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Codilupi T, Szybinski J, Arunasalam S, Jungius S, Dunbar AC, Stivala S, Brkic S, Albrecht C, Vokalova L, Yang JL, Buczak K, Ghosh N, Passweg JR, Rovo A, Angelillo-Scherrer A, Pankov D, Dirnhofer S, Levine RL, Koche R, Meyer SC. Development of Resistance to Type II JAK2 Inhibitors in MPN Depends on AXL Kinase and Is Targetable. Clin Cancer Res 2024; 30:586-599. [PMID: 37992313 PMCID: PMC10831334 DOI: 10.1158/1078-0432.ccr-23-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/21/2023] [Accepted: 11/20/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Myeloproliferative neoplasms (MPN) dysregulate JAK2 signaling. Because clinical JAK2 inhibitors have limited disease-modifying effects, type II JAK2 inhibitors such as CHZ868 stabilizing inactive JAK2 and reducing MPN clones, gain interest. We studied whether MPN cells escape from type ll inhibition. EXPERIMENTAL DESIGN MPN cells were continuously exposed to CHZ868. We used phosphoproteomic analyses and ATAC/RNA sequencing to characterize acquired resistance to type II JAK2 inhibition, and targeted candidate mediators in MPN cells and mice. RESULTS MPN cells showed increased IC50 and reduced apoptosis upon CHZ868 reflecting acquired resistance to JAK2 inhibition. Among >2,500 differential phospho-sites, MAPK pathway activation was most prominent, while JAK2-STAT3/5 remained suppressed. Altered histone occupancy promoting AP-1/GATA binding motif exposure associated with upregulated AXL kinase and enriched RAS target gene profiles. AXL knockdown resensitized MPN cells and combined JAK2/AXL inhibition using bemcentinib or gilteritinib reduced IC50 to levels of sensitive cells. While resistant cells induced tumor growth in NOD/SCID gamma mice despite JAK2 inhibition, JAK2/AXL inhibition largely prevented tumor progression. Because inhibitors of MAPK pathway kinases such as MEK are clinically used in other malignancies, we evaluated JAK2/MAPK inhibition with trametinib to interfere with AXL/MAPK-induced resistance. Tumor growth was halted similarly to JAK2/AXL inhibition and in a systemic cell line-derived mouse model, marrow infiltration was decreased supporting dependency on AXL/MAPK. CONCLUSIONS We report on a novel mechanism of AXL/MAPK-driven escape from type II JAK2 inhibition, which is targetable at different nodes. This highlights AXL as mediator of acquired resistance warranting inhibition to enhance sustainability of JAK2 inhibition in MPN.
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Affiliation(s)
- Tamara Codilupi
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jakub Szybinski
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefanie Arunasalam
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Sarah Jungius
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew C. Dunbar
- Human Oncology and Pathogenesis Program and Leukemia service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Simona Stivala
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sime Brkic
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Camille Albrecht
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lenka Vokalova
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julie L. Yang
- Human Oncology and Pathogenesis Program and Leukemia service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katarzyna Buczak
- Proteomics Core Facility Biozentrum, University of Basel, Basel, Switzerland
| | - Nilabh Ghosh
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jakob R. Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Angelillo-Scherrer
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dmitry Pankov
- Immunology Program, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stefan Dirnhofer
- Department of Pathology, University Hospital Basel, Basel, Switzerland
| | - Ross L. Levine
- Human Oncology and Pathogenesis Program and Leukemia service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Koche
- Human Oncology and Pathogenesis Program and Leukemia service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sara C. Meyer
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Schifferli A, Rüfer A, Rovo A, Nimmerjahn F, Cantoni N, Holbro A, Favre G, Dirks J, Wieland A, Faeth H, Pereira R, Kühne T. Immunomodulation with romiplostim as a second-line strategy in primary immune thrombocytopenia: The iROM study. Br J Haematol 2023; 203:119-130. [PMID: 37735543 DOI: 10.1111/bjh.19074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 09/23/2023]
Abstract
Thrombopoietin receptor agonists (TPO-RAs) stimulate platelet production, which might restore immunological tolerance in primary immune thrombocytopenia (ITP). The iROM study investigated romiplostim's immunomodulatory effects. Thirteen patients (median age, 31 years) who previously received first-line treatment received romiplostim for 22 weeks, followed by monitoring until week 52. In addition to immunological data, secondary end-points included the sustained remission off-treatment (SROT) rate at 1 year, romiplostim dose, platelet count and bleedings. Scheduled discontinuation of romiplostim and SROT were achieved in six patients with newly diagnosed ITP, whereas the remaining seven patients relapsed. Romiplostim dose titration was lower and platelet count response was stronger in patients with SROT than in relapsed patients. In all patients, regulatory T lymphocyte (Treg) counts increased until study completion and the counts were higher in patients with SROT. Interleukin (IL)-4, IL-9 and IL-17F levels decreased significantly in all patients. FOXP3 (Treg), GATA3 (Th2) mRNA expression and transforming growth factor-β levels increased in patients with SROT. Treatment with romiplostim modulates the immune system and possibly influences ITP prognosis. A rapid increase in platelet counts is likely important for inducing immune tolerance. Better outcomes might be achieved at an early stage of autoimmunity, but clinical studies are needed for confirmation.
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Affiliation(s)
- Alexandra Schifferli
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland
| | - Axel Rüfer
- Department of Hematology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Falk Nimmerjahn
- Department of Biology, Institute of Genetics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nathan Cantoni
- Department of Hematology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Andreas Holbro
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Geneviève Favre
- Department of Hematology, Cantonal Hospital Liestal, Switzerland
| | - Jan Dirks
- Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Anna Wieland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heike Faeth
- Medical University of Basel, Basel, Switzerland
| | | | - Thomas Kühne
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland
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Vrotniakaite-Bajerciene K, Tritschler T, Jalowiec KA, Broughton H, Schmidli F, Schneider JS, Haynes A, Rovo A, Hovinga JAK, Aujesky D, Angelillo-Scherrer A. Adherence to thrombophilia testing guidelines and its influence on anticoagulation therapy: A single-center cross-sectional study. Thromb Res 2023; 223:87-94. [PMID: 36724651 DOI: 10.1016/j.thromres.2022.12.001] [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: 08/23/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The collected evidence on thrombophilia guidelines is scarce and data about their impact on clinical decisions are unknown. We aimed to investigate the adherence to thrombophilia testing guidelines, its therapeutic impact in patients with guideline-adherent and non-adherent testing and identify the patients' clinical characteristics mostly associated with treatment decisions. MATERIALS AND METHODS We conducted a single-center cross-sectional study of patients referred for thrombophilia testing at the outpatient clinic of a tertiary hospital between 01/2010-10/2020. We systematically evaluated the adherence of thrombophilia testing to internal guidelines and the influence of test results on anticoagulation therapy. Using multivariable logistic regression, we evaluated the association between clinical characteristics and influence of thrombophilia tests on anticoagulation therapy in the entire cohort and by indication for referral. RESULTS Of 3686 included patients, mostly referred for venous thromboembolism (2407, 65 %) or arterial thrombosis (591, 16 %), 3550 patients (96 %) underwent thrombophilia testing. Indication for testing was according to guidelines in 1208 patients (33 %). Test results influenced treatment decisions in 56 of 1102 work-ups (5.1 %) that were adherent to guidelines, and in 237 of 2448 (9.7 %) non-adherent work-ups (absolute difference, 4.3 %; 95 % confidence interval, 2.9-6.3 %). Age < 50 years, female sex, absence of risk factors and co-morbidities, weakly provoked venous thromboembolism and referral indication other than venous thromboembolism were associated with influence on anticoagulation therapy. CONCLUSIONS Adherence to guidelines for thrombophilia testing was poor and did not have an impact on treatment decisions. Refinement of selection criteria is needed to increase the therapeutic impact of thrombophilia testing.
