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Pantelidou D, Pilalas D, Daios S, Polychronopoulos G, Papadopoulou D, Perifanis V, Savopoulos C, Kaiafa G. Hyperhaemolytic transfusion reaction in two β-thalassaemia major patients: The role of eculizumab. J Clin Pharm Ther 2021; 47:411-414. [PMID: 34397109 DOI: 10.1111/jcpt.13510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/26/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Hyperhaemolytic transfusion reactions are rare life-threatening events predominantly affecting patients with haemoglobinopathies. We report two cases in β-thalassaemia major patients on chronic transfusion therapy and highlight the role of eculizumab in its management. CASE SUMMARY Patient 1 presented with intravascular haemolysis on day 7 (D7) post-transfusion and responded to treatment with corticosteroids and intravenous immunoglobulin. However, patient 2 presented with severe symptomatic anaemia (D4 post-transfusion) unresponsive to the aforementioned measures. Eculizumab administration led to resolution of the hyperhaemolysis. WHAT IS NEW AND CONCLUSION We report the successful management of hyperhaemolysis with eculizumab in a β-thalassemia major patient.
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Affiliation(s)
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Daios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Polychronopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Vassilios Perifanis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kamperidis V, Vlachou M, Pappa Z, Pantelidou D, Karamitsos T, Papadopoulou D, Kartas A, Vlachaki E, Giannakoulas G, Karvounis H. Prediction of long-term survival in haemoglobinopathies: insights from cardiac imaging and ferritin. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims.The data on echocardiography, cardiac magnetic resonance (CMR) and ferritin predicting long-term survival in haemoglobinopathies are scarce. The current study evaluated the association of these parameters with the 10-years survival in haemoglobinopathies.
Methods.This prospective study included stable consecutive haemoglobinopathy patients .Demographics, ferritin, echocardiography and CMR parameters were prospectively collected.
Results. In total, 83 patients (mean age 38.4 ± 12.0 years, 46% male) with haemoglobinopathies were included and dichotomized based on their survival status after a follow-up of 9.8 ± 1.4 years. Patients who died were older (45.3 ± 11.6 vs 37.1 ± 11.7 years, p = 0.025), had higher ferritin levels (2498 vs 754 ng/ml, p = 0.001), higher right ventricular systolic pressure (RVSP) (41 ± 10 vs 31 ± 11mmHg, p = 0.001), more frequently elevated left ventricular (LV) end-diastolic pressure (70 vs 35%, p = 0.039) and lower CMR T2* values (23 ± 12 vs 35 ± 12ms, p = 0.007). Older age (HR: 1.053, p = 0.018), ferritin >2000ng/ml (HR: 3.517, p = 0.03), and >950ng/ml (HR: 11,135, p = 0.02), elevated LV end-diastolic pressure (HR: 3.977, p = 0.046), RVSP >34mmHg(HR: 10,134, p = 0.003), CMR T2* <20msec (HR: 4.900, p = 0.018) and <36msec (HR: 9.376, p = 0.035) were associated with increased all-cause mortality. A baseline model including age was created andit became more predictive of worse survival by adding RVSP >34mmHg than elevated LV end-diastolic pressure (C index 0.777 vs. 0.757 respectively) or ferritin >950ng/ml than >2000ng/ml (C index 0.805 vs. 0.770 respectively) or CMR T2*<36msec than <20msec (C index 0.825 vs. 0.810 respectively).
Conclusions. In haemoglobinopathy patients, RVSP >34mmHg, ferritin >2000ng/ml and CMR T2* <20ms were associated with worse long term survival.In the current era of advanced chelation therapy, aiming for ferritin <950ng/ml and CMR T2* >36ms appears to improve their prognosis.
Abstract Figure.
