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Klonizakis P, Roy N, Papatsouma I, Mainou M, Christodoulou I, Pantelidou D, Kokkota S, Diamantidis M, Kourakli A, Lazaris V, Andriopoulos D, Tsapas A, Klaassen RJ, Vlachaki E. A Cross-Sectional, Multicentric, Disease-Specific, Health-Related Quality of Life Study in Greek Transfusion Dependent Thalassemia Patients. Healthcare (Basel) 2024; 12:524. [PMID: 38470634 PMCID: PMC10931193 DOI: 10.3390/healthcare12050524] [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: 12/08/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The assessment of health-related quality of life (HRQoL) in thalassemia offers a holistic approach to the disease and facilitates better communication between physicians and patients. This study aimed to evaluate the HRQoL of transfusion-dependent thalassemia (TDT) patients in Greece. This was a multicentric, cross-sectional study conducted in 2017 involving 283 adult TDT patients. All participants completed a set of two QoL questionnaires, the generic SF-36v2 and the disease-specific TranQol. Demographic and clinical characteristics were used to predefine patient subgroups. Significant factors identified in the univariate analysis were entered into a multivariate analysis to assess their effect on HRQoL. The SF-36 scores of TDT patients were consistently lower compared to the general population in Greece. The mean summary score of TranQol was relatively high (71 ± 14%), exceeding levels observed in national surveys in other countries. Employment emerged as the most significant independent factor associated with better HRQoL, whereas age had the most significant negative effect. This study represents the first comprehensive QoL assessment of a representative sample of the TDT population in Greece. The implementation of TranQol allowed for the quantification of HRQoL in Greece, establishing a baseline for future follow-up, and identifying more vulnerable patient subgroups.
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Affiliation(s)
- Philippos Klonizakis
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Noémi Roy
- Department of Haematology, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 0AG, UK;
| | - Ioanna Papatsouma
- Department of Mathematics, Imperial College London, London SW7 2BP, UK;
| | - Maria Mainou
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Ioanna Christodoulou
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Despina Pantelidou
- Thalassemia Unit, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.K.)
| | - Smaro Kokkota
- Thalassemia Unit, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.K.)
| | - Michael Diamantidis
- Thalassemia and Sickle Cell Disease Unit, General Hospital of Larissa, 41110 Larissa, Greece;
| | - Alexandra Kourakli
- Thalassemia and Hemoglobinopathies Center, University Hospital of Patras, 26504 Patras, Greece; (A.K.); (V.L.)
| | - Vasileios Lazaris
- Thalassemia and Hemoglobinopathies Center, University Hospital of Patras, 26504 Patras, Greece; (A.K.); (V.L.)
| | - Dimitrios Andriopoulos
- Haemato-Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK;
| | - Apostolos Tsapas
- 2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Robert J. Klaassen
- Department of Pediatrics, Division of Hematology/Oncology, University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada;
| | - Efthymia Vlachaki
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
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2
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Gavriilaki E, Nikolousis E, Koravou EE, Dimou-Besikli S, Kartsios C, Papakonstantinou A, Mpanti A, Pontikoglou C, Kalpadaki C, Bitsani A, Tassi I, Touloumenidou T, Chatziconstantinou T, Papathanasiou M, Syrigou A, Ztriva E, Kaiafa G, Mandala E, Mellios Z, Karakasis D, Kourakli A, Symeonidis A, Kapsali E, Papadaki HH, Lalayanni C, Sakellari I. Caplacizumab for immune thrombotic thrombocytopenic purpura: real-world multicenter data. Front Med (Lausanne) 2023; 10:1226114. [PMID: 37901415 PMCID: PMC10600458 DOI: 10.3389/fmed.2023.1226114] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Given the limited real-world data of caplacizumab, our multicenter real-world study was designed to assess the safety and efficacy of caplacizumab in immune thrombotic thrombocytopenic pupura (iTTP), compared to historic controls. We have studied 70 patients: 23 in the caplacizumab and 47 in the historic control group. Plasma exchange was applied in all episodes except for two patients that denied plasma exchange. Rituximab as first-line treatment was more common in the caplacizumab group compared to historic control. Caplacizumab (10 mg daily) was given at a median on day 7 (1-43) from initial diagnosis for 32 (6-47) dosages. In the caplacizumab group, a median of 12 (8-23) patients required plasma exchange sessions versus 14 (6-32) in the control group. Caplacizumab administration did not produce any grade 3 complications or major hemorrhagic events. After a median of 19.0 (2.6-320) months since the iTTP diagnosis, 5 deaths occurred (4 in the control group and 1 in the caplacizumab group, p = 0.310). Caplacizumab patients achieved early platelet normalization and ADAMTS13 activity normalization at the end of treatment. Relapse was observed only in 2/23 (9%) caplacizumab patients, compared to 29/47 (62%) historic controls (p < 0.001). Overall, caplacizumab is safe and effective in treating iTTP, including cases refractory to plasma exchange, re-administration, and cases without previous plasma exchange treatment. No major hemorrhagic events were observed. Cessation of dosing guided by ADAMTS13 has ensured a low relapse rate.
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Affiliation(s)
- Eleni Gavriilaki
- BMT Unit - Department of Hematology, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | | | | | | | | | - Anastasia Mpanti
- Department of Hematology, Papageorgiou Hospital, Thessaloniki, Greece
| | | | - Christina Kalpadaki
- Department of Hematology, University of Crete School of Medicine, Crete, Greece
| | - Aikaterini Bitsani
- First Department of Internal Medicine, LAIKO General Hospital, Athens, Greece
| | - Ilianna Tassi
- Department of Hematology, University Hospital, Ioannina, Greece
| | | | | | - Maria Papathanasiou
- BMT Unit - Department of Hematology, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Antonia Syrigou
- BMT Unit - Department of Hematology, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Eleutheria Ztriva
- 1st Medical Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Kaiafa
- 1st Medical Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdokia Mandala
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zois Mellios
- Department of Hematology, Evangelismos Hospital, Athens, Greece
| | | | - Alexandra Kourakli
- Division of Hematology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Argiris Symeonidis
- Division of Hematology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Eleni Kapsali
- Department of Hematology, University Hospital, Ioannina, Greece
| | | | - Chrysavgi Lalayanni
- BMT Unit - Department of Hematology, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Ioanna Sakellari
- BMT Unit - Department of Hematology, G. Papanicolaou Hospital, Thessaloniki, Greece
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Manganas K, Delicou S, Xydaki A, Kourakli A, Evliati L, Vlachaki E, Klironomos E, Diamantidis M, Lafiatis I, Kattamis A, Koskinas J. Predisposing factors for advanced liver fibrosis in patients with sickle cell disease. Br J Haematol 2023; 202:1192-1198. [PMID: 37438880 DOI: 10.1111/bjh.18970] [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: 12/27/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
Sickle cell disease (SCD) is one of the most common monogenic disorders worldwide and liver complications are common in this group of patients. Our study aims to highlight the prevalence of chronic liver complications and the main predisposing factors for advanced liver fibrosis in SCD patients. For this purpose, 219 patients from eight Thalassemia and Sickle Cell Units across Greece enrolled in our study and history of liver related disease complications was recorded, as well as a full laboratory and imaging analysis concerning their liver function. 13.6% of the patients had advanced liver fibrosis. The presence of liver fibrosis was significantly correlated with advanced age, male gender, cholelithiasis and higher LDH, γ-GT, INR, direct and indirect bilirubin levels. These patients had exhibited significantly more episodes of liver crises and acute intrahepatic cholestasis. No correlation was observed with right heart failure or previous viral hepatitis. Patients with advanced liver fibrosis were receiving a more intensive transfusion therapy for a longer period of time and had higher Liver Iron Concentration levels. Our study shows that liver complications and cirrhosis is a significant cause of morbidity in patients with SCD and it is primarily associated with intravascular hemolysis and vaso-occlusive phenomena and secondarily with iron overload.
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Affiliation(s)
| | - Sophia Delicou
- Thalassemia and Sickle Cell Unit, Hippokration General Hospital, Athens, Greece
| | - Aikaterini Xydaki
- Thalassemia and Sickle Cell Unit, Hippokration General Hospital, Athens, Greece
| | - Alexandra Kourakli
- Thalassemia & Hemoglobinopathies Unit, Hematology Division, Department of Internal Medicine, University of Patras Medical School, University Hospital, Patras, Greece
| | - Loukia Evliati
- Thalassemia and Sickle Cell Unit, General Hospital of Athens "Evaggelismos", Athens, Greece
| | - Efthymia Vlachaki
- Thalassemia and Sickle Cell Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Klironomos
- Thalassemia and Sickle Cell Unit, "Venizelion" General Hospital, Heraklion, Greece
| | - Michail Diamantidis
- Thalassemia and Sickle Cell Unit, General Hospital of Larissa, Larissa, Greece
| | - Ioannis Lafiatis
- Thalassemia and Sickle Cell Unit, "Vostanio" General Hospital of Mytilene, Mytilene, Greece
| | - Antonios Kattamis
- "Agia Sophia" Children Hospital, First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Koskinas
- Department of Internal Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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4
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Kattamis A, Voskaridou E, Delicou S, Klironomos E, Lafiatis I, Petropoulou F, Diamantidis MD, Lafioniatis S, Evliati L, Kapsali E, Karvounis‐Marolachakis K, Timotheatou D, Deligianni C, Viktoratos P, Kourakli A. Real-world complication burden and disease management paradigms in transfusion-related β-thalassaemia in Greece: Results from ULYSSES, an epidemiological, multicentre, retrospective cross-sectional study. EJHaem 2023; 4:569-581. [PMID: 37601860 PMCID: PMC10435690 DOI: 10.1002/jha2.695] [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] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 08/22/2023]
Abstract
Patients with transfusion-dependent beta (β)-thalassaemia experience a broad range of complications. ULYSSES, an epidemiological, multicentre, retrospective cross-sectional study, aimed to assess the prevalence and severity of treatment and disease complications, capture disease management and identify predictors of complications in patients with transfusion-dependent β-thalassaemia, treated in routine settings in Greece. Eligible patients were adults diagnosed with β-thalassaemia ≥12 months before enrolment and having received ≥6 red blood cell (RBC) units (excluding elective surgery) with no transfusion-free period ≥35 days in the 24 weeks before enrolment. Primary data were collected at a single visit and through chart review. Between Oct 21, 2019, and Jun 15, 2020, 201 eligible patients [median (interquartile range, IQR) age 45.7 (40.2-50.5) years; 75.6% > 40 years old; 64.2% female] were enrolled, a mean (standard deviation) of 42.9 (7.8) years after diagnosis. Median (IQR) age at diagnosis and RBC transfusion initiation were 0.8 (0.4-2.8) and 1.3 (1.0-5.0) years, respectively. From diagnosis to enrolment, patients had developed a median of six (range: 1-55) complications; 19.6% were grade ≥3. The most represented complications were endocrine/metabolic/nutrition disorders (91.5%), surgical/medical procedures (67.7%) and blood/lymphatic system disorders (64.7%). Real-world data generated by ULYSSES underscore the substantial complication burden of transfusion-dependent β-thalassaemia patients, routinely managed in Greece.
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Affiliation(s)
- Antonis Kattamis
- First Department of PediatricsThalassemia UnitNational and Kapodistrian University of AthensAthensGreece
| | - Ersi Voskaridou
- Expertise Center in Rare Haematological Diseases‐HaemoglobinopathiesGeneral Hospital of Athens “Laikon”AthensGreece
| | - Sophia Delicou
- Thalassemia and Sickle Cell UnitGeneral Hospital of Athens “Hippocrateion”AthensGreece
| | - Evangelos Klironomos
- Thalassemia and Sickle Cell UnitGeneral Hospital of Heraklion “Venizelion”HeraklionGreece
| | - Ioannis Lafiatis
- Thalassemia and Sickle Cell UnitGeneral Hospital of Mytilene “Vostanio”MytileneGreece
| | - Foteini Petropoulou
- Thalassemia UnitGeneral Hospital of Athens “Georgios Gennimatas”AthensGreece
| | - Michael D. Diamantidis
- Thalassemia and Sickle Cell Disease UnitGeneral Hospital of Larissa “Koutlimbaneio & Triantafylleio”LarissaGreece
| | - Stylianos Lafioniatis
- Thalassemia and Sickle Cell UnitGeneral Hospital of Volos “Achilopouleio,”VolosGreece
| | - Loukia Evliati
- Thalassemia and Sickle Cell UnitGeneral Hospital of Athens “Evaggelismos”AthensGreece
| | - Eleni Kapsali
- Department of HematologyUniversity Hospital of IoanninaIoanninaGreece
| | | | | | | | | | - Alexandra Kourakli
- Department of Internal MedicineHematology DivisionUniversity General Hospital of PatrasPatrasGreece
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5
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Mitroulis I, Papadopoulos V, Lamprianidou E, Mirtschink P, Liapis K, Zafeiropoulou K, Kourakli A, Moysiadis T, Papoutselis M, Vrachiolias G, Symeonidis A, Kotsianidis I. Common cardiovascular biomarkers can independently predict outcome of patients with Myelodysplastic syndromes. Blood Cancer J 2023; 13:64. [PMID: 37137883 PMCID: PMC10156800 DOI: 10.1038/s41408-023-00844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Ioannis Mitroulis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Eleftheria Lamprianidou
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Peter Mirtschink
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Konstantinos Liapis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Kalliopi Zafeiropoulou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Theodoros Moysiadis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, Nicosia, 2417, Cyprus
| | - Menelaos Papoutselis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece.
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6
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Siamoglou S, Boers R, Koromina M, Boers J, Tsironi A, Chatzilygeroudi T, Lazaris V, Verigou E, Kourakli A, van IJcken WFJ, Gribnau J, Symeonidis A, Patrinos GP. Genome-wide analysis toward the epigenetic aetiology of myelodysplastic syndrome disease progression and pharmacoepigenomic basis of hypomethylating agents drug treatment response. Hum Genomics 2023; 17:37. [PMID: 37098643 PMCID: PMC10127336 DOI: 10.1186/s40246-023-00483-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/05/2023] [Indexed: 04/27/2023] Open
Abstract
Myelodysplastic syndromes (MDS) consist of a group of hematological malignancies characterized by ineffective hematopoiesis, cytogenetic abnormalities, and often a high risk of transformation to acute myeloid leukemia (AML). So far, there have been only a very limited number of studies assessing the epigenetics component contributing to the pathophysiology of these disorders, but not a single study assessing this at a genome-wide level. Here, we implemented a generic high throughput epigenomics approach, using methylated DNA sequencing (MeD-seq) of LpnPI digested fragments to identify potential epigenomic targets associated with MDS subtypes. Our results highlighted that PCDHG and ZNF gene families harbor potential epigenomic targets, which have been shown to be differentially methylated in a variety of comparisons between different MDS subtypes. Specifically, CpG islands, transcription start sites and post-transcriptional start sites within ZNF124, ZNF497 and PCDHG family are differentially methylated with fold change above 3,5. Overall, these findings highlight important aspects of the epigenomic component of MDS syndromes pathogenesis and the pharmacoepigenomic basis to the hypomethylating agents drug treatment response, while this generic high throughput whole epigenome sequencing approach could be readily implemented to other genetic diseases with a strong epigenetic component.
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Affiliation(s)
- Stavroula Siamoglou
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras, School of Health Sciences, University Campus, 265 04, Rion, Patras, Greece
| | - Ruben Boers
- Department of Developmental Biology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maria Koromina
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras, School of Health Sciences, University Campus, 265 04, Rion, Patras, Greece
| | - Joachim Boers
- Department of Developmental Biology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anna Tsironi
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras, School of Health Sciences, University Campus, 265 04, Rion, Patras, Greece
| | - Theodora Chatzilygeroudi
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Vasileios Lazaris
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Evgenia Verigou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | | | - Joost Gribnau
- Department of Developmental Biology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - George P Patrinos
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras, School of Health Sciences, University Campus, 265 04, Rion, Patras, Greece.
- Department of Genetics and Genomics, United Arab Emirates University, College of Medicine and Health Sciences, Al-Ain, Abu Dhabi, United Arab Emirates.
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, United Arab Emirates.
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7
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Liapis K, Papadopoulos V, Pontikoglou C, Vrachiolias G, Stavroulaki E, Kourakli A, Lazaris V, Galanopoulos AG, Papoutselis M, Papageorgiou SG, Diamantopoulos PT, Pappa V, Viniou NA, Τsokanas D, Vassilakopoulos TP, Hatzimichael E, Bouronikou E, Ximeri M, Megalakaki A, Zikos P, Panayiotidis P, Dimou M, Karakatsanis S, Papaioannou M, Papadakis S, Vardi A, Kontopidou F, Harchalakis N, Adamopoulos I, Symeonidis A, Papadaki HA, Kotsianidis I. Myelodysplastic neoplasm with isolated thrombocytopenia and immune thrombocytopenic purpura in adults: insights from a comparison of two national registries. Leukemia 2023; 37:708-711. [PMID: 36646886 DOI: 10.1038/s41375-023-01819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Konstantinos Liapis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece.