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Affiliation(s)
- Kristina Vrotniakaite-Bajerciene
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland.
| | - Tobias Tritschler
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Katarzyna Aleksandra Jalowiec
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | - Helen Broughton
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | - Fabienne Schmidli
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | - Jenny Sarah Schneider
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | | | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Johanna Anna Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Angelillo-Scherrer
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
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Simeunovic H, Dickenmann M, Nabergoj M, Baldomero H, Masouridi‐Levrat S, Nair G, Schanz U, Passweg J, Rovo A, Chalandon Y, Rebmann E. Allogeneic hematopoietic stem cell transplantation in Hodgkin lymphoma in Switzerland, 20 years of experience: 2001-2020. EJHaem 2022; 4:262-265. [PMID: 36819181 PMCID: PMC9928795 DOI: 10.1002/jha2.629] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022]
Abstract
Despite the high cure rate with initial therapy, approximately 10% of Hodgkin lymphoma (HL) patients are refractory to initial treatment, and up to 30% of patients will relapse after achieving initial complete remission. Despite promising initial results of treatment by immune checkpoint inhibitors, most patients will eventually progress. We analyzed 62 adult patients with relapsed or refractory HL (rrHL) treated by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in one of three University Hospitals of Switzerland (Zurich, Basel, and Geneva) between May 2001 and January 2020. The primary endpoint was overall survival (OS). Secondary endpoints were relapse-free survival (RFS), non-relapse mortality (NRM), and relapse incidence, which were assessed in univariate analysis. The median follow-up was 61 months (interquartile range 59-139). The 2- and 5-year OS was 54% (standard error (SE) ±12) and 50.2% (SE ±13.3), respectively, and the 2- and 5-year RFS was 40.7% (SE ±16.3) and 34.4% (SE ±19.0), respectively. NRM was 23.1% (SE ±2.2) and 27.4% (SE ±2.5) at 2 and 5 years, respectively. The cumulative incidence of relapse was 36.1% (SE ±5.6) at 2 years and 38.2% (SE ±6.6) at 5 years. Our analysis of allo-HSCT outcomes in the context of rrHL shows encouraging OS and RFS rates, with the mortality rate reaching plateau at 50% at 2 years after allo-HSCT. This confirms that allo-HSCT still remains as a potentially curative option for half of patients with rrHL.
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Affiliation(s)
| | | | | | | | | | - Gayathri Nair
- University Hospital of Zurich (USZ)ZurichSwitzerland
| | - Urs Schanz
- University Hospital of Zurich (USZ)ZurichSwitzerland
| | | | - Alicia Rovo
- University Hospital of Bern (Inselspital)BernSwitzerland
| | - Yves Chalandon
- Department of OncologyDivision of HematologyGeneva University Hospitals (HUG)GenevaSwitzerland,Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Ekaterina Rebmann
- University Hospital of Bern (Inselspital)BernSwitzerland,Hospital of Neuchâtel (RHNE)NuechatelSwitzerland
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Rebmann E, Nabergoj M, Grandjean B, Stakia P, Stern A, Medinger M, Masouridi‐Levrat S, Dantin C, Schanz U, Baldomero H, Passweg J, Nair G, Rovo A, Chalandon Y. Allogeneic hematopoietic stem cell transplantation in non-Hodgkin lymphoma in Switzerland, 30 years of experience: Sooner is better. EJHaem 2022; 4:258-261. [PMID: 36819159 PMCID: PMC9928653 DOI: 10.1002/jha2.614] [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] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/30/2022] [Indexed: 11/15/2022]
Abstract
Due to relatively high nonrelapse mortality (NRM), allogeneic hematopoietic stem cell transplantation (allo-HSCT) in non-Hodgkin's lymphoma (NHL) remains the ultimate line of treatment but the only curable approach in a setting of relapse/refractory disease. Here, we conducted a retrospective, multicenter, registry-based analysis on patients who underwent allo-HSCT for NHL in Switzerland, over 30-year (1985-2020) period. The study included 301 allo-HSCTs performed for NHL patients in three University Hospitals of Switzerland (Zurich, Basel and Geneva) 09/1985 to 05/2020. We assessed in univariate and multivariable analysis the impact on survivals (overall survival [OS], relapse free survival [RFS], relapse incidence [RI], and non-treatment related mortality [NRM]). The maximum follow-up was 25 years with median follow-up for alive patients of 61 months. The median age at allo-HSCT was 51 years. Three- and -year OS was - 59.5% and 55.4%; 3- and 5-year PFS was 50% and 44%; 3- and 5-year NRM was 21.7% and 23.6%. RI at 3 and 5 years was 27.4% and 34.9%. In conclusion, our analysis of the entire Swiss experience of allo-HSCT in patients with NHL shows promising 5- and possibly 10-year OS and relatively acceptable NRM rates for such population, the majority being not in complete remission (CR) at the time of transplantation.
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Affiliation(s)
- Ekaterina Rebmann
- Department of HematologyUniversity Hospital of Bern (Inselspital)BernSwitzerland,Department of Oncology‐HematologyHospital of Neuchâtel (RHNE)NeuchâtelSwitzerland
| | - Mitja Nabergoj
- Department of HematologyL'Hôpital Riviera‐ChablaisVaud‐ValaisSwitzerland
| | - Bastien Grandjean
- Department of HematologyUniversity Hospital of Bern (Inselspital)BernSwitzerland
| | - Paraskevi Stakia
- Department of HematologyGeneva University Hospitals (HUG)GenèveSwitzerland
| | - Alix Stern
- Department of Oncology‐HematologyHospital of Neuchâtel (RHNE)NeuchâtelSwitzerland,Faculty of MedicineUniversity of BaselBaselSwitzerland
| | - Michael Medinger
- Department of HematologyUniversity Hospital of Basel (USB)BaselSwitzerland
| | | | - Carole Dantin
- Department of HematologyGeneva University Hospitals (HUG)GenèveSwitzerland
| | - Urs Schanz
- Department of HematologyUniversity Hospital of Zurich (UZH)ZürichSwitzerland
| | - Helen Baldomero
- Department of HematologyUniversity Hospital of Basel (USB)BaselSwitzerland,SBST Data Registry OfficeUnivesiry Hospital of BaselBaselSwitzerland
| | - Jakob Passweg
- Department of HematologyUniversity Hospital of Basel (USB)BaselSwitzerland,Faculty of MedicineUniversity of BaselBaselSwitzerland
| | - Gayathri Nair
- Department of HematologyUniversity Hospital of Zurich (UZH)ZürichSwitzerland
| | - Alicia Rovo
- Department of HematologyUniversity Hospital of Bern (Inselspital)BernSwitzerland
| | - Yves Chalandon
- Department of HematologyGeneva University Hospitals (HUG)GenèveSwitzerland,Faculty of MedicineUniversity of GenevaGenevaSwitzerland
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Draxler DF, Brodard J, Zante B, Jakob SM, Wiegand J, Kremer Hovinga JA, Angelillo-Scherrer A, Rovo A. The potential impact of Covid-19 on the capacity of routine laboratory tests to detect heparin-induced thrombocytopenia. Thromb J 2022; 20:55. [PMID: 36163073 PMCID: PMC9510722 DOI: 10.1186/s12959-022-00411-0] [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: 03/21/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022] Open
Abstract
In Covid-19, anticoagulation with heparin is often administered to prevent or treat thromboembolic events. Heparin-induced thrombocytopenia (HIT) is a severe complication of heparin treatment, caused by heparin-dependent, platelet activating anti-platelet factor 4 (PF4)/heparin antibodies. Diagnosis of HIT is based on the combination of clinical parameters, allowing to determine the pretest probability, and laboratory testing for anti-PF4/heparin antibodies and confirmatory functional assays, such as the heparin-induced platelet activation (HIPA) test. We report the case of a patient with severe Covid-19 pneumonia requiring ECMO treatment, who developed recurrent clotting of the ECMO filter and a drop in platelet count under heparin treatment. He was therefore suspected to have HIT and the anticoagulation was switched to argatroban. Despite high clinical probability and high titres of anti-PF4/heparin antibodies, the functional HIPA test was negative. Nevertheless, argatroban was continued rather than to reinstate anticoagulation with heparin. Reevaluation 7 days later then demonstrated a strongly positive functional HIPA test and confirmed the diagnosis of HIT. Under anticoagulation with argatroban the patient gradually improved and was finally weaned off the ECMO. In conclusion, this case highlights the critical importance of clinical judgement, exploiting the 4 T score, given that Covid-19 patients may present a different pattern of routine laboratory test results in HIT diagnostics. The possibility of a false negative HIPA test has to be considered, particularly in early phases of presentation. In cases of a discrepancy with high clinical probability of HIT and/or high titre anti-PF4/heparin antibodies despite a negative HIPA test, a reevaluation within 3 to 5 days after the initial test should be considered in order to avoid precipitant reestablishment of unfractionated heparin, with potentially fatal consequences.