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Affiliation(s)
- V Kamperidis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - M Vlachou
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Z Pappa
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - D Pantelidou
- Ahepa General Hospital of Aristotle University, Thalassaemia Unit, Thessaloniki, Greece
| | - T Karamitsos
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - D Papadopoulou
- Ahepa General Hospital of Aristotle University, Thalassaemia Unit, Thessaloniki, Greece
| | - A Kartas
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - E Vlachaki
- Hippokration General Hospital of Thessloniki, Thalassaemia Unit, Thessaloniki, Greece
| | - G Giannakoulas
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - H Karvounis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
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Kamperidis V, Vlachou M, Pappa Z, Pantelidou D, Karamitsos T, Papadopoulou D, Kartas A, Boutou A, Ventoulis I, Vlachaki E, Giannakoulas G, Karvounis H. Prediction of long-term survival in patients with transfusion-dependent hemoglobinopathies: Insights from cardiac imaging and ferritin. Hellenic J Cardiol 2021; 62:429-438. [PMID: 33524617 DOI: 10.1016/j.hjc.2021.01.010] [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: 09/04/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS The current study evaluated the association of echocardiography, cardiac magnetic resonance (CMR), and ferritin data with 10-year survival in thalassemia patients. METHODS Demographics, ferritin, echocardiography, and CMR parameters of stable consecutive thalassemia patients were prospectively collected. RESULTS In total, 75 patients (mean age 37 ± 11 years, 45% male) with thalassemia were included and dichotomized based on their survival status after a median follow-up period of 10.3 [9.6-10.9] years. Older age (HR: 1.071, p = 0.001), ferritin ≥2000 ng/ml (HR: 4.682, p = 0.007) and ≥1700 ng/ml (HR: 7.817, p = 0.002), elevated LV end-diastolic pressure (HR: 1.019, p = 0.044), TR Vmax >2.8 m/s (HR: 6.845, p = 0.005), and CMR T2∗ ≤20 msec (HR: 3.602, p = 0.043) and ≤34 msec (HR: 5.854, p = 0.026) were associated with increased all-cause mortality (primary endpoint). A baseline model including age was created and became more predictive of worse survival by adding TR Vmax >2.8 m/s instead of elevated LV end-diastolic pressure (C index 0.767 vs. 0.760, respectively), ferritin ≥1700 ng/ml instead of ≥2000 ng/ml (C index 0.890 vs. 0.807, respectively), or CMR T2∗≤34 msec instead of ≤20 msec (C index 0.845 vs. 0.839, respectively). Parameters associated with the combined endpoint of cardiac mortality/cardiac hospitalization (secondary endpoint) after adjusting for age were ferritin ≥1700 ng/ml (HR 3.770, p = 0.014), ratio E/A wave >2 (HR 3.565, p = 0.04), TR Vmax >2.8 m/s (HR 4.541, p = 0.049), CMR T2∗ ≤20 ms (HR 9.462, p = 0.001), and CMR T2∗ ≤34 ms (HR 11.735, p = 0.002). The model including age and T2∗ ≤34 ms instead of T2∗ ≤20 ms was more predictive of the secondary endpoint (C-index 0.844 vs 0.838, respectively). CONCLUSIONS In thalassemia patients, TR Vmax >2.8 m/s, ferritin ≥2000 ng/ml, and CMR T2∗ ≤20 ms were associated with worse long-term survival. In the current era of advanced chelation therapy, aiming for ferritin ≤1700 ng/ml and CMR T2∗ ≥34 ms may improve their prognosis.