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Charalambos Pontikoglou
- Department of Hematology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Emily Stavroulaki
- Department of Hematology, Benizeleion Hospital, Heraklion, Crete, Greece
| | - Alexandra Kourakli
- Greece Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Vasileios Lazaris
- Greece Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | | | - Menelaos Papoutselis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | | | | | - Vassiliki Pappa
- Second Department of Internal Medicine, Attikon University General Hospital, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Τsokanas
- Department of Clinical Hematology, Georgios Gennimatas Hospital, Athens, Greece
| | - Theodoros P Vassilakopoulos
- Department of Hematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Bouronikou
- Department of Hematology, University Hospital of Larissa, Larissa, Greece
| | - Maria Ximeri
- Department of Hematology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Panagiotis Zikos
- Department of Hematology, Aghios Andreas General Hospital, Patras, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Papaioannou
- Department of Hematology, AHEPA University Hospital, Thessaloniki, Greece
| | - Stavros Papadakis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Anna Vardi
- Department of Hematology and Stem cell Transplantation, Georgios Papanicolaou General Hospital, Thessaloniki, Greece
| | - Flora Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokratio General Hospital, Athens, Greece
| | - Nikolaos Harchalakis
- Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Ioannis Adamopoulos
- Department of Hematology and Thalassemia, Kalamata General Hospital, Kalamata, Greece
| | - Argiris Symeonidis
- Department of Hematology, Benizeleion Hospital, Heraklion, Crete, Greece
| | - Helen A Papadaki
- Department of Hematology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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8
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Diamantopoulos PT, Solomou E, Symeonidis A, Pappa V, Kotsianidis I, Galanopoulos A, Pontikoglou C, Anagnostopoulos A, Vassilopoulos G, Zikos P, Hatzimichael E, Papaioannou M, Megalakaki A, Vassilakopoulos T, Dimou M, Tsokanas D, Papoutselis MK, Papageorgiou S, Kourakli A, Papadaki H, Panayiotidis P, Viniou NA. The prognostic significance of macrocytosis in patients with myelodysplastic neoplasms. Am J Hematol 2023; 98:E119-E122. [PMID: 36808739 DOI: 10.1002/ajh.26886] [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: 01/16/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Panagiotis T Diamantopoulos
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Solomou
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School-University Hospital, Patras, Greece
| | - Vasiliki Pappa
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Athanasios Galanopoulos
- Department of Clinical Hematology, 'G. Gennimatas' District General Hospital, Athens, Greece
| | | | - Achilles Anagnostopoulos
- Hematology Department, General Hospital of Thessaloniki "George Papanikolaou", Pilea Chortiatis, Greece
| | - George Vassilopoulos
- Department of Hematology, Larissa University Hospital, University of Thessalia, Larissa, Greece
| | - Panagiotis Zikos
- Department of Hematology, 'St Andrew' General Hospital, Patras, Greece
| | | | - Maria Papaioannou
- Hematology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | | | - Theodoros Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria Dimou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Tsokanas
- Department of Clinical Hematology, 'G. Gennimatas' District General Hospital, Athens, Greece
| | | | - Sotirios Papageorgiou
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University of Patras Medical School-University Hospital, Patras, Greece
| | - Helen Papadaki
- Haematology Laboratory, School of Medicine, University of Crete, Greece
| | - Panayiotis Panayiotidis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nora-Athina Viniou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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9
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Symeonidis A, Chondropoulos S, Verigou E, Lazaris V, Kourakli A, Tsirigotis P. Allogeneic Hematopoietic Stem Cell Transplantation for Mixed or Overlap Myelodysplastic/Myeloproliferative Disorders. Front Oncol 2022; 12:884723. [PMID: 35992818 PMCID: PMC9389581 DOI: 10.3389/fonc.2022.884723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/23/2022] [Indexed: 12/30/2022] Open
Abstract
Chronic myelomonocytic leukemia (CMML) and the remaining, less frequent hybrid, mixed, or overlap myelodysplastic syndromes/myeloproliferative neoplasms (MDSs/MPNs) are difficult to treat neoplastic hematological disorders, exhibiting substantial clinical and prognostic heterogeneity, for which clear therapeutic guidelines or effective treatment options are still missing. CMML has an overall survival ranging from a few months to several years. Although patients with proliferative or dysplastic features may benefit from hydroxyurea and hypomethylating agent treatment, respectively, none of these treatments can establish long-term remission and prevent the inevitable transformation to acute leukemia. Novel targeted treatment approaches are emerging but are still under investigation. Therefore, currently, allogeneic stem cell transplantation (allo-SCT) remains the only treatment modality with a curative potential, but its widespread application is limited, due to significant morbidity and mortality associated with the procedure, especially in the elderly and in patients with comorbidities. Recognition of patient eligibility for allo-SCT is crucial, and the procedure should be addressed to patients with a good performance status without severe comorbidities and mainly to those in intermediate- to high-risk category, with a suitable stem cell donor available. The issues of best timing for performing transplantation, patient and donor eligibility, the type of conditioning regimen, and the outcomes after various allo-SCT procedures are the topics of this review.
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Affiliation(s)
- Argiris Symeonidis
- University of Patras Medical School, Hematology Division, Patras, Greece
- *Correspondence: Argiris Symeonidis, ; orcid.org/0000-0002-0543-046X
| | | | - Evgenia Verigou
- Hematology Division, General University Hospital of Patras, Rion of Patras, Greece
| | - Vasileios Lazaris
- Hematology Division, General University Hospital of Patras, Rion of Patras, Greece
| | - Alexandra Kourakli
- Hematology Division, General University Hospital of Patras, Rion of Patras, Greece
| | - Panagiotis Tsirigotis
- Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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10
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Thomopoulos TP, Symeonidis A, Kourakli A, Papageorgiou SG, Pappa V. Chronic Neutrophilic Leukemia: A Comprehensive Review of Clinical Characteristics, Genetic Landscape and Management. Front Oncol 2022; 12:891961. [PMID: 35494007 PMCID: PMC9048254 DOI: 10.3389/fonc.2022.891961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic neutrophilic leukemia (CNL) represents a rare disease, that has been classified among the BCR/ABL-negative myeloproliferative neoplasms. The disease is characterized by marked leukocytosis with absolute neutrophilia and its clinical presentation may vary from asymptomatic to highly symptomatic with massive splenomegaly and constitutional symptoms. CNL prognosis remains relatively poor, as most patients succumb to disease complications or transform to acute myeloid leukemia. Recent studies have demonstrated that CSF3R mutations drive the disease, albeit the presence of other secondary mutations perplex the genetic landscape of the disease. Notably, the presence of CSF3R mutations has been adopted as a criterion for diagnosis of CNL. Despite the vigorous research, the management of the disease remains suboptimal. Allogeneic stem cell transplantation represents the only treatment that could lead to cure; however, it is accompanied by high rates of treatment-related mortality. Recently, ruxolitinib has shown significant responses in patients with CNL; however, emergence of resistance might perturbate long-term management of the disease. The aim of this review is to summarize the clinical course and laboratory findings of CNL, highlight its pathogenesis and complex genetic landscape, and provide the context for the appropriate management of patients with CNL.
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Affiliation(s)
- Thomas P. Thomopoulos
- Second Department of Internal Medicine, Attikon Hospital, Research Institute, National and Kapodistrian University of Athens, Athens, Greece
| | - Argiris Symeonidis
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Alexandra Kourakli
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Sotirios G. Papageorgiou
- Second Department of Internal Medicine, Attikon Hospital, Research Institute, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine, Attikon Hospital, Research Institute, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: Vasiliki Pappa,
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11
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Matsagos S, Verigou E, Kourakli A, Alexis S, Vrakas S, Argyropoulou C, Lazaris V, Spyropoulou P, Labropoulou V, Georgara N, Lykouresi M, Karakantza M, Alepi C, Symeonidis A. High Frequency of Post-Transfusion Microchimerism Among Multi-Transfused Beta-Thalassemic Patients. Front Med (Lausanne) 2022; 9:845490. [PMID: 35252277 PMCID: PMC8888870 DOI: 10.3389/fmed.2022.845490] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 01/19/2023] Open
Abstract
Background Transfusion-associated microchimerism implies the presence of allogeneic hematopoietic cells in an individual, following the transfusion of a blood product. It is a transfusion-related adverse effect/long-term consequence, which has not been well-investigated among regularly transfused patients with thalassemia. Patients and Methods We investigated 64 regularly transfused, homozygous β-thalassemic patients and 21 never-transfused healthy volunteer blood donors (controls) for the presence of microchimerism in their sera, using real-time PCR targeting circulating allogeneic, both, Human Leukocyte Antigen-DR isotype (HLA-DR) and non-HLA alleles. The investigation was longitudinally repeated in patient subsets for more than 2 years. Results were correlated with clinical and laboratory parameters, peripheral blood lymphocyte immunophenotype, blood storage time, and donor's gender to identify potential contributing factors for microchimerism generation. Results Overall, microchimerism was detected in 52 of the 64 patients (81.2%) and in 6 of the 21 controls (28.5%, p = 0.0001). Forty-four patients (68.7%) exhibited long-term microchimerism (persisted for more than 6 months), confirmed at all time-points investigated. Microchimerism was more frequent among elderly, women, splenectomized and more heavily transfused patients, and among those who exhibit higher serum ferritin levels. In these patients, a distinct descending pattern of CD16dim+CD56dim+ natural killer (NK)-cells (p < 0.001) and an ascending pattern of CD4+CD25brightCD127– regulatory T-cells (p = 0.022) for increasing allelic burden were noticed, suggesting the establishment of recipient immune tolerance against the donor-derived chimeric alleles. Both splenectomized and non-splenectomized thalassemic patients exhibited the same trend. The storage time of transfused blood products and donor/gender mismatch had no impact on the development of microchimerism. Discussion-Conclusive Remarks Transfusion-associated microchimerism appears to be a very common complication among multi-transfused thalassemic patients. The potential clinical consequences of this phenomenon remain as yet unclear. Immune tolerance attributed to disease itself and to repeated transfusions might at least in part explain its appearance.
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Affiliation(s)
- Spyridon Matsagos
- Department of Transfusion Medicine and Blood Bank, "Tzaneion" General Hospital, Piraeus, Greece.,Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Evgenia Verigou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Spyridon Alexis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Spyridon Vrakas
- Gastroenterology Department, "Tzaneion" General Hospital, Piraeus, Greece
| | - Constantina Argyropoulou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Vasileios Lazaris
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Panagiota Spyropoulou
- Department of Transfusion Medicine and Blood Bank, "Tzaneion" General Hospital, Piraeus, Greece
| | - Vasiliki Labropoulou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Nicoletta Georgara
- Department of Transfusion Medicine and Blood Bank, University Regional General Hospital of Patras, Patras, Greece
| | - Maria Lykouresi
- Department of Transfusion Medicine and Blood Bank, "Tzaneion" General Hospital, Piraeus, Greece
| | - Marina Karakantza
- Haematology and Transfusion Department, National Health Service Blood and Transplant, Leeds Teaching, Hospital Trust, Leeds, United Kingdom
| | - Chrysoula Alepi
- Department of Transfusion Medicine and Blood Bank, "Tzaneion" General Hospital, Piraeus, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
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12
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Liapis K, Papadopoulos V, Vrachiolias G, Stavroulaki E, Misidou C, Kourakli A, Galanopoulos A, Papoutselis MK, Papageorgiou S, Diamantopoulos PT, Pappa V, Viniou NA, Tsokanas D, Vassilakopoulos TP, Hatzimichael E, Koumpis E, Papathanasiou K, Bouronikou E, Ximeri M, Pontikoglou C, Megalakaki A, Zikos P, Panayiotidis P, Dimou M, Karakatsanis SJ, Vardi A, Kontopidou F, Charchalakis N, Adamopoulos I, Papadaki HA, Symeonidis A, Ioannis K. Myelodysplastic Syndromes (MDS) Presenting with Isolated Thrombocytopenia: Characteristics, Outcomes, and Clinical Presentation Differences from Immune Thrombocytopenic Purpura (ITP). Blood 2021; 138:1535-1535. [DOI: https:/doi.org/10.1182/blood-2021-149630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Introduction: Less than 5% of patients with MDS present with thrombocytopenia as an isolated abnormality (MDS-IT). There have been few systematic studies on MDS-IT and data regarding its course and prognosis are conflicting. Previous studies have defined MDS-IT based on the IPSS thresholds (Hb ≥10 g/dL; ANC ≥1.8×10 9/L; PLT <100×10 9/L). However, these were developed for prognostic, not diagnostic purposes which means that mild anemia and/or neutropenia might be present concomitantly with "isolated" thrombocytopenia. We aimed to investigate the characteristics, overall survival (OS), and leukemia-free survival (LFS) of patients with MDS-IT.
Methods: We identified patients who had PLT <150 ×10 9/L, Hb >13 g/dL (men) or >12 g/dL (women), and ANC ≥1.8 ×10 9/L, registered in the Hellenic National Registry of Myelodysplastic and Hypoplastic Syndromes which includes 2792 patients (analysis cut-off date; July 7, 2016). Patients were divided into 4 groups: group 1 had PLT 149-100 ×10 9/L; group 2, 99-50 ×10 9/L; group 3, <50 ×10 9/L; and group 4, <25 ×10 9/L. We also collected data from the Hellenic National ITP Registry which includes 1317 adult patients with ITP.
Results: A total of 77 patients (45 men; 32 women) with MDS-IT were identified (2.9% of total MDS cohort). Of these, 28.6% were classified in group 1; 49.4% in group 2; 14.3% in group 3; and 7.8% in group 4. Median PLT count was 87 ×10 9/L (12-139 ×10 9/L), WBC count 4.6 ×10 9/L, and Hb 13.6 g/dL. Bone marrow (BM) blasts ranged from 0-9% (median, 2%). Median follow-up was 51.0 months (41.6-60.4), during which 15 (19.5%) patients died. AML developed in 9 patients (11.7%). Histologically, MDS with multilineage dysplasia (MLD) was seen in 77.6% whereas MDS with excess blasts (EB) and MDS with single lineage dysplasia (SLD) comprised 10.7% and 11.9% of cases, respectively. Most patients (73.5%) had lower-risk MDS on the IPSS-R (i.e. IPSS-R ≤3.5). Of the 59 patients with cytogenetic data, 83.1% had favorable, 13.5% intermediate, and 3.4% poor risk cytogenetics. Most (40) had a normal karyotype followed by isolated del(20q) (6). All patients with del(20q) showed a characteristic set of clinical features: age >60 years, blasts 0-3%, bilineage (erythroid/megakaryocytic) dysplasia, and increased reticulin fibrosis. There were no significant differences between any of the 4 PLT groups regarding age, sex, IPSS-R, cytogenetics, BM blasts, and histology.
Median OS was 109 months (95% CI 103-115) and LFS 108 months (101-115). Our results showed no significant difference in OS (P=0.891) and LFS (P=0.871) between the 4 PLT groups. As compared with total MDS cohort, MDS-IT occurred at younger age (64.7 vs. 72.4 years, P<0.001). In a Kaplan-Meier analysis, patients with MDS-IT had markedly longer OS and LFS than patients in the total MDS cohort, even after adjustment for age, sex, IPSS-R, blasts, and PLT (P=0.013 for OS; P=0.017 for LFS) (Figure 1A). There were no differences in the top causes of death: infection was the commonest cause followed by disease progression and cardiovascular disease. Major bleeding comprised 10.3% of deaths in MDS-IT vs. 12.7% in total MDS cohort (P=0.217).
In comparing MDS-IT with ITP, the median age at diagnosis was 66.0 years for MDS-IT and 49.0 years for ITP (P<0.001).MDS-IT was uncommon in patients <50 or >80 years. Its incidence reached a peak between the ages of 70-79 years, whereas ITP occurred at a more constant level over time (Figure 1B). Women predominated in ITP and men in MDS-IT (P=0.007). Overall, ITP was associated with more marked thrombocytopenia than MDS-IT (15.0 ×10 9/L vs. 87.0 ×10 9/L) (P<0.001). Median WBC count was higher in ITP (7.6 ×10 9/L vs. 4.6 ×10 9/L; P<0.001). Median Hb was similar in the 2 groups. Patients with ITP had longer OS than MDS-IT (P<0.001).
Conclusions: In one of the largest reported series, we conclude that MDS-IT is associated with MDS-MLD, favorable cytogenetics, lower-risk IPSS-R, high survival rate, and a low risk of AML evolution. Our data suggest that the superior prognosis in MDS-IT than general MDS may have intrinsic genomic underpinnings as survival curves remained unchanged after correcting for age, sex, blasts and IPSS-R. Importantly, no significant differences in OS and LFS were noted between the 4 PLT subgroups, suggesting that the degree of thrombocytopenia does not correlate with mortality in MDS-IT. From the diagnostic standpoint, age <50 or >80 years and PLT <25 ×10 9/L favored a diagnosis of ITP over MDS-IT.
Figure 1 Figure 1.
