleveland Clinic Foundation, 9500 Euclid Avenue R35, Cleveland OH 44195, USA
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Periáñez R, Absi A, Villa M, Moreno HP, Manjón G. Self-cleaning in an estuarine area formerly affected by 226Ra anthropogenic enhancements: numerical simulations. Sci Total Environ 2005; 339:207-218. [PMID: 15740770 DOI: 10.1016/j.scitotenv.2004.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Revised: 07/15/2004] [Accepted: 07/30/2004] [Indexed: 05/24/2023]
Abstract
A numerical model of the Odiel-Tinto estuary (Spain) has been developed to study the self-cleaning process that was evidenced from 226Ra measurements in water and sediments collected in the period 1999-2002, after direct releases from a fertilizer complex ceased (in 1998). The hydrodynamic model is first calibrated, and standard tidal analysis is carried out to calculate tidal constants required by the dispersion code to determine instantaneous water currents and elevations over the estuary. In this way, long-term simulations may be carried out. The dispersion code includes advective/diffusive transport of radionuclides plus exchanges with bottom sediments described through a kinetic approach. The dispersion model is first tested by comparing computed and measured 226Ra concentrations over the estuary resulting after releases in the Odiel and Tinto rivers. Next, it is applied to simulate the self-cleaning process of the estuary. The time evolution of radium concentrations in bed sediments is in generally good agreement with observations. The computed sediment halving time of the estuary is 510 days, which also is in good agreement with that estimated from measurements.
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Affiliation(s)
- R Periáñez
- Departamento Física Aplicada I, EUITA, Universidad de Sevilla, Ctra Utrera km 1, 41013-Sevilla, Spain.
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Absi A, Villa M, Moreno HP, Manjón G, Periañez R. Self-cleaning in an estuarine area formerly affected by 226Ra anthropogenic enhancements. Sci Total Environ 2004; 329:183-195. [PMID: 15262166 DOI: 10.1016/j.scitotenv.2004.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Revised: 02/13/2004] [Accepted: 03/02/2004] [Indexed: 05/24/2023]
Abstract
The estuary of the Odiel River has been affected by both direct discharges of phosphogypsum (radium enriched industrial waste) and dissolution and weathering of the exposed piles where this radium enriched waste was stored. In 1998 the waste management policy for industries changed. The direct discharges stopped and the new phosphogypsum piles were well protected against dissolution processes, avoiding any transference of radium into the environment. This work presents a study of the evolution with time (1999-2002) of the levels of 226Ra in river water and sediment samples with the new waste management policy. A liquid scintillation technique was used to measure the 226Ra activity concentration in sediment samples. A gas-proportional counter was also used to measure the 226Ra activity concentration in river water samples. The main conclusion is that a systematic and continuous decrease of the activity concentration of 226Ra with time in the Odiel River estuary is occurring. Thus, a possible self-cleaning in the estuary, once the direct waste discharges were avoided, can be inferred.
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Affiliation(s)
- A Absi
- E.T.S. Arquitectura, Universidad de Sevilla, Dpt. Física Aplicada II, Av. Reina Mercedes, 2. 41012 Sevilla, Spain
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