1
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Makris A, Pagkali A, Nikolousis E, Filippatos TD, Agouridis AP. High-density lipoprotein cholesterol and multiple myeloma: A systematic review and meta-analysis. Atheroscler Plus 2023; 54:7-13. [PMID: 37780686 PMCID: PMC10539640 DOI: 10.1016/j.athplu.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/19/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Background and aims To systematically investigate all relevant evidence on the association between high-density lipoprotein cholesterol (HDL-C) and multiple myeloma (MM). Methods We searched PubMed and Cochrane library databases (up to 20 September 2022) for studies with evidence on HDL-C in patients with MM. A qualitative synthesis of published prospective and retrospective studies for the role of HDL-C and other lipid profile parameters in MM was performed. Additionally, a meta-analysis on HDL-C mean differences (MD) between MM cases and controls was performed. Results Fourteen studies (3 prospective, 11 retrospective) including 895 MM patients were eligible for this systematic review. Ten studies compared HDL-C levels in MM patients with healthy controls. In these 10 studies (n = 17,213), pooled analyses showed that MM patients had significantly lower HDL-C levels compared to healthy controls (MD: -13.07 mg/dl, 95% CI: -17.83, -8.32, p < 0.00001). Regarding secondary endpoints, total cholesterol (TC) (MD: -22.19 mg/dl, 95% CI: -39.08, -5.30) and apolipoprotein A-I (apoA-I) (-40.20 mg/dl, 95% CI: -55.00, -25.39) demonstrated significant decreases, while differences in low-density lipoprotein cholesterol (LDL-C) (MD: -11.33 mg/dl, 95% CI: -36.95, 14.30) and triglycerides (MD: 9.93 mg/dl, 95% CI: -3.40, 23.26) were not shown to be significant. Conclusions HDL-C, as well as TC and apoA-I, levels are significantly decreased in MM. Hence, lipid profile parameters should be taken into account when assessing such patients.
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Affiliation(s)
- Anastasios Makris
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Antonia Pagkali
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | | | | | - Aris P. Agouridis
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Department of Internal Medicine, German Oncology Center, Limassol, Cyprus
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2
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Dennis M, Copland M, Kaur H, Kell J, Nikolousis E, Mehta P, Palanicawandar R, Potter V, Raj K, Thomas I, Wilson A. Management of older patients with frailty and acute myeloid leukaemia: A British Society for Haematology good practice paper. Br J Haematol 2022; 199:205-221. [PMID: 36000944 DOI: 10.1111/bjh.18369] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Mike Dennis
- The Christie NHS Foundation Trust, Manchester, UK
| | - Mhairi Copland
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Harpreet Kaur
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Priyanka Mehta
- University Hospitals of Bristol and Weston NHS Trust, Bristol, UK
| | | | | | - Kavita Raj
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Andrew Wilson
- University College London Hospitals NHS Foundation Trust, London, UK
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3
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Chander G, Dassanayake H, Kaparou M, Ahmed M, Kishore B, Nikolousis E, Kanellopoulos A. Nodular Lymphocyte Predominant Hodgkin Lymphoma With Aberrant Immunophenotype or Variant Histopathology: Insights From Case Series of Three Patients. Anticancer Res 2021; 41:4017-4020. [PMID: 34281867 DOI: 10.21873/anticanres.15200] [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: 06/06/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) with variant histopathology or aberrant immunophenotype is exceedingly rare and there is paucity of data with regards to its clinical characteristics and course. CASE REPORT Herein, we present three cases of NLPHL with aberrant immunophenotype or variant histopathological picture, which displayed distinct clinical and imaging findings. These case reports involved a patient with CD30 and CD20 positivity without Reed-Sternberg cells present, a NLPHL patient with aggressive, persistent disease activity with progressive transformation to germinal centres, and a patient with combined morphology of NLPHL and classical Hodgkin's lymphoma. CONCLUSION Aberrant immunophenotype/variant NLPHL might represent a distinct form of NLPHL, sharing characteristics with classical Hodgkin, non-Hodgkin lymphomas or benign, progressive transformation of germinal centre lymphadenopathy.