Disclosures
Viniou: Sandoz: Research Funding; Takeda: Research Funding; Novartis: Honoraria, Research Funding; Sanofi: Research Funding; Janssen: Honoraria, Research Funding; Pfizer: Research Funding; Abbvie: Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Roche: Research Funding; Astellas: Research Funding; Celgene: Research Funding. Vassilakopoulos: Dr. Reddy's: Research Funding; Amgen: Honoraria, Research Funding; GlaxoSmithKline: Honoraria, Other: Travel; AbbVie: Consultancy, Honoraria; Integris: Honoraria; Pfizer: Research Funding; Roche: Consultancy, Honoraria, Other: Travel; Takeda: Consultancy, Honoraria, Other: Travel, Research Funding; Genesis Pharma: Consultancy, Honoraria, Other: Travel; Merck: Honoraria, Research Funding; Novartis: Consultancy, Honoraria; Karyopharm: Research Funding; AstraZeneca: Honoraria. Hatzimichael: Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; MSD: Consultancy, Honoraria; Gilead: Honoraria; Janssen Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Genesis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria; Pharmathen- Innovis: Honoraria; GSK: Honoraria; Bristol Myersr Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees. Symeonidis: Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi/Genzyme: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Demo: Research Funding; MSD: Consultancy, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; WinMedica: Research Funding; Astellas: Consultancy, Research Funding; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GSK: Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GenesisPharma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Affiliation(s)
- Konstantinos Liapis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Emily Stavroulaki
- Department of Hematology, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Christina Misidou
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Rio, Patras, Greece
| | | | | | - Sotirios Papageorgiou
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Vassiliki Pappa
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tsokanas
- Department of Clinical Hematology, G. Gennimatas General Hospital, Athens, Greece
| | - Theodoros P. Vassilakopoulos
- Department of Haematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | - Eleni Bouronikou
- Department of Hematology, Larisa University Hospital, Larisa, Greece
| | - Maria Ximeri
- University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | | | | | - Panagiotis Zikos
- Department of Hematology, "Agios Andreas" General Hospital of Patras, Patras, Greece
| | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Anna Vardi
- Hematology Department and HCT Unit, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - Flora Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokrateio General Hospital, Athens, Greece
| | | | - Ioannis Adamopoulos
- Hematology and Thalassemia Unit, Kalamata General Hospital, Kalamata, Greece
| | | | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Rio, Patras, Greece
| | - Kotsianidis Ioannis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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13
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Liapis K, Papadopoulos V, Vrachiolias G, Stavroulaki E, Misidou C, Kourakli A, Galanopoulos A, Papoutselis MK, Papageorgiou S, Diamantopoulos PT, Pappa V, Viniou NA, Tsokanas D, Vassilakopoulos TP, Hatzimichael E, Koumpis E, Papathanasiou K, Bouronikou E, Ximeri M, Pontikoglou C, Megalakaki A, Zikos P, Panayiotidis P, Dimou M, Karakatsanis SJ, Vardi A, Kontopidou F, Charchalakis N, Adamopoulos I, Papadaki HA, Symeonidis A, Ioannis K. Myelodysplastic Syndromes (MDS) Presenting with Isolated Thrombocytopenia: Characteristics, Outcomes, and Clinical Presentation Differences from Immune Thrombocytopenic Purpura (ITP). Blood 2021. [DOI: https://doi.org/10.1182/blood-2021-149630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction: Less than 5% of patients with MDS present with thrombocytopenia as an isolated abnormality (MDS-IT). There have been few systematic studies on MDS-IT and data regarding its course and prognosis are conflicting. Previous studies have defined MDS-IT based on the IPSS thresholds (Hb ≥10 g/dL; ANC ≥1.8×10 9/L; PLT <100×10 9/L). However, these were developed for prognostic, not diagnostic purposes which means that mild anemia and/or neutropenia might be present concomitantly with "isolated" thrombocytopenia. We aimed to investigate the characteristics, overall survival (OS), and leukemia-free survival (LFS) of patients with MDS-IT.
Methods: We identified patients who had PLT <150 ×10 9/L, Hb >13 g/dL (men) or >12 g/dL (women), and ANC ≥1.8 ×10 9/L, registered in the Hellenic National Registry of Myelodysplastic and Hypoplastic Syndromes which includes 2792 patients (analysis cut-off date; July 7, 2016). Patients were divided into 4 groups: group 1 had PLT 149-100 ×10 9/L; group 2, 99-50 ×10 9/L; group 3, <50 ×10 9/L; and group 4, <25 ×10 9/L. We also collected data from the Hellenic National ITP Registry which includes 1317 adult patients with ITP.
Results: A total of 77 patients (45 men; 32 women) with MDS-IT were identified (2.9% of total MDS cohort). Of these, 28.6% were classified in group 1; 49.4% in group 2; 14.3% in group 3; and 7.8% in group 4. Median PLT count was 87 ×10 9/L (12-139 ×10 9/L), WBC count 4.6 ×10 9/L, and Hb 13.6 g/dL. Bone marrow (BM) blasts ranged from 0-9% (median, 2%). Median follow-up was 51.0 months (41.6-60.4), during which 15 (19.5%) patients died. AML developed in 9 patients (11.7%). Histologically, MDS with multilineage dysplasia (MLD) was seen in 77.6% whereas MDS with excess blasts (EB) and MDS with single lineage dysplasia (SLD) comprised 10.7% and 11.9% of cases, respectively. Most patients (73.5%) had lower-risk MDS on the IPSS-R (i.e. IPSS-R ≤3.5). Of the 59 patients with cytogenetic data, 83.1% had favorable, 13.5% intermediate, and 3.4% poor risk cytogenetics. Most (40) had a normal karyotype followed by isolated del(20q) (6). All patients with del(20q) showed a characteristic set of clinical features: age >60 years, blasts 0-3%, bilineage (erythroid/megakaryocytic) dysplasia, and increased reticulin fibrosis. There were no significant differences between any of the 4 PLT groups regarding age, sex, IPSS-R, cytogenetics, BM blasts, and histology.
Median OS was 109 months (95% CI 103-115) and LFS 108 months (101-115). Our results showed no significant difference in OS (P=0.891) and LFS (P=0.871) between the 4 PLT groups. As compared with total MDS cohort, MDS-IT occurred at younger age (64.7 vs. 72.4 years, P<0.001). In a Kaplan-Meier analysis, patients with MDS-IT had markedly longer OS and LFS than patients in the total MDS cohort, even after adjustment for age, sex, IPSS-R, blasts, and PLT (P=0.013 for OS; P=0.017 for LFS) (Figure 1A). There were no differences in the top causes of death: infection was the commonest cause followed by disease progression and cardiovascular disease. Major bleeding comprised 10.3% of deaths in MDS-IT vs. 12.7% in total MDS cohort (P=0.217).
In comparing MDS-IT with ITP, the median age at diagnosis was 66.0 years for MDS-IT and 49.0 years for ITP (P<0.001).MDS-IT was uncommon in patients <50 or >80 years. Its incidence reached a peak between the ages of 70-79 years, whereas ITP occurred at a more constant level over time (Figure 1B). Women predominated in ITP and men in MDS-IT (P=0.007). Overall, ITP was associated with more marked thrombocytopenia than MDS-IT (15.0 ×10 9/L vs. 87.0 ×10 9/L) (P<0.001). Median WBC count was higher in ITP (7.6 ×10 9/L vs. 4.6 ×10 9/L; P<0.001). Median Hb was similar in the 2 groups. Patients with ITP had longer OS than MDS-IT (P<0.001).
Conclusions: In one of the largest reported series, we conclude that MDS-IT is associated with MDS-MLD, favorable cytogenetics, lower-risk IPSS-R, high survival rate, and a low risk of AML evolution. Our data suggest that the superior prognosis in MDS-IT than general MDS may have intrinsic genomic underpinnings as survival curves remained unchanged after correcting for age, sex, blasts and IPSS-R. Importantly, no significant differences in OS and LFS were noted between the 4 PLT subgroups, suggesting that the degree of thrombocytopenia does not correlate with mortality in MDS-IT. From the diagnostic standpoint, age <50 or >80 years and PLT <25 ×10 9/L favored a diagnosis of ITP over MDS-IT.
Figure 1 Figure 1.
Disclosures
Viniou: Sandoz: Research Funding; Takeda: Research Funding; Novartis: Honoraria, Research Funding; Sanofi: Research Funding; Janssen: Honoraria, Research Funding; Pfizer: Research Funding; Abbvie: Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Roche: Research Funding; Astellas: Research Funding; Celgene: Research Funding. Vassilakopoulos: Dr. Reddy's: Research Funding; Amgen: Honoraria, Research Funding; GlaxoSmithKline: Honoraria, Other: Travel; AbbVie: Consultancy, Honoraria; Integris: Honoraria; Pfizer: Research Funding; Roche: Consultancy, Honoraria, Other: Travel; Takeda: Consultancy, Honoraria, Other: Travel, Research Funding; Genesis Pharma: Consultancy, Honoraria, Other: Travel; Merck: Honoraria, Research Funding; Novartis: Consultancy, Honoraria; Karyopharm: Research Funding; AstraZeneca: Honoraria. Hatzimichael: Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; MSD: Consultancy, Honoraria; Gilead: Honoraria; Janssen Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Genesis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria; Pharmathen- Innovis: Honoraria; GSK: Honoraria; Bristol Myersr Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees. Symeonidis: Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi/Genzyme: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Demo: Research Funding; MSD: Consultancy, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; WinMedica: Research Funding; Astellas: Consultancy, Research Funding; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GSK: Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GenesisPharma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Affiliation(s)
- Konstantinos Liapis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Emily Stavroulaki
- Department of Hematology, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Christina Misidou
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Rio, Patras, Greece
| | | | | | - Sotirios Papageorgiou
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Vassiliki Pappa
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tsokanas
- Department of Clinical Hematology, G. Gennimatas General Hospital, Athens, Greece
| | - Theodoros P. Vassilakopoulos
- Department of Haematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | - Eleni Bouronikou
- Department of Hematology, Larisa University Hospital, Larisa, Greece
| | - Maria Ximeri
- University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | | | | | - Panagiotis Zikos
- Department of Hematology, "Agios Andreas" General Hospital of Patras, Patras, Greece
| | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Anna Vardi
- Hematology Department and HCT Unit, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - Flora Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokrateio General Hospital, Athens, Greece
| | | | - Ioannis Adamopoulos
- Hematology and Thalassemia Unit, Kalamata General Hospital, Kalamata, Greece
| | | | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Rio, Patras, Greece
| | - Kotsianidis Ioannis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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14
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Kakkas I, Tsinti G, Kalala F, Farmaki E, Kourakli A, Kapousouzi A, Dimou M, Kalaitzidou V, Sevdali E, Peristeri AM, Tsiouma G, Patiou P, Papadimitriou E, Vassilakopoulos TP, Panayiotidis P, Kioumi A, Symeonidis A, Speletas M. TACI Mutations in Primary Antibody Deficiencies: A Nationwide Study in Greece. ACTA ACUST UNITED AC 2021; 57:medicina57080827. [PMID: 34441032 PMCID: PMC8401742 DOI: 10.3390/medicina57080827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: Monoallelic (heterozygous) or biallelic (homozygous or compound heterozygous) TACI mutations have been reported as the most common genetic defects in patients with common variable immunodeficiency (CVID), which is the most common clinically significant primary immunodeficiency in humans. The aim of our study was to evaluate the prevalence and any correlations of TACI defects in Greek patients with primary antibody deficiencies. Materials and Methods: 117 patients (male/female: 53/64) with CVID (110) and a combined IgA and IgG subclass deficiency (7) with a CVID-like clinical phenotype were enrolled in the study. Genomic DNA was extracted from peripheral blood and the molecular analysis of the TACI gene was performed by PCR (Polymerase Chain Reaction) and sequencing of all 5 exons, including exon–intron boundaries. Results: Seventeen patients (14.5%) displayed TACI defects, four (23.5%) carried combined heterozygous mutations and 13 (76.5%) carried single heterozygous mutations. The most frequently detected mutation was C104R (58.8%), followed by I87N (23.5%) and A181E (11.8%), while R20C, C62Y, P151L, K188M and E236X mutations were present in only one patient each. Patients with TACI defects were more frequently male (p = 0.011) and displayed a benign lymphoproliferation (splenomegaly and lymph node enlargement, p = 0.047 and p = 0.002, respectively), had a history of tonsillectomy (p = 0.015) and adenoidectomy (p = 0.031) and more frequently exhibited autoimmune cytopenias (p = 0.046). Conclusions: Considering that accumulating evidence suggests several CVID patients have a complex rather than a monogenic inheritance, our data further support the notion that TACI mutations, particularly as monoallelic defects, should be primarily considered as susceptibility co-factors and/or modifiers of primary antibody deficiencies.
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Affiliation(s)
- Ioannis Kakkas
- Immunology and Histocompatibility Department, “Evaggelismos” General Hospital, 106 76 Athens, Greece;
| | - Gerasimina Tsinti
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
| | - Fani Kalala
- Hematology Department, Henry Dunant Hospital, 115 26 Athens, Greece;
| | - Evangelia Farmaki
- Pediatric Immunology and Rheumatology Referral Center, First Department of Pediatrics, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.F.); (E.P.)
| | - Alexandra Kourakli
- Department of Internal Medicine, Hematology Division, Medical School—University Hospital, University of Patras, 265 04 Patras, Greece; (A.K.); (P.P.); (A.S.)
| | - Androniki Kapousouzi
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
| | - Maria Dimou
- Hematology Section, First Department of Propedeutic Internal Medicine, “Laikon” General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (M.D.); (P.P.)
| | - Vassiliki Kalaitzidou
- Department of Hematology, Papageorgiou General Hospital, 564 29 Thessaloniki, Greece; (V.K.); (A.K.)
| | - Eirini Sevdali
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
| | - Athanasia-Marina Peristeri
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
| | - Georgia Tsiouma
- ENT Department, “Achillopoulion” General Hospital of Volos, 382 21 Volos, Greece;
| | - Peristera Patiou
- Department of Internal Medicine, Hematology Division, Medical School—University Hospital, University of Patras, 265 04 Patras, Greece; (A.K.); (P.P.); (A.S.)
| | - Eleni Papadimitriou
- Pediatric Immunology and Rheumatology Referral Center, First Department of Pediatrics, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.F.); (E.P.)
| | - Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, “Laikon” General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece;
| | - Panayiotis Panayiotidis
- Hematology Section, First Department of Propedeutic Internal Medicine, “Laikon” General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (M.D.); (P.P.)
| | - Anna Kioumi
- Department of Hematology, Papageorgiou General Hospital, 564 29 Thessaloniki, Greece; (V.K.); (A.K.)
| | - Argiris Symeonidis
- Department of Internal Medicine, Hematology Division, Medical School—University Hospital, University of Patras, 265 04 Patras, Greece; (A.K.); (P.P.); (A.S.)
| | - Matthaios Speletas
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
- Correspondence: ; Tel.: +30-241-350-2173; Fax: +30-241-068-5687
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15
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Panagiotopoulos V, Theofanopoulos A, Kourakli A, Symeonidis A, Krisela V, Mastronikolis NS, Zampakis P. Ruptured infectious ICA pseudoaneurysm into the sphenoid sinus after maxillofacial infection, successfully treated by selective embolization. Surg Neurol Int 2021; 12:191. [PMID: 34084619 PMCID: PMC8168689 DOI: 10.25259/sni_52_2021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/03/2021] [Indexed: 11/04/2022] Open
Abstract
Background Intracranial infectious aneurysms are cerebral aneurysms caused by pathogen-induced inflammation undermining the arterial wall. We present a rare case of inflammatory pseudoaneurysm of cavernous internal carotid artery (ICA). Case Description A 51-year-old female with a recent diagnosis of acute lymphoblastic leukemia developed maxillofacial infection with Pseudomonas and Acinetobacter after chemotherapy onset. Initial plain computed tomography (CT) revealed bony dehiscence of the left ICA canal, as well as bilateral protrusion of the vessel within the sphenoid sinus. Following infection spread into the left sphenoid sinus, she presented with episodes of intermittent epistaxis, without any profound vascular abnormalities on postcontrast CT. CT angiography that was performed 15 days later, due to refractory epistaxis, illustrated a large narrow necked irregular shape pseudoaneurysm of the left paraophthalmic ICA, extending into the ipsilateral sphenoid sinus. The aneurysm was completely occluded by selective embolization without parent or adjacent vessel sacrifice, documented on both intraoperative and follow-up angiogram, with no recurrence of epistaxis. Conclusion Conclusively, ruptured internal carotid infectious aneurysms are rare but potentially fatal causes of epistaxis when extended into the sphenoid sinus. Selective coiling is feasible and can provide definitive treatment of these lesions.