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Affiliation(s)
- Dominik F Draxler
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Bern Center for Precision Medicine, Bern, Switzerland.
| | - Justine Brodard
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Björn Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Wiegand
- Department of Intensive Care Medicine, Lindenhofspital, Bern, Switzerland
| | - Johanna A Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Angelillo-Scherrer
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Bern Center for Precision Medicine, Bern, Switzerland
| | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Vrotniakaite-Bajerciene K, Tritschler T, Jalowiec KA, Broughton H, Brodard J, Porret NA, Haynes A, Rovo A, Kremer Hovinga JA, Aujesky D, Angelillo-Scherrer A. Thrombophilia Impact on Treatment Decisions, Subsequent Venous or Arterial Thrombosis and Pregnancy-Related Morbidity: A Retrospective Single-Center Cohort Study. J Clin Med 2022; 11:jcm11144188. [PMID: 35887951 PMCID: PMC9316471 DOI: 10.3390/jcm11144188] [Citation(s) in RCA: 2] [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: 06/12/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Thrombophilia testing utility has remained controversial since its clinical introduction, because data on its influence on treatment decisions are limited. (2) Methods: We conducted a single-center retrospective cohort study of 3550 unselected patients referred for thrombophilia consultation at the Bern University Hospital in Switzerland from January 2010 to October 2020. We studied the influence of thrombophilia testing results on treatment decisions and evaluated the association between thrombophilia and thromboembolic and pregnancy-related morbidity events after testing up to 03/2021. (3) Results: In 1192/3550 patients (34%), at least one case of thrombophilia was found and 366 (10%) had high-risk thrombophilia. A total of 211/3550 (6%) work-ups (111/826 (13%) with low-risk thrombophilia and 100/366 (27%) with high-risk thrombophilia) led to an appropriate decision to extend or initiate anticoagulation, and 189 (5%) negative results led to the withholding of anticoagulation therapy inappropriately. A total of 2492 patients (69%) were followed up for >30 days, with a median follow-up of 49 months (range, 1−183 months). Patients with high-risk thrombophilia had a higher risk of subsequent venous thromboembolic events and pregnancy-related morbidity compared to those without thrombophilia. (4) Conclusions: Our study demonstrated the limited usefulness of thrombophilia work-up in clinical decision-making. High-risk thrombophilia was associated with subsequent venous thromboembolism and pregnancy-related morbidity.
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Affiliation(s)
- Kristina Vrotniakaite-Bajerciene
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
- Correspondence:
| | - Tobias Tritschler
- Department of General Internal Medicine, Bern University Hospital, 3010 Bern, Switzerland; (T.T.); (D.A.)
| | - Katarzyna Aleksandra Jalowiec
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
| | - Helen Broughton
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Justine Brodard
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Naomi Azur Porret
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Alan Haynes
- Clinical Trials Unit Bern, University of Bern, 3012 Bern, Switzerland;
| | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Johanna Anna Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, 3010 Bern, Switzerland; (T.T.); (D.A.)
| | - Anne Angelillo-Scherrer
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
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8
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Phelan R, Im A, Hunter RL, Inamoto Y, Lupo-Stanghellini MT, Rovo A, Badawy SM, Burns L, Eissa H, Murthy HS, Prasad P, Sharma A, Suelzer E, Agrawal V, Aljurf M, Baker K, Basak GW, Buchbinder D, DeFilipp Z, Grkovic LD, Dias A, Einsele H, Eisenberg ML, Epperla N, Farhadfar N, Flatau A, Gale RP, Greinix H, Hamilton BK, Hashmi S, Hematti P, Jamani K, Maharaj D, Murray J, Naik S, Nathan S, Pavletic S, Peric Z, Pulanic D, Ross R, Salonia A, Sanchez-Ortega I, Savani BN, Schechter T, Shah AJ, Smith SM, Snowden JA, Steinberg A, Tremblay D, Vij SC, Walker L, Wolff D, Yared JA, Schoemans H, Tichelli A. Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Bone Marrow Transplant 2022; 57:1150-1163. [PMID: 35523848 DOI: 10.1038/s41409-022-01591-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. We provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. The systematic review summarizes incidence, risk factors, screening, prevention and treatment of these complications and provides consensus evidence-based recommendations for clinical practice and future research.
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Affiliation(s)
- Rachel Phelan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Annie Im
- University of Pittsburgh/UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Rebecca L Hunter
- Division of Hematology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Burns
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hesham Eissa
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Pinki Prasad
- Louisiana State University Health Sciences Center/Children's Hospital of New Orleans, Department of Pediatrics, New Orleans, LA, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Vaibhav Agrawal
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Karen Baker
- Duke University Medical Center, Durham, NC, USA
| | - Grzegorz W Basak
- University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hermann Einsele
- Universitätsklinikum Würzburg, Department of Internal Medicine II, Würzburg, Germany
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Arthur Flatau
- Association of Cancer Online Resources, Association of Cancer Online Resources, Austin, TX, USA
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | | | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Kareem Jamani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Dipnarine Maharaj
- South Florida Bone Marrow Stem Cell Transplant Institute, Boynton Beach, FL, USA
| | - John Murray
- The Christie NHS Foundation Trust, Manchester, UK
| | - Seema Naik
- Division Hematology and Oncology, Department of Medicine, Penn State Cancer Institute, Milton Hershey Medical Center, Hershey, PA, USA
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Steven Pavletic
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Zinaida Peric
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | - Drazen Pulanic
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | | | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tal Schechter
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ami J Shah
- Division of Hematology/ Oncology/ Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA, USA
| | - Stephanie M Smith
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - John A Snowden
- The University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Douglas Tremblay
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lauren Walker
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Daniel Wolff
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Hélène Schoemans
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
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9
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Greenfield DM, Salooja N, Peczynski C, van der Werf S, Schoemans H, Hill K, Cortelezzi A, Lupo-Stangellini M, Özkurt ZN, Arat M, Metzner B, Turlure P, Rovo A, Socié G, Mohty M, Nagler A, Kröger N, Dreger P, Labopin M, Han TS, Tichelli A, Duarte R, Basak G, Snowden JA. Metabolic syndrome and cardiovascular disease after haematopoietic cell transplantation (HCT) in adults: an EBMT cross-sectional non-interventional study. Bone Marrow Transplant 2021; 56:2820-2825. [PMID: 34274955 PMCID: PMC8563418 DOI: 10.1038/s41409-021-01414-7] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/28/2021] [Accepted: 07/07/2021] [Indexed: 12/03/2022]
Abstract
Metabolic syndrome (MetS) is associated with cardiovascular disease in the general population and is also a potential cardiovascular risk factor in survivors of haematopoietic cell transplantation (HCT). We report an EBMT cross-sectional, multi-centre, non-interventional study of 453 adult HCT patients surviving a minimum of 2 years post-transplant attending routine follow-up HCT and/or late effects clinics in 9 centres. The overall prevalence of MetS was 37.5% rising to 53% in patients >50 years of age at follow-up. There were no differences in rates of MetS between autologous and allogeneic HCT survivors, nor any association with graft-versus-host disease (GvHD) or current immunosuppressant therapy. Notably, there was a significantly higher occurrence of cardiovascular events (CVE, defined as cerebrovascular accident, coronary heart disease or peripheral vascular disease) in those with MetS than in those without MetS (26.7% versus 9%, p < 0.001, OR 3.69, 95% CI 2.09-6.54, p < 0.001), and, as expected, MetS and CVE were age-related. Unexpectedly, CVE were associated with occurrence of second malignancy. Screening for and management of MetS should be integrated within routine HCT long-term follow-up care for both allogeneic and autologous HCT survivors. Further research is warranted, including randomised controlled trials of interventional strategies and mechanistic studies of cardiovascular risk in HCT survivors.
