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Braester A, Akria L, Zarfati M, Barhoum M. [PATIENT BLOOD MANAGEMENT - IT IS IMPOSSIBLE TO IGNORE THIS POLICY]. Harefuah 2024; 163:244-248. [PMID: 38616635] [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] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Anemia is common and is an independent risk factor for morbidity and mortality, especially in pre- (30-40% of patients undergoing major surgery) or post-operative anemia (up to 80-90%). Using World Health Organization (WHO) criteria, in 2010 one quarter of the global population was anemic (1.9 billion people) and iron deficiency anemia (IDA( was and still remains the most common type of anemia worldwide, accounting for more than half of the total anemia burden. In a systematic analysis for the Global Burden of Disease Study 2016, IDA was the fourth leading cause of years lived with disability, particularly in women, thus highlighting prevention and treatment of IDA as a major public health goal. Red blood cells (RBC) transfusion is a common therapeutic intervention with considerable variation in clinical practice. More than 85 million units packed RBC (PRBC) are transfused annually worldwide. The principal indication for blood transfusion (BT) is anemia, yet a significant percentage of RBC transfusions are inappropriately overused. For many physicians and clinicians, across many different specialties, BT is still considered to be the first-line treatment when facing anemia. The Joint Commission along with the American Medical Association has included BT in a list of the five most overused therapeutic procedures in the United States. Restrictive blood transfusion (RBT) is an evidence-based policy, at least as effective, if not superior to the liberal policy of BT. Patient blood management (PBM) is a patient-centered systematic, evidence-based approach, supported by RBT. In this article we analyze the factors which influence the implementation of PBM.
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Affiliation(s)
- Andrei Braester
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Galilee Medical Center, Nahariya
| | - Luiza Akria
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Galilee Medical Center, Nahariya
| | | | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Galilee Medical Center, Nahariya
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Adir A, Braester A, Natalia P, Najib D, Akria L, Suriu C, Masad B, Igor W. The role of blood inflammatory markers in the preoperative diagnosis of acute appendicitis. Int J Lab Hematol 2024; 46:58-62. [PMID: 37644670 DOI: 10.1111/ijlh.14163] [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: 03/05/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Acute appendicitis (AA) requires a prompt diagnosis. According to postoperative pathological results, a significant number of appendectomies are performed on a normal appendix (NA). The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting and improving the clinical diagnosis of AA, extracting more information from CBC parameters. METHODS The study is a retrospective one. The histopathological results of operated appendix from 102 patients, who underwent appendectomy for clinically suspected AA, were extracted from the Galilee Medical Center systems. Two patient groups (NA and true AA) were compared for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and mean platelet volume (MPV). The obtained data were statistically analyzed, using the independent sample t test and Mann-Whitney test. Category data have been compared among groups with the chi-squared test. The primary endpoint of our research was to assess the predictive power of blood biomarkers. RESULTS Patients with suspected AA, based on clinical picture and contrast enhanced computed tomography (CECT), and with MLR-value ≥0.3357 were 5.25 times more likely than normal to have AA. Patients with NLR-value ≥3.2223 were 7 times more likely than normal to have AA. The differences in PLR and MPV values were not statistically significant. CONCLUSIONS The NLR and MLR biomarkers can assist in diagnosis of AA. This can be particularly helpful in cases where CECT is contraindicated, as in pregnant women or children.
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Affiliation(s)
- Alper Adir
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | | | - Dally Najib
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
- Hematology Institute, Ziv Medical Center, Safed, Israel
| | - Luiza Akria
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | - Celia Suriu
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | - Barhoum Masad
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | - Waksman Igor
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
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Merkel D, Soffer S, Filanovsky K, Braester A, Fibach E, Dana M, Ofran Y, Greenbaum U, Nagler A, Amitai I, Mittelman M. The Effect of The Oral Iron Chelator Deferiprone on Iron Overload and Oxidative Stress in Patients with Myelodysplastic Syndromes A Study by the Israeli MDS Working Group. Acta Haematol 2023:000535749. [PMID: 38104534 DOI: 10.1159/000535749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Most patients with lower risk myelodysplastic neoplasms (MDS) become RBC transfusion-dependent, resulting in iron overload, which is associated with an increased oxidative stress state. Iron-chelation therapy is applied to attenuate the toxic effects of this state. Deferiprone (DFP) is an oral iron chelator, which is not commonly used in this patient population, due to safety concerns, mainly agranulocytosis. The purpose of this study was to assess the effect of DFP, on oxidative stress parameters in iron overloaded RBC transfusion-dependent patients with lower risk MDS. METHODS Adult lower-risk MDS patients with a cumulative transfusion burden of >20 red blood cells units and evidence of iron overload (serum ferritin >1,000 ng/mL) were included in this study. DFP was administered (100 mg/kg/day) for 4 months. Blood samples for oxidative stress parameters and iron overload parameters were done at baseline and monthly: reactive oxygen species (ROS), phosphatidylserine, reduced glutathione, membrane lipid peroxidation, serum ferritin and cellular labile iron pool. The primary efficacy variable was ROS. Tolerability and side-effects were recorded as well. A paired t-test was applied for statistical analyses. RESULTS Eighteen patients were treated with DFP. ROS significantly decreased in all cell lineages: median decrease of 58.6% in RBC, 33.3% in PMN, and 39.8% in platelets (p<0.01 for all). Other oxidative stress markers improved: phosphatidylserine decreased by 57.95%, lipid peroxidase decreased by 141.3%, and reduced gluthathione increased by 72.8% (p<0.01 for all). The iron-overload marker, cellular labile iron pool, decreased by 35% in RBCs, 44.3% in PMN, and 46.3% in platelets (p<0.01 for all). No significant changes were observed in SF levels. There were no events of agranulocytosis. All AEs were grade 1-2. CONCLUSIONS Herein we showed preliminary evidence that DFP decreases iron-induced oxidative stress in MDS patients with a good tolerability profile (albeit a short follow-up period). No cases of severe neutropenia or agranulocytosis were reported. The future challenge is to prove that reduction in iron toxicity will eventually be translated into a clinically meaningful improvement.
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Dally N, Baranes M, Akria L, Kashlikov M, Tarabia K, Sharabi-Nov A, Suriu C, Braester A. Ethnic disparities in presentation but not outcome in multiple myeloma patients: a multicenter retrospective study in Northern Israel. Leuk Lymphoma 2023; 64:2148-2155. [PMID: 37715316 DOI: 10.1080/10428194.2023.2251072] [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: 03/13/2023] [Accepted: 08/18/2023] [Indexed: 09/17/2023]
Abstract
Several studies showed ethnic disparities in multiple myeloma (MM) incidence and prognosis. In order to compare prognosis and overall survival between different ethnic groups, a multicenter retrospective study was conducted in Northern Israel. A total of 145 patients suffering from MM were included (72% Jewish, and 28% Arabs) who were treated between 2008-2018. A difference was found in the stage of the disease at the time of diagnosis, patients of Arab origin were diagnosed at a more advanced stage (III), (53.7% vs. 33.7%, respectively). A mortality rate of 48.9% was found in the study, regardless of population ethnic origin. No significant differences in rates of MGUS, MM symptoms, treatments, or progression-free survival (PFS) and overall survival (OS) were observed between ethnic groups. This suggests that raising awareness of MM may result in an earlier diagnosis, especially among patients of Arab origin, preventing unnecessary suffering from these patients.
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Affiliation(s)
- Najib Dally
- Hematology Institute Ziv Medical Center, Safed, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Myriam Baranes
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Luiza Akria
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Hematology Institute the Galilee Medical Center, Naharia, Israel
| | | | | | - Adi Sharabi-Nov
- Hematology Institute Ziv Medical Center, Safed, Israel
- Tel-Hai Academic College, Kiryat Shmona, Israel
| | - Celia Suriu
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Hematology Institute the Galilee Medical Center, Naharia, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Hematology Institute the Galilee Medical Center, Naharia, Israel
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Braester A, Suriu C, Akria L, Zarfati M, Dally N, Barhoum M. Can an Anemic Patient Be a Partner to Treatment Decision-Making? Isr Med Assoc J 2023; 25:766-768. [PMID: 37980625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Celia Suriu
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Luiza Akria
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Moran Zarfati
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Najib Dally
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel, Department of Hematology, Ziv Medical Center, Safed, Israel
| | - Masad Barhoum
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Levi S, Bronstein Y, Goldschmidt N, Morabito F, Ziv-Baran T, Del Poeta G, Bairey O, Del Principe MI, Fineman R, Mauro FR, Gutwein O, Reda G, Ruchlemer R, Sportoletti P, Laurenti L, Shvidel L, Coscia M, Tadmor T, Varettoni M, Aviv A, Murru R, Braester A, Chiarenza A, Visentin A, Pietrasanta D, Loseto G, Zucchetto A, Bomben R, Olivieri J, Neri A, Rossi D, Gaidano G, Trentin L, Foà R, Cuneo A, Perry C, Gattei V, Gentile M, Herishanu Y. Efficacy of front-line ibrutinib versus fludarabine, cyclophosphamide, and rituximab in patients with chronic lymphocytic leukemia: A retrospective multicenter "Real-World" study. Am J Hematol 2023; 98:E24-E27. [PMID: 36349541 DOI: 10.1002/ajh.26779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Shai Levi
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yotam Bronstein
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Fortunato Morabito
- Biothechnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology and Bone Marrow Transplant Unit, Hemato-Oncology Department, Augusta Victoria Hospital, Jerusalem, Israel
| | - Tomer Ziv-Baran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | | | - Gianluigi Reda
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), University of Perugia, Perugia, Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma, Roma, Italy
| | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Marzia Varettoni
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | | | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | - Daniela Pietrasanta
- Division of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari "Carlo Melzi", Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Antonio Neri
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Rossi
- Department of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Chava Perry
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Michelis R, Milhem L, Galouk E, Stemer G, Aviv A, Tadmor T, Shehadeh M, Shvidel L, Barhoum M, Braester A. Increased serum level of alpha-2 macroglobulin and its production by B-lymphocytes in chronic lymphocytic leukemia. Front Immunol 2022; 13:953644. [PMID: 36119042 PMCID: PMC9478581 DOI: 10.3389/fimmu.2022.953644] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL), the most common adult’s leukemia in the western world, is caused in 95% of the cases by uncontrolled proliferation of monoclonal B-lymphocytes. The complement system in CLL is chronically activated at a low level via the classical pathway (CP). This chronic activation is induced by IgG-hexamers, which are formed after binding to alpha-2-macroglobulin (A2M). The study investigated for the first time the serum levels of A2M in CLL patients, their association with the disease severity, and A2M production by the malignant B-lymphocytes. Blood samples were collected from 65 CLL patients and 30 normal controls (NC) subjects, and used for quantifications of the A2M levels, the complement activation marker (sC5b-9), the complement components C2, C3 and C4, and clinical biochemistry and hematology parameters. The production of A2M was studied in B-lymphocytes isolated from blood samples as well as in CLL and non-CLL cell lines.The serum A2M levels were significantly higher in CLL patients vs NCs, showing values of 3.62 ± 0.22 and 1.97 ± 0.10 mg/ml, respectively. Within the CLL group, A2M levels correlated significantly with the disease stage, with sC5b-9, and with clinical indicators of the disease severity. Increased A2M production was showed in three out of four CLL B-lymphocytic lines that were studied, as compared to non-CLL lines, to a non-lymphocytic line, and to blood-derived primary B-lymphocytes. A2M production was further increased both in primary cells and in the CLL cell-line after incubation with CLL sera, compared to NC sera. This study shows for the first time that serum A2M levels in CLL are significantly increased, likely due to A2M production by the malignant B-lymphocytes, and are correlated with the disease severity and with chronic complement activation. The moderate change in A2M production after incubation with NC sera in-vitro supports the hypothesis that inhibition of excess A2M production can be achieved, and that this may potentially down-regulate the IgG-hexamerization and the resulting chronic CP activation. This may also help restore complement system activity, and eventually improve complement activity and immunotherapy outcomes in CLL.
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Affiliation(s)
- Regina Michelis
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
- *Correspondence: Regina Michelis,
| | - Lama Milhem
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Evleen Galouk
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Galia Stemer
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mona Shehadeh
- Biochemistry Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel
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Trujillo-Santos J, Farge-Bancel D, Pedrajas JM, Gómez-Cuervo C, Ballaz A, Braester A, Mahé I, Villalobos A, Porras JA, Monreal M. Enoxaparin versus dalteparin or tinzaparin in patients with cancer and venous thromboembolism: The RIETECAT study. Res Pract Thromb Haemost 2022; 6:e12736. [PMID: 35664535 PMCID: PMC9164243 DOI: 10.1002/rth2.12736] [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: 05/24/2021] [Revised: 04/06/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a frequent complication in patients with cancer and a leading cause of morbidity and death. Objectives The objective of the RIETECAT study was to compare the long‐term effectiveness and safety of enoxaparin versus dalteparin or tinzaparin for the secondary prevention of VTE in adults with active cancer. Methods We used the data from the multicenter, multinational RIETE registry to compare the rates of VTE recurrences, major bleeding, or death over 6 months in patients with active cancer and acute VTE using full doses of enoxaparin versus dalteparin or tinzaparin, and a multivariable Cox proportional hazard model was used to analyze the primary end point. Results From January 2009 to June 2018, 4451 patients with active cancer received full doses of the study drugs: enoxaparin, 3526 patients; and dalteparin or tinzaparin, 925 (754 + 171) patients. There was limited difference in VTE recurrences (2.0% vs 2.5%) and mortality rate (19% vs 17%) between the enoxaparin and dalteparin or tinzaparin subgroups. However, there was a slight numerical increase in major bleeding (3.1% vs 1.9%). Propensity score matching confirmed that there were no differences in the risk for VTE recurrences (adjusted hazard ratio [aHR], 0.81; 95% confidence interval [CI], 0.48‐1.38), major bleeding (aHR, 1.40; 95% CI, 0.80‐2.46), or death (aHR, 1.07; 95% CI, 0.88‐1.30) between subgroups. Conclusions In RIETECAT, in patients with cancer and VTE receiving full‐dose enoxaparin or dalteparin or tinzaparin, no statistically significant differences were observed regarding effectiveness and safety outcomes over a 6‐month period.