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Affiliation(s)
- Vasileios Kamperidis
- 1st Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
| | - Maria Vlachou
- 1st Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Zoi Pappa
- 1st Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Theodoros Karamitsos
- 1st Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Anastasios Kartas
- 1st Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Afroditi Boutou
- Pulmonary Department, Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioannis Ventoulis
- 1st Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, Thessaloniki, Greece
| | - George Giannakoulas
- 1st Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Haralambos Karvounis
- 1st Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Vlachou M, Kamperidis V, Vlachaki E, Tziatzios G, Pantelidou D, Boutou A, Apostolou C, Papadopoulou D, Giannakoulas G, Karvounis H. Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major. Diagnostics (Basel) 2020; 11:diagnostics11010001. [PMID: 33375056 PMCID: PMC7822012 DOI: 10.3390/diagnostics11010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022] Open
Abstract
Patients with beta-thalassemia major (β-ΤΜ) may develop cardiac arrhythmias through a multifactorial mechanism. The current study evaluated the association of cardiac structure and function on echocardiography with atrial ectopic burden on 24-hour tape recording in β-ΤΜ patients. This prospective study included consecutive β-ΤΜ patients. Demographic, laboratory, echocardiographic, cardiac magnetic resonance (CMR) T2* and 24-hour tape recording data were prospectively collected. The patients were classified according to the median value of premature atrial contractions (PACs) on 24-hour tape. In total, 50 β-TM patients (37.6 ± 9.1 years old, 50% male) were divided in 2 groups; PACs ≤ 24/day and > 24/day. Patients with PACs > 24/day were treated with blood transfusion for a longer period of time (39.0 ± 8.6 vs. 32.0 ± 8.9 years, p < 0.007), compared to their counterparts. Older age (OR: 1.121, 95% CI: 1.032–1.217, p = 0.007), longer duration of blood transfusion (OR:1.101, 95% CI:1.019–1.188, p = 0.014), larger LV end-diastolic diameter (OR: 4.522, 95% CI:1.009–20.280, p = 0.049), higher values of LA peak systolic strain (OR: 0.869, 95% CI: 0.783–0.964, p = 0.008), higher MV E/E′ average (OR: 1.407, 95% CI: 1.028–1.926, p = 0.033) and higher right ventricular systolic pressure (OR: 1.147, 95% CI: 1.039–1.266, p = 0.006) were univariably associated with PACs > 24/day. LA peak systolic strain remained significantly associated with PACs > 24/day after adjusting for the duration of blood transfusions or for CMR T2*. The multivariable model including blood transfusion duration and LA peak systolic strain was the most closely associated with PACs > 24/day. Receiver operating characteristic curve analysis identified a left atrial peak systolic strain of 31.5%, as the best cut-off value (83% sensitivity, 68% specificity) for prediction of PACs > 24/day. In β-TM patients, LA peak systolic strain was associated with the atrial arrhythmia burden independently to the duration of blood transfusions and CMR T2*.
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Affiliation(s)
- Maria Vlachou
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Vasileios Kamperidis
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
- Correspondence: ; Tel./Fax: +30-2310-994830
| | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, 54642 Thessaloniki, Greece; (E.V.); (C.A.)
| | - Georgios Tziatzios
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Despoina Pantelidou
- Thalassaemia Unit, AHEPA University Hospital, 54621 Thessaloniki, Greece; (D.P.); (D.P.)
| | - Afroditi Boutou
- Pulmonary Department, Papanikolaou Hospital, 57010 Thessaloniki, Greece;
| | - Chrysa Apostolou
- Thalassaemia Unit, Ippokratio University Hospital, 54642 Thessaloniki, Greece; (E.V.); (C.A.)
| | - Despoina Papadopoulou
- Thalassaemia Unit, AHEPA University Hospital, 54621 Thessaloniki, Greece; (D.P.); (D.P.)
| | - George Giannakoulas
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
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Nemtsas P, Arnaoutoglou M, Perifanis V, Koutsouraki E, Spanos G, Arnaoutoglou N, Chalkia P, Pantelidou D, Orologas A. Polyneuropathy and myopathy in beta-thalassemia major patients. Ann Hematol 2018; 97:899-904. [PMID: 29427184 DOI: 10.1007/s00277-018-3251-7] [Citation(s) in RCA: 6] [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: 05/23/2017] [Accepted: 01/18/2018] [Indexed: 12/17/2022]
Abstract
The thalassemias are the most common single gene disorder in the world. Nowadays, the average life expectancy of patients in developed countries has increased significantly, while, there was an increase of complications. We aimed to investigate peripheral neuropathy and myopathy in this patient group using a neurophysiological study. We performed nerve conduction studies and electromyography of upper and lower extremities on 36 beta-thalassemia major (β-thal) patients. The electrophysiological findings were correlated with demographic data and laboratory parameters of the disease. Patients with β-thal present polyneuropathy or myopathy at (50%). Polyneuropathy was detected in (38.9%) and myopathy in (27.8%), while polyneuropathy and myopathy were present at (16.7%) with an overlap of the diseases in 1/3 of the patients. There was not a statistically significant correlation of polyneuropathy and myopathy with age, sex, splenectomy, nor with respect to laboratory parameters, hemoglobin, and ferritin. However, there was a statistically significant correlation of polyneuropathy and myopathy with iron overload, as recorded by the magnetic resonance imaging (MRI) of the heart and the liver. Our findings suggest that iron overload plays a key role in the pathogenesis of polyneuropathy and myopathy in β-thal patients, and performing heart and liver MRI for the prediction of such lesions in an annual basis is warranted.