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Affiliation(s)
- Gurvin Chander
- Haematology Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Hansini Dassanayake
- Haematology Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Maria Kaparou
- Haematology Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Maria Ahmed
- Haematology Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Bhuvan Kishore
- Haematology Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Emmanouil Nikolousis
- Haematology Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Alexandros Kanellopoulos
- Haematology Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K. .,Haematology Department and Bone Marrow Transplantation Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
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4
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Chander G, Nikolousis E, Kanellopoulos A. Human papilloma virus (HPV)-associated lesions in a post-bone marrow transplant patient responding to HPV vaccination. Br J Haematol 2021; 195:7. [PMID: 33934338 DOI: 10.1111/bjh.17514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Gurvin Chander
- Haematology Department and Haematopoietic Stem Cell Transplant Unit, Heartlands Hospital, University Hospitals Birmingham NHS trust, Birmingham, UK
| | - Emmanouil Nikolousis
- Haematology Department and Haematopoietic Stem Cell Transplant Unit, Heartlands Hospital, University Hospitals Birmingham NHS trust, Birmingham, UK
| | - Alexandros Kanellopoulos
- Haematology Department and Haematopoietic Stem Cell Transplant Unit, Heartlands Hospital, University Hospitals Birmingham NHS trust, Birmingham, UK.,Haematology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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5
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Styczyński J, Tridello G, Xhaard A, Medinger M, Mielke S, Taskinen M, Blijlevens N, Rodriguez MAB, Solano C, Nikolousis E, Biffi A, Groll AH, Junghanss C, Tsirigotis P, Lioure B, Šrámek J, Holler E, Galaverna F, Fagioli F, Knelange N, Wendel L, Gil L, de la Camara R, Mikulska M, Ljungman P. Use of letermovir in off-label indications: Infectious Diseases Working Party of European Society of Blood and Marrow Transplantation retrospective study. Bone Marrow Transplant 2020; 56:1171-1179. [PMID: 33288863 DOI: 10.1038/s41409-020-01166-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/07/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022]
Abstract
Letermovir (LMV) is licensed for prophylaxis of CMV infection in allogeneic hematopoietic cell transplant adult CMV-seropositive patients. Due to its favorable safety profile, LMV brings potential for use in other clinical situations, outside the approved indication. The objective of the study was to analyze the efficacy and safety of the use of LMV in off-label indications in EBMT centers. A total of 49 patients were reported including 44 adults and 5 children. LMV was administered for: secondary prophylaxis (37 adults, 3 children), primary prophylaxis (2 children), pre-emptive treatment (5 adults), and therapy of CMV disease (2 adults; pneumonia, colitis). Cyclosporine was concomitantly used in 26 patients. Overall, LMV was used for a median 112 days (range: 10-473). Cumulative incidence of breakthrough infections during secondary prophylaxis was 10.1% (95% CI = 3.1-21.9). Prophylactic treatment with LMV resulted in 94.9% (95% CI = 81.0-98.7), and 81.9% (95% CI = 65.7-90.9) probability of, respectively, 60 and 120-day survival without CMV infection in patients receiving secondary prophylaxis. During therapy of CMV infection/disease, probability of 60 and 120-day overall survival was 100% and 71.4% (95% CI = 25.8-92.0), respectively. No breakthrough infection occurred in children on LMV prophylaxis. Adverse events were reported in 15/49 (30.4%) patients: the most common being nausea/vomiting (22.4%). In conclusion, the efficacy of the use of LMV as secondary prophylaxis was high, and the preliminary experience with the use of LMV for the treatment of patients with refractory CMV infection/disease was positive. Our data showed that higher dose or prolonged therapy did not result in increased rate of adverse events.
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Affiliation(s)
- Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland.
| | | | - Alienor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris-Diderot, 75010, Paris, France
| | - Michael Medinger
- Divisions of Hematology and Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Stephan Mielke
- Department for Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Helsinki University Hospital, Helsinki, Finland
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Center Nijmegen, Nijmegen, The Netherlands
| | | | - Carlos Solano
- Hospital Clínico Universitario-INCLIVA. University of Valencia, Valencia, Spain
| | | | - Alessandra Biffi
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Padova, Padova, Italy
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | | | | | | | - Jiří Šrámek
- Department of Hematology and Oncology, University Hospital Pilsen, Pilsen, Czech Republic.,Department of Histology and Embryology, Faculty of Medicine, Pilsen, Czech Republic
| | | | - Federica Galaverna
- Department of Pediatric Oncology, Hematology, Cell and Gene therapy, IRCCS Bambino Gesu' Pediatric Hospital, Rome, Italy
| | | | - Nina Knelange
- EBMT Data Office, Dept. of Medical Statistics & Bioinformatics, Leiden, Netherlands
| | - Lotus Wendel
- EBMT Data Office, Dept. of Medical Statistics & Bioinformatics, Leiden, Netherlands
| | - Lidia Gil
- Department of Hematology and Hematopoietic Cell Transplantation, Medical University, Poznan, Poland
| | | | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Per Ljungman
- Department for Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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6
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Horgan C, Kanellopoulos A, Paneesha S, Kishore B, Lovell R, Nikolousis E. ERRATUM: A unique case of durable complete remission after salvage with azacitidine and DLI for high risk flt-3 positive acute myeloid leukemia, following relapse 18 months post allogeneic stem cell transplant. Hematol Rep 2020; 12:8995. [PMID: 33282167 PMCID: PMC7686852 DOI: 10.4081/hr.2020.8995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Claire Horgan
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
| | | | - Shankara Paneesha
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
| | - Bhuvan Kishore
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
| | - Richard Lovell
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
| | - Emmanouil Nikolousis
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
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7
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Lloyd R, Nikolousis E, Kishore B, Lovell R, Shankara P, Zeid NA, Horgan C, Panteliadou AK, McIlroy G, Xenou E, Kaparou M, Holder K, Murthy V, Kanellopoulos A. Autoimmune Cytopenias Developing Late Post Alemtuzumab-Based Allogeneic Stem Cell Transplantation: Presentation of Short Case Series from a Transplant Center. Cell Transplant 2020; 29:963689720950641. [PMID: 32806929 PMCID: PMC7784502 DOI: 10.1177/0963689720950641] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Stem cell transplantation remains the curative option for many patients with hematological malignancies. The long-term effects of these treatments on the patients and their immune systems have been extensively investigated, but there remains a paucity of data regarding autoimmune manifestations post-transplant, although these effects are well recognized. Herein we present the clinical picture and therapeutic approach in three patients (cases 1–3), with varied presentations of autoimmune disease post-transplant. Case 1 exhibited autoimmune hemolytic anemia and other autoimmune manifestations (serositis, thyroiditis), that were probably linked to graft versus relapsed leukemia effect. Cases 2 and 3 had pure red white cell aplasia and pure red cell aplasia, respectively, which were associated with hyperglobulinemia and a clonal T cell expansion.