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Affiliation(s)
- Vasileios Panagiotopoulos
- Department of Neurosurgery and Endovascular Neurosurgery, University of Patras, Patra, Achaia, Greece
| | | | - Alexandra Kourakli
- Department of Internal Medicine, Division of Hematology, University of Patras, Patra, Achaia, Greece
| | - Anargyros Symeonidis
- Department of Internal Medicine, Division of Hematology, University of Patras, Patra, Achaia, Greece
| | - Valera Krisela
- Department of Internal Medicine, Division of Hematology, University of Patras, Patra, Achaia, Greece
| | - Nicholas S Mastronikolis
- Department of Otorhinolaryngology, Head and Neck Surgery University of Patras, Patra, Achaia, Greece
| | - Petros Zampakis
- Department of Radiology and Interventional Neuroradiology, University of Patras, Patra, Achaia, Greece
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16
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Pavlakou P, Papasotiriou M, Ntrinias T, Kourakli A, Bratsiakou A, Goumenos DS, Papachristou E. Case Report: Kidney Transplantation in a Patient With Acquired Agammaglobulinemia and SLE. Issues and Challenges. Front Med (Lausanne) 2021; 8:665475. [PMID: 33777986 PMCID: PMC7994764 DOI: 10.3389/fmed.2021.665475] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Lupus nephritis in the context of Systemic Lupus Erythematosus (SLE) is characterized by an unpredicted course with remissions and flare-ups. Among others, it remains a significant cause of end-stage kidney disease (ESKD) in relatively young patients. Therapeutic regimens with newer immunosuppressive agents have been introduced in order to control SLE clinical manifestations more efficiently and limit organ damage induced by immune complex formation and sustained inflammation. Treatment is usually long-term, and the cumulative impact of immunosuppression is expressed through the increased frequency of infections and neoplasms. However, if the observed immunity dysregulation is secondary and pharmaceutically induced or there is a pre-existing, primary immunodeficiency that shares common pathogenetic pathways with SLE's autoimmunity is not always clear. Herein, we present the case of a 39-year-old woman, that reached ESKD due to lupus nephritis. After an upper respiratory cytomegalovirus (CMV) infection and concomitant CMV reactivations the investigation revealed significant immunodeficiency. Not long after the initiation of intravenous immunoglobulin (IVIG) administration, patient received a cadaveric kidney transplant. IVIG was continued along with standard immunosuppression so that both recurrent infections and allograft rejection are avoided. Patient is closely monitored, and her post-transplant course is remarkably satisfying so far. ESKD patients with immunodeficiency syndromes should not be excluded by definition from kidney transplantation.
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Affiliation(s)
- Paraskevi Pavlakou
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, Achaia, Greece
| | - Marios Papasotiriou
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, Achaia, Greece
| | - Theodoros Ntrinias
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, Achaia, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Achaia, Greece
| | - Adamantia Bratsiakou
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, Achaia, Greece
| | - Dimitrios S Goumenos
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, Achaia, Greece
| | - Evangelos Papachristou
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, Achaia, Greece
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17
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Grafanaki K, Kourakli A, Skeparnias I, Spiliopoulos T, Koumoundourou D, Bravou V, Alexopoulos A, Symeonidis A, Georgiou S. Rare lobular capillary hemangioma associated with azacitidine in high-risk myelodysplastic syndrome patient. Dermatol Ther 2021; 34:e14884. [PMID: 33594760 DOI: 10.1111/dth.14884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Katerina Grafanaki
- Department of Dermatology, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece.,Department of Biochemistry, School of Medicine, University of Patras, Patras, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, School of Medicine, Patras, Greece
| | - Ilias Skeparnias
- Department of Biochemistry, School of Medicine, University of Patras, Patras, Greece
| | - Theofanis Spiliopoulos
- Department of Dermatology, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece
| | - Dimitra Koumoundourou
- Department of Anatomy-Histology-Embryology, School of Medicine, University of Patras, Patras, Greece
| | - Vasiliki Bravou
- Department of Anatomy-Histology-Embryology, School of Medicine, University of Patras, Patras, Greece
| | - Angelos Alexopoulos
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, School of Medicine, Patras, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, School of Medicine, Patras, Greece
| | - Sophia Georgiou
- Department of Dermatology, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece
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18
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Liapis K, Papadopoulos V, Vrachiolias G, Galanopoulos AG, Papoutselis M, Papageorgiou SG, Diamantopoulos PT, Pappa V, Viniou NA, Kourakli A, Τsokanas D, Vassilakopoulos TP, Hatzimichael E, Bouronikou E, Ximeri M, Pontikoglou C, Megalakaki A, Zikos P, Panayiotidis P, Dimou M, Karakatsanis S, Papaioannou M, Vardi A, Kontopidou F, Harchalakis N, Adamopoulos I, Symeonidis A, Kotsianidis I. Refinement of prognosis and the effect of azacitidine in intermediate-risk myelodysplastic syndromes. Blood Cancer J 2021; 11:30. [PMID: 33574231 PMCID: PMC7878783 DOI: 10.1038/s41408-021-00424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/20/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Konstantinos Liapis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece.
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | | | - Menelaos Papoutselis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | | | | | - Vassiliki Pappa
- Second Department of Internal Medicine, Attikon University General Hospital, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Kourakli
- Greece Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Dimitris Τsokanas
- Department of Clinical Hematology, Georgios Gennimatas Hospital, Athens, Greece
| | - Theodoros P Vassilakopoulos
- Department of Hematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Bouronikou
- Department of Hematology, University Hospital of Larissa, Larissa, Greece
| | - Maria Ximeri
- Department of Hematology, University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | - Charalambos Pontikoglou
- Department of Hematology, University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | | | - Panagiotis Zikos
- Department of Hematology, Aghios Andreas General Hospital, Patras, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Papaioannou
- Department of Hematology, AHEPA University Hospital, Thessaloniki, Greece
| | - Anna Vardi
- Department of Hematology and Stem cell Transplantation, Georgios Papanicolaou General Hospital, Thessaloniki, Greece
| | - Flora Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokratio General Hospital, Athens, Greece
| | - Nikolaos Harchalakis
- Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Ioannis Adamopoulos
- Department of Hematology and Thalassemia, Kalamata General Hospital, Kalamata, Greece
| | - Argiris Symeonidis
- Greece Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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19
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Pleyer L, Leisch M, Kourakli A, Padron E, Maciejewski JP, Xicoy Cirici B, Kaivers J, Ungerstedt J, Heibl S, Patiou P, Hunter AM, Mora E, Geissler K, Dimou M, Jimenez Lorenzo MJ, Melchardt T, Egle A, Viniou AN, Patel BJ, Arnan M, Valent P, Roubakis C, Bernal Del Castillo T, Galanopoulos A, Calabuig Muñoz M, Bonadies N, Medina de Almeida A, Cermak J, Jerez A, Montoro MJ, Cortés A, Avendaño Pita A, Lopez Andrade B, Hellstroem-Lindberg E, Germing U, Sekeres MA, List AF, Symeonidis A, Sanz GF, Larcher-Senn J, Greil R. Outcomes of patients with chronic myelomonocytic leukaemia treated with non-curative therapies: a retrospective cohort study. Lancet Haematol 2021; 8:e135-e148. [PMID: 33513373 DOI: 10.1016/s2352-3026(20)30374-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Approval of hypomethylating agents in patients with chronic myelomonocytic leukaemia is based on trials done in patients with myelodysplastic syndromes. We aimed to investigate whether hypomethylating agents provide a benefit in subgroups of patients with chronic myelomonocytic leukaemia compared with other treatments. METHODS For this retrospective cohort study, data were retrieved between Nov 30, 2017, and Jan 5, 2019, from 38 centres in the USA and Europe. We included non-selected, consecutive patients diagnosed with chronic myelomonocytic leukaemia, who received chronic myelomonocytic leukaemia-directed therapy. Patients with acute myeloid leukaemia according to 2016 WHO criteria at initial diagnosis (ie, ≥20% blasts in the bone marrow or peripheral blood) or with unavailability of treatment data were excluded. Outcomes assessed included overall survival, time to next treatment, and time to transformation to acute myeloid leukaemia. Analyses were adjusted by age, sex, platelet count, and Chronic myelomonocytic leukaemia-Specific Prognostic Scoring System (CPSS). Patients were grouped by first received treatment with either hydroxyurea, hypomethylating agents, or intensive chemotherapy, and stratified by risk according to blast count, French-American-British subtype, CPSS, WHO 2016 subtype, and the eligibility criteria of the DACOTA trial (NCT02214407). FINDINGS 949 patients diagnosed with chronic myelomonocytic leukaemia between April 13, 1981, and Oct 26, 2018, were included. Median follow-up was 23·4 months (IQR 11·5-42·3) from diagnosis and 16·2 months (6·6-31·6) from start of first-line treatment. 412 (43%) of 949 patients received hypomethylating agents as first treatment, 391 (41%) hydroxyurea, and 83 (9%) intensive chemotherapy. Adjusted median overall survival for patients treated with hydroxyurea versus hypomethylating agents was 15·6 months (95% CI 13·1-17·3) versus 20·7 months (17·9-23·4); hazard ratio (HR) 1·39 (1·17-1·65; p=0·0002) and 14·0 months (9·8-17·2) versus 20·7 months (17·9-23·4; HR 1·55 [1·16-2·05]; p=0·0027) for those treated with intensive chemotherapy versus hypomethylating agents. In patients with myeloproliferative chronic myelomonocytic leukaemia (myeloproliferative CMML), median overall survival was 12·6 months (10·7-15·0) versus 17·6 months (14·8-21·5; HR 1·38 [1·12-1·70]; p=0·0027) for patients treated with hydroxyurea versus hypomethylating agents, and 12·3 months (8·4-16·6) versus 17·6 months (14·8-21·5; HR 1·44 [1·02-2·03]; p=0·040) for intensive chemotherapy versus hypomethylating agents. Hypomethylating agents did not confer an overall survival advantage for patients classified as having lower-risk disease (ie, myelodysplastic chronic myelomonocytic leukaemia with <10% blasts, CMML-0, or lower-risk CPSS). INTERPRETATION These data suggest hypomethylating agents as the preferred therapy for patients with higher-risk chronic myelomonocytic leukaemia and those with myeloproliferative CMML. Our findings also suggest that CPSS is a valuable tool to identify patients who are most likely to benefit from hypomethylating agents. Further evidence from prospective cohorts would be desirable. FUNDING The Austrian Group for Medical Tumor Therapy.
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Affiliation(s)
- Lisa Pleyer
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.
| | - Michael Leisch
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Eric Padron
- Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jaroslaw Pawel Maciejewski
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Blanca Xicoy Cirici
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jennifer Kaivers
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Johanna Ungerstedt
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institute, and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Peristera Patiou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Anthony Michael Hunter
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Elvira Mora
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Klaus Geissler
- Fifth Medical Department, Hospital Hietzing, Vienna, Austria
| | - Maria Dimou
- 141st Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria-José Jimenez Lorenzo
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Thomas Melchardt
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Alexander Egle
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Athina-Nora Viniou
- 141st Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Bhumika Jayantibhai Patel
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Montserrat Arnan
- Institut Català d'Oncologia-Hospital Duran y Reynals, Hospitalet de Llobregat, Barcelona, Spain
| | - Peter Valent
- Department of Internal Medicine, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Teresa Bernal Del Castillo
- Hospital Universitario Central Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University Institute of Oncology of Asturias-Cajastur Social Programme, Oviedo, Spain
| | | | | | - Nicolas Bonadies
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Antonio Medina de Almeida
- Hospital da Luz, Lisbon, Portugal; Centro de Investigação Interdisciplinar em Saúde, Universidade Católica Portuguesa de Lisboa, Lisbon, Portugal
| | - Jaroslav Cermak
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Andrés Jerez
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB, Murcia, Spain
| | - Maria Julia Montoro
- Hematology Department, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Albert Cortés
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Eva Hellstroem-Lindberg
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institute, and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mikkael Aaron Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan Francis List
- Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Guillermo Francisco Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigacion Biomedica en Red Cance, Instituto Carlos III, Madrid, Spain
| | | | - Richard Greil
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
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20
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Papageorgiou SG, Kotsianidis I, Bouchla A, Symeonidis A, Galanopoulos A, Viniou NA, Hatzimichael E, Vassilakopoulos TP, Gogos D, Megalakaki A, Zikos P, Diamantopoulos P, Kourakli A, Giannoulia P, Papoutselis M, Poulakidas E, Arapaki M, Vardi A, Anagnostopoulos A, Mparmparousi D, Papaioannou M, Bouronikou E, Dimou M, Papadaki H, Panayiotidis P, Pappa V. Serum ferritin and ECOG performance status predict the response and improve the prognostic value of IPSS or IPSS-R in patients with high-risk myelodysplastic syndromes and oligoblastic acute myeloid leukemia treated with 5-azacytidine: a retrospective analysis of the Hellenic national registry of myelodysplastic and hypoplastic syndromes. Ther Adv Hematol 2020; 11:2040620720966121. [PMID: 33343854 PMCID: PMC7727043 DOI: 10.1177/2040620720966121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background: 5-azacytidine (5-AZA) improves survival of patients with higher-risk myelodysplastic syndromes (MDSs) and oligoblastic acute myeloid leukemia (AML); however, predictive factors for response and outcome have not been consistently studied. Methods: This study of the Hellenic MDS Study Group included 687 consecutive patients with higher-risk MDS and oligoblastic AML treated with 5-AZA. Results: The International Prognostic Scoring System (IPSS) revised version (IPSS-R), Eastern Cooperative Oncology Group Performance Status (ECOG PS) (0 or 1 versus ⩾2) and baseline serum ferritin (SF) levels > 520 ng/ml were shown to independently predict response to 5-AZA. In the survival analysis, the IPSS and IPSS-R risk classification systems along with the ECOG PS and SF levels > 520 ng/ml proved to be independent prognosticators for overall survival (OS), as well as for leukemia-free survival (LFS). Next, we built new multivariate models for OS and LFS, incorporating only ECOG PS and SF levels besides IPSS or IPSS-R risk classification systems. Thereby, the new modified IPSS and IPSS-R risk classification systems (H-PSS, H-PSS-R) could each discriminate a low, an intermediate and a high-risk patient group regarding OS and LFS. The H-PSS and H-PSS-R proved to be better predictors of OS than their previous counterparts as well as the French prognostic score, while the most powerful OS predictor was the new, H-PSS-R system. Conclusions: ECOG PS and SF levels > 520 ng/ml independently predict response to 5-AZA, OS and LFS. Their incorporation in the IPSS and IPSS-R scores enhances these scores’ predictive power in 5-AZA-treated higher-risk MDS and oligoblastic AML patients.
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Affiliation(s)
- Sotirios G Papageorgiou
- Consultant of Hematology, Second Department of Internal Medicine and Research Unit, University General Hospital "Attikon", 1 Rimini St., Haidari, Athens, 12462, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Anthi Bouchla
- Second Department of Internal Medicine and Research Unit, University General Hospital "Attikon", Haidari, Athens, Greece
| | | | | | | | | | - Theodoros P Vassilakopoulos
- Department of Hematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | | | | | | | - Menelaos Papoutselis
- Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Elias Poulakidas
- "401" Army General Hospital of Athens, Mesogeion and Kanellopoulou 1, Athens, Greece
| | - Maria Arapaki
- Department of Hematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Anna Vardi
- Hematology Department, General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, Greece
| | - Achilles Anagnostopoulos
- Hematology Department, General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, Greece
| | - Despoina Mparmparousi
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Papaioannou
- Hematology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Eleni Bouronikou
- University General Hospital of Larissa, Mezourlo, Larissa, Greece
| | - Maria Dimou
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Papadaki
- University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine and Research Unit, University General Hospital "Attikon", Haidari, Athens, Greece
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21
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Diamantopoulos PT, Symeonidis A, Pappa V, Kotsianidis I, Galanopoulos A, Pontikoglou C, Anagnostopoulos A, Vassilopoulos G, Zikos P, Hatzimichael E, Papaioannou M, Megalakaki A, Repousis P, Kotsopoulou M, Dimou M, Solomou E, Dryllis G, Tsokanas D, Papoutselis MK, Papageorgiou S, Kyrtshonis MC, Kourakli A, Papadaki H, Panayiotidis P, Viniou NA. The effect of 5-azacytidine treatment delays and dose reductions on the prognosis of patients with myelodysplastic syndrome: how to optimize treatment results and outcomes. Br J Haematol 2020; 192:978-987. [PMID: 32862447 DOI: 10.1111/bjh.17062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/06/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Abstract
The regimen of 5-azacytidine for patients with myelodysplastic syndrome (MDS) has remained unchanged since its first approval. Although several modifications have since been made and delays and dose reductions are common especially during the first treatment cycles, there are minimal data on the prognostic effect of these modifications. In this study, based on data from 897 patients with MDS treated with 5-azacytidine recorded in a national registry, the effect of treatment delays and dose reductions on response, transformation to acute myeloid leukaemia, and survival (after 5-azacytidine initiation, OST ) were analysed. Delays during the first two cycles were noted in 150 patients (16·7%) and were found to adversely affect OST independently of the International Prognostic Scoring System score [hazard ratio (HR), 1·368; P = 0·033] or pre-existing neutropenia (HR, 1·42; P = 0·015). In patients achieving a response, delays before response achievement were correlated with its type (complete remission, 2·8 days/cycle; partial remission, 3·3 days/cycle; haematologic improvement, 5·6 days/cycle; P = 0·041), while delays after response achievement did not have any effect on retention of response or survival. Dose reductions were found to have no prognostic impact. Based on our results, treatment delays especially during the first cycles should be avoided, even in neutropenic patients. This strict strategy may be loosened after achieving a favourable response.