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Affiliation(s)
- Javier Trujillo-Santos
- Department of Internal Medicine Hospital General Universitario Santa Lucía Universidad Católica de Murcia Murcia Spain
| | - Dominique Farge-Bancel
- Unité de Médecine Interne Maladies Auto-immunes et Pathologie Vasculaire (UF 04) IRSL EA-3518 Université de Paris Paris France
| | | | | | - Aitor Ballaz
- Department of Pneumonology Hospital de Galdakao Vizcaya Spain
| | - Andrei Braester
- Department of Haematology Azrieli Faculty of Medicine Bar-Ilan University Safed Israel
| | - Isabelle Mahé
- Department of Internal Medicine Hôpital Louis Mourier Colombes (APHP) University Paris France
| | - Aurora Villalobos
- Department of Internal Medicine Hospital Regional Universitario de Málaga Málaga Spain
| | - José Antonio Porras
- Department of Internal Medicine Hospital Universitario Joan XXIII de Tarragona Tarragona Spain
| | - Manuel Monreal
- Department of Internal Medicine Hospital Germans Trias i Pujol, Badalona Universidad Católica de Murcia Universidad Autónoma de Barcelona Badalona Spain
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Ruiz-Sada P, Mazzolai L, Braester A, Ballaz A, Madridano O, Accassat S, Fernández-Reyes JL, López-Sáez JB, Del Carmen Díaz-Pedroche M, Monreal M. Venous thromboembolism in patients with autoimmune disorders: a comparison between bleeding complications during anticoagulation and recurrences after its discontinuation. Br J Haematol 2022; 197:489-496. [PMID: 35261031 DOI: 10.1111/bjh.18124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Pablo Ruiz-Sada
- Department of Internal Medicine, Hospital Reina Sofía, Tudela, Navarra, Spain
| | - Lucia Mazzolai
- Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Andrei Braester
- Department of Haematology, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Aitor Ballaz
- Department of Pneumonology, Hospital de Galdakao, Vizcaya, Spain
| | - Olga Madridano
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Sandrine Accassat
- Department of Médecine et Thérapeutique, Hôpital Nord - CHU St-Etienne, Saint-Etienne, France
| | | | - Juan Bosco López-Sáez
- Department of Internal Medicine, Hospital Universitario de Puerto Real, Cádiz, Spain
| | | | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
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Braester A, Barhoum M. Choosing Wisely Project and Patient Shared Decision-making: Between Hammer and Alvin. Isr Med Assoc J 2021; 23:754. [PMID: 34811998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Masad Barhoum
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Braester A, Shturman A, Raviv B, Dorosinsky L, Rosental E, Atar S. What a Family Doctor Should Know about Incidental Finding of High Mean Platelet Volume, Metabolic Syndrome, and Pre-diabetes. Isr Med Assoc J 2021; 23:699-702. [PMID: 34811984] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Mean platelet volume (MPV), an essential component of the complete blood count (CBC) indices, is underutilized in common practice. In recent years, MPV has drawn strong interest, especially in clinical research. During inflammation, the MPV has a higher value because of platelet activation. OBJECTIVES To verify whether high MPV values discovered incidentally in healthy naïve patients indicates the development or the presence of cardiovascular risk factors, particularly metabolic syndrome and pre-diabetes. METHODS A cohort study was used to assess the diagnostic value of high MPV discovered incidentally, in naïve patients (without any known cause of an abnormal high MPV, greater than upper limit of the normal range, such as active cardiovascular diseases and metabolic syndrome). RESULTS The mean MPV value in the patient group was 12.3 femtoliter. There was a higher incidence of metabolic syndrome in our research group than in the general population and a non-significant tendency of pre-diabetes. Family doctors more frequently meet naïve patients with high MPV than a hospital doctor. The results of our study are more relevant for him, who should know the relevance of such a finding and search for a hidden pre-diabetes or metabolic syndrome. CONCLUSIONS High MPV values discovered incidentally in healthy naïve subjects suggest the development or the presence of cardiovascular risk factors, particularly metabolic syndrome and pre-diabetes. No statistically significant association was found between MPV and the presence of cardiovascular disease.
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Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Alexander Shturman
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Bennidor Raviv
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Lev Dorosinsky
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eyal Rosental
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Shaul Atar
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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12
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Braester A, Stemer G, Khouri S, Raviv B, Barhoum M. Is There a Predictive Value of High Mean Platelet Volume in Early Diagnosis of Venous Thromboembolism? Isr Med Assoc J 2021; 23:635-638. [PMID: 34672445] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a serious disease, which demands a fast accurate diagnosis to begin suitable treatment. It presents a major problem in the emergency department (ED), and its confirmation requires adequate evaluation. OBJECTIVES To evaluate a potential role of mean platelet volume (MPV) in differentiating VTE from other potential diagnosis in patients with suspected VTE. METHODS We conducted a retrospective case-controlled study of 440 consecutive patients who presented to the ED of our hospital with clinical VTE, but only 316 with proven VTE. A control group was composed of patients (124) who presented with clinical VTE but without proven VTE. We checked the MPV value in all 440 patients and the correlation with VTE occurrence in the study group vs. control group. RESULTS Statistical analysis of the acquired results indicated that MPV value could not aid in determining the difference of real VTE vs. patients with VTE-like clinical picture presenting to the ED. We found an inverse correlation between MPV value and proven VTE, in contrast to most researchers who have studied the same issue. CONCLUSIONS Although MPV can be a useful diagnostic marker in many diseases, we found no definite association between low MPV and VTE.
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Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Sahar Khouri
- Department of Hematology Galilee Medical Center, Nahariya, Israel
| | - Bennidor Raviv
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Masad Barhoum
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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13
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Braester A, Shaoul E, Mizrachi O, Akria L, Shelev L, Barhoum M. Patient Involvement in the Transfusion Decision-Making Can Change Patient Blood Management Practice for Better or Worse. Acta Haematol 2021; 145:5-8. [PMID: 34525473 DOI: 10.1159/000518947] [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: 04/21/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Red blood cell transfusion (RBCT) is a therapeutic procedure with important and undesirable secondary effects. Inappropriate overuse of RBCT is significant, and a significant percentage of physicians prescribe RBCT unnecessarily. Patient involvement in treatment decision-making is poor worldwide. Shared (with the patient) transfusion decision-making (TrDM) can temper a "quick finger on the trigger" of blood transfusion (BT). The objective of this study was to determine patients' preferences surrounding their involvement in the TrDM process as well as physicians' willingness to involve the patient in TrDM. The study also determined the role of patient age, gender, ethnicity, and schooling years in the TrDM process. METHODS This cross-sectional study was conducted in a variety of departments, with 123 patients over 18 years old, who received a BT for the first time. The patients completed an anonymous questionnaire which included demographic characteristics (age, gender, ethnicity, and schooling years) and 2 questions linked to potential willingness to participate in the decision to transfuse. RESULTS The questionnaire response rate was 100%. The data showed that 60% of patients (especially younger patients), independent of ethnicity, preferred a passive role in TrDM and 40% preferred to share the decision. CONCLUSIONS The majority of patients, especially younger patients, prefer a passive role in TrDM, possibly due to insufficient information about the need for BT and its significance. We feel that active involvement on the part of the patient can provoke a more judicious thought process about the real need of BT on the part of the physician and have a positive influence on patient blood management.
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Affiliation(s)
- Andrei Braester
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ety Shaoul
- Galilee Medical Center, Nahariya, Israel
| | - Oded Mizrachi
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Luiza Akria
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Masad Barhoum
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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14
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Levy I, Lavi A, Zimran E, Grisariu S, Aumann S, Itchaki G, Berger T, Raanani P, Harel R, Aviv A, Lavi N, Zuckerman T, Shvidel L, Jarchowsky O, Ellis M, Herzog Tzarfati K, Koren-Michowitz M, Sherf Y, Levi I, Sofer O, Shpilberg O, Dally N, Suriu C, Braester A, Ben Barouch S, Leiba M, Goldstein D, Sarid N, Yeganeh S, Halloun J, Mittelman M, Tadmor T. COVID-19 among patients with hematological malignancies: a national Israeli retrospective analysis with special emphasis on treatment and outcome. Leuk Lymphoma 2021; 62:3384-3393. [PMID: 34405767 DOI: 10.1080/10428194.2021.1966782] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This national Israeli multicenter retrospective study aimed to characterize the clinical course of COVID-19 infection among patients with hematological malignancies, with special emphasis on treatment efficacy and outcome. Clinical and laboratory data from haemato-oncological patients diagnosed with COVID-19 from 16 medical centers were centrally reported. Multivariate regression analyses were used to determine variables associated with severe disease, hospitalization, and mortality. In total, 313 patients were included: 103 (35.7%) developed severe/critical respiratory infection, 178 (61.4%) were hospitalized, and 60 (20.0%) died. Age > 70 years was associated with severe/critical disease (p = 0.036) and mortality (p = 0.023), hypertension with severe/critical disease (p = 0.046) and hospitalization (p = 0.001), active haemato-oncological treatment with hospitalization (p = 0.009), and remdesivir treatment was associated with decreased mortality (p = 0.021). Convalescent plasma, enoxaparin, and corticosteroids resulted in no clinical benefit. In conclusion, COVID-19 infection seems particularly severe in patients with hematological malignancies, and of all examined therapies, remdesivir appears to be the most effective.
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Affiliation(s)
- Ilana Levy
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel.,Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Avital Lavi
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Eran Zimran
- Hematology Department, Hadassah Hospital, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Grisariu
- Hematology Department, Hadassah Hospital, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shlomzion Aumann
- Hematology Department, Hadassah Hospital, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Berger
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reut Harel
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Ariel Aviv
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Noa Lavi
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Institute, Rambam Medical Center, Haifa, Israel
| | - Tsila Zuckerman
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Institute, Rambam Medical Center, Haifa, Israel
| | - Lev Shvidel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Hematology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Osnat Jarchowsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Department, Meir Medical Center, Kfar Saba, Israel
| | - Martin Ellis
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Department, Meir Medical Center, Kfar Saba, Israel
| | - Katrin Herzog Tzarfati
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Department, Shamir Medical Center, Zerifin, Israel
| | - Maya Koren-Michowitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Department, Shamir Medical Center, Zerifin, Israel
| | - Yehonatan Sherf
- Hematology Department, Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itai Levi
- Hematology Department, Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orit Sofer
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Shpilberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Unit, Assuta Ramat Hahayal Medical Center, Tel Aviv, Israel
| | - Nagib Dally
- Hematology Unit, Ziv Medical Center, Safed, Israel.,Faculty of Medicine, Bar Ilan Unifersity, Safed, Israel
| | - Celia Suriu
- Faculty of Medicine, Bar Ilan Unifersity, Safed, Israel.,Hematology Institute, Western Galilee Hospital, Nahariya, Israel
| | - Andrei Braester
- Faculty of Medicine, Bar Ilan Unifersity, Safed, Israel.,Hematology Institute, Western Galilee Hospital, Nahariya, Israel
| | - Sharon Ben Barouch
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Hematology Unit, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Merav Leiba
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Hematology Unit, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Daniela Goldstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Unit, Wolfson Medical Center, Holon, Israel
| | - Nadav Sarid
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Unit, Wolfson Medical Center, Holon, Israel
| | - Shay Yeganeh
- Faculty of Medicine, Bar Ilan Unifersity, Safed, Israel.,Hematology Unit, Baruch Padeh Medical Center, Poriyah, Israel
| | - Jabour Halloun
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Moshe Mittelman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Internal Medicine A Department, Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel.,Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
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15
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Benjamini O, Rokach L, Itchaki G, Braester A, Shvidel L, Goldschmidt N, Shapira S, Dally N, Avigdor A, Rahav G, Lustig Y, Ben David SS, Fineman R, Paz A, Bairey O, Polliack A, Levy I, Tadmor T. Safety and efficacy of BNT162b mRNA Covid19 Vaccine in patients with chronic lymphocytic leukemia. Haematologica 2021; 107:625-634. [PMID: 34320789 PMCID: PMC8883569 DOI: 10.3324/haematol.2021.279196] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/09/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) have a suboptimal humoral response to vaccination. Recently, BNT162b2, an mRNA COVID-19 vaccine with a high efficacy of 95% in immunocompetent individuals, was introduced. We investigated the safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with CLL from nine medical centers in Israel, Overall 400 patients were included, of whom 373 were found to be eligible for the analysis of antibody response. The vaccine appeared to be safe and only grade 1-2 adverse events were seen in 50% of the patients. Following the second dose, an antibody response was detected in 43% of the cohort. Among these CLL patients, 61% of the treatment-naïve patients responded to the vaccine, while responses developed in only 18% of those with ongoing disease, 37% of those previously treated with a BTK inhibitor and 5% of those recently given an anti-CD20 antibody. Among patients treated with BCL2 as monotherapy or in combination with anti-CD20, 62% and 14%, respectively, developed an immune response. There was a high concordance between neutralizing antibodies and positive serological response to spike protein. Based on our findings we developed a simple seven-factor score including timing of any treatment with anti-CD20, age, treatment status, and IgG, IgA, IgM and hemoglobin levels. The sum of all the above parameters can serve as a possible estimate to predict whether a given CLL patient will develop sufficient antibodies. In conclusion, the BNT162b2 mRNA COVID-19 vaccine was found to be safe in patients with CLL, but its efficacy is limited, particularly in treated patients.