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Affiliation(s)
- P Nemtsas
- First Department of Neurology, University General Hospital of Thessaloniki AHEPA, St.Kiriakidis 1, P.O, 546 36, Thessaloniki, Greece.
| | - M Arnaoutoglou
- First Department of Neurology, University General Hospital of Thessaloniki AHEPA, St.Kiriakidis 1, P.O, 546 36, Thessaloniki, Greece
| | - V Perifanis
- First Propedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - E Koutsouraki
- First Department of Neurology, University General Hospital of Thessaloniki AHEPA, St.Kiriakidis 1, P.O, 546 36, Thessaloniki, Greece
| | - G Spanos
- Tomographia Diagnostic Center, Thessaloniki, Greece
| | - N Arnaoutoglou
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - P Chalkia
- Thalassemia Unit, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - D Pantelidou
- Thalassemia Unit, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Orologas
- First Department of Neurology, University General Hospital of Thessaloniki AHEPA, St.Kiriakidis 1, P.O, 546 36, Thessaloniki, Greece
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Yavropoulou MP, Pikilidou M, Pantelidou D, Tsalikakis DG, Mousiolis A, Chalkia P, Yovos JG, Zebekakis P. Insulin Secretion and Resistance in Normoglycemic Patients with Sickle Cell Disease. Hemoglobin 2017; 41:6-11. [PMID: 28372488 DOI: 10.1080/03630269.2017.1295983] [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] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diabetes mellitus has been described in chronic hemolytic anemias, but data are scarce regarding glucose metabolism in normoglycemic patients. To address this issue, we evaluated insulin sensitivity and secretion in patients with sickle cell disease (SCD) and normal oral glucose tolerance test (OGTT). Forty-five adult patients with homozygous sickle cell disease and Hb S/β-thalassemia (β-thal) (mean age 42.5 ± 9.5 years) and 45 healthy individuals matched for age and body mass index (BMI) were included in the study. All participants underwent an oral glucose tolerance test (OGTT) after an overnight fast. All patients had normal OGTT. Fasting glucose values did not differ significantly between groups, however, fasting insulin levels were significantly lower in the patient group compared to the control group (5.1 ± 2.7 μUI/mL vs. 11.3 ± 6.6 μUI/mL, p <0.005, respectively). Pancreatic β-cell insulin secretion index in the fasting state was significantly lower in patients with sickle cell disease compared with controls as assessed by calculations of the homeostatic model assessment for β-cell function (HOMA β%) (77.0 vs. 106.0%, respectively, p <0.001), while HOMA insulin resistance (HOMA IR), was lower in the sickle cell disease patients, albeit not statistically significant (0.8 vs. 1.1, respectively, p = 0.054). The HOMA β% was significantly correlated with ferritin levels (r = -526, p <0.001) (negative correlation) and with 25-hydroxy (OH)-vitamin D levels (r = 0.479, p <0.001) (positive correlation), even when adjusted for serum ferritin levels. Normoglycemic patients with sickle cell disease demonstrated impaired β-cell function with reduced insulin secretion even before OGTT was impaired.