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Affiliation(s)
- Panagiotis T Diamantopoulos
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argiris Symeonidis
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Vasiliki Pappa
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Athanasios Galanopoulos
- Department of Clinical Hematology, 'G. Gennimatas' District General Hospital, Athens, Greece
| | | | - Achilles Anagnostopoulos
- Hematology Department, General Hospital of Thessaloniki "George Papanikolaou", Pilea Chortiatis, Greece
| | - George Vassilopoulos
- Department of Hematology, Larissa University Hospital, University of Thessalia, Larissa, Greece
| | - Panagiotis Zikos
- Department of Hematology, St Andrew' General Hospital, Patras, Greece
| | | | - Maria Papaioannou
- Hematology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | | | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Solomou
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Georgios Dryllis
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tsokanas
- Department of Clinical Hematology, 'G. Gennimatas' District General Hospital, Athens, Greece
| | | | - Sotirios Papageorgiou
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marie-Christine Kyrtshonis
- First Propedeutic Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Kourakli
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Helen Papadaki
- Haematology Laboratory, School of Medicine, University of Crete, Heraklion, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nora-Athina Viniou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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22
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Liapis K, Vrachiolias G, Papadopoulos V, Kourakli A, Galanopoulos AG, Papoutselis M, Papageorgiou SG, Diamantopoulos PT, Pappa V, Viniou N, Vassilakopoulos TP, Hatzimichael E, Bouronikou E, Ximeri M, Pontikoglou C, Panayiotidis P, Karakatsanis S, Vardi A, Symeonidis A, Kotsianidis I. Risk factors for cardiovascular disease mortality in patients with myelodysplastic syndromes: A nationwide, registry‐based cohort study. eJHaem 2020; 1:255-261. [DOI: https:/doi.org/10.1002/jha2.30] [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] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Konstantinos Liapis
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | - Georgios Vrachiolias
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | - Vasileios Papadopoulos
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | | | | | - Menelaos Papoutselis
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | | | | | - Vassiliki Pappa
- Second Department of Internal MedicineAttikon University General Hospital Athens Greece
| | - Nora‐Athina Viniou
- First Department of Internal MedicineNational and Kapodistrian University of Athens Athens Greece
| | | | | | - Eleni Bouronikou
- Department of HematologyUniversity Hospital of Larissa Larissa Greece
| | - Maria Ximeri
- Department of HematologyUniversity General Hospital of Heraklion Heraklion Greece
| | | | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal MedicineNational and Kapodistrian University of Athens Athens Greece
| | | | - Anna Vardi
- Department of Hematology and Stem Cell TransplantationGeorgios Papanicolaou General Hospital Thessaloniki Greece
| | | | - Ioannis Kotsianidis
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
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23
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Liapis K, Vrachiolias G, Papadopoulos V, Kourakli A, Galanopoulos AG, Papoutselis M, Papageorgiou SG, Diamantopoulos PT, Pappa V, Viniou N, Vassilakopoulos TP, Hatzimichael E, Bouronikou E, Ximeri M, Pontikoglou C, Panayiotidis P, Karakatsanis S, Vardi A, Symeonidis A, Kotsianidis I. Risk factors for cardiovascular disease mortality in patients with myelodysplastic syndromes: A nationwide, registry‐based cohort study. eJHaem 2020; 1:255-261. [PMID: 35847690 PMCID: PMC9176014 DOI: 10.1002/jha2.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022]
Abstract
Cardiovascular disease (CVD) emerges as a major cause of death in patients with myelodysplastic syndrome (MDS), but predictors of fatal CVD and the effect of MDS‐specific treatments on CVD mortality remain largely unknown. In an analysis involving 831 patients with MDS with known causes of death, we noted an independent association of lower risk MDS, age >70 years, pre‐existing CVD, and treatment with erythropoiesis‐stimulating agents with a higher risk of death from CVD. If externally validated, these simple risk factors could increase clinicians’ awareness toward CVD complications and guide early introduction of intensive monitoring and preventive interventions in MDS patients.
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Affiliation(s)
- Konstantinos Liapis
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | - Georgios Vrachiolias
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | - Vasileios Papadopoulos
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | | | | | - Menelaos Papoutselis
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | | | | | - Vassiliki Pappa
- Second Department of Internal MedicineAttikon University General Hospital Athens Greece
| | - Nora‐Athina Viniou
- First Department of Internal MedicineNational and Kapodistrian University of Athens Athens Greece
| | | | | | - Eleni Bouronikou
- Department of HematologyUniversity Hospital of Larissa Larissa Greece
| | - Maria Ximeri
- Department of HematologyUniversity General Hospital of Heraklion Heraklion Greece
| | | | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal MedicineNational and Kapodistrian University of Athens Athens Greece
| | | | - Anna Vardi
- Department of Hematology and Stem Cell TransplantationGeorgios Papanicolaou General Hospital Thessaloniki Greece
| | | | - Ioannis Kotsianidis
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
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24
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Papadopoulos V, Diamantopoulos PT, Papageorgiou SG, Papoutselis M, Vrachiolias G, Pappa V, Galanopoulos AG, Vassilakopoulos TP, Hatzimichael E, Zikos P, Papadaki HA, Bouchla A, Panayiotidis P, Megalakaki A, Papaioannou M, Liapis K, Dryllis G, Tsokanas D, Kourakli A, Symeonidis A, Viniou NA, Kotsianidis I. Estimated glomerular filtration rate independently predicts outcome of azacitidine therapy in higher-risk Myelodysplastic syndromes. Results from 536 patients of the Hellenic National Registry of Myelodysplastic and Hypoplastic syndromes. Hematol Oncol 2020; 38:541-553. [PMID: 32495951 DOI: 10.1002/hon.2756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/25/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/23/2022]
Abstract
Higher-risk Myelodysplastic syndromes (MDS) patients undergoing treatment with 5-azacytidine (AZA) are typically elderly with several comorbidities. However, the effect of comorbidities on the effectiveness and safety of AZA in real-world settings remains unclear. We analyzed data from 536 AZA-treated patients with higher-risk MDS, Myelodysplastic/Myeloproliferative neoplasms and low blast count Acute Myeloid Leukemia enrolled to the Hellenic National Registry of Myelodysplastic and Hypoplastic Syndromes. Multivariate analysis adjusted also for the International Prognostic Scoring System (IPSS), its revised version (IPSS-R) and the French Prognostic Scoring System (FPSS), demonstrated independent associations of overall and leukemia-free survival with estimated glomerular filtration rate (eGFR) <45 mL min-1 /1.73 m2 (P = .039, P = .023, respectively), ECOG performance status <2 (P = .015, P = .006), and presence of peripheral blood blasts (P = .008, P = .034), while secondary MDS also correlated with significantly shorter leukemia-free survival (P = .039). Addition of eGFR <45 mL min-1 /1.73 m2 , in IPSS-R and FPSS increased the predictive power of both models. Only FPSS ≤2 and eGFR <45 mL min-1 /1.73 m2 predicted worse response to AZA in multivariate analysis, whereas eGFR <45 mL min-1 /1.73 m2 correlated significantly with death from hemorrhage (P = .003) and cardiovascular complications (P = .006). In conclusion, in the second largest real-world series of AZA-treated MDS patients, we show that an eGFR <45 mL min-1 /1.73 m2 is an independent predictor of worse response and survival. This higher cut-off, instead of the commonly used serum creatinine >2 mg/dL, can be utilized as a more precise indicator of renal comorbidity during AZA therapy. Incorporation of eGFR in the prognostic assessment of AZA-treated MDS patients may prove useful not only in routine practice, but also for the appropriate patient stratification in clinical trials with AZA combinations.
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Affiliation(s)
- Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | | | - Sotirios G Papageorgiou
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Athens, Greece
| | - Menelaos Papoutselis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Vassiliki Pappa
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Athens, Greece
| | | | - Theodoros P Vassilakopoulos
- Department of Hematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiotis Zikos
- Department of Hematology, General Hospital of Patras "Agios Andreas", Patras, Greece
| | - Helen A Papadaki
- Department of Hematology, University General Hospital of Heraklion, Heraklion, Greece
| | - Anthi Bouchla
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Papaioannou
- Department of Hematology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Liapis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - George Dryllis
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tsokanas
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Alexandra Kourakli
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Argiris Symeonidis
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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25
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Papageorgiou S, Papadopoulos V, Menelaos P, Bouhla A, Symeonidis A, Galanopoulos A, Viniou NA, Hatzimichael E, Gogos D, Zikos P, Vassilakopoulos TP, Kourakli A, Giannoulia P, Vrachiolias G, Megalakaki A, Diamantopoulos PT, Poulakidas E, Vardi A, Anagnostopoulos A, Mparmparousi D, Papaioannou M, Mpouronikou E, Papadaki HA, Dimou M, Panayiotidis P, Pappa V, Kotsianidis I. Estimated Glomerular Filtration Rate Is an Independent Predictor of Outcome in High-Risk Myelodysplastic Syndrome (MDS) and Low Blast Count Acute Myeloid Leukaemia (AML) Patients Treated with Azacytidine (AZA). a Retrospective Study from the MDS Registry of the Hellenic MDS Study Group. Blood 2019. [DOI: https://doi.org/10.1182/blood-2019-125806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction. Myelodysplastic Syndrome (MDS) is a disease of the elderly. Apart from IPSS, IPSS-R and WPSS, several indexes incorporating patient comorbidities (such as the MDS CI index- Della Porta et al Haematologica 2011, the HCT-CI index - Sorror et al Blood 2005) and performance status (the GFM index- Itzykson et al Blood 2011) have been used to predict outcome in MDS patients treated with azacytidine (AZA). We sought to investigate the effect of comorbidities on the outcome after AZA in a large group of patients from the MDS registry of the Hellenic MDS Study Group.
Methods. The present study has been conducted as a retrospective observational cohort one. It included high-risk MDS and low blast count AML patients treated with AZA from 26 centers in Greece from 2007 to 2018. T-test and ANOVA were used to compare scale variables between two or more groups respectively. Univariate analysis of nominal and scale survival data was performed using Kaplan-Meier survival curves and Cox regression respectively. All variables achieving p<0.05 at univariate analysis were considered eligible for multivariate analysis; the latter was based on Cox regression method.
Results. We analyzed 536 consecutive patients. Patient characteristics are depicted in Table 1. The median follow-up period was 27.5±4.8 months. 371 patients received at least four cycles of AZA and 165 patients received less than 4 cycles of AZA. Patients who received ≥4 cycles of AZA did not differ from those who received <4 cycles regarding gender, age, estimated Glomerular Filtration Rate (eGFR), cardiovascular, renal, and tumor comorbidities. Significantly higher IPSS-R and GFM scores at baseline were found in the group of patients receiving < 4 cycles of AZA compared to patients who received ≥ 4 cycles of AZA (p=0.042 and 0.05 respectively), while transfusion dependence at baseline occurred more often in patients who received ≥ 4 cycles of AZA (p=0.039).
To assess the prognostic significance of risk factors on leukemia free survival (LFS) and overall survival (OS), univariate and multivariate analysis for the whole population was performed, as well as a landmark analysis for patients who were treated with at least 4 cycles of AZA. ECOG performance status and the presence of peripheral blasts were independent prognostic factors for LFS and OS for the whole cohort analysis while response to AZA and the presence of peripheral blasts were independent prognosticators for LFS and OS in the landmark analysis. In addition, prior low dose cytarabine was an independent adverse prognostic factor for LFS in the landmark analysis. As regards comorbidities, neither of MDS-CI, HCT-CI and GFM systems independently predicted LFS or OS in either analysis, but eGFR with a cut-off of 45 ml/min was a strong and independent prognosticator for LFS and OS in both the standard and the landmark analysis. Kaplan-Meier survival curves regarding LFS and OS at AZA initiation and landmark analysis after 4th cycle of AZA in relation with eGFR are shown in Figure 1.
Conclusion. This is the first study to demonstrate the importance of eGFR at baseline as a prognostic marker for LFS and OS in high-risk MDS and low-blast AML patients treated with AZA. The role of comorbidities and PS needs to be further evaluated in this patient group.
Disclosures
Symeonidis: Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; MSD: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Tekeda: Membership on an entity's Board of Directors or advisory committees, Research Funding. Vassilakopoulos:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; WinMedica: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene / GenesisPharma: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Panayiotidis:Bayer: Other: Support of clinical trial. Pappa:Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Research Funding; Gilead: Honoraria, Research Funding; Novartis: Honoraria, Research Funding, Speakers Bureau; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene / GenesisPharma: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Research Funding; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Kotsianidis:Celgene: Research Funding.
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Affiliation(s)
- Sotirios Papageorgiou
- Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Haidari, Athens, Greece
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis., Alexandroupolis, Greece
| | - Papoutselis Menelaos
- Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Anthi Bouhla
- Second Department of Internal Medicine and Research Unit,, University General Hospital Attikon, Haidari, Athens, Greece
| | - Argiris Symeonidis
- Department of Medicine, Division Hematology, Hematology Division, Dept of Int. Medicine, University Hospital of Patras, Patras, Greece
| | | | - Nora-Athina Viniou
- Hematology Dept., 1st Propedeutic Internal Medicine Clinic, Laikon General Hospital, Athens, Greece
| | | | | | | | | | - Alexandra Kourakli
- Hematology Division, Dept. of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Panagiota Giannoulia
- Department of Hematology,, Evangelismos General Hospital, Athens, Athens, Greece
| | - George Vrachiolias
- 1. Department of Hematology, University hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece, Alexandroupolis, Greece
| | - Aikaterini Megalakaki
- Department of Haematology, Anticancer Hospital of Peiraia "Metaxa",, Peireas, Greece
| | - Panagiotis T Diamantopoulos
- 1st Department of Internal Medicine,, National and Kapodistrian University of Athens., Goudi, Athens, Greece
| | | | - Anna Vardi
- Hematology Department and HCT Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Despoina Mparmparousi
- Department of Clinical Therapeutics,, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Papaioannou
- First Department of Internal Medicine, Division of Haematology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Maria Dimou
- Hematology Dept., 1st Propedeutic Internal Medicine Clinic, Laikon General Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- First Department of Propedeutic Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece, Athens, Greece
| | | | - Ioannis Kotsianidis
- Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
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26
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Papageorgiou S, Papadopoulos V, Menelaos P, Bouhla A, Symeonidis A, Galanopoulos A, Viniou NA, Hatzimichael E, Gogos D, Zikos P, Vassilakopoulos TP, Kourakli A, Giannoulia P, Vrachiolias G, Megalakaki A, Diamantopoulos PT, Poulakidas E, Vardi A, Anagnostopoulos A, Mparmparousi D, Papaioannou M, Mpouronikou E, Papadaki HA, Dimou M, Panayiotidis P, Pappa V, Kotsianidis I. Estimated Glomerular Filtration Rate Is an Independent Predictor of Outcome in High-Risk Myelodysplastic Syndrome (MDS) and Low Blast Count Acute Myeloid Leukaemia (AML) Patients Treated with Azacytidine (AZA). a Retrospective Study from the MDS Registry of the Hellenic MDS Study Group. Blood 2019; 134:5423-5423. [DOI: https:/doi.org/10.1182/blood-2019-125806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Introduction. Myelodysplastic Syndrome (MDS) is a disease of the elderly. Apart from IPSS, IPSS-R and WPSS, several indexes incorporating patient comorbidities (such as the MDS CI index- Della Porta et al Haematologica 2011, the HCT-CI index - Sorror et al Blood 2005) and performance status (the GFM index- Itzykson et al Blood 2011) have been used to predict outcome in MDS patients treated with azacytidine (AZA). We sought to investigate the effect of comorbidities on the outcome after AZA in a large group of patients from the MDS registry of the Hellenic MDS Study Group.
Methods. The present study has been conducted as a retrospective observational cohort one. It included high-risk MDS and low blast count AML patients treated with AZA from 26 centers in Greece from 2007 to 2018. T-test and ANOVA were used to compare scale variables between two or more groups respectively. Univariate analysis of nominal and scale survival data was performed using Kaplan-Meier survival curves and Cox regression respectively. All variables achieving p<0.05 at univariate analysis were considered eligible for multivariate analysis; the latter was based on Cox regression method.
Results. We analyzed 536 consecutive patients. Patient characteristics are depicted in Table 1. The median follow-up period was 27.5±4.8 months. 371 patients received at least four cycles of AZA and 165 patients received less than 4 cycles of AZA. Patients who received ≥4 cycles of AZA did not differ from those who received <4 cycles regarding gender, age, estimated Glomerular Filtration Rate (eGFR), cardiovascular, renal, and tumor comorbidities. Significantly higher IPSS-R and GFM scores at baseline were found in the group of patients receiving < 4 cycles of AZA compared to patients who received ≥ 4 cycles of AZA (p=0.042 and 0.05 respectively), while transfusion dependence at baseline occurred more often in patients who received ≥ 4 cycles of AZA (p=0.039).
To assess the prognostic significance of risk factors on leukemia free survival (LFS) and overall survival (OS), univariate and multivariate analysis for the whole population was performed, as well as a landmark analysis for patients who were treated with at least 4 cycles of AZA. ECOG performance status and the presence of peripheral blasts were independent prognostic factors for LFS and OS for the whole cohort analysis while response to AZA and the presence of peripheral blasts were independent prognosticators for LFS and OS in the landmark analysis. In addition, prior low dose cytarabine was an independent adverse prognostic factor for LFS in the landmark analysis. As regards comorbidities, neither of MDS-CI, HCT-CI and GFM systems independently predicted LFS or OS in either analysis, but eGFR with a cut-off of 45 ml/min was a strong and independent prognosticator for LFS and OS in both the standard and the landmark analysis. Kaplan-Meier survival curves regarding LFS and OS at AZA initiation and landmark analysis after 4th cycle of AZA in relation with eGFR are shown in Figure 1.