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Affiliation(s)
- Ohad Benjamini
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Lior Rokach
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel
| | | | | | - Najib Dally
- Division of Hematology, Ziv Medical Center, Safed, Israel
| | - Abraham Avigdor
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Galia Rahav
- The Infectious Disease Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Riva Fineman
- Department of Hematology and BMT, Rambam Health Care Campus, Haifa, Israel
| | - Alona Paz
- Infectious Disease Unit, Bnai Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Osnat Bairey
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - Ilana Levy
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Tamar Tadmor
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Hematology Unit, Bnai Zion Medical Center, Haifa, Israel.
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16
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Braester A, Barhoum M. Implementation of patient blood management strategies in an Israeli hospital: caught between hope and despair. Isr Med Assoc J 2021; 23:198. [PMID: 33734637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Masad Barhoum
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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17
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Naseraldeen N, Michelis R, Barhoum M, Chezar J, Tadmor T, Aviv A, Shvidel L, Litmanovich A, Shehadeh M, Stemer G, Shaoul E, Braester A. The Role of Alpha 2 Macroglobulin in IgG-Aggregation and Chronic Activation of the Complement System in Patients With Chronic Lymphocytic Leukemia. Front Immunol 2021; 11:603569. [PMID: 33643290 PMCID: PMC7905172 DOI: 10.3389/fimmu.2020.603569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/07/2020] [Accepted: 12/31/2020] [Indexed: 12/29/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults in the western world. One of the treatments offered for CLL is immunotherapy. These treatments activate various cellular and biochemical mechanisms, using the complement system. Recently it was shown that the complement system in CLL patients is persistently activated at a low level through the classical pathway (CP). The mechanism of chronic CP activation involves the formation of IgG-hexamers (IgG-aggregates). According to recent studies, formation of ordered IgG-hexamers occurs on cell surfaces via specific interactions between Fc regions of the IgG monomers, which occur after antigen binding. The present study investigated the formation of IgG-hexamers in CLL patients and normal (non-malignant) controls (NC), their ability to activate complement, their incidence as cell-free and cell-bound forms and the identity of the antigen causing their formation. Sera from 30 patients and 12 NC were used for separation of IgG- aggregates. The obtained IgG- aggregates were measured and used for assessment of CP activation. For evaluation of the presence of IgG- aggregates on blood cells, whole blood samples were stained and assessed by flow cytometry. Serum levels of IgG- aggregates were higher in CLL and they activated the complement system to a higher extent than in NC. Alpha 2 macroglobulin (A2M) was identified as the antigen causing the hexamerization/aggregation of IgG, and was found to be part of the hexamer structure by mass spectrometry, Western blot and flow cytometry analysis. The presence of A2M-IgG-hexamers on B-cells suggests that it may be formed on B cells surface and then be detached to become cell-free. Alternatively, it may form in the plasma and then attach to the cell surface. The exact time course of A2M-IgG-hexamers formation in CLL should be further studied. The results in this study may be useful for improvement of current immunotherapy regimens.
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Affiliation(s)
- Naseba Naseraldeen
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Regina Michelis
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.,Institute of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Judith Chezar
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Adi Litmanovich
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Mona Shehadeh
- Biochemistry Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Galia Stemer
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Ety Shaoul
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.,Institute of Hematology, Galilee Medical Center, Nahariya, Israel
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18
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Blondon M, Jimenez D, Robert‐Ebadi H, Del Toro J, Lopez‐Jimenez L, Falga C, Skride A, Font L, Vazquez FJ, Bounameaux H, Monreal M, Prandoni P, Brenner, B, Farge‐Bancel D, Barba R, Di Micco P, Bertoletti L, Schellong S, Tzoran I, Reis A, Bosevski M, Malý R, Verhamme P, Caprini JA, My Bui H, Adarraga MD, Agud M, Aibar J, Aibar MA, Alfonso J, Amado C, Arcelus JI, Baeza C, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón‐Andrés B, Blanco‐Molina A, Botella E, Camon AM, Castro J, Caudevilla MA, Cerdà P, Chasco L, Criado J, de Ancos C, de Miguel J, Demelo‐Rodríguez P, Díaz‐Peromingo JA, Díez‐Sierra J, Díaz‐Simón R, Domínguez IM, Encabo M, Escribano JC, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Reyes JL, Fidalgo MA, Flores K, Font C, Francisco I, Gabara C, Galeano‐Valle F, García MA, García‐Bragado F, García‐Mullor MM, Gavín‐Blanco O, Gavín‐Sebastián O, Gil‐Díaz A, Gómez‐Cuervo C, González‐Martínez J, Grau E, Guirado L, Gutiérrez J, Hernández‐Blasco L, Jara‐Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lecumberri R, Lima J, Lobo JL, López‐Brull H, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Marchena PJ, Martín del Pozo M, Martín‐Martos F, Martínez‐Baquerizo C, Mella C, Mellado M, Mercado MI, Moisés J, Morales MV, Muñoz‐Blanco A, Muñoz‐Guglielmetti D, Muñoz‐Rivas N, Nart E, Nieto JA, Núñez MJ, Olivares MC, Ortega‐Michel C, Ortega‐Recio MD, Osorio J, Otalora S, Otero R, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez‐Jacoiste A, Peris ML, Pesántez D, Porras JA, Portillo J, Reig L, Riera‐Mestre A, Rivas A, Rodríguez‐Cobo A, Rodríguez‐Matute C, Rogado J, Rosa V, Rubio CM, Ruiz‐Artacho P, Ruiz‐Giménez N, Ruiz‐Ruiz J, Ruiz‐Sada P, Sahuquillo JC, Salgueiro G, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Sigüenza P, Sirisi M, Soler S, Suárez S, Suriñach JM, Tiberio G, Torres MI, Tolosa C, Trujillo‐Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vidal G, Vilar C, Villares P, Zamora C, Gutiérrez P, Vázquez FJ, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Bura‐Riviere A, Crichi B, Debourdeau P, Espitia O, Farge‐Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Ciammaichella M, Colaizzo D, Dentali F, Di Micco P, Giammarino E, Grandone E, Mangiacapra S, Mastroiacovo D, Maida R, Mumoli N, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Zalunardo B, Kalejs RV, Maķe K, Ferreira M, Fonseca S, Martins F, Meireles J, Bosevski M, Zdraveska M, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, Bui HM. Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study. J Thromb Haemost 2021; 19:408-416. [PMID: 33119949 DOI: 10.1111/jth.15146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
AIMS Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. METHODS AND RESULTS We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-to-event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24). CONCLUSION In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.
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Affiliation(s)
- Marc Blondon
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - David Jimenez
- Respiratory Department Hospital Ramón y Cajal and Medicine Department Universidad de Alcalá (IRYCIS) Madrid Spain
| | - Helia Robert‐Ebadi
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Jorge Del Toro
- Department of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid Spain
| | | | - Conxita Falga
- Department of Internal Medicine Hospital de Mataro Barcelona Spain
| | - Andris Skride
- Department of Cardiology Ospedale Pauls Stradins Clinical University Hospital Riga Latvia
| | - Llorenç Font
- Department of Haematology Hospital de Tortosa Verge de la Cinta Tarragona Spain
| | | | - Henri Bounameaux
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Manuel Monreal
- Department of Internal Medicine Hospital Germans Trias i Pujol Badalona Spain
- Universidad Catolica de Murcia Murcia Spain
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Tadmor T, Benjamini O, Braester A, Rahav G, Rokach L. Antibody persistence 100 days following the second dose of BNT162b mRNA Covid19 vaccine in patients with chronic lymphocytic leukemia. Leukemia 2021; 35:2727-2730. [PMID: 34376803 PMCID: PMC8353933 DOI: 10.1038/s41375-021-01380-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Tamar Tadmor
- grid.414529.fHematology Unit, Bnai Zion Medical Center, Haifa, Israel ,grid.6451.60000000121102151The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ohad Benjamini
- grid.413795.d0000 0001 2107 2845Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Andrei Braester
- grid.415839.2Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Galia Rahav
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ,grid.413795.d0000 0001 2107 2845The Infectious Disease Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Lior Rokach
- grid.7489.20000 0004 1937 0511Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Braester A, Akria L, Yakir O, Shelev L, Barhoum M. Blood Myths and Ethnic-Cultural Background as Impediments in Patient Blood Management Education. J Relig Health 2020; 59:2918-2927. [PMID: 32285248 DOI: 10.1007/s10943-020-01015-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A significant percentage of red blood cell transfusions (RBCTs) are the result of overuse. The implementation of patient blood management (PBM) is challenging. We examined whether blood-linked myths and ethnic-cultural background factors are impediments to PBM education and implementation. Data about the influence of blood myths and diverse ethnic-cultural communities were collected from physicians in our medical center via an anonymous questionnaire which contained questions about myths as well as knowledge of blood transfusion. No statistical differences were found between ethnic and cultural groups regarding blood myths and cultural background influence, although the Jewish participants were less influenced by myths than their Arab colleagues. The influence of blood myths concerning the decision to transfuse exists in both studied ethnic groups. With regard to the association between knowledge and myths influence, we found that the greater the knowledge of the participant, the lower was the myths influence. In a significant proportion of our physician cohort, blood myths and cultural-ethnic status influenced their approach toward RBCT and can be considered an impediment in PBM education. A high knowledge level is associated with less myths influence. The myths and cultural-ethnic background may play a role in PBM education.
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Affiliation(s)
- Andrei Braester
- Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.
- Hematology Institute, Galilee Medical Center, POB 21, 22100, Nahariya, Israel.
| | - Luiza Akria
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Orly Yakir
- Galilee Medical Center, Nahariya, Israel
| | | | - Masad Barhoum
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
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21
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Filanovsky K, Haran M, Mirkin V, Braester A, Shevetz O, Stanevsky A, Sigler E, Votinov E, Zaltsman-Amir Y, Berrebi A, Gross A, Shvidel L. Peripheral Blood Cell Mitochondrial Dysfunction in Myelodysplastic Syndrome Can Be Improved by a Combination of Coenzyme Q10 and Carnitine. Mediterr J Hematol Infect Dis 2020; 12:e2020072. [PMID: 33194146 PMCID: PMC7643803 DOI: 10.4084/mjhid.2020.072] [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: 06/20/2020] [Accepted: 10/03/2020] [Indexed: 11/08/2022] Open
Abstract
Structural mitochondrial abnormalities and genetic aberrations in mitochondrial proteins have been known in Myelodysplastic syndrome (MDS), yet there is currently little data regarding MDS's metabolic properties and energy production cells. In the current study, we used state-of-the-art methods to assess OXPHOS in peripheral blood cells obtained from MDS patients and healthy controls. We then assessed the effect of food supplements-Coenzyme Q10 and carnitine on mitochondrial function and hematological response. We show here for the first time that there is a significant impairment of mitochondrial respiration in peripheral blood cells in low-risk MDS, which can be improved with food supplements. We also show that these supplements may improve the cytopenia and quality of life.