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Affiliation(s)
- Maria P Yavropoulou
- a Division of Endocrinology and Metabolism, 1st Department of Internal Medicine , AHEPA University Hospital, Aristotle University of Thessaloniki (AUTH) , Thessaloniki , Greece
| | - Maria Pikilidou
- b Hypertention Excellence center, 1st Department of Internal Medicine , AHEPA University Hospital, Aristotle University of Thessaloniki (AUTH) , Thessaloniki , Greece
| | - Despoina Pantelidou
- c Division of Hematology and Thalassemia Unit, 1st Department of Internal Medicine , AHEPA University Hospital , Thessaloniki , Greece
| | - Dimitrios G Tsalikakis
- d Department of Informatics and Telecommunication Engineering , University of Western Macedonia , Kozani , Greece
| | - Athanasios Mousiolis
- a Division of Endocrinology and Metabolism, 1st Department of Internal Medicine , AHEPA University Hospital, Aristotle University of Thessaloniki (AUTH) , Thessaloniki , Greece
| | - Panagiota Chalkia
- c Division of Hematology and Thalassemia Unit, 1st Department of Internal Medicine , AHEPA University Hospital , Thessaloniki , Greece
| | - John G Yovos
- a Division of Endocrinology and Metabolism, 1st Department of Internal Medicine , AHEPA University Hospital, Aristotle University of Thessaloniki (AUTH) , Thessaloniki , Greece
| | - Pantelis Zebekakis
- b Hypertention Excellence center, 1st Department of Internal Medicine , AHEPA University Hospital, Aristotle University of Thessaloniki (AUTH) , Thessaloniki , Greece
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Diamantidis MD, Chatzileontiadou S, Pantelidou D, Papaioannou M. Prolonged complete remission in a primary MALT lymphoma of the lung after rituximab monotherapy. Hippokratia 2017; 21:108-110. [PMID: 30455566 PMCID: PMC6239084] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Primary pulmonary non-Hodgkin lymphoma (NHL) is a rare entity. Despite its favorable prognosis, an optimal treatment approach has not been established until today, as there are few debated heterogeneous data in the literature. Many therapeutic options such as surgery, radiotherapy, chemotherapy alone or in combination, immunotherapy and/or immunochemotherapy all with similar results, have been reported. CASE DESCRIPTION We report the case of a 68-year-old man diagnosed with a primary marginal zone B-cell pulmonary NHL, with a durable complete response to rituximab monotherapy. CONCLUSION We support the therapeutic application of rituximab monotherapy as an attractive option for this malignancy. This effective approach exhibits significant antitumor activity leading to long-term complete remission and minimal hematological toxicity in contrast to other intensive chemotherapies and/or radiotherapy, which might have serious side effects. HIPPOKRATIA 2017, 21(2): 108-110.
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Affiliation(s)
- M D Diamantidis
- Division of Hematology, 1 Department of Internal Medicine, Aristotle University of Thessaloniki (AUTH), AHEPA General Hospital, Thessaloniki, Greece
| | - S Chatzileontiadou
- Division of Hematology, 1 Department of Internal Medicine, Aristotle University of Thessaloniki (AUTH), AHEPA General Hospital, Thessaloniki, Greece
| | - D Pantelidou
- Division of Hematology, 1 Department of Internal Medicine, Aristotle University of Thessaloniki (AUTH), AHEPA General Hospital, Thessaloniki, Greece
| | - M Papaioannou
- Division of Hematology, 1 Department of Internal Medicine, Aristotle University of Thessaloniki (AUTH), AHEPA General Hospital, Thessaloniki, Greece
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Pikilidou M, Yavropoulou M, Antoniou M, Papakonstantinou E, Pantelidou D, Chalkia P, Nilsson P, Yovos J, Zebekakis P. Arterial Stiffness and Peripheral and Central Blood Pressure in Patients With Sickle Cell Disease. J Clin Hypertens (Greenwich) 2015; 17:726-31. [PMID: 25991400 DOI: 10.1111/jch.12572] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/09/2015] [Accepted: 03/19/2015] [Indexed: 11/29/2022]
Abstract
Blood pressure (BP) in patients with sickle cell disease (SCD) has been reported to be lower than in persons in the general population. Data on arterial stiffness, which is an important risk factor for the progression of BP, are inconclusive for this patient population. Forty-five adult patients with SCD and 40 controls matched for sex, age, and body mass index were studied. Brachial systolic BP (SBP) and diastolic BP (DBP) were significantly lower in the patient group (SBP 115.1±13.8 mm Hg vs 121.9±11.3 mm Hg and DBP 68.5±8.0 mm Hg vs 80.6±9.1 mm Hg, P<.05, respectively). Augmentation index (AIx), however, was significantly higher in SCD patients compared with healthy controls (24.9±9.6 for patients vs 12.4±10.8 for controls, P<.001), while carotid femoral pulse wave velocity was comparable between the two groups. The study shows that mechanisms other than arterial elasticity are involved in the low BP phenotype of patients with SCD.