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Affiliation(s)
- D M Greenfield
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | | | | | | | - H Schoemans
- Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - K Hill
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Cortelezzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Z N Özkurt
- Gazi University Hospital, Ankara/Turkey, Ankara, Turkey
| | - M Arat
- Sisli Florence Nightingale Hospital, Istanbul, Turkey
| | - B Metzner
- Klinikum Oldenburg, Oldenburg, Germany
| | | | - A Rovo
- University Hospital Bern, Bern, Switzerland
| | - G Socié
- Hospital St. Louis, Paris, France
| | - M Mohty
- Saint-Antoine Hospital, Sorbonne University, INSERM UMRs 938, Paris, France
| | - A Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - N Kröger
- University Hospital Eppendorf, Hamburg, Germany
| | - P Dreger
- University of Heidelberg, Heidelberg, Germany
| | - M Labopin
- EBMT Paris Study Office, Paris, France
| | - T S Han
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
| | | | - R Duarte
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - G Basak
- The Medical University of Warsaw, Warsaw, Poland
| | - J A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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10
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Schär DT, Daskalakis M, Mansouri B, Rovo A, Zeerleder S. Thromboembolic complications in autoimmune hemolytic anemia: Retrospective study. Eur J Haematol 2021; 108:45-51. [PMID: 34551149 PMCID: PMC9297871 DOI: 10.1111/ejh.13710] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 01/09/2023]
Abstract
Introduction A small number of retrospective studies suggest AIHA to be associated with an increased risk to suffer from thromboembolic events. However, based on these studies it remains unclear whether the complement activation per is a risk factor to develop thromboembolic events in AIHA patients. The aim of this retrospective study is to investigate the incidence of thromboembolic events and the relation to complement activation in a cohort of AIHA patients. Patients and Methods We included 77 patients in this study with a positive DAT and hemolytic parameters or with AIHA diagnosis based on the medical report. The included patients were screened for thromboembolic events (TEE) and have been stratified in groups with and without complement activation based on the positivity for complement in the DAT. Results Of the 77 included patients, 51 (66%) had warm AIHA, 13 (17%) cold‐AIHA, 5 (7%) mixed AIHA, and 8 (10%) atypical AIHA, respectively. Primary and secondary AIHA was diagnosed in 44% and 56%, respectively. Twenty patients (26%) suffered from TEE. The majority (80%) of these patients suffered from warm AIHA and 10% from cold‐AIHA. Hemolysis parameters did not differ in patients with and without TEE. There was no correlation with complement activation as evidenced by a positivity for complement in the monospecific DAT with the occurrence of TEE. Conclusion AIHA is associated with an increased risk of TEE. Based on these results prophylactic anticoagulation might be considered as soon as the diagnosis of AIHA is confirmed.
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Affiliation(s)
- Deborah Tabita Schär
- Department Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Michael Daskalakis
- Department Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Behrouz Mansouri
- Department Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Alicia Rovo
- Department Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Sacha Zeerleder
- Department Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland.,Division Research, Department of Immunopathology, Sanquin Blood Supply, Amsterdam, the Netherlands
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11
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De Gottardi J, Montani M, Angelillo-Scherrer A, Rovo A, Berzigotti A. Hepatic sinusoidal hemophagocytosis with and without hemophagocytic lymphohistiocytosis. PLoS One 2019; 14:e0226899. [PMID: 31887162 PMCID: PMC6936840 DOI: 10.1371/journal.pone.0226899] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/PURPOSE Hemophagocytic lymphohistiocytosis (HLH) is a rare, life threatening hyperinflammatory syndrome. Sinusoidal hemophagocytosis is occasionally observed on liver biopsy in patients who do not have clinical suspicion of HLH. We aimed at comparing the clinical characteristics and outcomes of patients with signs of hemophagocytosis on liver biopsy meeting and not meeting the HLH diagnostic criteria. METHODS We reviewed the clinical, laboratory features and outcomes of all adult patients consecutively admitted in our center between 08/2011 and 08/2017 presenting with liver histology showing sinusoidal hemophagocytosis and of critically ill patients presenting with severe liver disease in whom hemophagocytosis was histologically confirmed. The characteristics of patients fulfilling and not fulfilling the diagnostic criteria of HLH were compared. RESULTS We identified 12 cases (58% male, median age 61, 75% with a chronic underlying disease) with liver histology showing sinusoidal hemophagocytosis. All had at least some of the clinical features typically associated with HLH. Six were critical ill patients. In 4 cases with insufficient laboratory and clinical criteria, liver biopsy allowed to confirm the HLH diagnosis. Six patients died, of which four met the diagnostic criteria for HLH. Two patients with chronic liver disease died despite not fulfilling the diagnostic criteria of HLH. CONCLUSION Hemophagocytosis on liver biopsy may contribute to confirming a diagnosis of HLH in suspected cases with indeterminate clinical and laboratory findings. Sinusoidal hemophagocytosis in patients with cirrhosis was associated with bad outcome.
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Affiliation(s)
- Jacqueline De Gottardi
- Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, DBMR, University of Bern, Berne, Switzerland
| | - Matteo Montani
- Institute of Pathology, University of Bern, Berne, Switzerland
| | | | - Alicia Rovo
- Department of Hematology, Inselspital, University of Bern, Berne, Switzerland
| | - Annalisa Berzigotti
- Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, DBMR, University of Bern, Berne, Switzerland
- * E-mail:
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12
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Lawitschka A, Schwarze P, Rovelli A, Badoglio M, Socie G, Tichelli A, Bauer D, Rovo A, Basak G, Schoemans H, Peters C, Salooja N. Management of growth failure and growth hormone deficiency after pediatric allogeneic HSCT: Endocrinologists are of importance for further guidelines and studies. Pediatr Hematol Oncol 2019; 36:494-503. [PMID: 31633441 DOI: 10.1080/08880018.2019.1670764] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Growth failure (GF) is a frequent problem after pediatric allogeneic hematopoietic stem cell transplantation (HSCT). Growth hormone deficiency (GHD) occurs in 20 to 85%, but published data on the efficacy of growth hormone treatment (GHT) are conflicting. Currently, there are no recommendations on screening for and treatment of GHD after HSCT. We aimed to describe the management of endocrine follow-up (FU)and details of GHT within European Society for Blood and Marrow Transplantation (EBMT) centers.In a retrospective questionnaire study, all EBMT centers performing pediatric HSCT were invited. Results were evaluated in correlation with the structure of endocrine aftercare (HSCT-clinicians and endocrinologists).The majority of centers (80%) reported endocrine FU by an endocrinologist - either within the HSCT-center or in a separate endocrine clinic. Fifty-four percent reported FU outside of the HSCT-center. As diagnostic tests the insulin-like growth factor IGF-I and insulin-like growth factor binding protein IGFBP3, insulin tolerance test and arginine stimulation test were most frequently used. Sixty-four percent of centers performed GHT and endocrinologists were more likely to prescribe GH (74%) compared to HSCT-clinicians (33%). The most frequent indication for GHT was GHD in 60%, with a distinct different approach of endocrinologists in comparison with HSCT-clinicians.Our study reveals substantial variation in practice and emphasizes the need for endocrine aftercare performed by dedicated endocrinologists in close collaboration with the HSCT-center. Our results indicate that the management of GHT depends on the structure of endocrine aftercare, which is important for the future development and distribution of studies and guidelines.