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Affiliation(s)
- Kalman Filanovsky
- Hematology Institute, Kaplan medical center, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel
| | - Michal Haran
- Hematology Institute, Kaplan medical center, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel
| | - Vita Mirkin
- Hematology Institute, Kaplan medical center, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel
| | - Andrei Braester
- Hematology institute, Galilee medical center, Nahariya, Israel
| | - Olga Shevetz
- Hematology Institute, Kaplan medical center, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel
| | - Anfisa Stanevsky
- Hematology Institute, Kaplan medical center, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel
| | - Erica Sigler
- Hematology Institute, Kaplan medical center, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel
| | - Ekaterina Votinov
- Hematology Institute, Kaplan medical center, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel
| | | | - Alain Berrebi
- Hematology Institute, Kaplan medical center, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel
| | - Atan Gross
- Dept. of biological regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan medical center, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel
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22
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Braester A, Bornstein J, Zverev A, Kukuyev Y, Stemer G, Barhoum M. Reassessment of Venous Thromboembolism Risk and Prophylaxis in Postdelivery Period of Healthy Women. Am J Med Sci 2020; 360:604-606. [DOI: 10.1016/j.amjms.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/10/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
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Catella J, Bertoletti L, Mismetti P, Ollier E, Samperiz A, Soler S, Suriñach JM, Mahé I, Lorente MA, Braester A, Monreal M. Severe renal impairment and risk of bleeding during anticoagulation for venous thromboembolism. J Thromb Haemost 2020; 18:1728-1737. [PMID: 32299150 DOI: 10.1111/jth.14837] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 11/26/2019] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 08/31/2023]
Abstract
BACKGROUND Detection of severe renal impairment in patients with venous thromboembolism (VTE) is mandatory both for selecting anticoagulant therapy and for evaluating major bleeding risk, increased by severe renal impairment. OBJECTIVES To determine whether the Cockcroft and Gault (CG) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas identify severe renal impairment in the same VTE patients presenting the same risk of major bleeding. PATIENTS/METHODS We compared clinical characteristics and outcomes during the first 3 months of anticoagulation between VTE patients in the RIETE registry with severe renal impairment according to the CG and/or CKD-EPI formula (estimated glomerular filtration rate <30 mL/min and <30 mL/min/1.73 m2 , respectively). The primary outcome was major bleeding. RESULTS Up to October 2017, 41 796 patients were included in RIETE. Among the 4676 patients with severe renal impairment according to at least one of the formulas, this was not confirmed by the other formula in 1904 (40.7%). Major bleeding risk was increased in every patient subgroup with severe renal impairment vs patients without this condition (CG or CKD-EPI < 30: odds ratio [OR] = 2.26, 95% confidence interval [CI 2.01-2.53], only CG < 30: OR = 1.72, 95% CI [1.37-2.13], only CKD-EPI < 30: OR = 2.34, 95% CI [1.77-3.05], CG+CKD-EPI < 30: OR = 2.47, 95% CI [2.16-2.83], all vs CG+CKD-EPI > 30). CONCLUSION The CG and CKD-EPI formulas identify different subgroups of patients with severe renal impairment, leading to discordant results in 40.7% of these patients. Irrespective of the formula used for their identification, patients with severe renal impairment have a higher risk of major bleeding under anticoagulant therapy.
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Affiliation(s)
- Judith Catella
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint-Etienne, France
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint-Etienne, France
| | - Edouard Ollier
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- URCIP, CHU de St-Etienne, Saint-Etienne, France
| | - Angel Samperiz
- Department of Internal Medicine, Hospital Reina Sofía, Tudela, Spain
| | - Silvia Soler
- Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain
| | - José Maria Suriñach
- Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Isabelle Mahé
- F-CRIN INNOVTE network, Saint-Etienne, France
- Department of Internal Medicine, Hôpital Louis Mourier (APHP), University Paris 7, Colombes, France
| | | | - Andrei Braester
- Department of Haematology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
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24
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Herishanu Y, Shaulov A, Fineman R, Bašić‐Kinda S, Aviv A, Wasik‐Szczepanek E, Jaksic O, Zdrenghea M, Greenbaum U, Mandac I, Simkovic M, Morawska M, Benjamini O, Spacek M, Nemets A, Bairey O, Trentin L, Ruchlemer R, Laurenti L, Stanca Ciocan O, Doubek M, Shvidel L, Dali N, Mirás F, De Meûter A, Dimou M, Mauro FR, Coscia M, Bumbea H, Szász R, Tadmor T, Gutwein O, Gentile M, Scarfò L, Tedeschi A, Sportoletti P, Gimeno Vázquez E, Marquet J, Assouline S, Papaioannou M, Braester A, Levato L, Gregor M, Rigolin GM, Loscertales J, Medina Perez A, Nijziel MR, Popov VM, Collado R, Slavutsky I, Itchaki G, Ringelstein S, Goldschmidt N, Perry C, Levi S, Polliack A, Ghia P. Frontline treatment with the combination obinutuzumab ± chlorambucil for chronic lymphocytic leukemia outside clinical trials: Results of a multinational, multicenter study by ERIC and the Israeli CLL study group. Am J Hematol 2020; 95:604-611. [PMID: 32096887 DOI: 10.1002/ajh.25766] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/14/2022]
Abstract
In recent years, considerable progress has been made in frontline therapy for elderly/physically unfit patients with CLL. The combination of obinutuzumab and chlorambucil (O-Clb) has been shown to prolong progression free survival (PFS, median PFS-31.5 months) and overall survival (OS) compared to chlorambucil alone. More recently, obinutuzumab given in combination with either ibrutinib or venetoclax improved PFS but not OS when compared to O-Clb. In this retrospective multinational, multicenter co-operative study, we evaluated the efficacy and safety of frontline treatment with O ± Clb in unfit patients with CLL, in a "real-world" setting. Patients with documented del (17p13.1)/TP53 mutation were excluded. A total of 437 patients (median age, 75.9 years; median CIRS score, 8; median creatinine clearance, 61.1 mL/min) were included. The clinical overall response rate was 80.3% (clinical complete and partial responses in 38.7% and 41.6% of patients, respectively). Median observation time was 14.1 months and estimated median PFS was 27.6 months (95% CI, 24.2-31.0). In a multivariate analysis, high-risk disease [del (11q22.3) and/or IGHV-unmutated], lymph nodes of diameter > 5 cm, obinutuzumab monotherapy and reduced cumulative dose of obinutuzumab, were all independently associated with shorter PFS. The median OS has not yet been reached and estimated 2-year OS is 88%. In conclusion, in a "real-world" setting, frontline treatment with O-Clb achieves PFS comparable to that reported in clinical trials. Inferior outcomes were noted in patients with del (11q22.3) and/or unmutated IGHV and those treated with obinutuzumab-monotherapy. Thus, O-Clb can be still considered as legitimate frontline therapy for unfit CLL patients with low-risk disease.
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Affiliation(s)
- Yair Herishanu
- Department of HematologyTel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of MedicineTel Aviv University Tel‐Aviv Israel
| | - Adir Shaulov
- Hadassah Hebrew University Medical Center Jerusalem Israel
| | - Riva Fineman
- Department of HematologyRambam Health Care Campus Haifa Israel
| | | | - Ariel Aviv
- Department of HematologyHaEmek Medical Center Afula Israel
- Faculty of MedicineTechnion Israel Institute of Technology Haifa Israel
| | - Ewa Wasik‐Szczepanek
- Department of Hematooncologyand Bone Marrow Transplantation Medical University Lublin Poland
| | | | - Mihnea Zdrenghea
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj‐Napoca Romania
| | - Uri Greenbaum
- Ben‐Gurion University, Soroka University Medical Center Beer Sheva Israel
| | | | - Martin Simkovic
- University Hospital and Medical School Hradec Kralove Hradec Kralove Czech Republic
| | | | - Ohad Benjamini
- Sackler Faculty of MedicineTel Aviv University Tel‐Aviv Israel
- Hematology DivisionChaim Sheba Medical Center Ramat Gan Israel
| | - Martin Spacek
- Charles University and General Hospital in Prague Prague Czech Republic
| | | | - Osnat Bairey
- Rabin Medical Center, Beilinson Hospital; Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | | | - Rosa Ruchlemer
- Department of HematologyShaare Zedek Medical Center Jerusalem Israel
| | - Luca Laurenti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | | | - Michael Doubek
- Department of Internal Medicine‐Hematology and OncologyMedical Faculty of Masaryk University and University Hospital Brno Brno Czech Republic
| | - Lev Shvidel
- Department of HematologyKaplan Medical Center Rehovot Israel
- Hebrew University of Jerusalem Jerusalem Israel
| | | | | | | | - Maria Dimou
- Hematology Section ‐ 1st Department Of Propaedeutic Internal MedicineLaikon Hospital Athens Greece
| | - Francesca R. Mauro
- Hematology, Department of Translational and Precision MedicineSapienza University, Policlinico Umberto I Rome Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health SciencesUniversity of Torino Torino Italy
| | - Horia Bumbea
- Emergency University Clinical Hospital Bucharest Romania
| | - Róbert Szász
- Division of Hematology, Department of Internal Medicine, Faculty of MedicineUniversity of Debrecen Debrecen Hungary
| | | | | | - Massimo Gentile
- Hematology Unit and Biotechnology Research Unit, A.O. of Cosenza Cosenza Italy
| | - Lydia Scarfò
- Division of Experimental OncologyIRCCS Ospedale San Raffaele Milan Italy
- Università Vita‐Salute San Raffaele Milan Italy
| | - Alessandra Tedeschi
- Department of Haematology, Niguarda Cancer CenterASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Paolo Sportoletti
- Institute of Hematology and Center for Hemato‐Oncological Research, Ospedale S. Maria della Misericordia, University of Perugia Perugia Italy
| | | | - Juan Marquet
- Hematology and HemotherapyHospital Universitario Ramón y Cajal Madrid Spain
| | - Sarit Assouline
- Division of HematologyJewish General Hospital, Montreal Quebec Canada
| | - Maria Papaioannou
- First Department of Internal Medicine, Division of HaematologyAHEPA University Hospital, Aristotle University of Thessaloniki Thessaloniki Greece
| | | | - Luciano Levato
- Department Hematology‐OncologyAzienda Ospedaliera Pugliese‐Ciaccio Catanzaro Italy
| | - Michael Gregor
- Division of HematologyCantonal Hospital of Lucerne Lucerne Switzerland
| | - Gian M. Rigolin
- Hematology Section, Department of Medical SciencesUniversity of Ferrara‐Azienda Ospedaliera‐Universitaria di Ferrara, University of Ferrara Ferrara Italy
| | | | | | | | | | | | | | - Gilad Itchaki
- Rabin Medical Center, Beilinson Hospital; Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | | | | | - Chava Perry
- Department of HematologyTel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of MedicineTel Aviv University Tel‐Aviv Israel
| | - Shai Levi
- Department of HematologyTel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Aaron Polliack
- Hadassah Hebrew University Medical Center Jerusalem Israel
| | - Paolo Ghia
- Division of Experimental OncologyIRCCS Ospedale San Raffaele Milan Italy
- Università Vita‐Salute San Raffaele Milan Italy
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25
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Mehdipoor G, Jimenez D, Bertoletti L, Fidalgo Á, Sanchez Muñoz-Torrero JF, Gonzalez-Martinez JP, Blanco-Molina Á, Ángel Aibar M, Bonnefoy PB, Khorasani R, Prince MR, Bikdeli B, Monreal M, Adarraga MD, Agud M, Azcarate-Agüero P, Aibar J, Alfonso J, Amado C, Ignacio Arcelus J, Ballaz A, Barba R, Barrón CBM, Barrón-Andrés B, Camon AM, Cañas I, Criado J, Ancos CD, Miguel JD, del Toro J, Demelo-Rodríguez P, Díaz-Pedroche C, Díaz-Peromingo JA, Díaz-Simón R, Díez-Sierra J, Milagros Domínguez I, Escribano JC, Farfán AI, Fernández-Capitán C, Fernández-Reyes JL, Flores K, Font C, Font L, Francisco I, Gabara C, Galeano-Valle F, Ángeles García M, García-Bragado F, García-García M, García-Raso A, Gavín-Blanco O, Gavín-Sebastián O, Carmen Gayol M, Gil-Díaz A, Gómez-Cuervo C, Grau E, Gutiérrez-Guisado J, Hernández-Blasco L, Iglesias M, Jara-Palomares L, Jesús Jaras M, Joya MD, Jou I, Lacruz B, Lalueza A, Lecumberri R, Lima J, Llamas P, Luis Lobo J, López-Jiménez L, López-Miguel P, José López-Núñez J, López-Reyes R, Bosco López-Sáez J, Alejandro Lorente M, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Javier Marchena P, Martín-Fernández M, Miguel Martín-Guerra J, Martín-Martos F, Mellado M, Mercado MI, Moisés J, del Valle Morales M, Muñoz-Blanco A, Muñoz-Guglielmetti D, Antonio Nieto J, Jesús Núñez M, Ortega-Michel MCOC, Dolores Ortega-Recio M, Osorio J, Otero R, Paredes D, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez-Ductor C, Asunción Pérez-Jacoíste M, Pesántez D, Porras JA, Portillo J, Reig L, Riera-Mestre A, Rivas A, Rodríguez-Cobo A, Rodríguez-Galán I, Rodríguez-Matute C, Rosa V, María Rubio C, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Ruiz J, Ruiz-Sada P, Ruiz-Torregrosa P, Carles Sahuquillo J, Salgueiro G, Sampériz Á, Sancho T, Soler S, Suárez S, María Suriñach J, Tiberio G, Isabel Torres M, Tolosa C, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Ramón Vela J, Vidal G, Villares P, Zamora C, Gutiérrez P, Javier Vázquez F, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bura-Riviere A, Crichi B, Debourdeau P, Farge-Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Colaizzo D, Dentali F, Micco PD, Giammarino E, Grandone E, Maggi F, Mangiacapra S, Mastroiacovo D, Maida R, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tiraferri E, Tufano A, Visonà A, Hong NV, Zalunardo B, Kalejs RV, Kigitovica D, Skride A, Ferreira M, Meireles J, Reis A, Bosevski M, Krstevski G, Zdraveska M, Bounameaux H, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, My Bui H. Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism. Circ Cardiovasc Imaging 2020; 13:e010651. [DOI: 10.1161/circimaging.120.010651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE.
Methods:
Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging.
Results:
Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%,
P
<0.001). The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018,
P
<0.001).
Conclusions:
In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.
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Affiliation(s)
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain (D.J.)
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne and INSERM U1059 SAINBIOSE - CIC 1408, Université Jean-Monnet, Saint-Etienne, France (L.B.)