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Affiliation(s)
- Maria Pikilidou
- Hypertension Excellence Center, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Yavropoulou
- Division of Clinical and Molecular Endocrinology, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Antoniou
- Hypertension Excellence Center, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Despoina Pantelidou
- Division of Hematology and Thalassemia Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Panagiota Chalkia
- Division of Hematology and Thalassemia Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Peter Nilsson
- Department of Clinical Sciences, Lund University, Malmo, Sweden
| | - John Yovos
- Division of Clinical and Molecular Endocrinology, AHEPA University Hospital, Thessaloniki, Greece
| | - Pantelis Zebekakis
- Hypertension Excellence Center, AHEPA University Hospital, Thessaloniki, Greece
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Tsatalas C, Chalkia P, Pantelidou D, Margaritis D, Bourikas G, Spanoudakis E. Pregnancy inβ-thalassemia trait carriers: an uneventful journey. Hematology 2013; 14:301-3. [DOI: 10.1179/102453309x439791] [Citation(s) in RCA: 13] [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] [Indexed: 12/25/2022] Open
Affiliation(s)
- Constantinos Tsatalas
- Department of HaematologyDemocritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Panagiota Chalkia
- Thalassaemia UnitA.H.E.P.A. University Hospital, Thessaloniki, Greece
| | | | - Dimitrios Margaritis
- Department of HaematologyDemocritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Georgios Bourikas
- Department of HaematologyDemocritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Emmanouil Spanoudakis
- Department of HaematologyDemocritus University of Thrace Medical School, Alexandroupolis, Greece
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Vadikolia CM, Tsatalas C, Anagnostopoulos K, Trypsianis G, Pantelidou D, Bazdiara I, Anastasiadis A, Spanoudakis E, Kotsianidis I, Margaritis D, Kortsaris A, Bourikas G. Proteolytic matrix metallopeptidases and inhibitors in BCR-ABL1-negative myeloproliferative neoplasms: correlation with JAK2 mutation status. Acta Haematol 2011; 126:54-62. [PMID: 21474922 DOI: 10.1159/000324436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 01/17/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) share the same acquired lesion JAK2(V617F) and may exhibit substantial overlap. Variability in JAK activation and allele burden, complemented by host, genetic and non-genetic modifiers, determine the phenotype. The aim of this study was to investigate the presence of the JAK2 mutation in association with the ratio of metallopeptidases inhibitors (TIMPs) to tissue metallopeptidases (MMPs) in MPNs, where inhibitory rather than proteolytic activity in marrow microenvironment appears to predominate. METHODS 94 patients with polycythemia vera, essential thrombocythemia and primary myelofibrosis, and 102 healthy individuals were evaluated. Allele-specific PCR and RFLP were used to detect JAK2 and genomic status. Serum concentrations of MMP and TIMP were measured by ELISA. The parameters were assessed with covariance analysis, and adjusted for gender, age and co-morbidity. RESULTS Mutation frequency was 81.91%. Abnormal TIMP/MMP ratios were identified in all three diseases. JAK2 mutation was correlated with significant changes in TIMP concentrations. CONCLUSIONS Identification of an abnormal TIMP/MMP ratio in all three diseases, regardless of the JAK2 status, indicates invariable marrow remodeling. In this particular group of patients, presence of a JAK2(V617F) mutation, being associated with even higher ratios, appears to be a concurring participant in bone marrow-reforming processes. Additional research may delineate correlates with the JAK2 allelic burden.