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Affiliation(s)
- A Lawitschka
- St. Anna Children's Hospital, Vienna Medical University, Vienna, Austria
| | - P Schwarze
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital, Tuebingen, Germany
| | - A Rovelli
- MBBM Foundation, Bone Marrow Transplantation Unit, Pediatric Department of Milano-Bicocca University, Monza, Italy
| | - M Badoglio
- Department of Haematology, EBMT Paris Study Office, Saint Antoine Hospital, Paris, France
| | - G Socie
- Department of Hematology, Hôpital Saint Louis, Paris, France
| | - A Tichelli
- Department for Haematology, University Hospital Basel, Basel, Switzerland
| | - D Bauer
- St. Anna Children's Hospital, Vienna Medical University, Vienna, Austria
| | - A Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern
| | - G Basak
- Department of Hematology, Oncology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - H Schoemans
- Department of Hematology, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - C Peters
- St. Anna Children's Hospital, Vienna Medical University, Vienna, Austria
| | - N Salooja
- Centre for Haematology, Imperial College London, London, UK
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13
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Moiseev IS, Tsvetkova T, Aljurf M, Alnounou RM, Bogardt J, Chalandon Y, Drokov MY, Dvirnyk V, Faraci M, Friis LS, Giglio F, Greinix HT, Kornblit BT, Koelper C, Koenecke C, Lewandowski K, Niederwieser D, Passweg JR, Peczynski C, Penack O, Peric Z, Piekarska A, Ronchi PE, Rovo A, Rzepecki P, Scuderi F, Sigrist D, Siitonen SM, Stoelzel F, Sulek K, Tsakiris DA, Wilkowojska U, Duarte RF, Ruutu T, Basak GW. Clinical and morphological practices in the diagnosis of transplant-associated microangiopathy: a study on behalf of Transplant Complications Working Party of the EBMT. Bone Marrow Transplant 2018; 54:1022-1028. [DOI: 10.1038/s41409-018-0374-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 11/09/2022]
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14
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Bürki S, Shumilov E, Bonadies N, Flach J, Legros M, Banz Y, Oppliger-Leibundgut E, Fiedler M, Angelillo-Scherrer A, Rovo A, Bacher U. Coincidence of 5q deletion and the JAK2V617F mutation: report of two patients with overlapping myelodysplastic and myeloproliferative features and review of the literature. Leuk Lymphoma 2018; 59:2233-2237. [PMID: 29295644 DOI: 10.1080/10428194.2017.1416367] [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] [Indexed: 10/18/2022]
Affiliation(s)
- Susanne Bürki
- a Department of Haematology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Evgenii Shumilov
- b Department of Haematology and Clinical Oncology , University Medicine Göttingen (UMG) , Göttingen , Germany
| | - Nicolas Bonadies
- a Department of Haematology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Johanna Flach
- b Department of Haematology and Clinical Oncology , University Medicine Göttingen (UMG) , Göttingen , Germany.,c Institute of Molecular Oncology , University Medicine Göttingen (UMG) , Göttingen , Germany
| | - Myriam Legros
- a Department of Haematology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.,d Center of Laboratory Medicine (ZLM) , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Yara Banz
- e Institute of Pathology , University of Bern , Bern , Switzerland
| | - Elisabeth Oppliger-Leibundgut
- a Department of Haematology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.,f Department of Clinical Research , University of Bern , Bern , Switzerland
| | - Martin Fiedler
- d Center of Laboratory Medicine (ZLM) , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Anne Angelillo-Scherrer
- a Department of Haematology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Alicia Rovo
- a Department of Haematology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Ulrike Bacher
- a Department of Haematology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.,d Center of Laboratory Medicine (ZLM) , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
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15
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Glier H, Heijnen I, Hauwel M, Dirks J, Quarroz S, Lehmann T, Rovo A, Arn K, Matthes T, Hogan C, Keller P, Dudkiewicz E, Stüssi G, Fernandez P. Standardization of 8-color flow cytometry across different flow cytometer instruments: A feasibility study in clinical laboratories in Switzerland. J Immunol Methods 2017; 475:112348. [PMID: 28760670 DOI: 10.1016/j.jim.2017.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 04/30/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 02/03/2023]
Abstract
The EuroFlow Consortium developed a fully standardized flow cytometric approach from instrument settings, through antibody panel, reagents and sample preparation protocols, to data acquisition and analysis. The Swiss Cytometry Society (SCS) promoted a study to evaluate the feasibility of using such standardized measurements of 8-color data across two different flow cytometry platforms - Becton Dickinson (BD) FACSCanto II and Beckman Coulter (BC) Navios, aiming at increasing reproducibility and inter-laboratory comparability of immunophenotypic data in clinical laboratories in Switzerland. The study was performed in two phases, i.e. a learning phase (round 1) and an analytical phase (rounds 2 and 3) consisting of a total of three rounds. Overall, 10 laboratories using BD FACSCanto II (n=6) or BC Navios (n=4) flow cytometers participated. Each laboratory measured peripheral blood samples from healthy donors stained with a uniform antibody panel of reagents - EuroFlow Lymphoid Screening Tube (LST) - applying the EuroFlow standardized protocols for instrument setup and sample preparation (www.EuroFlow.org). All data files were analyzed centrally and median fluorescence intensity (MedFI) values for individual markers on defined lymphocyte subsets were recorded; variability from reference MedFI values was assessed using performance scores. Data troubleshooting and discussion of the results with the participants followed after each round at SCS meetings. The results of the learning phase demonstrated that standardized instrument setup and data acquisition are feasible in routine clinical laboratories without previous experience with EuroFlow. During the analytical phase, highly comparable data were obtained at the different laboratories using either BD FACSCanto II or BC Navios. The coefficient of variation of MedFI for 7 of 11 markers performed repeatedly below 30%. In the last study round, 89% of participants scored over 90% MedFI values within the acceptance criteria (P-score), in line with the results of the EuroFlow quality assessment rounds performed by the EuroFlow expert laboratories(Kalina et al., 2015). Central analysis of data allowed identification of deviations from the standardized procedures and technical issues (e.g. failure to perform correct instrument setup and improper compensation). In summary, here we show that inter-laboratory cross-platform standardization of 8-color flow cytometric measurements in clinical laboratories is feasible and allows for fully comparable MedFI results across BD FACSCanto II and BC Navios instruments. However, adherence to standardized protocols is crucial. Thus, training of the laboratory personnel in the EuroFlow standardized procedures is highly recommended to prevent errors in instrument setup and sample preparation.
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Affiliation(s)
- Hana Glier
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
| | - Ingmar Heijnen
- Medical Immunology, University Hospital Basel, Basel, Switzerland
| | - Mathieu Hauwel
- Hematology Laboratory, Geneva University Hospital, Geneva, Switzerland
| | - Jan Dirks
- Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Stéphane Quarroz
- Hematology Laboratory, Vaudoise University Hospital Center, Lausanne, Switzerland
| | - Thomas Lehmann
- Clinical Chemistry, Hematology and Immunology Laboratory, Center for Laboratory Medicine, St. Gallen, Switzerland
| | - Alicia Rovo
- Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Kornelius Arn
- Center for Laboratory Medicine, Cantonal Hospital, Lucerne, Switzerland
| | - Thomas Matthes
- Hematology Laboratory, Geneva University Hospital, Geneva, Switzerland
| | - Cassandra Hogan
- Hematology Laboratory, Geneva University Hospital, Geneva, Switzerland
| | - Peter Keller
- University Clinic of Hematology, Inselspital/University Hospital Bern, University of Bern, Switzerland
| | - Ewa Dudkiewicz
- Hematology Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Georg Stüssi
- Hematology Laboratory, Oncology Institute of Southern Switzerland and EOLAB, Regional Hospital of Bellinzona and Valli, Bellinzona, Switzerland
| | - Paula Fernandez
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
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16
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Bonadies N, Feller A, Rovo A, Ruefer A, Blum S, Gerber B, Stuessi G, Benz R, Cantoni N, Holbro A, Schmidt A, Lehmann T, Wilk CM, Arndt V. Trends of classification, incidence, mortality, and survival of MDS patients in Switzerland between 2001 and 2012. Cancer Epidemiol 2017; 46:85-92. [PMID: 28056392 DOI: 10.1016/j.canep.2016.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 09/11/2016] [Revised: 11/17/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
Abstract
Myelodysplastic syndromes (MDS) are emerging disorders of the elderly with an increasing burden on healthcare systems. He we report on the first population-based, epidemiological analysis of patients diagnosed with MDS in Switzerland between 2001 and 2012. The aim of this study was to characterize the extent and limitations of currently available population-based, epidemiological data and formulate recommendations for future health services research. The investigated outcomes comprised trends of annual case frequency, classification of morphological subtypes, incidence, mortality and survival. Annual case frequency increased by 20% (from 263 to 315 cases per year), whereas age-standardized incidence-/mortality-rates remained stable (2.5/1.1 per 100'000 person-years). This observation reflects population growth as well as higher diagnostic awareness and not an increase of age-specific risk. However, it will inevitably influence the future prevalence of MDS and the impact on healthcare systems. Reporting of classification in MDS subtypes was poor with modest improvement from 20% to 39% and increased awareness for mainly higher-risk diseases. Relative survival for all patients at 5-years (RS) ranged between 37 and 40%. Significant better RS was found for younger compared to older higher-risk MDS patients (48% vs. 17%), reflecting the effect of allogeneic hematopoietic stem-cell transplantation. However, no survival advantage was found in elderly patients after introduction of hypomethylating agents as standard for care in this patient group. Our data is in line with results from other MDS and cancer registries. It allows formulating recommendations for future collaborative health services research on MDS patients with national and international partners.