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Affiliation(s)
- Rebecca Lloyd
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Emmanouil Nikolousis
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Bhuvan Kishore
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Richard Lovell
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Paneesha Shankara
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Nervana Abou Zeid
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Claire Horgan
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Alkistis Kyra Panteliadou
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Graham McIlroy
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Evgenia Xenou
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Maria Kaparou
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Kathleen Holder
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Vidhya Murthy
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
| | - Alexandros Kanellopoulos
- University Hospitals Birmingham NHS, Bone Marrow Transplant Unit Heartlands Hospital, Birmingham, UK
- Alexandros Kanellopoulos, MD, Consultant Hematologist, University Hospitals Birmingham Heartlands Hospital, 27 Rodbourne Rd, Birmingham, West Midlands, B17 0PN, UK. Emails: ;
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8
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Horgan C, Kartsios C, Nikolousis E, Shankara P, Kishore B, Lovell R, Murthy V, Rudzki Z, Dyer S, Holtom P, Thompson G, Kaparou M, Xenou E, Lloyd R, Venkatadasari I, Kanellopoulos AG. First case of near haploid philadelphia negative B-Cell acute lymphoblastic leukaemia relapsing as acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation. Leuk Res Rep 2020; 14:100213. [PMID: 32612922 PMCID: PMC7317226 DOI: 10.1016/j.lrr.2020.100213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022] Open
Abstract
Herein we present a female patient aged 61 with Philadelphia negative acute lymphoblastic leukaemia demonstrating near haploid karyotype and abnormal TP53 expression at diagnosis, who relapsed with lineage switch as Acute Monocytic Leukemia post allogeneic stem cell transplantation. Molecular analysis established that both neoplasms were derived from the same founder clone. The leukemic lineage switch phenomenon has recently re-attracted interest as mechanism of leukemic evasion post treatment with chimeric antigen receptor T-cells but there is paucity of data on its presence post allograft or following novel antibody treatments such as Inotuzumab Ozogamicin or Blinatumomab. Our proposition for cancer research is that near haploidy in ALL could be linked to leukemic stem cell plasticity evading stem cell transplantation and other immunotherapy approaches.
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Affiliation(s)
- Claire Horgan
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | | | | | - Paneesha Shankara
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | - Bhuvan Kishore
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | - Richard Lovell
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | - Vidhya Murthy
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | - Zbigniew Rudzki
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | - Sara Dyer
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust
| | - Pam Holtom
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | - Gillian Thompson
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | - Maria Kaparou
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | - Evgenia Xenou
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | - Rebecca Lloyd
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
| | | | - Alexandros Georgios Kanellopoulos
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital
- Corresponding author. Consultant in Bone Marrow Transplantation, University Hospitals Birmingham NHS FT, Heartlands Hospital, Bordesley Green East, Birmingham, West Midlands, United Kingdom, B17 0PN.
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9
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Kanellopoulos A, Ahmed MZ, Kishore B, Lovell R, Horgan C, Paneesha S, Lloyd R, Salhan B, Giles H, Chauhan S, Venkatadasari I, Khakwani M, Murthy V, Xenou E, Dassanayake H, Srinath S, Kaparou M, Nikolousis E. COVID-19 in bone marrow transplant recipients: reflecting on a single centre experience. Br J Haematol 2020; 190:e67-e70. [PMID: 32469077 PMCID: PMC7283684 DOI: 10.1111/bjh.16856] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Alexandros Kanellopoulos
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Maria Z Ahmed
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bhuvan Kishore
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Lovell
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claire Horgan
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shankara Paneesha
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rebecca Lloyd
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Beena Salhan
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hannah Giles
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saleena Chauhan
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Indrani Venkatadasari
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Muhammad Khakwani
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vidhya Murthy
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Evgenia Xenou
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hansini Dassanayake
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Swathy Srinath
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Maria Kaparou
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emmanouil Nikolousis
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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10