Conclusion. This is the first study to demonstrate the importance of eGFR at baseline as a prognostic marker for LFS and OS in high-risk MDS and low-blast AML patients treated with AZA. The role of comorbidities and PS needs to be further evaluated in this patient group.
Disclosures
Symeonidis: Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; MSD: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Tekeda: Membership on an entity's Board of Directors or advisory committees, Research Funding. Vassilakopoulos:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; WinMedica: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene / GenesisPharma: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Panayiotidis:Bayer: Other: Support of clinical trial. Pappa:Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Research Funding; Gilead: Honoraria, Research Funding; Novartis: Honoraria, Research Funding, Speakers Bureau; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene / GenesisPharma: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Research Funding; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Kotsianidis:Celgene: Research Funding.
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Affiliation(s)
- Sotirios Papageorgiou
- Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Haidari, Athens, Greece
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis., Alexandroupolis, Greece
| | - Papoutselis Menelaos
- Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Anthi Bouhla
- Second Department of Internal Medicine and Research Unit,, University General Hospital Attikon, Haidari, Athens, Greece
| | - Argiris Symeonidis
- Department of Medicine, Division Hematology, Hematology Division, Dept of Int. Medicine, University Hospital of Patras, Patras, Greece
| | | | - Nora-Athina Viniou
- Hematology Dept., 1st Propedeutic Internal Medicine Clinic, Laikon General Hospital, Athens, Greece
| | | | | | | | | | - Alexandra Kourakli
- Hematology Division, Dept. of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Panagiota Giannoulia
- Department of Hematology,, Evangelismos General Hospital, Athens, Athens, Greece
| | - George Vrachiolias
- 1. Department of Hematology, University hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece, Alexandroupolis, Greece
| | - Aikaterini Megalakaki
- Department of Haematology, Anticancer Hospital of Peiraia "Metaxa",, Peireas, Greece
| | - Panagiotis T Diamantopoulos
- 1st Department of Internal Medicine,, National and Kapodistrian University of Athens., Goudi, Athens, Greece
| | | | - Anna Vardi
- Hematology Department and HCT Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Despoina Mparmparousi
- Department of Clinical Therapeutics,, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Papaioannou
- First Department of Internal Medicine, Division of Haematology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Maria Dimou
- Hematology Dept., 1st Propedeutic Internal Medicine Clinic, Laikon General Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- First Department of Propedeutic Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece, Athens, Greece
| | | | - Ioannis Kotsianidis
- Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
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Stratopoulos A, Kolliopoulou A, Karamperis K, John A, Kydonopoulou K, Esftathiou G, Sgourou A, Kourakli A, Vlachaki E, Chalkia P, Theodoridou S, Papadakis MN, Gerou S, Symeonidis A, Katsila T, Ali BR, Papachatzopoulou A, Patrinos GP. Genomic variants in members of the Krüppel-like factor gene family are associated with disease severity and hydroxyurea treatment efficacy in β-hemoglobinopathies patients. Pharmacogenomics 2019; 20:791-801. [PMID: 31393228 DOI: 10.2217/pgs-2019-0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/07/2023] Open
Abstract
Aim: β-Type hemoglobinopathies are characterized by vast phenotypic diversity as far as disease severity is concerned, while differences have also been observed in hydroxyurea (HU) treatment efficacy. These differences are partly attributed to the residual expression of fetal hemoglobin (HbF) in adulthood. The Krüppel-like family of transcription factors (KLFs) are a set of zinc finger DNA-binding proteins which play a major role in HbF regulation. Here, we explored the possible association of variants in KLF gene family members with response to HU treatment efficacy and disease severity in β-hemoglobinopathies patients. Materials & methods: Six tag single nucleotide polymorphisms, located in four KLF genes, namely KLF3, KLF4, KLF9 and KLF10, were analyzed in 110 β-thalassemia major patients (TDT), 18 nontransfusion dependent β-thalassemia patients (NTDT), 82 sickle cell disease/β-thalassemia compound heterozygous patients and 85 healthy individuals as controls. Results: Our findings show that a KLF4 genomic variant (rs2236599) is associated with HU treatment efficacy in sickle cell disease/β-thalassemia compound heterozygous patients and two KLF10 genomic variants (rs980112, rs3191333) are associated with persistent HbF levels in NTDT patients. Conclusion: Our findings provide evidence that genomic variants located in KLF10 gene may be considered as potential prognostic biomarkers of β-thalassemia clinical severity and an additional variant in KLF4 gene as a pharmacogenomic biomarker, predicting response to HU treatment.
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Affiliation(s)
- Apostolos Stratopoulos
- University of Patras, School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics & Individualized Therapy, Patras, Greece
| | - Alexandra Kolliopoulou
- University of Patras, School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics & Individualized Therapy, Patras, Greece
| | - Kariofyllis Karamperis
- University of Patras, School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics & Individualized Therapy, Patras, Greece
| | - Anne John
- United Arab Emirates University, College of Medicine & Health Sciences, Department of Pathology, Al-Ain, United Arab Emirates
| | | | | | - Argyro Sgourou
- School of Science & Technology, Biology Laboratory, Hellenic Open University, Patras, Greece
| | - Alexandra Kourakli
- Thalassemia & Hemoglobinopathies Unit, Hematology Division, Department of Internal Medicine, General University Hospital of Patras, Patras, Greece
| | - Efthimia Vlachaki
- Thalassemia Unit, "Hippocrateion" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Panagiota Chalkia
- Thalassemia & Sickle Cell Unit, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Stamatia Theodoridou
- Thalassemia Unit, "Hippocrateion" General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | | | - Argiris Symeonidis
- Medical Faculty, Hematology Division, Department of Internal Medicine, University of Patras, Patras, Greece
| | - Theodora Katsila
- University of Patras, School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics & Individualized Therapy, Patras, Greece
| | - Bassam R Ali
- United Arab Emirates University, College of Medicine & Health Sciences, Department of Pathology, Al-Ain, United Arab Emirates
| | | | - George P Patrinos
- University of Patras, School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics & Individualized Therapy, Patras, Greece.,United Arab Emirates University, College of Medicine & Health Sciences, Department of Pathology, Al-Ain, United Arab Emirates.,United Arab Emirates University, Zayed Center of Health Sciences, Al-Ain, United Arab Emirates
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28
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Kolliopoulou A, Siamoglou S, John A, Sgourou A, Kourakli A, Symeonidis A, Vlachaki E, Chalkia P, Theodoridou S, Ali BR, Katsila T, Patrinos GP, Papachatzopoulou A. Role of Genomic Biomarkers in Increasing Fetal Hemoglobin Levels Upon Hydroxyurea Therapy and in β-Thalassemia Intermedia: A Validation Cohort Study. Hemoglobin 2019; 43:27-33. [PMID: 31039620 DOI: 10.1080/03630269.2019.1597732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/08/2023]
Abstract
Hemoglobinopathies exhibit a remarkable phenotypic diversity in terms of disease severity, while individual genetic background plays a key role in differential response to drug treatment. In the last decade, genomic variants in genes located within, as well as outside the human β-globin cluster have been shown to be significantly associated with Hb F increase, in relation to hydroxyurea (HU) therapy in patients with these diseases. Here, we aim to determine the effect of genomic variants located in genes, such as MAP3K5, ASS1, NOS2A, TOX, PDE7B, NOS1, FLT1 and ARG2, previously shown to modulate fetal hemoglobin (Hb F) levels in patients with β type hemoglobinopathies and reflecting disease severity and response to HU therapy in an independent cohort of Greek patients with these diseases. We recruited and genotyped 45 β-thalassemia patients (β-thal), either transfusion-dependent (TDT) or non transfusion-dependent (NTDT), 42 Hb S (HBB: c.20A>T)-β-thal compound heterozygotes, who were treated with HU, as well as 53 healthy individuals, all of Hellenic origin. Our study showed that genomic variants of the MAP3K5, NOS2A and ARG2 gene are associated with HU therapy efficacy in Hb S-β-thal compound heterozygotes. We have also shown that FLT1 and ARG2 genomic variants are associated with the mild phenotype of NTDT patients. Our findings provide evidence that MAP3K5, NOS2A, ARG2 and FLT1 genomic variants could be considered as genomic biomarkers to predict HU therapy efficacy in Hb S-β-thal compound heterozygotes and also to describe disease severity in patients with β type hemoglobinopathies.
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Affiliation(s)
- Alexandra Kolliopoulou
- a University of Patras , Medical Faculty, Laboratory of General Biology , Patras , Greece
| | - Stavroula Siamoglou
- b School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy , University of Patras , Greece
| | - Anne John
- c United Arab Emirates University , College of Medicine and Health Sciences, Department of Pathology , Al-Ain , United Arab Emirates
| | - Argyro Sgourou
- d School of Science and Technology, Biology Laboratory , Hellenic Open University , Patras , Greece
| | - Alexandra Kourakli
- e Thalassemia and Hemoglobinopathies Unit, Hematology Division, Department of Internal Medicine , University of Patras Medical School, University Hospital , Patras , Greece
| | - Argiris Symeonidis
- f Medical School, Hematology Division, Department of Internal Medicine , University of Patras, University of Patras , Greece
| | - Efthymia Vlachaki
- g Adults Thalassemia Unit , 'Hippokration' General Hospital of Thessaloniki , Greece
| | - Panagiota Chalkia
- h Thalassemia and Sickle Cell Unit , University General Hospital of Thessaloniki , Greece
| | - Stamatia Theodoridou
- g Adults Thalassemia Unit , 'Hippokration' General Hospital of Thessaloniki , Greece
| | - Bassam R Ali
- c United Arab Emirates University , College of Medicine and Health Sciences, Department of Pathology , Al-Ain , United Arab Emirates
| | - Theodora Katsila
- b School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy , University of Patras , Greece
| | - George P Patrinos
- b School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy , University of Patras , Greece.,c United Arab Emirates University , College of Medicine and Health Sciences, Department of Pathology , Al-Ain , United Arab Emirates.,i United Arab Emirates University , Zayed Center of Health Sciences , Al-Ain , United Arab Emirates
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29
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Diamantopoulos P, Koumbi D, Kotsianidis I, Pappa V, Symeonidis A, Galanopoulos A, Zikos P, Papadaki HA, Panayiotidis P, Dimou M, Hatzimichael E, Vassilopoulos G, Delimpasis S, Mparmparousi D, Papageorgiou S, Variami E, Kyrtsonis MC, Megalakaki A, Kotsopoulou M, Repousis P, Adamopoulos I, Kontopidou F, Christoulas D, Kourakli A, Tsokanas D, Konstantinos Papoutselis M, Kyriakakis G, Viniou NA. The prognostic significance of chromosome 17 abnormalities in patients with myelodysplastic syndrome treated with 5-azacytidine: Results from the Hellenic 5-azacytidine registry. Cancer Med 2019; 8:2056-2063. [PMID: 30897290 PMCID: PMC6536924 DOI: 10.1002/cam4.2090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/28/2018] [Accepted: 02/12/2019] [Indexed: 11/12/2022] Open
Abstract
In patients with myelodysplastic syndrome (MDS), the prognostic significance of chromosome 17 abnormalities has not yet been fully elucidated, except for isochromosome 17q that has been characterized as an intermediate risk abnormality in the Revised International Prognostic Scoring System (IPSS‐R). To further characterize the prognostic significance of chromosome 17 abnormalities we analyzed the hematologic and prognostic characteristics of 548 adult patients with MDS treated with 5‐azacytidine through the Hellenic 5‐azacytidine registry and found 32 patients with a chromosome 17 abnormality (6 with i[17q], 15 with ‐17, 3 with add[17p] and the rest with other rarer abnormalities, mostly translocations). The presence of a chromosome 17 abnormality was correlated with poor prognostic features (high IPSS, IPSS‐R, and WPSS scores) and a low overall survival rate (15.7 vs 36.4 months for patients without chromosome 17 abnormalities, Kaplan–Meier, Log Rank P < 0.00001), but these results were confounded by the fact that most (92.3%) of the cases with a chromosome 17 abnormality (with the exception of i(17q) that was found in all cases as an isolated abnormality) were found in the context of a complex karyotype. Nevertheless, one should not ignore the contribution of chromosome 17 abnormalities to the prognostic significance of a complex karyotype since 33.8% of complex karyotypes encompassed a chromosome 17 abnormality.
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Affiliation(s)
- Panagiotis Diamantopoulos
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dafni Koumbi
- Institute of Nuclear and Radiological Sciences, National Center for Scientific Research Demokritos, Athens, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Vasiliki Pappa
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argiris Symeonidis
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Athanasios Galanopoulos
- Department of Clinical Hematology, 'G. Gennimatas' District General Hospital, Athens, Greece
| | - Panagiotis Zikos
- Department of Hematology, 'St Andrew' General Hospital, Patras, Greece
| | - Helen A Papadaki
- Haematology Laboratory, School of Medicine, University of Crete, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - George Vassilopoulos
- Department of Hematology, Larissa University Hospital, University of Thessalia, Larissa, Greece
| | | | | | - Sotirios Papageorgiou
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Variami
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Propedeutic Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | | | | | - Flora Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokratio General Hospital, Athens, Greece
| | | | - Alexandra Kourakli
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Dimitrios Tsokanas
- Department of Clinical Hematology, 'G. Gennimatas' District General Hospital, Athens, Greece
| | | | - Georgios Kyriakakis
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nora-Athina Viniou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Terpos E, Katodritou E, Symeonidis A, Zagouri F, Gerofotis A, Christopoulou G, Gavriatopoulou M, Christoulas D, Ntanasis-Stathopoulos I, Kourakli A, Konstantinidou P, Kastritis E, Dimopoulos MA. Effect of induction therapy with lenalidomide, doxorubicin and dexamethasone on bone remodeling and angiogenesis in newly diagnosed multiple myeloma. Int J Cancer 2019; 145:559-568. [PMID: 30650184 DOI: 10.1002/ijc.32125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/09/2018] [Revised: 12/11/2018] [Accepted: 01/02/2019] [Indexed: 11/08/2022]
Abstract
There is limited data regarding the efficacy and safety of lenalidomide, adriamycin and dexamethasone (RAD) combination on newly diagnosed multiple myeloma (NDMM) patients. There is also scarce information about the effect of lenalidomide on bone metabolism and angiogenesis in NDMM. Thus, we conducted a Phase 2 study to evaluate the efficacy and safety of RAD regimen as induction in transplant-eligible NDMM patients and we studied the effects on bone metabolism and angiogenesis. A total of 45 patients were enrolled. Following four cycles of RAD, the overall response rate was 66.7% and after a median follow up of 29.1 months (range 21.0-34.9), the median survival outcomes have not been reached yet. RAD had a favorable toxicity profile and did not impair stem cell collection. RAD significantly reduced bone resorption markers CTX (p = 0.03) and TRACP-5b (p < 0.01). Interestingly, RAD also increased bone formation markers bone-specific alkaline phosphatase (p = 0.036), procollagen type 1 amino-terminal propeptide (p = 0.028) and osteocalcin (p = 0.026), which has not been described before with lenalidomide-containing regimens in the absence of bortezomib coadministration. Furthermore, the angiogenic cytokines VEGF (p = 0.01), angiogenin (p = 0.02) and bFGF (p < 0.01) were significantly reduced post-RAD induction. Our results suggest that RAD is an effective induction regimen before autologous stem cell transplantation with beneficial effects on bone metabolism and angiogenesis.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Eirini Katodritou
- Department of Hematology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Argiris Symeonidis
- Department of Internal Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Antonis Gerofotis
- Department of Hematology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Georgia Christopoulou
- Department of Internal Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandra Kourakli
- Department of Internal Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | | | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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31
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Diamantopoulos PT, Kotsianidis I, Symeonidis A, Pappa V, Galanopoulos A, Gogos D, Karakatsanis S, Papadaki H, Palla A, Hatzimichael E, Dimou M, Papageorgiou S, Delimpasis S, Papaioannou M, Papoutselis M, Kourakli A, Tsokanas D, Anagnostopoulos A, Kontos CK, Panayiotidis P, Viniou NA. Chronic myelomonocytic leukemia treated with 5-azacytidine - results from the Hellenic 5-Azacytidine Registry: proposal of a new risk stratification system. Leuk Lymphoma 2018; 60:1721-1730. [PMID: 30424699 DOI: 10.1080/10428194.2018.1540783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/14/2022]
Abstract
Hypomethylating agents are widely used in chronic myelomonocytic leukemia (CMML). We analyzed the characteristics of 88 patients with CMML homogeneously treated with 5-azacytidine (Hellenic 5-Azacytidine Registry). The overall response rate was 48.9% and the median overall survival (OS) 29.7 months. Out of the seven most widely used prognostic scoring systems for CMML, the Dusseldorf score (DUSS) showed the best prognostic capability (HR, 2.27; p < .001). Forty-one (48.8%) patients progressed to acute myeloid leukemia (AML) after a median time of 15.2 months following treatment initiation. High serum ferritin levels at diagnosis were independently correlated with low OS (HR, 2.84; p = .022), as were circulating blasts (HR, 3.47; p = .014), while a platelet count <100 × 109/L was marginally predictive of lower OS (HR, 1.45; p = .06). We selected these three factors to create a new risk stratification system for CMML with three risk groups. Finally, we highlighted for the first time the prognostic significance of serum ferritin levels in CMML.