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain (A.F.)
| | | | - José Pedro Gonzalez-Martinez
- Department of Internal Medicine, Hospital Universitari St Joan de Deu Manresa (Barcelona) Fundació Althaia (J.P.G.-M.)
| | - Ángeles Blanco-Molina
- Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain (A.B.-M.)
| | - Miguel Ángel Aibar
- Internal Medicine Department and IIS Aragón, Hospital Clínico Universitario, Zaragoza, Spain (M.A.A.)
| | - Pierre-Benoît Bonnefoy
- Service de médecine nucléaire, Hôpital Nord, CHU de St-Etienne, Saint-Etienne, France (P.-B.B.)
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.K.)
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital (M.R.P.)
- Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital (B.B.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (B.B.)
- Cardiovascular Research Foundation (CRF), New York, NY (B.B.)
| | - Manuel Monreal
- Department of Internal Medicine, Hospital de Badalona Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain (M.M.)
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26
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Michelis R, Tadmor T, Aviv A, Stemer G, Majdob R, Shvidel L, Shehadeh M, Barhoum M, Braester A. Cell-free IgG-aggregates in plasma of patients with chronic lymphocytic leukemia cause chronic activation of the classical complement pathway. PLoS One 2020; 15:e0230033. [PMID: 32150580 PMCID: PMC7062264 DOI: 10.1371/journal.pone.0230033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/19/2020] [Indexed: 11/18/2022] Open
Abstract
Therapy regimens for Chronic lymphocytic leukemia (CLL) commonly include chemotherapy and immunotherapy, which act through complement-mediated-cytotoxicity (CDC) and other mechanisms. CDC depends on several factors, including the availability and activity of the complement classical pathway (CP). Recently, a significant decrease in CP activity was shown to be associated with an immunoglobulin-C5a complex (Ig-C5a) and other markers of chronic CP activation in 40% of the patients. The study focused on the involvement of IgG-hexamers, an established CP activator, in the mechanism of chronic CP activation in CLL. Sera from 51 naïve CLL patients and 20 normal controls were collected. CP and alternative pathway (AP) activities were followed by the complement activity marker sC5b-9. Serum high molecular weight (HMW) proteins were collected by gel-filtration chromatography and their complement activation capacity was assessed. The levels of IgM, another established CP activator, were measured. Data were associated with the presence of Ig-C5a. Baseline levels of activation markers negatively correlated with CP and the AP activities, supporting chronic complement activation. In patients with Ig-C5a, HMW proteins that are not IgM, activated the complement. HMW proteins were identified as IgG-aggregates by affinity binding assays and Western blot analysis. The data indicate chronic CP activation, mediated by cell-free IgG-hexamers as a cause of decreased CP activity in part of the CLL population. This mechanism may affect immunotherapy outcomes due to compromised CP activity and CDC.
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Affiliation(s)
- Regina Michelis
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
| | - Tamar Tadmor
- Hematology Division, Bnai Zion Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Galia Stemer
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Rawan Majdob
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Mona Shehadeh
- Biochemistry Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Andrei Braester
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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27
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Giorgi-Pierfranceschi M, López-Núñez JJ, Monreal M, Cattabiani C, Lodigiani C, Di Micco P, Bikdeli B, Braester A, Soler S, Dentali F. Morbid Obesity and Mortality in Patients With VTE: Findings From Real-Life Clinical Practice. Chest 2020; 157:1617-1625. [PMID: 32004553 DOI: 10.1016/j.chest.2019.12.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The influence of morbid obesity on mortality in patients receiving anticoagulant therapy for VTE has not been consistently evaluated. METHODS Data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry were used to compare the mortality risk during anticoagulation in patients with VTE and morbid obesity (BMI ≥ 40 kg/m2) vs those with normal weight (BMI, 18.5-24.9 kg/m2). Patients with or without active cancer were analyzed separately. RESULTS By September 2018, there were 1,642 patients with VTE and morbid obesity and 14,848 with normal weight in RIETE. Of these, 245 (5.5%) and 1,397 (11.6%), respectively, had cancer. Median duration of anticoagulant therapy was longer in the morbidly obese patients, with cancer (185 vs 114 days) or without cancer (203 vs 177 days). Among cancer patients, 44 (18.0%) morbidly obese and 1,377 (32.8%) patients with normal weight died during anticoagulation. Among those without cancer, 44 (3.1%) morbidly obese died and 601 (5.6%) with normal weight died. On bivariate analysis, morbid obesity was associated with a lower mortality rate, both in patients with cancer (hazard ratio, 0.34; 95% CI, 0.25-0.45) and in those without cancer (hazard ratio, 0.43; 95% CI, 0.32-0.58). Multivariable analysis confirmed a lower hazard of death in morbidly obese patients with cancer (hazard ratio, 0.68; 95% CI, 0.50-0.94) and without cancer (hazard ratio, 0.67; 95% CI, 0.49-0.96). The risk for VTE recurrences or major bleeding did not differ in patients with or without morbid obesity. CONCLUSIONS In patients with VTE, the risk for death during anticoagulation was about one-third lower in morbidly obese patients than in those with normal weight, independently of the presence of cancer.
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Affiliation(s)
| | - Juan J López-Núñez
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Universidad Autónoma de Barcelona, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Universidad Autónoma de Barcelona, Spain
| | - Chiara Cattabiani
- Department of Internal Medicine, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Corrado Lodigiani
- Thrombosis and Hemorrhagic Diseases Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (Mi), Italy
| | - Pierpaolo Di Micco
- Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY; Yale New Haven Health, Center for Outcomes Research & Evaluation, New Haven, CT; Cardiovascular Research Foundation, New York, NY
| | - Andrei Braester
- Department of Haematology, Azrieli School of Medicine in Galilee, Bar-ilan University, Safed, Israel
| | - Silvia Soler
- Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain
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28
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Avnery O, Martin M, Bura-Riviere A, Barillari G, Mazzolai L, Mahé I, Marchena PJ, Verhamme P, Monreal M, Ellis MH, Aibar MA, Aibar J, Amado C, Arcelus JI, Ballaz A, Barba R, Barrón M, Barrón‐Andrés B, Bascuñana J, ina A, Camon AM, Cañas I, Carrasco C, Castro J, Ancos C, Toro J, Demelo P, Díaz‐Peromingo JA, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Criado MC, Fernández‐Núñez S, Fidalgo MA, Font C, Font L, Freire M, Gallego M, García MA, García‐Bragado F, García‐Morillo M, García‐Raso A, Gavín O, Gayol MC, Gil‐Díaz A, Gómez V, Gómez‐Cuervo C, González‐Martínez J, Grau E, Gutiérrez J, Hernández‐Blasco LM, Iglesias M, Jara‐Palomares L, Jaras MJ, Jiménez R, Jiménez‐Castro D, Jiménez‐López J, Joya MD, Lima J, Llamas P, Lobo JL, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Martín del Pozo M, Martín‐Guerra JM, Martín‐Romero M, Mellado M, Morales MV, Muñoz N, Nieto‐Cabrera MA, Nieto‐Rodríguez JA, Núñez‐Ares A, Núñez MJ, Olivares MC, Otalora S, Otero R, Pedrajas JM, Pellejero G, Pérez‐Rus G, Peris ML, Porras JA, Rivas A, Rodríguez‐Dávila MA, Rodríguez‐Hernández A, Rubio CM, Ruiz‐Artacho P, Ruiz‐Ruiz J, Ruiz‐Torregrosa P, Ruiz‐Sada P, Sahuquillo JC, Salazar V, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Soler S, Sopeña B, Suriñach JM, Tolosa C, Torres MI, Trujillo‐Santos J, Uresandi F, Valle R, Vidal G, Villares P, Gutiérrez P, Vázquez FJ, Vilaseca A, Vanassche T, Vandenbriele C, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Debourdeau P, Farge‐Bancel D, Hij A, Moustafa F, Schellong S, Braester A, Brenner B, Tzoran I, Sharif‐Kashani B, Bilora F, Bortoluzzi C, Bucherini E, Ciammaichella M, Dentali F, Di Micco P, Di Pangrazio M, Maida R, Mastroiacovo D, Pace F, Pallotti G, Parisi R, Pesavento R, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Gibietis V, Skride A, Strautmane S, Bosevski M, Zdraveska M, Bounameaux H, Fresa M, Ney B, Caprini J, Bui HM, Pham KQ. D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry. J Intern Med 2020; 287:32-41. [PMID: 31394000 DOI: 10.1111/joim.12969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/14/2022]
Abstract
BACKGROUND Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy. METHODS We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel). RESULTS In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI: 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI: 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI: 5.71-10.4) and 3.34 (95% CI: 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR]: 2.14; 95% CI: 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR: 2.34; 95% CI: 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR: 1.74; 95% CI: 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors. CONCLUSIONS Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.
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Affiliation(s)
- O Avnery
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Martin
- Hospital Infanta Sofia San Sebastian de los Reyes and Universidad Europea de Madrid, Madrid, Spain
| | - A Bura-Riviere
- Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France
| | - G Barillari
- Department of Internal Medicine, Ospedale S. Maria della Misericordia, Udine, Italy
| | - L Mazzolai
- Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - I Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Colombes (APHP), University Paris 7, Colombes, France
| | - P J Marchena
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain
| | - P Verhamme
- Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
| | - M Monreal
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M H Ellis
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tadmor T, Braester A, Najib D, Aviv A, Herishanu Y, Yuklea M, Shvidel L, Rahimi-Levene N, Ruchlemer R, Arad A, Fogl C, Henig C, Barak M, Magal L, Polliack A, Townsend K. A new risk model to predict time to first treatment in chronic lymphocytic leukemia based on heavy chain immunoparesis and summated free light chain. Eur J Haematol 2019; 103:335-341. [PMID: 31278876 DOI: 10.1111/ejh.13288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is frequently accompanied by immune dysregulation. AIMS In this multicenter prospective study, we investigated whether heavy + light chains (HLC: IgGκ, IgGλ, IgAκ, IgAκ, IgMκ, IgMλ) and IgG subclasses (IgG1, IgG2, IgG3, and IgG4) could be used as novel prognostic markers of immunoparesis in 105 treatment-naïve patients with CLL. RESULTS Heavy + light chains immunoparesis of ≥1, ≥2, and ≥3 isotypes was evident in 74 (70%), 58 (55%), and 36 (34%) patients, respectively. Severe HLC immunoparesis was identified in 40 (38%) patients. Of the IgG subclasses, IgG1 and IgG2 were most frequently suppressed, affecting 46 (44%) and 36 (34%) patients, respectively; 63 (60%) patients had low levels of at least one IgG subclass. In multivariate analysis, severe HLC immunoparesis (hazard ratio [HR]: 36.5; P = .010) and ΣFLC ≥ 70 mg/L (HR: 13.2; P = .004) were the only factors independently associated with time to first treatment (TTFT). A risk model including these variables identified patients with 0, 1, and 2 risk factors and significantly different TTFT (P < .001). Patients with two factors represented an ultra-high-risk group with a median TTFT of only 1.3 months. CONCLUSION The above findings demonstrate the potential for the use of HLC immunoparesis, together with sFLC measurements, as future prognostic biomarkers in CLL.
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Affiliation(s)
- Tamar Tadmor
- Bnai Zion Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Andrei Braester
- Western Galilee Hospital, Nahariya, Israel.,Bar Ilan University, Ramat Gan, Israel
| | | | | | - Yair Herishanu
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Tel-Aviv University, Tel Aviv, Israel
| | | | | | | | | | - Ariela Arad
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Clara Henig
- Haifa and Western Galilee Laboratory, Nesher, Israel
| | - Mira Barak
- Haifa and Western Galilee Laboratory, Nesher, Israel
| | - Lee Magal
- Almog Diagnostic, Park Shoham, Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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30
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Tadmor T, Levy I, Herishanu Y, Goldschmidt N, Bairey O, Yuklea M, Shvidel L, Fineman R, Aviv A, Ruchlemer R, Braester A, Dally N, Rouvio O, Shaulov A, Greenbaum U, Inbar M, Polliack A. Primary peg-filgrastim prophylaxis versus filgrastim given "on demand" for neutropenia during therapy with cladribine for hairy cell leukemia. Leuk Res 2019; 82:24-28. [PMID: 31152919 DOI: 10.1016/j.leukres.2019.05.006] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major advances in the treatment of patients with hairy cell leukemia (HCL) have been made following the introduction of purine analogues. The major significant short-term toxicity of cladribine therapy are neutropenia and neutropenic fever (NF) which may be life-threatening. AIM In this retrospective study, we compared the incidence and duration of neutropenia and hospitalization in patients with HCL treated with cladribine followed by peg-filgrastim as primary prophylaxis versus daily filgrastim given "on demand" according to absolute neutrophil count (ANC). METHODS Medical records of patients with HCL diagnosed and followed in 12 medical centers in Israel during 1985-2015 were examined for details of disease at diagnosis. The efficacy of peg-filgrastim and filgrastim was assessed by evaluating the incidence of neutropenia (ANC < 1.0 × 10 [9]/L), number and length of hospitalizations, and number of days from the last day of therapy to recovery of ANC to >1.0 × 10 [9]/L. RESULTS The study population included 202 patients with HCL, 159 of whom (80.7%) were treated with cladribine; 78 patients (49%) required hospitalization for the administration of broad-spectrum antibiotics due to NF. Twenty-eight (19%) patients were treated with peg-filgrastim as primary prophylaxis, while 74 (64%) received filgrastim "on demand" due to neutropenia. Median length of hospitalization, and nadir duration were 8 and 18 days respectively (p = 0.71, p = 0.44). CONCLUSIONS Infectious complications post-cladribine treatment remain high. No difference was found in terms of incidence of NF, number of febrile days, and nadir duration in patients receiving primary peg-filgrastim prophylaxis compared to filgrastim given on demand. Both approaches are justifiable, and the choice remains at the physician's discretion.