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Affiliation(s)
- Nicolas Bonadies
- Department of Haematology and Central Haematology Laboratory, Inselspital Bern, University Hospital and University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Anita Feller
- Foundation National Institute for Cancer Epidemiology and Registration (NICER) c/o University of Zurich, Seilergraben 49, CH-8001 Zurich, Switzerland
| | - Alicia Rovo
- Department of Haematology and Central Haematology Laboratory, Inselspital Bern, University Hospital and University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Axel Ruefer
- Division of Haematology and Central Haematology Laboratory, Cantonal Hospital Lucern, Spitalstrasse, CH-6000 Luzern 16, Switzerland
| | - Sabine Blum
- Service and Central Laboratory of Haematology, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Bernhard Gerber
- Clinic of Haematology, Oncology Institute of Southern Switzerland, Via Ospedale, CH-6500 Bellinzona, Switzerland
| | - Georg Stuessi
- Clinic of Haematology, Oncology Institute of Southern Switzerland, Via Ospedale, CH-6500 Bellinzona, Switzerland
| | - Rudolf Benz
- Cantonal Hospital Muensterlingen, Spitalcampus 1, CH-8596, Muensterlingen, Switzerland
| | - Nathan Cantoni
- Division of Haematology, University Clinic of Medicine, Kantonsspital Aarau AG, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Andreas Holbro
- Clinic of Haematology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Adrian Schmidt
- Clinic of Medical Oncology and Haematology, City Hospital Triemli Zurich, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland
| | - Thomas Lehmann
- Centre of Laboratory Medicine, Cantonal Hospital St. Gallen, Frohbergstrasse 3, CH-9001 St. Gallen, Switzerland
| | - C Matthias Wilk
- Haematology, University and University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Volker Arndt
- Foundation National Institute for Cancer Epidemiology and Registration (NICER) c/o University of Zurich, Seilergraben 49, CH-8001 Zurich, Switzerland
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18
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Stuehler C, Stüssi G, Halter J, Nowakowska J, Schibli A, Battegay M, Dirks J, Passweg J, Heim D, Rovo A, Kalberer C, Bucher C, Weisser M, Dumoulin A, Hirsch HH, Khanna N. Combination therapy for multidrug-resistant cytomegalovirus disease. Transpl Infect Dis 2015; 17:751-5. [PMID: 26432076 DOI: 10.1111/tid.12435] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 04/17/2015] [Revised: 06/16/2015] [Accepted: 07/26/2015] [Indexed: 11/30/2022]
Abstract
Multidrug-resistant (MDR) cytomegalovirus (CMV) emerged after transient responses to ganciclovir, foscarnet, and cidofovir in a CMV-seropositive recipient who underwent allogeneic hematopoietic stem cell transplantation from a CMV-seronegative donor. Experimental treatments using leflunomide and artesunate failed. Re-transplantation from a CMV-seropositive donor supported by adoptive transfer of pp65-specific T cells and maribavir was followed by lasting suppression. This case illustrates that successful MDR CMV therapy may require individualized multidisciplinary approaches.
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Affiliation(s)
- C Stuehler
- Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland
| | - G Stüssi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - J Halter
- Division of Hematology, Department of Biomedicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - J Nowakowska
- Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland
| | - A Schibli
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - M Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - J Dirks
- Division of Hematology, Department of Biomedicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - J Passweg
- Division of Hematology, Department of Biomedicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - D Heim
- Division of Hematology, Department of Biomedicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - A Rovo
- Division of Hematology, Department of Biomedicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - C Kalberer
- Division of Hematology, Department of Biomedicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - C Bucher
- Division of Hematology, Department of Biomedicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - M Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - A Dumoulin
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - H H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland.,Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - N Khanna
- Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
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Dufour C, Veys P, Carraro E, Bhatnagar N, Pillon M, Wynn R, Gibson B, Vora AJ, Steward CG, Ewins AM, Hough RE, de la Fuente J, Velangi M, Amrolia PJ, Skinner R, Bacigalupo A, Risitano AM, Socie G, Peffault de Latour R, Passweg J, Rovo A, Tichelli A, Schrezenmeier H, Hochsmann B, Bader P, van Biezen A, Aljurf MD, Kulasekararaj A, Marsh JC, Samarasinghe S. Similar outcome of upfront-unrelated and matched sibling stem cell transplantation in idiopathic paediatric aplastic anaemia. A study on behalf of the UK Paediatric BMT Working Party, Paediatric Diseases Working Party and Severe Aplastic Anaemia Working Party of EBMT. Br J Haematol 2015. [PMID: 26223288 DOI: 10.1111/bjh.13614] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [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: 01/12/2023]
Abstract
We explored the feasibility of unrelated donor haematopoietic stem cell transplant (HSCT) upfront without prior immunosuppressive therapy (IST) in paediatric idiopathic severe aplastic anaemia (SAA). This cohort was then compared to matched historical controls who had undergone first-line therapy with a matched sibling/family donor (MSD) HSCT (n = 87) or IST with horse antithymocyte globulin and ciclosporin (n = 58) or second-line therapy with unrelated donor HSCT post-failed IST (n = 24). The 2-year overall survival in the upfront cohort was 96 ± 4% compared to 91 ± 3% in the MSD controls (P = 0·30) and 94 ± 3% in the IST controls (P = 0·68) and 74 ± 9% in the unrelated donor HSCT post-IST failure controls (P = 0·02).The 2-year event-free survival in the upfront cohort was 92 ± 5% compared to 87 ± 4% in MSD controls (P = 0·37), 40 ± 7% in IST controls (P = 0·0001) and 74 ± 9% in the unrelated donor HSCT post-IST failure controls (n = 24) (P = 0·02). Outcomes for upfront-unrelated donor HSCT in paediatric idiopathic SAA were similar to MSD HSCT and superior to IST and unrelated donor HSCT post-IST failure. Front-line therapy with matched unrelated donor HSCT is a novel treatment approach and could be considered as first-line therapy in selected paediatric patients who lack a MSD.
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Affiliation(s)
- Carlo Dufour
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Paul Veys
- Department of Haematology & Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Elisa Carraro
- Paediatric Haematology and Oncology, University of Padova, Padova, Italy
| | - Neha Bhatnagar
- Department of Haematology & Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marta Pillon
- Paediatric Haematology and Oncology, University of Padova, Padova, Italy
| | - Rob Wynn
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Brenda Gibson
- Department of Paediatric Haematology & Oncology, Royal Hospital for Sick Children, Glasgow, UK
| | - Ajay J Vora
- Department of Paediatric Haematology, The Children's Hospital, Sheffield, UK
| | | | - Anna M Ewins
- Department of Paediatric Haematology & Oncology, Royal Hospital for Sick Children, Glasgow, UK
| | | | - Josu de la Fuente
- Division of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | | | - Persis J Amrolia
- Department of Haematology & Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology and BMT, Great North Children's Hospital & Northern Institute for Cancer Research, Newcastle upon Tyne, UK
| | - Andrea Bacigalupo
- Haematology and Oncology Department, IRCCS A.O.U. San Martino Hospital, IST, Genoa, Italy
| | | | | | | | - Jakob Passweg
- Stem Cell Transplant Team, Division of Haematology, University Hospital Basel, Basel, Switzerland
| | - Alicia Rovo
- Haematology, University Hospital of Basel, Basel, Switzerland
| | - André Tichelli
- Haematology, University Hospital of Basel, Basel, Switzerland
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Transfusion Service Baden-Württemberg-Hessen und University Hospital Ulm, Ulm, Germany
| | - Britta Hochsmann
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Transfusion Service Baden-Württemberg-Hessen und University Hospital Ulm, Ulm, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Anja van Biezen
- EBMT Data Office, University Medical Centre, Leiden, The Netherlands
| | - Mahmoud D Aljurf
- Adult Haematology/HSCT Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Austin Kulasekararaj
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Judith C Marsh
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Sujith Samarasinghe
- Department of Haematology & Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Dufour C, Pillon M, Passweg J, Socié G, Bacigalupo A, Franceschetto G, Carraro E, Oneto R, Risitano AM, Peffault de Latour R, Tichelli A, Rovo A, Peters C, Hoechsmann B, Samarasinghe S, Kulasekararaj AG, Schrezenmeier H, Aljurf M, Marsh J. Outcome of aplastic anemia in adolescence: a survey of the Severe Aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation. Haematologica 2014; 99:1574-81. [PMID: 25085353 DOI: 10.3324/haematol.2014.106096] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We analyzed the outcome of 537 adolescents (age 12-18 years) with idiopathic aplastic anemia included in the database of the Severe Aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation comparing: i) matched family donor hematopoietic stem cell transplantation performed as first-line treatment with ii) front-line immunosuppressive therapy not followed by subsequent transplant given for failure and with iii) hematopoietic stem cell transplantation performed after failed front-line immunosuppressive therapy. Overall survival was 86% in the matched family donor hematopoietic stem cell transplantation group, 90% in patients given front-line immunosuppressive alone (those who did not fail this treatment and who did not receive subsequent rescue with hematopoietic stem cell transplantation) and 78% in subjects who underwent hematopoietic stem cell transplantation post failed front-line immunosuppressive therapy (P=0.14). Event-free survival in the same groups was respectively 83%, 64% and 71% (P=0.04). Cumulative incidence of rejection was 8% in matched family donor hematopoietic stem cell transplantation and 9% in transplants post failed front-line immunosuppression (P=0.62). Cumulative incidence of acute graft-versus-host disease was 12% in matched family donor transplants and 18% in transplants post failed immunosuppression (P=0.18). Chronic graft-versus-host disease was higher in matched family donor hematopoietic stem cell transplantation (8%) than in transplants post failed immunosuppressive therapy (20%) (P=0.0009). Cumulative incidence of post-therapy malignancies was 0.7% in matched family donor transplantations, 7% in transplantations post failed immunosuppression and 21% after front-line immunosuppression (P=0.0017). In the whole cohort, under multivariate analysis, the diagnosis to treatment interval of two months or under positively affected overall survival whereas up-front immunosuppression alone (with no subsequent rescue transplants) negatively affected event-free survival. In transplanted patients an interval from diagnosis to treatment of 2 months or under, bone marrow as source of cells and first-line matched family donor transplants provided a significant advantage in overall and event-free survival. Aplastic anemia in adolescents has a very good outcome. If a matched family donor is available, hematopoietic stem cell transplantation using bone marrow cells is the first choice treatment. If such a donor is not available, immunosuppressive treatment may still be an acceptable second choice, also because, in case of failure, hematopoietic stem cell transplantation is a very good rescue option.