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Affiliation(s)
- Panagiotis T Diamantopoulos
- a First Department of Internal Medicine, Hematology Unit , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Ioannis Kotsianidis
- b Department of Hematology , University Hospital of Alexandroupolis , Alexandroupoli , Greece
| | - Argiris Symeonidis
- c Department of Internal Medicine , University Hospital of Patras , Rio , Greece
| | - Vassiliki Pappa
- d Haematology Division, Second Department of Internal Medicine , Attikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Athanasios Galanopoulos
- e Department of Clinical Hematology , ' G. Gennimatas' District General Hospital , Athens , Greece
| | | | - Stamatios Karakatsanis
- g Third Department of Medicine , ' Sotiria' General Hospital of Thoracic Diseases, Hematology Unit, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Helen Papadaki
- h Haematology Laboratory , School of Medicine, University of Crete , Greece
| | | | | | - Maria Dimou
- k First Propedeutic Department of Internal Medicine, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Sotirios Papageorgiou
- d Haematology Division, Second Department of Internal Medicine , Attikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Sosana Delimpasis
- l Hematology Department , Evangelismos General Hospital , Athens , Greece
| | - Maria Papaioannou
- m Hematology Department , University General Hospital of Thessaloniki AHEPA , Thessaloniki , Greece
| | - Menelaos Papoutselis
- b Department of Hematology , University Hospital of Alexandroupolis , Alexandroupoli , Greece
| | - Alexandra Kourakli
- c Department of Internal Medicine , University Hospital of Patras , Rio , Greece
| | - Dimitrios Tsokanas
- e Department of Clinical Hematology , ' G. Gennimatas' District General Hospital , Athens , Greece
| | - Achilles Anagnostopoulos
- n Hematology Department , General Hospital of Thessaloniki 'George Papanikolaou' , Thessaloniki , Greece
| | - Christos K Kontos
- o Department of Biochemistry and Molecular Biology , National and Kapodistrian University of Athens , Athens , Greece
| | - Panayiotis Panayiotidis
- k First Propedeutic Department of Internal Medicine, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Nora-Athina Viniou
- a First Department of Internal Medicine, Hematology Unit , Laikon General Hospital, National and Kapodistrian University of Athens , Athens , Greece
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32
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Voskaridou E, Kattamis A, Fragodimitri C, Kourakli A, Chalkia P, Diamantidis M, Vlachaki E, Drosou M, Lafioniatis S, Maragkos K, Petropoulou F, Eftihiadis E, Economou M, Klironomos E, Koutsouka F, Nestora K, Tzoumari I, Papageorgiou O, Basileiadi A, Lafiatis I, Dimitriadou E, Kalpaka A, Kalkana C, Xanthopoulidis G, Adamopoulos I, Kaiafas P, Mpitzioni A, Goula A, Kontonis I, Alepi C, Anastasiadis A, Papadopoulou M, Maili P, Dionisopoulou D, Tsirka A, Makis A, Kostaridou S, Politou M, Papassotiriou I. National registry of hemoglobinopathies in Greece: updated demographics, current trends in affected births, and causes of mortality. Ann Hematol 2018; 98:55-66. [DOI: 10.1007/s00277-018-3493-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/31/2018] [Indexed: 12/11/2022]
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Chondrou V, Kolovos P, Sgourou A, Kourakli A, Pavlidaki A, Kastrinou V, John A, Symeonidis A, Ali BR, Papachatzopoulou A, Katsila T, Patrinos GP. Whole transcriptome analysis of human erythropoietic cells during ontogenesis suggests a role of VEGFA gene as modulator of fetal hemoglobin and pharmacogenomic biomarker of treatment response to hydroxyurea in β-type hemoglobinopathy patients. Hum Genomics 2017; 11:24. [PMID: 29061162 PMCID: PMC5654038 DOI: 10.1186/s40246-017-0120-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/16/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Human erythropoiesis is characterized by distinct gene expression profiles at various developmental stages. Previous studies suggest that fetal-to-adult hemoglobin switch is regulated by a complex mechanism, in which many key players still remain unknown. Here, we report our findings from whole transcriptome analysis of erythroid cells, isolated from erythroid tissues at various developmental stages in an effort to identify distinct molecular signatures of each erythroid tissue. RESULTS From our in-depth data analysis, pathway analysis, and text mining, we opted to focus on the VEGFA gene, given its gene expression characteristics. Selected VEGFA genomic variants, identified through linkage disequilibrium analysis, were explored further for their association with elevated fetal hemoglobin levels in β-type hemoglobinopathy patients. Our downstream analysis of non-transfusion-dependent β-thalassemia patients, β-thalassemia major patients, compound heterozygous sickle cell disease/β-thalassemia patients receiving hydroxyurea as fetal hemoglobin augmentation treatment, and non-thalassemic individuals indicated that VEGFA genomic variants were associated with disease severity in β-thalassemia patients and hydroxyurea treatment efficacy in SCD/β-thalassemia compound heterozygous patients. CONCLUSIONS Our findings suggest that VEGFA may act as a modifier gene of human globin gene expression and, at the same time, serve as a genomic biomarker in β-type hemoglobinopathy disease severity and hydroxyurea treatment efficacy.
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Affiliation(s)
- Vasiliki Chondrou
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, GR-265 04, Patras, Greece
| | - Petros Kolovos
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | | | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, Faculty of Medicine, University of Patras, Patras, Greece
| | - Alexia Pavlidaki
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, GR-265 04, Patras, Greece.,Present address: Institut de Génétique et de Biologie Moléculaire et Cellulaire IGBMC/CNRS/INSERM/UDS, 67404 ILLKIRCH, BP 10142, CU de Strasbourg, France
| | - Vlasia Kastrinou
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, GR-265 04, Patras, Greece
| | - Anne John
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, Faculty of Medicine, University of Patras, Patras, Greece
| | - Bassam R Ali
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Zayed Bin Sultan Center for Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | - Theodora Katsila
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, GR-265 04, Patras, Greece
| | - George P Patrinos
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, GR-265 04, Patras, Greece. .,Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates. .,Zayed Bin Sultan Center for Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
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34
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Taher AT, Origa R, Perrotta S, Kourakli A, Ruffo GB, Kattamis A, Goh A, Cortoos A, Huang V, Weill M, Merino Herranz R, Porter JB. New film-coated tablet formulation of deferasirox is well tolerated in patients with thalassemia or lower-risk MDS: Results of the randomized, phase II ECLIPSE study. Am J Hematol 2017; 92:420-428. [PMID: 28142202 PMCID: PMC6585741 DOI: 10.1002/ajh.24668] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/23/2017] [Accepted: 01/26/2017] [Indexed: 01/19/2023]
Abstract
Once‐daily deferasirox dispersible tablets (DT) have a well‐defined safety and efficacy profile and, compared with parenteral deferoxamine, provide greater patient adherence, satisfaction, and quality of life. However, barriers still exist to optimal adherence, including gastrointestinal tolerability and palatability, leading to development of a new film‐coated tablet (FCT) formulation that can be swallowed with a light meal, without the need to disperse into a suspension prior to consumption. The randomized, open‐label, phase II ECLIPSE study evaluated the safety of deferasirox DT and FCT formulations over 24 weeks in chelation‐naïve or pre‐treated patients aged ≥10 years, with transfusion‐dependent thalassemia or IPSS‐R very‐low‐, low‐, or intermediate‐risk myelodysplastic syndromes. One hundred seventy‐three patients were randomized 1:1 to DT (n = 86) or FCT (n = 87). Adverse events (overall), consistent with the known deferasirox safety profile, were reported in similar proportions of patients for each formulation (DT 89.5%; FCT 89.7%), with a lower frequency of severe events observed in patients receiving FCT (19.5% vs. 25.6% DT). Laboratory parameters (serum creatinine, creatinine clearance, alanine aminotransferase, aspartate aminotransferase and urine protein/creatinine ratio) generally remained stable throughout the study. Patient‐reported outcomes showed greater adherence and satisfaction, better palatability and fewer concerns with FCT than DT. Treatment compliance by pill count was higher with FCT (92.9%) than with DT (85.3%). This analysis suggests deferasirox FCT offers an improved formulation with enhanced patient satisfaction, which may improve adherence, thereby reducing frequency and severity of iron overload‐related complications.
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Affiliation(s)
- Ali T. Taher
- American University of Beirut Medical CenterBeirut Lebanon
| | - Raffaella Origa
- Ospedale Pediatrico Microcitemico “A. Cao,”University of CagliariCagliari Italy
| | | | - Alexandra Kourakli
- Hematology Division, Department of Internal MedicineUniversity of Patras Medical SchoolPatras Greece
| | | | | | - Ai‐Sim Goh
- Department of MedicineHospital Pulau PinangGeorgetown Penang Malaysia
| | | | - Vicky Huang
- Novartis Pharmaceuticals CorporationEast Hanover New Jersey USA
| | | | | | - John B. Porter
- Department of HaematologyUniversity College LondonLondon UK
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35
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Sinakos E, Kountouras D, Koskinas J, Zachou K, Karatapanis S, Triantos C, Vassiliadis T, Goulis I, Kourakli A, Vlachaki E, Toli B, Tampaki M, Arvaniti P, Tsiaoussis G, Bellou A, Kattamis A, Maragkos K, Petropoulou F, Dalekos GN, Akriviadis E, Papatheodoridis GV. Treatment of chronic hepatitis C with direct-acting antivirals in patients with β-thalassaemia major and advanced liver disease. Br J Haematol 2017; 178:130-136. [PMID: 28439915 DOI: 10.1111/bjh.14640] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 10/30/2016] [Accepted: 12/31/2016] [Indexed: 02/06/2023]
Abstract
Interferon-based regimens for chronic hepatitis C (CHC) were often deferred in patients with β-thalasaemia major (β-TM) due to poor efficacy and tolerance. Current guidelines recommend direct-acting antivirals (DAAs) for these patients. The aim of this study was to assess the safety and efficacy of DAAs in patients with β-TM and advanced liver disease due to CHC. Patients were recruited from eight liver units in Greece. The stage of liver disease was assessed using transient elastography and/or liver histology. Five regimens were used: sofosbuvir (SOF) + ribavirin (RBV); SOF + simeprevir ± RBV; SOF + daclatasvir ± RBV; ledipasvir/SOF ± RBV and ombitasvir/paritaprevir-ritonavir + dasabuvir ± RBV. Sixty-one patients (median age 43 years) were included. The majority of patients was previously treated for hepatitis C (75%) and had cirrhosis (79%). Viral genotype distribution was: G1a: n = 10 (16%); G1b: n = 22 (36%); G2: n = 2 (3%); G3: n = 14 (23%); G4: n = 13 (22%). The predominant chelation therapy was a combination of deferoxamine and deferiprone (35%). Overall sustained virological response rates were 90%. All treatment regimens were well tolerated and no major adverse events or drug-drug interactions were observed. Approximately half of the patients who received RBV (7/16, 44%) had increased needs for blood transfusion. Treatment of CHC with DAAs in patients with β-TM and advanced liver disease was highly effective and safe.
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Affiliation(s)
- Emmanouil Sinakos
- 4th Medical Department, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Dimitrios Kountouras
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.,Mitera Hospital, Athens, Greece
| | - John Koskinas
- 2nd Medical Department, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Kalliopi Zachou
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | | | - Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | - Themistoklis Vassiliadis
- 3rd Medical Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Goulis
- 4th Medical Department, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | | | - Efthymia Vlachaki
- Thalassaemia Unit, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Tampaki
- 2nd Medical Department, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Pinelopi Arvaniti
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Georgios Tsiaoussis
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | - Aristea Bellou
- 3rd Medical Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Kattamis
- Agia Sofia Children Hospital, University of Athens, Athens, Greece
| | | | | | - George N Dalekos
- 2nd Medical Department, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Evangelos Akriviadis
- 4th Medical Department, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - George V Papatheodoridis
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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36
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Gravia A, Chondrou V, Kolliopoulou A, Kourakli A, John A, Symeonidis A, Ali BR, Sgourou A, Papachatzopoulou A, Katsila T, Patrinos GP. Correlation of SIN3A genomic variants with β-hemoglobinopathies disease severity and hydroxyurea treatment efficacy. Pharmacogenomics 2016; 17:1785-1793. [PMID: 27767389 DOI: 10.2217/pgs-2016-0076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 02/08/2023] Open
Abstract
AIMS Hemoglobinopathies, particularly β-thalassemia and sickle cell disease, are characterized by great phenotypic variability in terms of disease severity, while notable differences have been observed in hydroxyurea treatment efficacy. In both cases, the observed phenotypic diversity is mostly dependent on the elevated fetal hemoglobin levels, resulting from the persistent fetal globin gene expression in the adult erythroid stage orchestrated by intricate mechanisms that still remain only partly understood. We have previously shown that several protein factors act as modifiers of fetal hemoglobin production, exerting their effect via different pathways. MATERIALS & METHODS Here, we explored whether SIN3A could act as a modifier of fetal globin gene expression, as it interacts with KLF10, a known modifier of fetal hemoglobin production. RESULTS We show that SIN3A genomic variants are associated both with β-thalassemia disease severity (rs11072544) as well as hydroxyurea treatment response (rs7166737) in β-hemoglobinopathies patients. CONCLUSION Our findings further underline that fetal hemoglobin production is the result of a complex interplay in which several human globin gene cluster variants interact with protein factors encoded by modifier genes to produce the observed clinical outcome.
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Affiliation(s)
- Aikaterini Gravia
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, Patras, Greece
| | - Vasiliki Chondrou
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, Patras, Greece
| | - Alexandra Kolliopoulou
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, Patras, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, Faculty of Medicine, University of Patras, Patras, Greece
| | - Anne John
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Argyris Symeonidis
- Hematology Division, Department of Internal Medicine, Faculty of Medicine, University of Patras, Patras, Greece
| | - Bassam R Ali
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | | | - Theodora Katsila
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, Patras, Greece
| | - George P Patrinos
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, Patras, Greece.,Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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37
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Chalikiopoulou C, Tavianatou AG, Sgourou A, Kourakli A, Kelepouri D, Chrysanthakopoulou M, Kanelaki VK, Mourdoukoutas E, Siamoglou S, John A, Symeonidis A, Ali BR, Katsila T, Papachatzopoulou A, Patrinos GP. Genomic variants in the ASS1 gene, involved in the nitric oxide biosynthesis and signaling pathway, predict hydroxyurea treatment efficacy in compound sickle cell disease/β-thalassemia patients. Pharmacogenomics 2016; 17:393-403. [PMID: 26895070 DOI: 10.2217/pgs.16.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/08/2023] Open
Abstract
AIM Hemoglobinopathies exhibit a remarkable phenotypic diversity that restricts any safe association between molecular pathology and clinical outcomes. PATIENTS & METHODS Herein, we explored the role of genes involved in the nitric oxide biosynthesis and signaling pathway, implicated in the increase of fetal hemoglobin levels and response to hydroxyurea treatment, in 119 Hellenic patients with β-type hemoglobinopathies. RESULTS We show that two ASS1 genomic variants (namely, rs10901080 and rs10793902) can serve as pharmacogenomic biomarkers to predict hydroxyurea treatment efficacy in sickle cell disease/β-thalassemia compound heterozygous patients. CONCLUSION These markers may exert their effect by inducing nitric oxide biosynthesis, either via altering splicing and/or miRNA binding, as predicted by in silico analysis, and ultimately, increase γ-globin levels, via guanylyl cyclase targeting.
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Affiliation(s)
- Constantina Chalikiopoulou
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, Patras, Greece
| | | | | | - Alexandra Kourakli
- University of Patras, Faculty of Medicine, Department of Internal Medicine, Hematology Division, Patras, Greece
| | - Dimitra Kelepouri
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, Patras, Greece
| | - Maria Chrysanthakopoulou
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, Patras, Greece
| | - Vasiliki-Kaliopi Kanelaki
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, Patras, Greece
| | - Evangelos Mourdoukoutas
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, Patras, Greece
| | - Stavroula Siamoglou
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, Patras, Greece
| | - Anne John
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Argyris Symeonidis
- University of Patras, Faculty of Medicine, Department of Internal Medicine, Hematology Division, Patras, Greece
| | - Bassam R Ali
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Theodora Katsila
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, Patras, Greece
| | | | - George P Patrinos
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, Patras, Greece.,Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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Kalafateli M, Kourakli A, Gatselis N, Lambropoulou P, Thomopoulos K, Tsamandas A, Christofidou M, Zachou K, Jelastopoulou E, Nikolopoulou V, Symeonidis A, Dalekos GN, Lambropoulou-Karatza C, Triantos C. Efficacy of Interferon A-2b monotherapy in Β-thalassemics with chronic hepatitis C. J Gastrointestin Liver Dis 2015; 24:189-96. [PMID: 26114179 DOI: 10.15403/jgld.2014.1121.242.a2b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND & AIMS Monotherapy with standard or pegylated interferon (PegIFN) remains the first-line treatment for HCV infection in patients with thalassemia major (βTM), although its long-term impact is still unknown. We aimed to assess the efficacy of IFN-a2b/PegIFN-a2b (one or multiple treatment sessions) and the predictors for sustained virological response (SVR) in HCV-infected βTM patients. METHODS Between 11/1992 and 12/2013 [median follow-up: 165.5 months (8-237)], 48 βTM HCV-infected patients [19 males, median age: 22 years (12-45)], received IFN-a2b (n=34) or PegIFN-a2b (n=14). Twenty-three patients (47.9%) had a previous splenectomy; 13/40 (32.5%) patients had Ishak stage >/=4 and 21/40 (52.5%) had siderosis grade 3-4. HCV-genotype was available in 36 patients (genotype 1: 47.2%, 2: 5.6%, 3: 25%, and 4: 22%). IL28B genotype was determined in 37 patients by means of in-house real-time PCR (CC: 27%, CT: 62.2%, TT: 10.8%). RESULTS Totally, 15/48 (31.3%) achieved SVR following the first treatment and 18/48 (37.5%) after multiple courses. Splenectomy (p=0.01) and fibrosis grade >/=4 (p<0.05) were negative predictors for SVR (first course), whereas splenectomy (p<0.05) and age >18 (p<0.02) for SVR after multiple courses. In HCV-genotype 1/4 (n=25), none of the patients with CT or TT IL28B genotype achieved SVR compared to 50% of the CC patients (p=0.004). CONCLUSIONS Interferon is an effective therapeutic option in HCV-infected βTM patients. IL28B genotype was a strong predictor for SVR, together with splenectomy, age and fibrosis.