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Affiliation(s)
- C M Vadikolia
- Department of Hematology, Democritus University Medical School, Alexandroupolis, Greece
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11
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Spanoudakis E, Bazdiara I, Pantelidou D, Kotsianidis I, Papadopoulos V, Margaritis D, Xanthopoulidis G, Moustakidis E, Mantzourani S, Bourikas G, Tsatalas C. Dynamics of telomere's length and telomerase activity in Philadelphia chromosome negative myeloproliferative neoplasms. Leuk Res 2011; 35:459-64. [DOI: 10.1016/j.leukres.2010.07.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/30/2010] [Accepted: 07/30/2010] [Indexed: 11/25/2022]
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12
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Christoforidou A, Pantelidou D, Anastasiadis A, Goutzouvelidis A, Margaritis D, Kotsianidis I, Spanoudakis E, Kaloutsi V, Bourikas G, Tsatalas C. Hydroxyurea and anagrelide combination therapy in patients with chronic myeloproliferative diseases resistant or intolerant to monotherapy. Acta Haematol 2009; 120:195-8. [PMID: 19129692 DOI: 10.1159/000189381] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 11/05/2008] [Indexed: 11/19/2022]
Affiliation(s)
- A Christoforidou
- Department of Haematology, Democritus University of Thrace, Alexandroupolis, Greece.
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13
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Spanoudakis E, Margaritis D, Kotsianidis I, Georgiou G, Tripsianis G, Anastasiadis A, Karakolios A, Pantelidou D, Panayiotidis P, Bourikas G, Tsatalas C. Long-term bone marrow cultures (LTBMC) from essential thrombocythemia (ET) patients with or without JAK2617V>F mutation. Leuk Res 2008; 32:1593-6. [DOI: 10.1016/j.leukres.2008.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 01/15/2008] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
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14
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Cassimos D, Bezirgiannidou Z, Pantelidou D, Christoforidis A, Chatzimichael A, Maritinis G. Warm autoimmune hemolytic anemia following recurrent mycoplasma pneumonia infections in a child with Down syndrome. Pediatr Hematol Oncol 2008; 25:693-8. [PMID: 18850483 DOI: 10.1080/08880010802237492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mycoplasma pneumonia (MP) is mainly associated with cold agglutinin syndrome, whereas both cold IgM and warm IgG autoantibodies have been identified in only two cases in the literature. The authors present an 8-year-old boy with Down syndrome, who suffered from recurrent episodes of MP infection, followed by episodes of hemolytic anemia with normal titer of cold agglutinins. The first 6 episodes were sequenced by nonimmune hemolytic anemia, whereas the latter 7 episodes were followed by episodes of warm autoimmune hemolytic anemia. This is believed to be the first described case of hemolytic anemia with warm IgG autoantibodies, following MP infection.
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Affiliation(s)
- Dimitris Cassimos
- Pediatric Department, General University Hospital of Alexandroupoli, Alexandroupolis, Greece
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15
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Kotsianidis I, Bazdiara I, Anastasiades A, Spanoudakis E, Pantelidou D, Margaritis D, Bourikas G, De Coster R, De Porre P, Tsatalas C. In vitro effects of the farnesyltransferase inhibitor tipifarnib on myelodysplastic syndrome progenitors. Acta Haematol 2008; 120:51-6. [PMID: 18824842 DOI: 10.1159/000158577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 07/03/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Farnesyltransferase inhibitors (FTIs) target proteins needing prenylation for functioning. Tipifarnib (Zarnestra), a potent and specific inhibitor of farnesyltransferase, showed considerable activity in phase I and II studies in myelodysplastic syndrome (MDS), but the optimal regimen achieving high response rates with minor myelosuppression remains to be determined. Additionally, a direct effect on purified human MDS progenitors has not yet been shown. METHODS MDS and normal CD34+ cells isolated by using immunomagnetic beads were plated for short-term cultures in semisolid media or liquid cultures for flow-cytometric assessment of apoptosis in the presence of either DMSO or various FTI concentrations. RESULTS Tipifarnib exerted selective in vitro toxicity against clonal MDS hematopoiesis at concentrations less than 10 nM the effect being more prominent in white cell progenitors. This action was not due to apoptosis induction as both normal and MDS progenitors displayed equivalent DiOC3 and annexin V expression up to 72 h after exposure to tipifarnib. CONCLUSION The leukemic clone is more susceptible in tipifarnib than normal progenitors. Since myelosuppression represents the main obstacle in the clinical use of tipifarnib in MDS, further reduction of the currently employed dose will potentially result in a more tolerable regimen without compromising its antileukemic action.