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Affiliation(s)
- Carlo Dufour
- Clinical and Experimental Hematology Unit. G Gaslini Childrens' Hospital, Genova, Italy
| | - Marta Pillon
- Pediatric Hemato-Oncology Clinic, University of Padova, Italy
| | | | - Gerard Socié
- Department of Hematology, Hospital St Louis, Paris, France
| | | | | | - Elisa Carraro
- Pediatric Hemato-Oncology Clinic, University of Padova, Italy
| | - Rosi Oneto
- Second Division of Hematology, San Martino Hospital, Genova, Italy
| | - Antonio Maria Risitano
- Hematology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | | | | | | | - Christina Peters
- Pediatric Hematopoietic Stem Cell Transplantation, St Anna Kinderspital, Vienna, Austria
| | - Britta Hoechsmann
- Institut for Clinical Transfusion Medicine and Immunogenetics, and Department of Transfusion Medicine University of Ulm, Germany
| | - Sujith Samarasinghe
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS. Current address: Great Ormond Street Children's Hospital, London UK
| | - Austin G Kulasekararaj
- Department of Haematological Medicine, King's College Hospital/King's College London, UK
| | - Hubert Schrezenmeier
- Institut for Clinical Transfusion Medicine and Immunogenetics, and Department of Transfusion Medicine University of Ulm, Germany
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Saudi Arabia
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, UK
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O'Meara A, Holbro A, Meyer S, Martinez M, Medinger M, Buser A, Halter J, Heim D, Gerull S, Bucher C, Rovo A, Kühne T, Tichelli A, Gratwohl A, Stern M, Passweg JR. Forty years of haematopoietic stem cell transplantation: a review of the Basel experience. Swiss Med Wkly 2014; 144:w13928. [PMID: 24567259 DOI: 10.4414/smw.2014.13928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to examine changes in haematopoietic stem cell transplant (HSCT) characteristics and outcome in our combined paediatric and adult programme over the past four decades, since its implementation in 1973. The total number of transplant procedures rose from 109 in the first decade (1973-82) to 939 in the last decade (2003-12). Transplant characteristics changed significantly over time: patient age increased, peripheral blood largely replaced bone marrow as stem cell source, unrelated donors became an alternative to matched siblings, and patients are increasingly transplanted in more advanced disease stages. Advances such as improved supportive care and histocompatibility typing resulted in a steady decrease of transplant-related mortality after allogeneic HSCT (43% in the first decade, 22% in the last decade). Despite this, unadjusted survival rates were stable in the last three decades for allogeneic HSCT (approximately 50% 5-year survival) and in the last two decades for autologous HSCT (approximately 60% 5-year survival). After adjustment for covariates such as donor type, age and stage, the relative risk of treatment failure continuously dropped (for allogeneic HSCT: first decade 1.0, second decade 0.58, third decade 0.51, last decade 0.41). Collectively, these data suggest that improvements in peri- and post-transplant care have allowed considerable extension of transplant indications without having a negative impact on outcome.
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Affiliation(s)
- Alix O'Meara
- Behandlungszentrum Stammzelltransplantation, Basel University Hospital, SWITZERLAND;
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Fernandez P, Solenthaler M, Spertini O, Quarroz S, Rovo A, Lovey PY, Leoncini L, Ruault-Jungblut S, D’Asaro M, Schaad O, Docquier M, Descombes P, Matthes T. Using digital RNA counting and flow cytometry to compare mRNA with protein expression in acute leukemias. PLoS One 2012; 7:e49010. [PMID: 23152841 PMCID: PMC3494663 DOI: 10.1371/journal.pone.0049010] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 10/03/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The diagnosis of malignant hematologic diseases has become increasingly complex during the last decade. It is based on the interpretation of results from different laboratory analyses, which range from microscopy to gene expression profiling. Recently, a method for the analysis of RNA phenotypes has been developed, the nCounter technology (Nanostring® Technologies), which allows for simultaneous quantification of hundreds of RNA molecules in biological samples. We evaluated this technique in a Swiss multi-center study on eighty-six samples from acute leukemia patients. METHODS mRNA and protein profiles were established for normal peripheral blood and bone marrow samples. Signal intensities of the various tested antigens with surface expression were similar to those found in previously performed Affymetrix microarray analyses. Acute leukemia samples were analyzed for a set of twenty-two validated antigens and the Pearson Correlation Coefficient for nCounter and flow cytometry results was calculated. RESULTS Highly significant values between 0.40 and 0.97 were found for the twenty-two antigens tested. A second correlation analysis performed on a per sample basis resulted in concordant results between flow cytometry and nCounter in 44-100% of the antigens tested (mean = 76%), depending on the number of blasts present in a sample, the homogeneity of the blast population, and the type of leukemia (AML or ALL). CONCLUSIONS The nCounter technology allows for fast and easy depiction of a mRNA profile from hematologic samples. This technology has the potential to become a valuable tool for the diagnosis of acute leukemias, in addition to multi-color flow cytometry.
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Affiliation(s)
| | - Max Solenthaler
- University Clinic for Hematology and Central Hematology Laboratory, Inselspital Bern and University of Bern, Bern, Switzerland
| | - Olivier Spertini
- Hematology Service, CHUV, University Hospital Lausanne, Lausanne, Switzerland
| | - Stephane Quarroz
- Hematology Service, CHUV, University Hospital Lausanne, Lausanne, Switzerland
| | - Alicia Rovo
- Hematology Department, University Hospital Basel, Basel, Switzerland
| | - Pierre-Yves Lovey
- Hematology Service, Institut Central des Hôpitaux Valaisans, Sion, Switzerland
| | - Leda Leoncini
- Hematology Service, Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | | | - Mathilde D’Asaro
- Hematology Service, University Hospital Geneva, Geneva, Switzerland
| | - Olivier Schaad
- Genomics Platform, CMU, University Medical Center, Geneva, Switzerland
| | - Mylène Docquier
- Genomics Platform, CMU, University Medical Center, Geneva, Switzerland
| | - Patrick Descombes
- Genomics Platform, CMU, University Medical Center, Geneva, Switzerland
| | - Thomas Matthes
- Hematology Service, University Hospital Geneva, Geneva, Switzerland
- * E-mail:
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23
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Medinger M, Buser A, Stern M, Heim D, Halter J, Rovo A, Tzankov A, Tichelli A, Passweg J. Aplastic anemia in association with a lymphoproliferative neoplasm: Coincidence or causality? Leuk Res 2012; 36:250-1. [DOI: 10.1016/j.leukres.2011.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/07/2011] [Accepted: 09/12/2011] [Indexed: 11/16/2022]
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Medinger M, Saller E, Harteveld CL, Lehmann T, Graf L, Rovo A, Buser A, Passweg J, Tichelli A. A rare case of coinheritance of Hemoglobin H disease and sickle cell trait combined with severe iron deficiency. Hematol Rep 2011; 3:e30. [PMID: 22593821 PMCID: PMC3269802 DOI: 10.4081/hr.2011.e30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 11/22/2011] [Indexed: 11/23/2022] Open
Abstract
We present a case of a 40-year-old female from Turkey, who was referred to our outpatient clinic for an undetermined thalassemia and sickle cell trait. At first consultation hemoglobin was decreased (71 g/L) with microcytosis (MCV 55.1 fL), and hypochromia (MCHC 239 g/L). The patient had severe iron deficiency. Brilliant cresyl blue staining showed >50% of the erythrocytes with typical Hemoglobin H (HbH) inclusions. High-performance liquid chromatography (HPLC) revealed normal levels of HbA(2) and Hemoglobin F (HbF), and additionally a hemoglobin S (19%). Molecular diagnostics revealed the mutations α2 IVS-I donor site -5nt and a -- MED II deletion in the alpha gene complex and confirmed the heterozygote mutation of the beta-gene at codon 6 (HBB:c.20A>T; HbS). In conclusion, we present an extremely rare combination of HbH disease and sickle cell trait. This combination may explain the mild form of the HbH disease, with moderate anemia, splenomegaly but iron deficiency, rather than iron overload, as usually observed in HbH disease.