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Stanworth SJ, Killick S, McQuilten ZK, Karakantza M, Weinkove R, Smethurst H, Pankhurst LA, Hodge RL, Hopkins V, Thomas HL, Deary AJ, Callum J, Lin Y, Wood EM, Buckstein R, Bowen D, Wallis L, Rabbi T, Serrano M, Williams R, Chacko J, Darlow J, Watson L, Earley K, Haas N, Woods L, Dimitriu C, Croft J, Carvalhosa A, Clarke C, Hickish T, Penny C, Sternberg A, Owen T, Parajes C, Meyer C, Dodge J, Meakin S, Lake D, Culligan D, Fletcher H, Forbes H, Johannesson N, Taylor G, Tomlinson J, Shaw A, Ratcliffe M, Lamacchia M, Vickers M, Duncan C, Untiveros P, Olaiya A, Tighe J, Preston G, Zaidi M, Lawrie A, Robertson C, Saadi H, Onyeakazi U, Radia R, Father T, Stainthorp K, Mc Connell S, Booth T, Langton C, Howcroft C, Saddiq I, Gupta ED, Byrne J, Lindsey‐Hill J, Badder D, Jones M, Pol R, Vyas P, Mead A, Peniket A, Bancroft R, Springett S, Yoganayagam S, Gray L, Friesen H, Wardle K, Murthy V, Pratt G, Kishore B, Mayer G, Nikolousis E, Smith N, Lovell R, Kartsios C, Ewing J, Lumley M, Khawaja J, Ali M, Sutton D, Murray D, Milligan D, Dhani S, O'Sullivan M, Whitehouse J, Schumacher A, Enstone R, Hardy A, Kelly M, Wallis J, Boal L, Davies M, Latter R, Wincup J, Ellis S, Poolan S, Birt M, Watts E, Charlton A, Forsyth H, Waring L, Twohig J, Marr H, Lennard A, Jones G, Menne T, Redding N, Jones S, Robinson K, Grand E, Cullis J, Collins F, Gamble L, Brown J, Tudgay S, Salisbury S, Mathew S, Tipler N, Parker T, Stobie E, Tribbeck M, Hebballi S, Millar C, Allotey D, Lala J, McGee N, Chmeil J, Hufton L, Dawson S, Weincove R, Smyth D, Buyck H, Hayden J, George A, Baluwala I, Wheeler M, Daysh L, Williams O, Millmow S, Miles R, Geller S, Blakemore M, Hargreaves A, Hayden G, Mo A, Van Dam M, Uhe M, Indran T, Wong J, Coughlin L, MacWhannell A, Beardsmore C, Lunn L, Pearson S, Shaw S, Parker J, Bowen A, Jones A, Player M. Red cell transfusion in outpatients with myelodysplastic syndromes: a feasibility and exploratory randomised trial. Br J Haematol 2020; 189:279-290. [PMID: 31960409 DOI: 10.1111/bjh.16347] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Abstract
Optimal red cell transfusion support in myelodysplastic syndromes (MDS) has not been tested and established. The aim of this study was to demonstrate feasibility of recruitment and follow-up in an outpatient setting with an exploratory assessment of quality of life (QoL) outcomes (EORTC QLQ-C30 and EQ-5D-5L). We randomised MDS patients to standardised transfusion algorithms comparing current restrictive transfusion thresholds (80 g/l, to maintain haemoglobin 85-100 g/l) with liberal thresholds (105 g/l, maintaining 110-125 g/l). The primary outcomes were measures of compliance to transfusion thresholds. Altogether 38 patients were randomised (n = 20 restrictive; n = 18 liberal) from 12 participating sites in UK, Australia and New Zealand. The compliance proportion for the intention-to-treat population was 86% (95% confidence interval 75-94%) and 99% (95-100%) for restrictive and liberal arms respectively. Mean pre-transfusion haemoglobin concentrations for restrictive and liberal arms were 80 g/l (SD6) and 97 g/l (SD7). The total number of red cell units transfused on study was 82 in the restrictive and 192 in the liberal arm. In an exploratory analysis, the five main QoL domains were improved for participants in the liberal compared to restrictive arm. Our findings support the feasibility and need for a definitive trial to evaluate the effect of different red cell transfusion thresholds on patient-centred outcomes.
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Affiliation(s)
- Simon J. Stanworth
- Oxford University Oxford United Kingdom
- The John Radcliffe Hospital Oxford GBR
- NHSBT Oxford United Kingdom
| | - Sally Killick
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Bournemouth United Kingdom
| | | | - Marina Karakantza
- Department of HaematologyLeeds Teaching Hospitals Leeds United Kingdom
| | - Robert Weinkove
- Wellington Blood & Cancer CentreCapital & Coast District Health Board Wellington New Zealand
- Malaghan Institute of Medical Research Wellington New Zealand
| | - Heather Smethurst
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | | | - Renate L. Hodge
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Valerie Hopkins
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Helen L. Thomas
- NHS Blood and Transplant Clinical Trials Unit Bristol United Kingdom
| | - Alison J. Deary
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre Toronto ON Canada
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto Toronto ON Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre Toronto ON Canada
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto Toronto ON Canada
| | - Erica M. Wood
- Transfusion Research UnitMonash University Melbourne Australia
| | - Rena Buckstein
- Odette Cancer CentreSunnybrook Health Sciences Centre Toronto ON Canada
| | - David Bowen
- Department of HaematologyLeeds Teaching Hospitals Leeds United Kingdom
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Dillon R, Hills R, Freeman S, Potter N, Jovanovic J, Ivey A, Kanda AS, Runglall M, Foot N, Valganon M, Khwaja A, Cavenagh J, Smith M, Ommen HB, Overgaard UM, Dennis M, Knapper S, Kaur H, Taussig D, Mehta P, Raj K, Novitzky-Basso I, Nikolousis E, Danby R, Krishnamurthy P, Hill K, Finnegan D, Alimam S, Hurst E, Johnson P, Khan A, Salim R, Craddock C, Spearing R, Gilkes A, Gale R, Burnett A, Russell NH, Grimwade D. Molecular MRD status and outcome after transplantation in NPM1-mutated AML. Blood 2020; 135:680-688. [PMID: 31932839 PMCID: PMC7059484 DOI: 10.1182/blood.2019002959] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Relapse remains the most common cause of treatment failure for patients with acute myeloid leukemia (AML) who undergo allogeneic stem cell transplantation (alloSCT), and carries a grave prognosis. Multiple studies have identified the presence of measurable residual disease (MRD) assessed by flow cytometry before alloSCT as a strong predictor of relapse, but it is not clear how these findings apply to patients who test positive in molecular MRD assays, which have far greater sensitivity. We analyzed pretransplant blood and bone marrow samples by reverse-transcription polymerase chain reaction in 107 patients with NPM1-mutant AML enrolled in the UK National Cancer Research Institute AML17 study. After a median follow-up of 4.9 years, patients with negative, low (<200 copies per 105ABL in the peripheral blood and <1000 copies in the bone marrow aspirate), and high levels of MRD had an estimated 2-year overall survival (2y-OS) of 83%, 63%, and 13%, respectively (P < .0001). Focusing on patients with low-level MRD before alloSCT, those with FLT3 internal tandem duplications(ITDs) had significantly poorer outcome (hazard ratio [HR], 6.14; P = .01). Combining these variables was highly prognostic, dividing patients into 2 groups with 2y-OS of 17% and 82% (HR, 13.2; P < .0001). T-depletion was associated with significantly reduced survival both in the entire cohort (2y-OS, 56% vs 96%; HR, 3.24; P = .0005) and in MRD-positive patients (2y-OS, 34% vs 100%; HR, 3.78; P = .003), but there was no significant effect of either conditioning regimen or donor source on outcome. Registered at ISRCTN (http://www.isrctn.com/ISRCTN55675535).