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Affiliation(s)
- Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Ilana Levy
- Internal Medicine B, Bnai Zion Medical Center, Haifa, Israel
| | - Yair Herishanu
- Department of Hematology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Hebrew University Medical center, Jerusalem, Israel
| | - Osnat Bairey
- Department of Hematology, Rabin Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv Petah-Tikvah, Israel
| | - Mona Yuklea
- Department of Hematology, Meir Medical Center, Kfar-Saba, Israel
| | - Lev Shvidel
- Hematology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Riva Fineman
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Ariel Aviv
- Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Rosa Ruchlemer
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Najib Dally
- Hematology Unit, Ziv Medical center, Safed, Israel
| | - Ory Rouvio
- Department of Hematology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Adir Shaulov
- Department of Hematology, Hadassah Hebrew University Medical center, Jerusalem, Israel
| | - Uri Greenbaum
- Department of Hematology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal Inbar
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah Hebrew University Medical center, Jerusalem, Israel
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Herishanu Y, Tadmor T, Braester A, Bairey O, Aviv A, Rahimi‐Levene N, Fineman R, Levi I, Yuklea M, Ruchlemer R, Shvidel L, Polliack A. Low‐dose fludarabine and cyclophosphamide combined with standard dose rituximab (LD‐FCR) is an effective and safe regimen for elderly untreated patients with chronic lymphocytic leukemia: The Israeli CLL study group experience. Hematol Oncol 2019; 37:185-192. [DOI: 10.1002/hon.2580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/16/2019] [Accepted: 02/07/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Yair Herishanu
- Department of HematologyTel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Tamar Tadmor
- Hematology UnitBnai‐Zion Medical Center Haifa Israel
| | - Andrei Braester
- Department of HematologyGalilee Medical Center and Faculty of Medicine in Galilee Nahariya Israel
| | - Osnat Bairey
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of HematologyRabin Medical Center Petah Tikva Israel
| | - Ariel Aviv
- Department of HematologyEmek Medical Center Afula Israel
| | | | - Riva Fineman
- Department of HematologyRambam Medical Center Haifa Israel
| | - Itai Levi
- Department of HematologySoroka Medical Center, Beer Sheba and Ben‐Gurion University, Beer Sheba Israel
| | - Mona Yuklea
- Department of HematologySapir Medical Center Kfar Saba Israel
| | - Rosa Ruchlemer
- Department of HematologyShaare Zedek Medical Center Jerusalem Israel
| | - Lev Shvidel
- Department of HematologyKaplan Medical Center Rehovot Israel
| | - Aaron Polliack
- Department of HematologyHadassah University Hospital and Hebrew University Medical School Jerusalem Israel
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Salazar V, Castillo A, Rivas A, Valle R, Nieto J, Font C, Schellong S, Braester A, Fidalgo A, Monreal M. O004: Vena caval filter in pregnant women with acute venous thromboembolism: is it useful and safe? Thromb Res 2019. [DOI: 10.1016/s0049-3848(19)30084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Inbar M, Herishanu Y, Goldschmidt N, Bairey O, Yuklea M, Shvidel L, Fineman R, Aviv A, Ruchlemer R, Braester A, Najib D, Rouvio O, Shaulov A, Greenbaum U, Polliack A, Tadmor T. Hairy Cell Leukemia: Retrospective Analysis of Demographic Data and Outcome of 203 Patients from 12 Medical Centers in Israel. Anticancer Res 2018; 38:6423-6429. [PMID: 30396967 DOI: 10.21873/anticanres.13003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 09/18/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In this retrospective study, we summarized the national Israeli experience with hairy cell leukemia (HCL) in a large cohort of patients with a long follow-up. PATIENTS AND METHODS Demographic data, and relevant laboratory and clinical parameters were analyzed, emphasizing the outcome after first-line treatment with cladribine. RESULTS Data on 203 patients was collected from 12 medical centers during 1985-2015. Mean and median follow-up were 7.5 years and 5.18 years (interquartile range=0.1-40 years), and 5- and 10-year survival were 96% and 90.62%, respectively. The median age of diagnosis was 55.5 years for Jews and 49 years for Arabs (p=0.021), and most patients were males (81.77%); 52.2% were Ashkenazi Jews, 36.1% Sephardic Jews and 11.7% were Arab, Druze or other ethnicity. Cladribine was given to 159 patients (80.7%%) and most (62%) received intravenous (i.v.) and 38% received subcutaneous (s.c.) therapy. Overall survival and time to next treatment were not significantly different between the two schedules (i.v., s.c.). In univariate analysis of a variety of factors, only age >65 years had a negative impact on outcome, with shorter overall survival. It is of interest that Arab patients with HCL were diagnosed at an earlier age, but had a similar clinical course and outcome to both Ashkenazi and Sephardic Jews.
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Affiliation(s)
- Michal Inbar
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yair Herishanu
- Department of Hematology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicne, Tel-Aviv University, Tel Aviv, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah University Hospital, Jerusalem, Israel
| | - Osnat Bairey
- Department of Hematology, Rabin Medical Center, Petah-Tikva, Israel
| | - Mona Yuklea
- Department of Hematology, Meir Medical Center, Kfar-Saba, Israel
| | - Lev Shvidel
- Hematology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Riva Fineman
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Ariel Aviv
- Hematology Unit, Emek Medical Center, Afula, Israel
| | - Rosa Ruchlemer
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Dally Najib
- Hematology Unit, Ziv Medical Center, Zefat, Israel
| | - Ory Rouvio
- Department of Hematology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Adir Shaulov
- Department of Hematology, Hadassah University Hospital, Jerusalem, Israel
| | - Uri Greenbaum
- Department of Hematology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah University Hospital, Jerusalem, Israel
| | - Tamar Tadmor
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel .,Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
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Weinberg I, Giri J, Kolluri R, Arcelus JI, Falgá C, Soler S, Braester A, Bascuñana J, Gutiérrez-Guisado J, Monreal M. Characteristics, treatment patterns and outcomes of patients presenting with venous thromboembolic events after knee arthroscopy in the RIETE Registry. J Thromb Thrombolysis 2018; 46:551-558. [PMID: 30196344 DOI: 10.1007/s11239-018-1736-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Knee arthroscopy is the most common orthopedic procedure worldwide. While incidence of post-arthroscopy venous thromboembolic events (VTE) is low, treatment patterns and patient outcomes have not been described. Patients from the "Registro Informatizado Enfermedad TromboEmbolica" who had confirmed post-arthroscopy VTE were compared to patients with provoked, post bone-fracture, and to patients with unprovoked VTE. Baseline characteristics, presenting signs and symptoms, treatment and outcomes including recurrent VTE, bleeds or death were compared. A total of 101 patients with post-arthroscopy VTE and 19,218 patients with unprovoked VTE were identified. Post-arthroscopy patients were younger (49.5 vs. 66 years, P < 0.0001) and had less history of VTE [5.9% vs. 20%, OR 0.26 (0.11-0.59)]. Among patients with isolated DVT, there were fewer proximal DVT in the post-arthroscopy group [40% vs. 86%, OR 0.11 (0.06-0.19)]. Treatment duration was shorter in the post-arthroscopy group (174 ± 140 vs. 311 ± 340 days, P < 0.0001) and more often with DOAC [OR 3.67 (1.95-6.89)]. Recurrent VTE occurred in 6.18 (1.96-14.9) and 11.9 (11.0-12.8) per 100 patient years [HR 0.52 (0.16-1.26)] after treatment in the post-arthroscopy and unprovoked groups, respectively. Recurrent VTE occurred in 5.17 (1.31-14.1) per 100 patient years in a separate post bone-fracture group (n = 147), also not statistically different than the post-arthroscopy recurrence rate. After anticoagulation cessation, some patients post-knee arthroscopy develop VTE. While our small sample size precludes drawing firm conclusions, this signal should warrant further research into the optimal treatment duration for these patients, as some patients may be at increased risk for long-term recurrence.
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Affiliation(s)
- Ido Weinberg
- Vascular Medicine, Division of Cardiology, Fireman Vascular Center, Massachusetts General Hospital, 55 Fruit Street, GRB-852G, Boston, MA, 02114, USA.
| | - Jay Giri
- Division of Cardiology, Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Raghu Kolluri
- OhioHealth Vascular Institute, Ohio Health, Columbus, OH, USA
| | - Juan Ignacio Arcelus
- Department of General Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Conxita Falgá
- Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | - Silvia Soler
- Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Girona, Spain
| | - Andrei Braester
- Department of Haematology, Galilee Medical Center, Nahariya, Israel
| | - José Bascuñana
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Javier Gutiérrez-Guisado
- Department of Internal Medicine, Hospital Monográfico ASEPEYO, Madrid, Spain.,Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,Universidad Católica de Murcia, Murcia, Spain
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Kuperman A, López-Reyes R, Bosco LSJ, Lorenzo A, José B, Farge Bancel D, Alfonso M, Lumbierres M, Stemer G, Monreal Bosch M, Braester A. Anemia and bleeding in patients receiving anticoagulant therapy for venous thromboembolism. J Thromb Thrombolysis 2018; 45:360-368. [PMID: 29383557 DOI: 10.1007/s11239-018-1610-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/25/2022]
Abstract
In patients receiving anticoagulant therapy for venous thromboembolism (VTE), the important issue of anemia influence on the risk of bleeding has not been consistently studied. We used the large registry data RIETE (Registro Informatizado Enfermedad Tromboembólica) to compare the rate of major bleeding in patients receiving anticoagulant therapy for VTE according to the presence or absence of anemia at baseline. Patients with or without cancer were separately studied. Until August 2016, 63492 patients had been enrolled. Of these, 21652 (34%) had anemia and 14312 (23%) had cancer. Anemia was found in 57% of the patients with cancer and in 28% without (odds ratio 3.46; 95% CI 3.33-3.60). During the course of anticoagulant therapy, 680 patients with cancer had a major bleeding event (gastrointestinal tract 43%, intracranial 14%, hematoma 12%). Cancer patients with anemia had a higher rate of major bleeding (rate ratio [RR]: 2.52; 95% CI 2.14-2.97) and fatal bleeding (RR 2.73; 95% CI 1.95-3.86) than those without anemia. During the course of anticoagulation, 1133 patients without cancer had major bleeding (gastrointestinal tract 32%, hematoma 24%, intracranial 21%). Patients with anemia had a higher rate of major bleeding (RR 2.84; 95% CI 2.52-2.39) and fatal bleeding (RR 2.76; 95% CI 2.07-3.67) than those without. On a multivariable analysis, anemia independently predicted the risk for major bleeding in patients with and without cancer (hazard ratios: 1.66; 95% CI 1.40-1.96 and 1.95; 95% CI 1.72-2.20, respectively). During anticoagulation for VTE, both cancer- and non-cancer anemic patients had a higher risk for major bleeding than those without anemia. In anemic patients (with or without cancer), the rate of major bleeding during the course of anticoagulant therapy exceeded the rate of VTE recurrences. In patients without anemia the rate of major bleeding was lower than the rate of VTE recurrences.
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Affiliation(s)
- Amir Kuperman
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel.,"Azriely" Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Raquel López-Reyes
- Department of Pulmonology, University and Polytechnic LA FE Hospital, Valencia, Spain
| | - Lopez-Saez Juan Bosco
- Department of Internal Medicine, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Alicia Lorenzo
- Laboratorio de Neuropatología Experimental, Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET-Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Bascuñana José
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Dominique Farge Bancel
- Department of Internal Medicine and Pathology, Hôpital Saint-Louis, Avenue Claude Vellefaux, 1, 75010, Paris, France
| | - María Alfonso
- Department of Pneumonology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marina Lumbierres
- Respiratory Department, Arnau de Vilanova-Santa María University Hospital, IRB Lleida, Lleida, Catalonia, Spain
| | - Galia Stemer
- Institute of Hematology, Ha'Emek Medical Center, Afula, Israel
| | - Manuel Monreal Bosch
- Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Murcia, Spain
| | - Andrei Braester
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel. .,"Azriely" Faculty of Medicine, Bar Ilan University, Safed, Israel. .,Galilee Medical Center, POB21, 22100, Nahariya, Israel.