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Affiliation(s)
- Ioannis Kotsianidis
- Department of Haematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece.
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Symeonidis A, Kouraklis-Symeonidis A, Zikos P, Galanopoulos A, Psyllaki M, Aktypi A, Michalopoulou S, Michali E, Protopapa M, Pantelidou D, Papadaki E, Anagnostopoulos N, Zoumbos N. P140 Factors predicting for a favorable response among patients with myelodysplastic syndromes treated with erythropoietin ± G-CSF. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70210-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Pantelidou D, Tsatalas C, Margaritis D, Anastasiadis AG, Kaloutsi V, Argyropoulou P, Prassopoulos P, Bourikas G. Successful treatment of lymph node extramedullary plasmacytoma with bortezomib. Ann Hematol 2006; 85:188-90. [PMID: 16397787 DOI: 10.1007/s00277-005-0052-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 11/12/2005] [Indexed: 12/28/2022]
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18
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Tsatalas C, Spanoudakis E, Pantelidou D, Margaritis D, Kotsianidis I, Chalkia P, Tripsianis G, Basdiara I, Kartasis Z, Karakolios A, Bourikas G. Amifostine stimulates the formation of hematopoietic bone marrow progenitors from B-cell chronic lymphocytic leukemia. Acta Haematol 2004; 112:136-40. [PMID: 15345895 DOI: 10.1159/000079724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2003] [Accepted: 02/16/2004] [Indexed: 11/19/2022]
Abstract
Amifostine is a phosphorylated aminothiol that not only protects hematopoietic progenitor cells from chemotherapy and radiotherapy, but also stimulates normal hematopoiesis. The effect of amifostine on the in vitro growth of hematopoietic progenitors derived from B-cell chronic lymphocytic leukemia(B-CLL) was investigated. The colony-forming units (CFU)-granulocyte macrophage (CFU-GM), the burst-forming units-erythroid (BFU-E) and the CFU-granulocyte erythroid macrophage megakaryocytes (CFU-GEMM) increased 38, 20 and 100%, respectively, after the incubation with amifostine. There was no statistical difference in the in vitro progenitor growth of patients grouped according to their disease stage, bone marrow lymphocytic infiltration or therapy. Our data indicate that apart from cytoprotection the parallel use of amifostine and chemotherapy in patients with B-CLL could enhance bone marrow recovery.
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Affiliation(s)
- Costas Tsatalas
- Hematology Department, Democritus University of Thrace School of Medicine, Alexandroupolis, Greece.
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Pantelidou D, Tsatalas C, Margaritis D, Karayiannakis AJ, Kaloutsi V, Spanoudakis E, Katsilieris I, Chatzipaschalis E, Sivridis E, Bourikas G. Extramedullary plasmacytoma: report of two cases with uncommon presentation. Ann Hematol 2004; 84:188-91. [PMID: 15042315 DOI: 10.1007/s00277-004-0854-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Accepted: 01/20/2004] [Indexed: 11/24/2022]
Abstract
Lymph node infiltration by monoclonal plasma cells can occur either in aggressive forms of myeloma or may represent regional extension of extramedullary plasmacytomas, whereas lymph node plasmacytoma presenting as a solitary extramedullary plasmacytoma is very unusual. We report two cases of lymph node plasmacytomas without systemic disease diagnosed after surgical excision. Clinical remission was achieved after local radiotherapy although one patient relapsed with multifocal extramedullary plasmacytomas 20 months after radiotherapy.
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Affiliation(s)
- D Pantelidou
- Hematology Department, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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