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MESH Headings
- Adolescent
- Adult
- Aged
- Female
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Nuclear Proteins/genetics
- Nucleophosmin
- Recurrence
- Young Adult
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Affiliation(s)
- Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Robert Hills
- Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Anju Shankar Kanda
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Manohursingh Runglall
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Nicola Foot
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Mikel Valganon
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Asim Khwaja
- Department of Haematology, University College, London, United Kingdom
| | | | | | | | | | - Mike Dennis
- Christie Hospital, Manchester, United Kingdom
| | - Steven Knapper
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Harpreet Kaur
- Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Priyanka Mehta
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Kavita Raj
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | | | | | | | | | - Kate Hill
- University Hospital, Southampton, United Kingdom
| | | | - Samah Alimam
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Erin Hurst
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | | | - Anjum Khan
- St James' Hospital, Leeds, United Kingdom
| | - Rahuman Salim
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | | | - Amanda Gilkes
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Rosemary Gale
- Department of Haematology, University College, London, United Kingdom
| | - Alan Burnett
- Blackwaterfoot, Isle of Arran, United Kingdom; and
| | - Nigel H Russell
- Department of Haematology, Guy's Hospital, London, United Kingdom
- Nottingham University Hospital, Nottingham, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
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12
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McIlroy G, Nikolousis E, Abou-Zeid N, Shankara P, Kishore B, Kaparou M, Lovell R, Elmoamly S, Davies D, Horgan C, Shenouda A, Kanellopoulos A. Mixed T-cell chimerism at 3 months followed by donor lymphocyte infusion is independently associated with favorable outcomes in alemtuzumab-based reduced-intensity allogeneic hematopoietic stem cell transplantation. Leuk Lymphoma 2019; 61:202-205. [DOI: 10.1080/10428194.2019.1650177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Graham McIlroy
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Emmanouil Nikolousis
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Nervana Abou-Zeid
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Paneesha Shankara
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Bhuvan Kishore
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Maria Kaparou
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Richard Lovell
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Shereef Elmoamly
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
- Internal Medicine and Clinical Hematology Department, Kasr Alainy Faculty of Medicine, Cairo University, Giza, Egypt
| | - David Davies
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Claire Horgan
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Amir Shenouda
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Alexandros Kanellopoulos
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
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Kinsella FAM, Inman CF, Gudger A, Chan YT, Murray DJ, Zuo J, McIlroy G, Nagra S, Nunnick J, Holder K, Wall K, Griffiths M, Craddock C, Nikolousis E, Moss P, Malladi R. Very early lineage-specific chimerism after reduced intensity stem cell transplantation is highly predictive of clinical outcome for patients with myeloid disease. Leuk Res 2019; 83:106173. [PMID: 31276965 DOI: 10.1016/j.leukres.2019.106173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/27/2019] [Accepted: 06/17/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The importance of chimerism status in the very early period after hematopoietic stem cell transplantation is unclear. We determined PBMC and T-cell donor chimerism 50 days after transplantation and related this to disease relapse and overall survival. METHODS 144 sequential patients underwent transplantation of which 90 had AML/MDS and 54 had lymphoma. 'Full donor chimerism' was defined as ≥99% donor cells and three patient groups were defined: 40% with full donor chimerism (FC) in both PBMC and T-cells; 25% with mixed chimerism (MC) within both compartments and 35% with 'split' chimerism (SC) characterised by full donor chimerism within PBMC and mixed chimerism within T-cells. RESULTS In patients with myeloid disease a pattern of mixed chimerism (MC) was associated with a one year relapse rate of 45% and a five year overall survival of 40% compared to values of 8% and 75%, and 17% and 60%, for those with SC or FC respectively. The pattern of chimerism had no impact on clinical outcome for lymphoma. CONCLUSION The pattern of lineage-specific chimerism at 50 days after transplantation is highly predictive of clinical outcome for patients with myeloid malignancy and may help to guide subsequent clinical management.
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Affiliation(s)
- Francesca A M Kinsella
- School of Cancer Sciences, University of Birmingham, Birmingham, UK; Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | | | - Amy Gudger
- Heartlands Hospital, Heart of England NHS Foundation trust, Birmingham, UK
| | - Yuen T Chan
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Duncan J Murray
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Jianmin Zuo
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Graham McIlroy
- Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - Sandeep Nagra
- Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - Jane Nunnick
- Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - Kathy Holder
- Heartlands Hospital, Heart of England NHS Foundation trust, Birmingham, UK
| | - Kerry Wall
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Mike Griffiths
- School of Cancer Sciences, University of Birmingham, Birmingham, UK; West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | | | - Paul Moss
- School of Cancer Sciences, University of Birmingham, Birmingham, UK; Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK.