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36
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Azoulay D, Herishanu Y, Shapiro M, Brandshaft Y, Suriu C, Akria L, Braester A. Elevated serum BDNF levels are associated with favorable outcome in CLL patients: Possible link to CXCR4 downregulation. Exp Hematol 2018; 63:17-21.e1. [DOI: 10.1016/j.exphem.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 01/01/2023]
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Rahav Koren R, Suriu C, Yakir O, Akria L, Barhoum M, Braester A. Physicians' lack of knowledge - a possible reason for red blood cell transfusion overuse? Isr J Health Policy Res 2017; 6:49. [PMID: 29228989 PMCID: PMC5725969 DOI: 10.1186/s13584-017-0173-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 08/30/2017] [Indexed: 12/13/2022] Open
Abstract
Background A significant percentage of red blood cell transfusions are inappropriately overused. This study investigated physicians from the western Galilee in terms of their knowledge of transfusion medicine as a potential reason for red blood cell overuse, and assessed the influence of personal background characteristics on their knowledge. Methods Data were collected via anonymous questionnaires. The questionnaires included a personal background section and a professional section. Study participants were grouped according to field of specialty, seniority, and location of medical school graduation, in order to correlate participant characteristics with knowledge. Results Scores were calculated on a 0–100 scale. The overall knowledge of the study population was low (mean score 47.8 ± 18.6). Knowledge regarding basic physiology of red blood cell transfusion was also low. Internal medicine physicians and senior physicians had significantly greater overall knowledge scores and were more familiar with a restrictive blood management policy than were surgeons and residents, respectively. Comparing knowledge scores, no difference was found regarding indications for transfusion. Conclusion General and fundamental knowledge in transfusion medicine is lacking among physicians in the non-operating room setting, which may play a role in red blood cell transfusion overuse. Field of specialty and professional status influenced knowledge of transfusion medicine. Educational programs and increased physicians’ awareness might help decrease unnecessary transfusions. Trial registration Not applicable. Electronic supplementary material The online version of this article (10.1186/s13584-017-0173-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roni Rahav Koren
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel. .,Meir Medical Center, Kfar Saba, Israel.
| | - Celia Suriu
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Orly Yakir
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Luiza Akria
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
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38
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Lobo J, Moustafa F, Jimenez D, Maestre A, Garcia-Bragado F, Uresandi F, Valle R, Lopez-Jimenez L, Lopez-Reyes R, Mazzolai L, Braester A, Skride A, Soler S, Duce R, Monreal M. P1616The echocardiogram in acute pulmonary embolism. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J.L. Lobo
- University Hospital of Araba, Department of pneumology, Alava, Spain
| | - F. Moustafa
- University Hospital Gabriel Montpied, Emergency Medicine, Clermont-Ferrand, France
| | - D. Jimenez
- University Hospital Ramon y Cajal de Madrid, Department of pneumologie, Madrid, Spain
| | - A. Maestre
- Hospital Vinalopo Salud, Department of internal medicine, Elche, Spain
| | - F. Garcia-Bragado
- University Hospital de Girona Dr. Josep Trueta, Department of internal medicine, Girona, Spain
| | - F. Uresandi
- Cruces University Hospital, Department of pneumology, Baracaldo, Spain
| | - R. Valle
- Hospital Sierrallana, Department of Internal medicine, Torrelavega, Spain
| | - L. Lopez-Jimenez
- University Hospital Reina Sofia, Department of internal medicine, Cordoba, Spain
| | - R. Lopez-Reyes
- Hospital Universitario y Politécnico La Fe, Department of pneumology, Valencia, Spain
| | - L. Mazzolai
- University Hospital Centre Vaudois (CHUV), Department of angiology, Lausanne, Switzerland
| | - A. Braester
- Nahariya Hospital for the Western Galilee, Department of haematology, Nahariya, Israel
| | - A. Skride
- Paul Stradins Clinical University Hospital, Department of cardiology, Riga, Latvia
| | - S. Soler
- Hospital Olot i Comarcal de la Garrotxa, Department of Internal medicine, Girona, Spain
| | - R. Duce
- Galliera Hospital, Department of Laboratory of analysis, Genoa, Italy
| | - M. Monreal
- Germans Trias i Pujol Hospital, Department of internal medicine, Badalona (Barcelona), Spain
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Joffe E, Ariela Arad N, Bairey O, Fineman R, Ruchlemer R, Rahimi-Levene N, Shvidel L, Greenbaum U, Aviv A, Tadmor T, Braester A, Goldschmidt N, Polliack A, Herishanu Y. Persistently low lymphocyte counts after FCR therapy for chronic lymphocytic leukemia are associated with longer overall survival. Hematol Oncol 2017. [PMID: 28639416 DOI: 10.1002/hon.2444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Decreased absolute lymphocyte counts (ALCs) following frontline therapy for chronic lymphocytic leukemia may be associated with disease control, even in patients without evidence of minimal residual disease. We studied the prognostic significance of ALCs during the first year following treatment with fludarabine, cyclophosphamide, and rituximab (FCR). We evaluated 99 patients who achieved a partial response without lymphocytosis (<4.0 × 103 cells/μL) or better after FCR. Absolute lymphocyte counts were recorded at 3-, 6-, 9-, and 12-month posttreatment and correlated with overall survival (OS) and event-free survival (EFS). For each time point, analyses were limited to patients without lymphocytosis, so as to avoid possible biases from undocumented disease progressions. Lymphopenia (ALC < 1.0 × 103 cells/μL) at 3 m after FCR (69% of patients n = 68), was associated with a longer OS (5y OS 91% vs 64%, P = .001), as were ALC ≤ 2 × 103 cells/μL at 6 m (5y OS 85% vs 48%, P = .004) and ALC ≤ 1.8 × 103 cells/μL at 9 m (5y OS 93% vs 54%, P = .009). A normal-range ALC (≤4 × 103 cells/μL) at 12 m was also associated with a 91% 5y OS. Higher ALCs (but without lymphocytosis) were associated with shorter EFS (median EFS 27 months for ALC > 1.8 vs not reached for ALC ≤ 0.7 at 9 months, P < .0001). In conclusion, lower ALC levels in the first few months following frontline FCR therapy were associated with longer OS and EFS. Possible explanations may be that lower ALCs reflect deeper clonal suppression or protracted Treg depletion. Absolute lymphocyte count levels may be a cheap and widely available prognostic marker, though the added value for clinical practice is the minimal residual disease era needs to be explored.
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Affiliation(s)
- Erel Joffe
- Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Tel Aviv, Israel.,Department of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - N Ariela Arad
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Osnat Bairey
- Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Tel Aviv, Israel.,Department of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - Riva Fineman
- Department of Hematology, Rambam Medical Center, Haifa, Israel
| | - Rosa Ruchlemer
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Naomi Rahimi-Levene
- Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Tel Aviv, Israel.,Hematology Institute, Assaf Harofe Medical Center, Zerifin, Israel
| | - Lev Shvidel
- Department of Hematology, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Uri Greenbaum
- Soroka Medical Center, Beer Sheba and Ben-Gurion University, Beer Sheva, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Andrei Braester
- Department of Hematology, Western Galilee Hospital, Nahariya, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Aaron Polliack
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yair Herishanu
- Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Tel Aviv, Israel.,The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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40
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Haran M, Mirkin V, Braester A, Harpaz N, Shevetz O, Shtreiter M, Greenberg S, Mordich O, Amram O, Binsky-Ehrenreich I, Marom A, Shachar I, Herishanu Y, Ruchlemer R, Berrebi A, Valinsky L, Shtalrid M, Shvidel L. A phase I-II clinical trial of the anti-CD74 monoclonal antibody milatuzumab in frail patients with refractory chronic lymphocytic leukaemia: A patient based approach. Br J Haematol 2017; 182:125-128. [PMID: 28466956 DOI: 10.1111/bjh.14726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Michal Haran
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Vita Mirkin
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Andrei Braester
- Haematology Institute, Galilee Medical Centre, Nahariya, Israel
| | - Nurith Harpaz
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Olga Shevetz
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Marina Shtreiter
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Shulamit Greenberg
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Orly Mordich
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Orna Amram
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | | | - Ayelet Marom
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Idit Shachar
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Yair Herishanu
- Department of Haematology, Sourasky Medical Centre and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rosa Ruchlemer
- Department of Haematology, Shaare Zedek, Jerusalem, Israel
| | - Alain Berrebi
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Liora Valinsky
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Mordechai Shtalrid
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
| | - Lev Shvidel
- Haematology Institute, Kaplan Medical Centre, affiliated with the Hebrew University, Rehovot, Israel
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Tzoran I, Papadakis M, Brenner B, Fidalgo Á, Rivas A, Wells PS, Gavín O, Adarraga MD, Moustafa F, Monreal M, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Papadakis M, Adarraga M, Aibar M, Alfonso M, Arcelus J, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Cañada G, Cañas I, Chic N, del Pozo R, del Toro J, Díaz-Pedroche M, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Fidalgo M, Font C, Font L, Gallego P, García A, García M, García-Bragado F, García-Brotons P, Gavín O, Gómez C, Gómez V, González J, González-Marcano D, Grau E, Grimón A, Guijarro R, Gutiérrez J, Hernández-Comes G, Hernández-Blasco L, Hermosa-Los Arcos M, Jara-Palomares L, Jaras M, Jiménez D, Joya M, Llamas P, Lecumberri R, Lobo J, López P, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Maestre A, Marchena P, Martín-Martos F, Monreal M, Nieto J, Nieto S, Núñez A, Núñez M, Odriozola M, Otero R, Pedrajas J, Pérez G, Pérez-Ductor C, Peris M, Porras J, Reig O, Riera-Mestre A, Riesco D, Rivas A, Rodríguez C, Rodríguez-Dávila M, Rosa V, Ruiz-Giménez N, Sahuquillo J, Sala-Sainz M, Sampériz A, Sánchez-Martínez R, Sánchez Simón-Talero R, Sanz O, Soler S, Suriñach J, Torres M, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vicente M, Villalobos A, Vanassche T, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, del Pozo G, Salgado E, Sánchez G, Bertoletti L, Bura-Riviere A, Mahé I, Merah A, Moustafa F, Papadakis M, Braester A, Brenner B, Tzoran I, Antonucci G, Barillari G, Bilora F, Bortoluzzi C, Cattabiani C, Ciammaichella M, Di Biase J, Di Micco P, Duce R, Ferrazzi P, Giorgi-Pierfranceschi M, Grandone E, Imbalzano E, Lodigiani C, Maida R, Mastroiacovo D, Pace F, Pesavento R, Pinelli M, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Gibietis V, Skride A, Vitola B, Monteiro P, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Bounameaux H, Calanca L, Erdmann A, Mazzolai L. Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation. Am J Med 2017; 130:482.e1-482.e9. [PMID: 27986523 DOI: 10.1016/j.amjmed.2016.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Received: 08/22/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored. METHODS We used the Registro Informatizado de Enfermedad TromboEmbólica database to compare rates of venous thromboembolism recurrence and bleeding events occurring during the anticoagulation course in factor V Leiden carriers, prothrombin mutation carriers, and noncarriers. RESULTS Between March 2001 and December 2015, 10,139 patients underwent thrombophilia testing. Of these, 1384 were factor V Leiden carriers, 1115 were prothrombin mutation carriers, and 7640 were noncarriers. During the anticoagulation course, 160 patients developed recurrent deep vein thrombosis and 94 patients developed pulmonary embolism (16 died); 154 patients had major bleeding (10 died), and 291 patients had nonmajor bleeding. On multivariable analysis, factor V Leiden carriers had a similar rate of venous thromboembolism recurrence (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.82-1.64), half the rate of major bleeding (adjusted HR, 0.50; 95% CI, 0.25-0.99) and a nonsignificantly lower rate of nonmajor bleeding (adjusted HR, 0.66; 95% CI, 0.43-1.01) than noncarriers. Prothrombin mutation carriers and noncarriers had a comparable rate of venous thromboembolism recurrence (adjusted HR, 1.00; 95% CI, 0.68-1.48), major bleeding (adjusted HR, 0.75; 95% CI, 0.42-1.34), and nonmajor bleeding events (adjusted HR, 1.10; 95% CI, 0.77-1.57). CONCLUSIONS During the anticoagulation course, factor V Leiden carriers had a similar risk for venous thromboembolism recurrence and half the risk for major bleeding compared with noncarriers. This finding may contribute to decision-making regarding anticoagulation duration in selected factor V Leiden carriers with venous thromboembolism.
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Affiliation(s)
- Inna Tzoran
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
| | - Manolis Papadakis
- Haematology and Hemostasis Unit, Hospital Papageorgiou, Saloniki, Greece
| | - Benjamin Brenner
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain
| | - Agustina Rivas
- Department of Pneumonology, Hospital Universitario Araba, Álava, Spain
| | - Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ontario, Canada
| | - Olga Gavín
- Department of Haematology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Farès Moustafa
- Department of Emergency, Clermont-Ferrand University Hospital, France
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Barcelona, Spain
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Mahé I, Chidiac J, Bertoletti L, Font C, Trujillo-Santos J, Peris M, Pérez Ductor C, Nieto S, Grandone E, Monreal M, Arcelus J, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Culla A, de Miguel J, del Toro J, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Font C, Font L, Gallego P, García-Bragado F, García-Brotons P, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández G, Hernández-Blasco L, Isern V, Jara-Palomares L, Jaras M, Jiménez D, Lacruz B, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Madridano O, Marchena P, Martín-Antorán J, Martín-Martos F, Monreal M, Morales M, Nauffal D, Nieto J, Nieto S, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez C, Pérez G, Peris M, Porras J, Ramírez L, Reig O, Riera A, Rivas A, Rodríguez-Dávila M, Rosa V, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Martínez C, Sampériz A, Sala C, Sanz O, Soler S, Sopeña B, Suarez I, Suriñach J, Tiberio G, Tolosa C, Trujillo-Santos J, Uresandi F, Valle R, Vela J, Villalta J, Malfante P, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, Salgado E, Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Apollonio A, Barillari G, Candeloro G, Ciammaichella M, Di Micco P, Ferrazzi P, Grandone E, Lessiani G, Lodigiani C, Mastroiacovo D, Pace F, Pinelli M, Prandoni P, Rota L, Tiraferri E, Tufano A, Visonà A, Belovs A, Skride A, Moreira M, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Alatri A, Bounameaux H, Calanca L, Mazzolai L, Serrano J, Decousus H, Reis A. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site. Am J Med 2017; 130:337-347. [PMID: 27884650 DOI: 10.1016/j.amjmed.2016.10.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [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] [Received: 01/26/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. AIM AND METHODS We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). RESULTS As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). CONCLUSIONS Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.