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Affiliation(s)
| | - Alexandra Kourakli
- Department of Internal Medicine, Hematology Division / Thalassemia and Hemoglobinopathies Unit, University Hospital of Patras, Patras; Greece
| | - Nikolaos Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa; Greece
| | - Polixeni Lambropoulou
- Department of Internal Medicine, Hematology Division / Thalassemia and Hemoglobinopathies Unit, University Hospital of Patras, Patras; Greece
| | | | | | | | - Kalliopi Zachou
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa; Greece
| | | | - Vasiliki Nikolopoulou
- Department of Digestive Oncology, Gustave Roussy Institute of Oncology, Villejuif; Department of Pathology, CHU Rouen, France
| | - Argiris Symeonidis
- Department of Internal Medicine, Hematology Division / Thalassemia and Hemoglobinopathies Unit, University Hospital of Patras, Patras
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa; Greece
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Tafrali C, Paizi A, Borg J, Radmilovic M, Bartsakoulia M, Giannopoulou E, Giannakopoulou O, Stojiljkovic-Petrovic M, Zukic B, Poulas K, Stavrou EF, Lambropoulou P, Kourakli A, Felice AE, Papachatzopoulou A, Philipsen S, Pavlovic S, Georgitsi M, Patrinos GP. Genomic variation in the MAP3K5 gene is associated with β-thalassemia disease severity and hydroxyurea treatment efficacy. Pharmacogenomics 2013; 14:469-83. [PMID: 23556445 DOI: 10.2217/pgs.13.31] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM In this study we explored the association between genetic variations in MAP3K5 and PDE7B genes, residing on chromosome 6q23, and disease severity in β-hemoglobinopathy patients, as well as the association between these variants with response to hydroxyurea (HU) treatment. Furthermore, we examined MAP3K5 expression in the context of high fetal hemoglobin (HbF) and upon HU treatment in erythroid progenitor cells from healthy and KLF1 haploinsufficient individuals. MATERIALS & METHODS For this purpose, we genotyped β-thalassemia intermedia and major patients and healthy controls, as well as a cohort of compound heterozygous sickle cell disease/β-thalassemia patients receiving HU as HbF augmentation treatment. Furthermore, we examined MAP3K5 expression in the context of high HbF and upon HU treatment in erythroid progenitor cells from healthy and KLF1 haploinsufficient individuals. RESULTS A short tandem repeat in the MAP3K5 promoter and two intronic MAP3K5 gene variants, as well as a PDE7B variant, are associated with low HbF levels and a severe disease phenotype. Moreover, MAP3K5 mRNA expression levels are altered in the context of high HbF and are affected by the presence of HU. Lastly, the abovementioned MAP3K5 variants are associated with HU treatment efficacy. CONCLUSION Our data suggest that these MAP3K5 variants are indicative of β-thalassemia disease severity and response to HU treatment.
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Affiliation(s)
- Christina Tafrali
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, Patras, Greece
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Borg J, Phylactides M, Bartsakoulia M, Tafrali C, Lederer C, Felice AE, Papachatzopoulou A, Kourakli A, Stavrou EF, Christou S, Hou J, Karkabouna S, Lappa-Manakou C, Ozgur Z, van Ijcken W, von Lindern M, Grosveld FG, Georgitsi M, Kleanthous M, Philipsen S, Patrinos GP. KLF10 gene expression is associated with high fetal hemoglobin levels and with response to hydroxyurea treatment in β-hemoglobinopathy patients. Pharmacogenomics 2013; 13:1487-500. [PMID: 23057549 DOI: 10.2217/pgs.12.125] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIM In humans, fetal hemoglobin (HbF) production is controlled by many intricate mechanisms that, to date, remain only partly understood. PATIENTS & METHODS Pharmacogenomic analysis of the effects of hydroxyurea (HU) on HbF production was undertaken in a collection of Hellenic β-thalassemia and sickle cell disease (SCD) compound heterozygotes and a collection of healthy and KLF1-haploinsufficient Maltese adults, to identify genomic signatures that follow high HbF patterns. RESULTS KLF10 emerged as a top candidate. Moreover, genotype analysis of β-thalassemia major and intermedia patients and an independent cohort of β-thalassemia/SCD compound heterozygous patients that do or do not respond to HU treatment showed that the homozygous mutant state of a tagSNP in the KLF10 3'UTR is not present in β-thalassemia intermedia patients and is underrepresented in β-thalassemia/SCD compound heterozygous patients that respond well to HU treatment. CONCLUSION These data suggest that KLF10 may constitute a pharmacogenomic marker to discriminate between response and nonresponse to HU treatment.
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Affiliation(s)
- Joseph Borg
- Erasmus University Medical Center, Department of Cell Biology, Rotterdam, The Netherlands
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Triantos C, Kourakli A, Kalafateli M, Giannakopoulou D, Koukias N, Thomopoulos K, Lampropoulou P, Bartzavali C, Fragopanagou H, Kagadis GC, Christofidou M, Tsamandas A, Nikolopoulou V, Karakantza M, Labropoulou-Karatza C. Hepatitis C in patients with β-thalassemia major. A single-centre experience. Ann Hematol 2013; 92:739-46. [PMID: 23412560 DOI: 10.1007/s00277-013-1692-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 01/30/2013] [Indexed: 01/19/2023]
Abstract
Chronic hepatitis C (CHC) and iron overload are the main causes of liver disease in β-thalassemia major (βTM). There is limited data regarding the course of CHC in this population. All patients (n=144) from the thalassemia centre of the University Hospital of Patras were evaluated (January 1981 to June 2012). Patients were classified into group A (n=57), which consisted of patients with CHC, who either had received antiviral treatment (n=49) or not (n=8), and group B which included 87 patients without CHC. Nineteen patients died during follow-up (median: 257.5 months (1-355)). Survival rates were 84.2 % and 88.5 % for group A and B, respectively. The causes of death were heart failure (63.2 %), accident (10.5 %), sepsis (5.3 %), liver failure (5.3 %), hepatocellular carcinoma (HCC) (5.3 %), non-Hodgkin lymphoma (5.3 %) and multiorgan failure (5.3 %). There were no differences in total survival between the two groups (p=0.524). In the multivariate analysis, survival was neither correlated with CHC (p=ns), nor with anti-HCV treatment (p=ns), whereas independent negative predictors were presence of heart failure (p<0.001), presence of malignancy other than HCC (p=0.001) and non-adherence to chelation treatment (p=0.013). Predictive factors for the development of cirrhosis were: CHC (p<0.001), age>35 years (p=0.007), siderosis grade 3/4 (p=0.029) and splenectomy (p=0.001); however, multivariately, only siderosis grade 3/4 was found to be significant (p=0.049). In this study, survival of patients with βTM was mainly associated with heart failure, presence of malignancy other than HCC and non-adherence to chelation treatment, rather than with liver disease. Multicentre studies need to be designed to define more accurately the indications of antiviral treatment in this population.
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Affiliation(s)
- Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, Stamatopoulou 4, Rio, 26504, Patras, Greece.
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Solomou E, Kraniotis P, Kourakli A, Petsas T. Extent of silent cerebral infarcts in adult sickle-cell disease patients on magnetic resonance imaging: is there a correlation with the clinical severity of disease? Hematol Rep 2013; 5:8-12. [PMID: 23888239 PMCID: PMC3719106 DOI: 10.4081/hr.2013.e3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/11/2012] [Accepted: 01/07/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of this paper is to correlate the extent of silent cerebral infarcts (SCIs) on magnetic resonance imaging (MRI) with the clinical severity of sickle cell disease (SCD) in adult patients. Twenty-four consecutive adult asymptomatic SCD patients (11 male and 13 female) with a mean age of 38.4 years (range 20-59) were submitted to brain MRI on a 1 Tesla Gyroscan Intera, Philips MR scanner with a dedicated head coil. The protocol consisted of TSE T2-weighted and FLAIR images on the axial and coronal planes. MRI readings were undertaken by two radiologists and consensus readings. Patients were compound heterozygotes (HbS/β-thal). The extent of SCIs was classified from 0-2 with 0 designating no lesions. Clinical severity was graded as 0-2 by the hematologist, according to the frequency and severity of vaso-occlusive crises. There was no statistically significant correlation between the severity of clinical disease and the extent of SCIs on MR imaging. The extent of SCI lesions did not differ statistically between younger and older patients. Patients receiving hydroxyurea had no statistically significant difference in the extent of SCI lesions. The extent of SCIs in heterozygous (HbS/β-thal) SCD patients is not age related and may be quite severe even in younger (<38.4 years) patients. However the extent of SCIs is not correlated with the severity of clinical disease.
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Giannopoulou E, Bartsakoulia M, Tafrali C, Kourakli A, Poulas K, Stavrou EF, Papachatzopoulou A, Georgitsi M, Patrinos GP. A Single Nucleotide Polymorphism in theHBBP1Gene in the Human β-Globin Locus is Associated with a Mild β-Thalassemia Disease Phenotype. Hemoglobin 2012; 36:433-45. [DOI: 10.3109/03630269.2012.717515] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hahalis G, Kalogeropoulos A, Terzis G, Tselepis AD, Kourakli A, Mylona P, Grapsas N, Alexopoulos D. Premature Atherosclerosis in Non-Transfusion-Dependent β-Thalassemia Intermedia. Cardiology 2011; 118:159-63. [DOI: 10.1159/000327997] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 03/10/2011] [Indexed: 11/19/2022]
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Papachatzopoulou A, Kourakli A, Stavrou EF, Fragou E, Vantarakis A, Patrinos GP, Athanassiadou A. Region-Specific Genetic Heterogeneity ofHBBMutation Distribution in South-Western Greece. Hemoglobin 2010; 34:333-42. [DOI: 10.3109/03630269.2010.486354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tselepis AD, Hahalis G, Tellis CC, Papavasiliou EC, Mylona PT, Kourakli A, Alexopoulos DC. Plasma levels of lipoprotein-associated phospholipase A(2) are increased in patients with β-thalassemia. J Lipid Res 2010; 51:3331-41. [PMID: 20625038 DOI: 10.1194/jlr.m007229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is an independent cardiovascular risk factor. We investigated the plasma levels of Lp-PLA(2) activity and mass as a function of plasma lipid levels, LDL subclass profile, and oxidative stress in patients with β-thalassemia. Thirty-five patients with β-thalassemia major (β-TM) and 25 patients with β-thalassemia intermedia (β-TI) participated in the study. Lp-PLA(2) activity and mass were measured in total plasma, in apolipoprotein (apo)B-depleted plasma (HDL-Lp-PLA(2)), and in LDL subclasses. Lp-PLA(2) activity produced and secreted from peripheral blood monocytes in culture was also determined. Patients with β-thalassemia are characterized by a predominance of small-dense LDL particles, increased oxidative stress, and very high plasma levels of Lp-PLA(2) mass and activity, despite low LDL-cholesterol levels. A significant positive correlation between plasma Lp-PLA(2) activity or mass and 8-isoprostane (8-epiPGF2a) and ferritin levels as well as intima-media thickness (IMT) values was observed. An increase in secreted and cell-associated Lp-PLA(2) activity from monocytes in culture was observed in both patient groups. The HDL-Lp-PLA(2) activity and mass as well as the ratio of HDL-Lp-PLA(2)/plasma Lp-PLA(2) were significantly higher in both patient groups compared with the control group. In conclusion, patients with β-thalassemia exhibit high plasma Lp-PLA(2) levels, attributed to increased enzyme secretion from monocytes/macrophages and to the predominance of sdLDL particles in plasma. Plasma Lp-PLA(2) is correlated with carotid IMT, suggesting that this enzyme may be implicated in premature carotid atherosclerosis observed in β-thalassemia.
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Hahalis G, Kourakli A, Gerasimidou I, Kalogeropoulos AP, Sitafidis G, Papageorgiou U, Davlouros P, Grapsas N, Zoumbos NC, Alexopoulos D. Cardiac mortality in β-thalassemia major: resting but not dobutamine stress echocardiography predicts mortality among initially cardiac disease-free patients in a prospective 12-year study. Eur J Heart Fail 2009; 11:1178-81. [DOI: 10.1093/eurjhf/hfp152] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- George Hahalis
- Department of Cardiology; Patras University Medical School; 7 Larnakos Street Rio Patras 26441 Greece
| | - Alexandra Kourakli
- Department of Hematology; Patras University Medical School; Rio Patras Greece
| | - Ioanna Gerasimidou
- Department of Cardiology; Patras University Medical School; 7 Larnakos Street Rio Patras 26441 Greece
| | - Andreas P. Kalogeropoulos
- Department of Cardiology; Patras University Medical School; 7 Larnakos Street Rio Patras 26441 Greece
| | - George Sitafidis
- Department of Cardiology; Patras University Medical School; 7 Larnakos Street Rio Patras 26441 Greece
| | | | - Periklis Davlouros
- Department of Cardiology; Patras University Medical School; 7 Larnakos Street Rio Patras 26441 Greece
| | - Nikos Grapsas
- Department of Cardiology; Agios Andreas Hospital; Patras Greece
| | - Nicholas C. Zoumbos
- Department of Hematology; Patras University Medical School; Rio Patras Greece
| | - Dimitrios Alexopoulos
- Department of Cardiology; Patras University Medical School; 7 Larnakos Street Rio Patras 26441 Greece
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Solomou E, Tsanaktsi A, Fertakis V, Dallas K, Karambina S, Tiniakou M, Kourakli A, Micheva I, Matsouka P, Zoumbos N. P062 Overexpansion of Th17 and Th1/17 cells in patients with myelodysplastic syndromes. Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70142-0] [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: 10/20/2022]
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Mougiou A, Pietrangelo A, Caleffi A, Kourakli A, Karakantza M, Zoumbos N. G80S-linked ferroportin disease: the first clinical description in a Greek family. Blood Cells Mol Dis 2008; 41:138-9. [PMID: 18420432 DOI: 10.1016/j.bcmd.2008.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 03/06/2008] [Indexed: 01/01/2023]
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Papachatzopoulou A, Kourakli A, Makropoulou P, Kakagianne T, Sgourou A, Papadakis M, Athanassiadou A. Genotypic heterogeneity and correlation to intergenic haplotype within high HbF beta-thalassemia intermedia. Eur J Haematol 2006; 76:322-30. [PMID: 16519704 DOI: 10.1111/j.1600-0609.2005.00618.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES A molecular study was carried out of beta-thalassemia intermedia patients, compound heterozygotes for mutations usually found in beta-thalassemia major, with high levels of HbF in the absence of hereditary persistence of fetal hemoglobin (HPFH) syndrome. Our objective was to locate cis-DNA structures, DNA haplotypes, motifs, or polymorphisms that may correlate with the presence of high HbF. METHODS Allele-specific oligonucleotide (ASO) hybridization was used for the detection of mutations and restriction fragment length polymorphism (RFLP) analysis and automated sequencing for motifs, haplotypes, and polymorphisms. Southern blot was used for investigating alpha-thalassemia and/or alpha- or gamma-globin genes triplications. RNA extracted from burst forming unit-erythroid (BFU-e) colonies of peripheral blood mononuclear cell cultures was used in reverse transcriptase-polymerase chain reaction (RT-PCR) to investigate intergenic transcription. RESULTS We established that (i) the combination: T haplotype of the Agamma-delta-globin intergenic region, the motif (TA)9N10(TA)10 in the HS2 site of locus control region (LCR), and TAG pre-Ggamma haplotype is sufficient but not necessary for high HbF, (ii) the genetic determinant(s) for high HbF involves an element associated with this combination and must be present in the specific R haplotype occurring in beta-thalassemia intermedia and (iii) the genetic determinant(s) for high HbF does not involve the abolition of intergenic transcription in the Agamma-delta-globin intergenic region. CONCLUSIONS The genetic determinant(s) of high HbF in the absence of HPFH is linked to intergenic haplotype T and does not disrupt intergenic transcription.
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