| | - Ram Malladi
- School of Cancer Sciences, University of Birmingham, Birmingham, UK; Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
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Horgan C, Elmoamly S, McIlroy G, Davies D, Kaparou M, Giles H, Xenou E, Kishore B, Lovell R, Nikolousis E, Shankara P, Kanellopoulos A. Reduced intensity alemtuzumab-containing allogeneic stem cell transplantation for relapsed/refractory low grade lymphoma: reflections on a single center experience. Leuk Lymphoma 2019; 60:3075-3077. [PMID: 31079514 DOI: 10.1080/10428194.2019.1607323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Claire Horgan
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Shereef Elmoamly
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Graham McIlroy
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - David Davies
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Maria Kaparou
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Hannah Giles
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Evgenia Xenou
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Bhuvan Kishore
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Richard Lovell
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | | | - Paneesha Shankara
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
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Horgan C, Kanellopoulos A, Paneesha S, Kishore B, Lovell R, Nikolousis E. A unique case of durable complete remission after salvage with azacitidine and DLI for high risk flt-3 positive acute myeloid leukemia, following relapse 18 months post allogeneic stem cell transplant. Hematol Rep 2019; 11:7800. [PMID: 30915202 PMCID: PMC6397996 DOI: 10.4081/hr.2019.7800] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/15/2018] [Indexed: 11/25/2022] Open
Abstract
A unique case of primary refractory FLT3-itd mutated acute myeloid leukemia in an elderly patient, who achieved completed morphological remission, and FLT3-itd negativity, following 9 cycles of azacitadine in combination with escalating doses of donor lymphocyte infusions following relapse 18 months post reduced intensity HLAA mismatch Campath conditioning allogeneic stem cell transplant.
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Affiliation(s)
- Claire Horgan
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
| | | | - Shankara Paneesha
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
| | - Bhuvan Kishore
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
| | - Richard Lovell
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
| | - Emmanouil Nikolousis
- Hematology and Stem Cell Transplantation Department, Heart of England NHS Trust, Birmingham, UK
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16
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Randall K, Kaparou M, Xenou E, Paneesha S, Kishore B, Kanellopoulos A, Lovell R, Holder K, Suhr J, Baker L, Ryan L, Nikolousis E. Reduced-intensity conditioning allogeneic transplantation after salvage treatment with DT-PACE in myeloma patients relapsing early after autologous transplant. Eur J Haematol 2017. [PMID: 28632322 DOI: 10.1111/ejh.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this retrospective single-centre study, we have looked into the transplant outcomes(overall survival OS, progression-free survival PFS, GvHD) and the role of chimerism, DLI and pretransplant characteristics in patients who had a suboptimal response (<12 months) to an autologous stem cell transplant for myeloma and underwent an alemtuzumab T-cell depleted reduced-intensity allograft(RIC). METHODS Twenty-four patients were salvaged with two cycles of DT-PACE and received a RIC transplant with fludarabine, melphalan and alemtuzumab. All the patients received PBSC grafts, eight patients had a sibling donor, and 16 had a graft from a fully matched unrelated donor. The median follow-up was 65.3 months (6-132 months). RESULTS The median overall survival was 55.4 months. DLI administration was associated with a trend towards better overall survival (P=.05). Disease status at allo-HCT, PR or VGPR, ISS score and CMV serostatus was not significant predictors of OS and PFS. Full donor whole blood chimerism (≥98%) at 3 months post-transplant was associated with PFS (P=.04) but did not have a significant impact on OS(P=.45). CONCLUSION Reduced-intensity alemtuzumab-conditioned allograft for myeloma after DT-PACE salvage chemotherapy is an efficient and low toxicity treatment for those who had a suboptimal response postautologous stem cell transplant for myeloma.
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Affiliation(s)
- Kate Randall
- Haematology Department, Warwick District general hospital, Warwick, UK
| | - Maria Kaparou
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | - Evgenia Xenou
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | | | - Bhuvan Kishore
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | | | - Richard Lovell
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | - Kathy Holder
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | - Julie Suhr
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | - Lynda Baker
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | - Lynn Ryan
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
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Chakupurakal G, Delgado J, Nikolousis E, Pitchapillai S, Allotey D, Holder K, Bratby L, de la Rue J, Milligan DW. Midazolam in conjunction with local anaesthesia is superior to Entonox in providing pain relief during bone marrow aspirate and trephine biopsy. J Clin Pathol 2015; 61:1051-4. [PMID: 18755727 DOI: 10.1136/jcp.2008.058180] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To compare intravenous titrated midazolam 5-10 mg and inhaled Entonox in addition to local anaesthesia in order to identify which agent provides optimum pain relief. METHODS Randomised, controlled trial. 49 patients were recruited, of which 46 were evaluable. 24 and 22 patients were recruited into the Entonox and midazolam arms, respectively. Patient experiences as well as staff observations were recorded with questionnaires after recovery from the procedure and 24 hours later. RESULTS 45% and 59% of the patients in the midazolam arm could recollect the procedure after 15 minutes and 24 hours, respectively, compared to 96% and 88% who received Entonox. Midazolam provided a more comfortable experience (p<0.01) and improved pain relief (p = 0.01) compared to Entonox immediately after the procedure; this further improved when recalled 24 hours later. Nausea, dizziness and hallucinations were observed with both treatments, but dizziness was significantly more frequent with Entonox (p = 0.048). Clinically relevant respiratory depression (O(2) saturation <90%) occurred in 19% of patients in the midazolam arm; sedation was reversed with flumazenil. CONCLUSION Midazolam in conjunction with local anaesthesia provides rapid and reversible sedation as well as effective pain relief during bone marrow biopsy, and is superior to Entonox; however, care must be taken to monitor respiratory function.