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Affiliation(s)
- Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France.
| | - Jean Chidiac
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France
| | - Laurent Bertoletti
- Department of Vascular and Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, French Clinical Research Infrastructure Network (F-CRIN), INNOVTE
| | - Carme Font
- Department of Medical Oncology, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clinic de Barcelona, Spain
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain
| | - Marisa Peris
- Department of Internal Medicine, Hospital Provincial Castellon; CEU Cardenal Herrero University, Spain
| | - Cristina Pérez Ductor
- Department of Emergency Medicine, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Santiago Nieto
- Department of Haematology, Hospital de la Vega Lorenzo Guirao, Murcia, Spain
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain
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Akria L, Chezar J, Zisman-Rozen S, Scheinman EJ, Zonis Z, Hoffmann Y, Falik-Zaccai T, Kalfon L, Weiss M, Braester A, Suriu C, Barhoum M, Kuperman A, Shaoul E. A Puzzling "Switch" in Blood Type Following Blood Transfusion. Ann Lab Med 2017; 37:293-295. [PMID: 28224781 PMCID: PMC5339107 DOI: 10.3343/alm.2017.37.3.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/04/2016] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Luiza Akria
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.
| | - Judith Chezar
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Simona Zisman-Rozen
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Eyal J Scheinman
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Zeev Zonis
- Pediatric Intensive Care Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Yoav Hoffmann
- Pediatric Intensive Care Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Tzipora Falik-Zaccai
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Cytogenetic Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Limor Kalfon
- Cytogenetic Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Michael Weiss
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Surgery, Galilee Medical Center, Nahariya, Israel
| | - Andrei Braester
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Celia Suriu
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Amir Kuperman
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Pediatrics, Galilee Medical Center, Nahariya, Israel
| | - Ety Shaoul
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
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44
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Azoulay D, Sonkin V, Akria L, Rozano Gorelick A, Trakhtenbrot L, Hershkovitz D, Shaoul E, Rozen S, Dementiev E, Cohen HI, Suriu C, Braester A. Hairy cell leukemia-variant without typical morphology and with near-tetraploid DNA content. Cytometry 2017; 94:169-171. [DOI: 10.1002/cyto.b.21503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/04/2016] [Accepted: 12/12/2016] [Indexed: 11/08/2022]
Affiliation(s)
- David Azoulay
- Department of Hematology; Galilee Medical Center; Nahariya Israel
| | - Vadim Sonkin
- Department of Pathology; Galilee Medical Center; Nahariya Israel
| | - Luiza Akria
- Department of Hematology; Galilee Medical Center; Nahariya Israel
| | | | | | - Dov Hershkovitz
- Department of Pathology; Rambam Health Care Campus; Haifa Israel
| | - Ety Shaoul
- Department of Hematology; Galilee Medical Center; Nahariya Israel
| | - Simona Rozen
- Department of Hematology; Galilee Medical Center; Nahariya Israel
| | - Eugene Dementiev
- Department of Pathology; Galilee Medical Center; Nahariya Israel
| | - Hector I Cohen
- Department of Pathology; Galilee Medical Center; Nahariya Israel
| | - Celia Suriu
- Department of Hematology; Galilee Medical Center; Nahariya Israel
| | - Andrei Braester
- Department of Hematology; Galilee Medical Center; Nahariya Israel
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45
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Newton DH, Monreal Bosch M, Amendola M, Wolfe L, Perez Ductor C, Lecumberri R, Levy MM, Monreal M, Decousus H, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Papadakis M, Agüero R, Aibar M, Alfonso M, Aranda R, Arcelus J, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Binetti J, Blanco-Molina A, Bueso T, Cañas I, Carmona F, Chic N, Culla A, del Pozo R, del Toro J, Díaz-Pedroche M, Díaz-Peromingo J, Falgá C, Fernández-Aracil C, Fernández-Capitán C, Fidalgo M, Font C, Font L, Gallego P, García M, García-Bragado F, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández-Comes G, Hernández-Blasco L, Jara-Palomares L, Jaras M, Jiménez D, Joya M, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Manrique-Abos I, Marchena P, Martín M, Martín-Antorán J, Martín-Martos F, Monreal M, Nieto J, Nieto S, Núñez A, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez G, Pérez I, Pérez-Ductor C, Peris M, Porras J, Reig O, Riera-Mestre A, Riesco D, Rivas A, Rodríguez-Dávila M, Rosa V, Rosillo-Hernández E, Ruiz-Artacho P, Ruiz-Giménez N, Sahuquillo J, Sala-Sainz M, Sampériz A, Sánchez R, Sanz O, Soler S, Sopeña B, Suriñach J, Tolosa C, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vidal G, Villalta J, Vanassche T, Verhamme P, Wells P, Hirmerova J, Malý R, Salgado E, Bertoletti L, Bura-Riviere A, Champion K, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Antonucci G, Barillari G, Bilora F, Ciammaichella M, Dentali F, Di Micco P, Duce R, Ferrazzi P, Grandone E, Lodigiani C, Maida R, Pace F, Pesavento R, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Drucka E, Kigitovica D, Skride A, Ramos A, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Bounameaux H, Erdmann A, Mazzolai L, Ney B. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry. J Vasc Surg Venous Lymphat Disord 2017; 5:18-24.e1. [DOI: 10.1016/j.jvsv.2016.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022]
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Mittelman M, Filanovsky K, Ofran Y, Rosenbaum H, Raanani P, Braester A, Goldschmidt N, Kirgner I, Herishanu Y, Perri C, Ellis M, Oster HS. Azacitidine-lenalidomide (ViLen) combination yields a high response rate in higher risk myelodysplastic syndromes (MDS)—ViLen-01 protocol. Ann Hematol 2016; 95:1811-8. [DOI: 10.1007/s00277-016-2776-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/29/2016] [Indexed: 12/14/2022]
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Suriu C, Akria L, Azoulay D, Shaoul E, Barhoum M, Braester A. Absolute lymphocyte count as a prognostic marker in newly diagnosed multiple myeloma patients. Int J Lab Hematol 2016; 38:e56-9. [PMID: 27018225 DOI: 10.1111/ijlh.12482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Suriu
- Department of Hematology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
| | - L Akria
- Department of Hematology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
| | - D Azoulay
- Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - E Shaoul
- Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - M Barhoum
- Galilee Medical Center, Bar Ilan University, Faculty of Medicine, Nahariya, Israel
| | - A Braester
- Department of Hematology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel.
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48
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Portillo J, de la Rocha IV, Font L, Braester A, Madridano O, Peromingo JAD, Apollonio A, Pagán B, Bascuñana J, Monreal M. Venous thromboembolism in patients with glioblastoma multiforme: Findings of the RIETE registry. Thromb Res 2015; 136:1199-203. [PMID: 26548619 DOI: 10.1016/j.thromres.2015.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/05/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is uncertainty about the optimal therapy of venous thromboembolism (VTE) in patients with glioblastoma multiforme (GBM). METHODS We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of VTE recurrences and major bleeding during the course of anticoagulation in patients with GBM, other cancers and in patients without cancer. RESULTS As of September 2014, 53,546 patients have been recruited in RIETE. Of these, 72 (0.13%) had GBM and 11,811 (22%) had other cancers. Most patients in all 3 subgroups received initial therapy with low-molecular-weight heparin (LMWH), but those with GBM received slightly lower doses than those with other cancers or without cancer. Then, most patients with GBM continued on LMWH for long-term therapy, at similar doses than those in the other subgroups. During the course of anticoagulation (mean, 202 days), 3 patients with GBM presented VTE recurrences (10.9 per 100 patient-years; 95% CI: 2.76-29.5) and 4 suffered major bleeding (one intracranial) (14.5 bleeds per 100 patient-years; 95%CI: 4.60-34.9). Compared with patients with other cancers, those with GBM had a similar rate of VTE recurrences and major bleeds, but had a higher rate of extracranial hematoma (p<0.05). Compared with VTE patients without cancer, those with GBM had a higher rate of PE recurrences (p<0.01) and major bleeding (p<0.001), particularly extracranial hematoma (p<0.001). CONCLUSIONS Patients with GBM and VTE had a similar rate of VTE recurrences or major bleeds during the course of anticoagulant therapy than those with other cancers.
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Affiliation(s)
- Jose Portillo
- Department of Internal Medicine, Hospital General Universitario de Ciudad Real, Spain; Facultad de Medicina de Ciudad Real, Universidad de Castilla La Mancha, Spain
| | | | - Llorenç Font
- Department of Haematology, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain
| | - Andrei Braester
- Department of Haematology, Galilee Medical Center, Nahariya, "Azriel" Faculty of Medicine in Galilee, Bar-ilan University, Israel
| | - Olga Madridano
- Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain
| | | | | | - Barbara Pagán
- Department of Internal Medicine, Hospital de Madrid Norte Sanchinarro, Madrid, Spain
| | - José Bascuñana
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain.
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49
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Azoulay D, Leibovici A, Sharoni R, Shaoul E, Gross B, Braester A, Goldberg H. Association between Met-BDNF allele and vulnerability to paclitaxel-induced peripheral neuropathy. Breast Cancer Res Treat 2015; 153:703-4. [PMID: 26272744 DOI: 10.1007/s10549-015-3546-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Affiliation(s)
- David Azoulay
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel. .,Hematology Unit, Galilee Medical Center, P.O.B 21, 22100, Naharia, Israel.
| | - Anca Leibovici
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Oncology Unit, Galilee Medical Center, Naharia, Israel
| | - Rivka Sharoni
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Hematology Unit, Galilee Medical Center, P.O.B 21, 22100, Naharia, Israel
| | - Eti Shaoul
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Hematology Unit, Galilee Medical Center, P.O.B 21, 22100, Naharia, Israel
| | - Bella Gross
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Department of Neurology, Galilee Medical Center, Naharia, Israel
| | - Andrei Braester
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Hematology Unit, Galilee Medical Center, P.O.B 21, 22100, Naharia, Israel
| | - Hadassah Goldberg
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Oncology Unit, Galilee Medical Center, Naharia, Israel
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50
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Ellis MH, Lavi N, Mishchenko E, Dally N, Lavie D, Courevitch A, Gutwein O, Bulvik S, Braester A, Chubar E, Tavor S, Duek A, Kirgner I, Koren-Michowitz M. Ruxolitinib treatment for myelofibrosis: Efficacy and tolerability in routine practice. Leuk Res 2015; 39:S0145-2126(15)30356-8. [PMID: 26364797 DOI: 10.1016/j.leukres.2015.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/28/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
Ruxolitinib has been shown in two randomized clinical trials to be effective in alleviating systemic symptoms and reducing spleen size in patients with myelofibrosis (MF). We retrospectively evaluated efficacy and tolerability of ruxolitinib in a cohort of unselected MF patients treated in routine clinical practice. One hundred and two patients who began ruxolitinib therapy were identified in 13 participating centers. Ninety three of the patients receiving ruxolitinib for at least 3 months were evaluated for treatment efficacy and toxicity. Median age at ruxolitinib initiation was 67 years. Indications for treatment were constitutional symptoms (15%), symptomatic splenomegaly (6%) or both (76%). Two patients received ruxolitinib for other indications. The median initial ruxolitinib dose was 30mg/day. Median duration of therapy was 11 months. Eighty two patients (88.2%) responded to therapy, 76 (84.4%) patients had improvement in constitutional symptoms and 60 patients (70.6%) had reduction in spleen length. While on ruxolitinib, 30% of patients had grade 3-4 anemia and 12.9% of patients had grade 3-4 thrombocytopenia. Thirteen patients (14%) discontinued therapy. This analysis of a cohort of MF patients treated with ruxolitinib in routine clinical practice demonstrates the efficacy and tolerability of this drug outside of a highly monitored clinical trial setting.
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Affiliation(s)
- Martin H Ellis
- Department of Hematology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Lavi
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
| | | | - Najib Dally
- Department of Hematology, Ziv Medical Center Associated with the Bar Ilan University, Faculty of Medicine, Safed, Israel
| | - David Lavie
- Department of Hematology and Bone Marrow Transplantation, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel
| | - Anna Courevitch
- Department of Hematology and Bone Marrow Transplantation, Soroka Medical Center, Beer-Sheva, Israel
| | - Odit Gutwein
- Department of Hematology, Assaf Harofeh Medical Center, Ramla, Israel
| | - Shlomo Bulvik
- Department of Hematology, Laniado Hospital-Sanz Medical Center, Netanya, Israel
| | - Andrei Braester
- Department of Hematology, Western Galilee Hospital, Nahariya, Israel
| | - Evgeni Chubar
- Department of Hematology, The Emek Medical Center, Afula, Israel
| | - Sigal Tavor
- Maccabi Health Organization, Tel Aviv, Israel
| | - Adrian Duek
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilya Kirgner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Maya Koren-Michowitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel Hashomer, Israel
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