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Leupin N, Schuller JC, Solenthaler M, Heim D, Rovo A, Beretta K, Gregor M, Bargetzi MJ, Brauchli P, Himmelmann A, Hanselmann S, Zenhäusern R. Efficacy of rituximab and cladribine in patients with chronic lymphocytic leukemia and feasibility of stem cell mobilization: a prospective multicenter phase II trial (protocol SAKK 34/02). Leuk Lymphoma 2010; 51:613-9. [PMID: 20218808 DOI: 10.3109/10428191003624231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This phase II trial investigated rituximab and cladribine in chronic lymphocytic leukemia. Four induction cycles, comprising cladribine (0.1 mg/kg/day days 1-5, cycles 1-4) and rituximab (375 mg/m(2) day 1, cycles 2-4), were given every 28 days. Stem cell mobilization (rituximab 375 mg/m(2) days 1 and 8; cyclophosphamide 4 g/m(2) day 2; and granulocyte colony-stimulating factor 10 microg/kg/day, from day 4) was performed in responders. Of 42 patients, nine achieved complete remission (CR), 15 very good partial remission, and two nodular partial remission (overall response rate 62%). Stem cell mobilization and harvesting (> or = 2 x 10(6) stem cells/kg body weight) were successful in 12 of 20 patients. Rituximab infusion-related adverse events were moderate. The main grade 3/4 adverse events during induction were neutropenia and lymphocytopenia. Rituximab plus cladribine was effective; however, the CR rate was modest and stem cell harvest was impaired in a large number of responding patients.
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Affiliation(s)
- Nicolas Leupin
- Department of Medical Oncology, University of Bern, Inselspital, 3010 Bern, Switzerland
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Degen C, Christen S, Rovo A, Gratwohl A. Bone marrow examination: a prospective survey on factors associated with pain. Ann Hematol 2010; 89:619-24. [PMID: 20333524 DOI: 10.1007/s00277-010-0934-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 02/22/2010] [Indexed: 11/25/2022]
Abstract
Bone marrow examination (BME) represents an essential tool for diagnosis and monitoring of haematological disorders. It remains associated with morbidity and discomfort; repeat examinations are frequent. We made a single-centre prospective survey on 700 BME between July 2007 and July 2008 with a structured anonymized questionnaire for patients undergoing and physicians performing BME, which includes at our institution always aspiration and trephine. All procedures were performed according to institutionalised standard operating procedures; 412 patients' (58.9%) and 554 physicians' (79.1%) questionnaires were returned. Pain was the only procedure-related complication; no pain was reported in 149 (36.7%), bearable pain in 242 (59.6%) and unbearable pain in 15 (3.7%) cases. Premedication associated complications were reported by 110 (32.7%) of the 336 (65.4%) patients with premedication before BME. None of these were > WHO grade 2; most frequently reported were tiredness (76 patients; 22.6%), dizziness (19 patients; 5.7%) and nausea (15 patients; 4.5%). Only two factors were significantly associated with unbearable pain: "pain during prior BME" (seven of 94 with versus one of 198 without previous pain; p < 0.01) and "information before BME" (four of 11 without versus 12 of 372 with adequate information before BME; p < 0.01). Inadequate information at any time showed a trend towards an association with unbearable pain (p = 0.08). No other factor was associated with unbearable pain. Good and adequate information appears to be the best way to reduce pain, even for a future BME.
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Affiliation(s)
- Christian Degen
- Division of Hematology, University Hospital Basel, CH-4031 Basel, Switzerland
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Meyer-Monard S, Passweg J, Troeger C, Eberhard HP, Roosnek E, de Faveri GN, Chalandon Y, Rovo A, Kindler V, Irion O, Holzgreve W, Gratwohl A, Müller C, Tichelli A, Tiercy JM. Cord blood banks collect units with different HLA alleles and haplotypes to volunteer donor banks: a comparative report from Swiss Blood stem cells. Bone Marrow Transplant 2009; 43:771-8. [PMID: 19060930 DOI: 10.1038/bmt.2008.391] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 08/19/2008] [Accepted: 08/22/2008] [Indexed: 11/09/2022]
Abstract
Allogeneic haematopoietic SCT is a standard therapy for many patients with haematological diseases. A major aim of public umbilical cord blood (UCB) banking is to establish an inventory with a large HLA diversity. Few studies have compared HLA diversity between UCB banks and volunteer unrelated donor (VUD) registries and examined whether UCB banks indeed collect more units with rare alleles and haplotypes. This study compares HLA-A/B/DRB1 allele frequencies and inferred A/B/DRB1-haplotypes in 1602 UCB units and 3093 VUD from two centres in distinct recruitment areas in Switzerland. The results show that the frequencies of HLA-DRB1 alleles as well as of the HLA-A/B/DRB1 haplotypes differ between UCB and VUD. Ten DRB1 alleles occurred at a 2- to 12-fold higher relative frequency in UCB than in VUD and 27 rare alleles were identified in UCB. Out of these 27 alleles, 15 were absent in the entire VUD data set of the national registry. This difference in allele frequencies was found only by intermediate/high-resolution typing. Targeted recruitment of UCB units from non-Caucasian donors could further increase HLA allele and haplotype diversity of available donors. Intermediate or high-resolution DNA typing is essential to identify rare alleles or allele groups.
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Affiliation(s)
- S Meyer-Monard
- Division of Hematology, Basel Stem Cell Transplant Team, University Hospital Basel, Basel, Switzerland.
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Buser A, Stern M, Arber C, Medinger M, Halter J, Rovo A, Favre G, Lohri A, Tichelli A, Gratwohl A. Impaired B-cell reconstitution in lymphoma patients undergoing allogeneic HSCT: an effect of pretreatment with rituximab? Bone Marrow Transplant 2008; 42:483-7. [DOI: 10.1038/bmt.2008.229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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29
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Friedman DL, Rovo A, Leisenring W, Locasciulli A, Flowers MED, Tichelli A, Sanders JE, Deeg HJ, Socie G. Increased risk of breast cancer among survivors of allogeneic hematopoietic cell transplantation: a report from the FHCRC and the EBMT-Late Effect Working Party. Blood 2007; 111:939-44. [PMID: 17911386 PMCID: PMC2200849 DOI: 10.1182/blood-2007-07-099283] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
As risk for secondary breast cancer is elevated among cancer survivors treated with conventional therapy, we sought to determine the risk among 3337 female 5-year survivors who underwent an allogeneic hematopoietic cell transplantation (HCT) at the Fred Hutchinson Cancer Research Center or at one of 82 centers reporting to the European Bone Marrow Transplant Registry. Risk was calculated using standardized incidence ratios (SIRs), and risk factors were evaluated with a multivariable Cox proportional hazards model. Fifty-two survivors developed breast cancer at a median of 12.5 (range: 5.7-24.8) years following HCT (SIR=2.2). Twenty-five-year cumulative incidence was 11.0%, higher among survivors who received total body irradiation (TBI) (17%) than those who did not receive TBI (3%). In multivariable analysis, increased risk was associated with longer time since transplantation (hazard ratio [HR] for 20+ years after transplantation=10.8), use of TBI (HR=4.0), and younger age at transplantation (HR=9.5 for HCT<18 years). Hazard for death associated with breast cancer was 2.5 (95% CI: 1.1-5.8). We conclude that female survivors of allogeneic HCT are at increased risk of breast cancer and should be educated about the need for regular screening.
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Affiliation(s)
- Debra L Friedman
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle 98109, USA.
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