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Affiliation(s)
- G Chakupurakal
- Department of Haematology, Heart of England Hospital, Birmingham, UK
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18
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Abbott S, Nikolousis E, Badger I. Intestinal lymphoma--a review of the management of emergency presentations to the general surgeon. Int J Colorectal Dis 2015; 30:151-7. [PMID: 25374417 DOI: 10.1007/s00384-014-2061-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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] [Accepted: 10/26/2014] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Intestinal non-Hodgkin's lymphoma (NHL) is uncommon but not rare. This paper aims to review the recent evidence for the management of perforated NHL of the intestine, consider when chemotherapy should be commenced and examine the likely outcomes and prognosis for patients presenting as surgical emergencies with this condition. METHODS MEDLINE and Cochrane databases were searched using intestinal lymphoma, clinical presentation, perforation, management and prognosis. The full text of relevant articles was retrieved and reference lists checked for additional articles. FINDINGS Emergency surgery was required at disease presentation for between 11 and 64% of intestinal NHL cases. Perforation occurs in 1-25% of cases, and also occurs whilst on chemotherapy for NHL. Intestinal bleeding occurs in 2-22% of cases. Obstruction occurs more commonly in small bowel (5-39%) than large bowel NHL and intussusceptions occur in up to 46%. Prognosis is generally poor, especially for T cell lymphomas. CONCLUSIONS There is a lack of quality evidence for the elective and emergency treatment of NHL involving the small and large intestine. There is a lack of information regarding the impact an emergency presentation has on the timing of postoperative chemotherapy and overall prognosis. It is proposed that in order to develop evidence-based treatment protocols, there should be an intestinal NHL registry.
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Affiliation(s)
- S Abbott
- Department of Colorectal Surgery, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK,
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19
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Lokare A, Nikolousis E, Phillips N, Rudzki Z, Lovell R, Kishore B, Milligan D, Paneesha S. Reduced intensity allogeneic stem cell transplant for treatment of blastic plasmacytoid dendritic cell neoplasm. Hematol Rep 2014; 6:5119. [PMID: 24711917 PMCID: PMC3977154 DOI: 10.4081/hr.2014.5119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/01/2013] [Accepted: 01/12/2014] [Indexed: 11/22/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm is a rare, aggressive tumor characterized by skin and/or marrow infiltration by CD4+ CD56+ cells. Historically, the tumor was variably thought to arise from either monocytes, T cells or NK cells giving rise to terms such as CD4+/CD56+ acute monoblastic leukemia, primary cutaneous CD4+/CD56+ hematodermic tumor and blastic NK-cell lymphoma. Whilst considerable progress has been made in understanding the histogenesis, the best modality of treatment remains to be defined. We are therefore reporting this case which was successfully treated with a T-deplete allogeneic transplant and the patient is currently alive and in remission 4 years post transplant.
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Affiliation(s)
- Anand Lokare
- Hematology Department, University Hospital Walsgrave , Coventry, UK
| | | | - Neil Phillips
- Hematology Department, University Hopital North Staffordshire , Stoke on Trent, UK
| | - Zbigniew Rudzki
- Histopathology Department, Heart of England NHS Trust , Birmingham, UK
| | - Richard Lovell
- Hematology Department, Heart of England Hospital NHS Trust , Birmingham, UK
| | - Bhuvan Kishore
- Hematology Department, Heart of England Hospital NHS Trust , Birmingham, UK
| | - Don Milligan
- Hematology Department, Heart of England Hospital NHS Trust , Birmingham, UK
| | - Shankara Paneesha
- Hematology Department, Heart of England Hospital NHS Trust , Birmingham, UK
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20
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Bousnaki M, Makaronidis I, Sioga A, Simou C, Nikolousis E, Konstantinidou E, Kaidoglou K, Papamitsou T, Emmanouil-Nikoloussi EN. Ultrastructural observations of brain neurotoxicity in neonatal mice after “in vivo” individual exposure to arsenic and lead during gestation. Reprod Toxicol 2013. [DOI: 10.1016/j.reprotox.2013.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Nikolousis E, Robinson S, Nagra S, Brookes C, Kinsella F, Tauro S, Jeffries S, Griffiths M, Mahendra P, Cook M, Paneesha S, Lovell R, Kishore B, Chaganti S, Malladi R, Raghavan M, Moss P, Milligan D, Craddock C. Post-transplant T cell chimerism predicts graft versus host disease but not disease relapse in patients undergoing an alemtuzumab based reduced intensity conditioned allogeneic transplant. Leuk Res 2013; 37:561-5. [PMID: 23395505 DOI: 10.1016/j.leukres.2013.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/12/2013] [Accepted: 01/13/2013] [Indexed: 11/18/2022]
Abstract
In this multicentre retrospective study we have studied the impact of T cell chimerism on the outcome of 133 patients undergoing an alemtuzumab based reduced intensity conditioning allograft (RIC). The median age of the patients was 50 years (range 42-55 years). 77 patients were transplanted using an HLA identical sibling donor while 56 patients received a fully matched volunteer unrelated donor graft. 64 patients had a lymphoid malignancy and 69 were transplanted for a myeloid malignancy. 38 patients (29%) relapsed with no significant difference in risk of relapse between patients developing full donor and mixed donor chimerism in the T-cell compartment on D+90 and D+180 post transplant. Day 90 full donor T cell chimerism correlated with an increased incidence of acute GVHD according to NIH criteria (p=0.0004) and the subsequent development of chronic GVHD. Consistent with previous observations, our results confirmed a correlation between the establishment of T cell full donor chimerism and acute GVHD in T deplete RIC allografts. However our study failed to identify any correlation between T cell chimerism and relapse risk and challenge the use of pre-emptive donor lymphocyte infusions (DLI) in patients with mixed T cell chimerism transplanted using an alemtuzumab based RIC regimen.
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Affiliation(s)
- E Nikolousis
- Department of Haematology, Heart of England NHS Foundation Trust, Birmingham, UK.
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22
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Nikolousis E, Velangi M. Two cases of aspergillus endocarditis in non neutropenic children on chemotherapy for acute lymphoblastic leukaemia. Hematol Rep 2011; 3:e7. [PMID: 22184529 PMCID: PMC3238470 DOI: 10.4081/hr.2011.e7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/08/2011] [Accepted: 06/08/2011] [Indexed: 11/23/2022] Open
Abstract
Fungal endocarditis (FE) is a rare complication in immunocompromised patients which is difficult to diagnose and has been characterized by excessive mortality (> 50%) and morbidity, regardless of treatment. The lack of clinical trials due to the small number of cases contributes further to a poor outcome. In our two cases of aspergilllus endocarditis we reviewed the clinical features, echocardiographic findings, microbiologic data, treatment, and outcome of these 2 cases and provide a current characterization of the syndrome. In this paper we have demonstrated the diversity of presentation of a critical fungal infection in immunocompromised but non neutropenic paediatric patients. The prompt diagnosis and initiation of treatment is crucial for a favourable outcome along with the use of double antifungal treatment with liposomal amphotericin and voriconazole initially which could be later switched to oral voriconazole with a good tissue penetration. Histological samples as well as radiological evidence and echocardiograms should be reviewed by experienced clinicians in order to aid diagnosis and promptly initiate treatment for these patients in order to achieve a favourable outcome.
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Goardon N, Nikolousis E, Sternberg A, Chu WK, Craddock C, Richardson P, Benson R, Drayson M, Standen G, Vyas P, Freeman S. Reduced CD38 expression on CD34+ cells as a diagnostic test in myelodysplastic syndromes. Haematologica 2009; 94:1160-3. [PMID: 19644143 DOI: 10.3324/haematol.2008.004085] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Diagnosis of myelodysplastic syndrome can be difficult especially in cases with a low blast count and a normal karyotype. Flow cytometry has been used to distinguish myelodysplastic syndrome from non-clonal cytopenias. No one single simple flow cytometric parameter has been proposed to be diagnostic of myelodysplastic syndrome. We have studied samples from 100 myelodysplastic syndrome patients and as control samples; 70 non-clonal cytopenias, 5 subjects with normal hematology, 31 patients with acute myeloid leukemia and 11 with chronic myelomonocytic leukemia or myeloproliferative disorder. We show that reduced relative mean fluorescence of CD38 below a threshold value on CD34(+) cells diagnosed low-grade myelodysplastic syndrome with 95% sensitivity (95% confidence interval, 87-99%) and 92% specificity (95% confidence interval, 82-97%). This simple flow cytometric test may be of value in the routine clinical diagnosis of myelodysplastic syndrome, especially in cases with a low blast count and normal karyotype.
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Affiliation(s)
- Nicolas Goardon
- Department of Haematology, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, Oxford, UK
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Craddock C, Nagra S, Peniket A, Brookes C, Buckley L, Nikolousis E, Duncan N, Tauro S, Yin J, Liakopoulou E, Kottaridis P, Snowden J, Milligan D, Cook G, Tholouli E, Littlewood T, Peggs K, Vyas P, Clark F, Cook M, Mackinnon S, Russell N. Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid leukemia. Haematologica 2009; 95:989-95. [PMID: 19951968 DOI: 10.3324/haematol.2009.013920] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Reduced intensity conditioning regimens permit the delivery of a potentially curative graft-versus-leukemia effect in older patients with acute myeloid leukemia. Although T-cell depletion is increasingly used to reduce the risk of graft-versus-host disease its impact on the graft-versus-leukemia effect and long-term outcome post-transplant is unknown. DESIGN AND METHODS We have characterized pre- and post-transplant factors determining overall survival in 168 patients with acute myeloid leukemia transplanted using an alemtuzumab based reduced intensity conditioning regimen with a median duration of follow-up of 37 months. RESULTS The 3-year overall survival for patients transplanted in CR1 or CR2/CR3 was 50% (95% CI, 38% to 62%) and 44% (95% CI, 31% to 56%), respectively compared to 15% (95% CI, 2% to 36%) for patients with relapsed/refractory disease. Multivariate analysis demonstrated that both survival and disease relapse were influenced by status at transplant (P=0.008) and presentation cytogenetics (P=0.01). Increased exposure to cyclosporine A (CsA) in the first 21 days post-transplant was associated with an increased relapse risk (P<0.0001) and decreased overall survival (P<0.0001). CONCLUSIONS Disease stage, presentation karyotype and post-transplant CsA exposure are important predictors of outcome in patients undergoing a T-cell depleted reduced intensity conditioning allograft for acute myeloid leukemia. These data confirm the presence of a potent graft-versus-leukemia effect after a T-cell depleted reduced intensity conditioning allograft in acute myeloid leukemia and identify CsA exposure as a manipulable determinant of outcome in this setting.
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Affiliation(s)
- Charles Craddock
- Centre for Clinical Haematology, Main Drive, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
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Nikolousis E, Revell P, Novitzky-Basso I, Amos A. Philadelphia-positive chronic-phase chronic myeloid leukaemia after long-term remission of Philadelphia-negative acute lymphoblastic leukaemia. Acta Haematol 2008; 119:124-5. [PMID: 18391563 DOI: 10.1159/000125191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 01/31/2008] [Indexed: 11/19/2022]
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