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Georgoulis V, Koumpis E, Hatzimichael E. The Role of Non-Coding RNAs in Myelodysplastic Neoplasms. Cancers (Basel) 2023; 15:4810. [PMID: 37835504 PMCID: PMC10571949 DOI: 10.3390/cancers15194810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Myelodysplastic syndromes or neoplasms (MDS) are a heterogeneous group of myeloid clonal disorders characterized by peripheral blood cytopenias, blood and marrow cell dysplasia, and increased risk of evolution to acute myeloid leukemia (AML). Non-coding RNAs, especially microRNAs and long non-coding RNAs, serve as regulators of normal and malignant hematopoiesis and have been implicated in carcinogenesis. This review presents a comprehensive summary of the biology and role of non-coding RNAs, including the less studied circRNA, siRNA, piRNA, and snoRNA as potential prognostic and/or predictive biomarkers or therapeutic targets in MDS.
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Affiliation(s)
- Vasileios Georgoulis
- Department of Haematology, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45 500 Ioannina, Greece; (V.G.); (E.K.)
| | - Epameinondas Koumpis
- Department of Haematology, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45 500 Ioannina, Greece; (V.G.); (E.K.)
| | - Eleftheria Hatzimichael
- Department of Haematology, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45 500 Ioannina, Greece; (V.G.); (E.K.)
- Computational Medicine Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19 107, USA
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2
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Koumpis E, Kyriazopoulou L, Tigas S, Kapsali E, Hatzimichael E. Central Diabetes Insipidus in a Patient With Lymphoma: A Case Report. Cureus 2023; 15:e41500. [PMID: 37551214 PMCID: PMC10404345 DOI: 10.7759/cureus.41500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Primary central nervous system (CNS) lymphoma or systemic non-Hodgkin lymphoma that infiltrates the CNS can cause central diabetes insipidus (CDI). Polyuria and polydipsia should raise the suspicion of CDI development in patients with lymphoma that infiltrates the CNS. CDI is effectively treated with desmopressin. However, careful monitoring of the patient's serum sodium, fluid intake, urine output, and weight is necessary because patients receiving desmopressin may develop hyponatremia, so they should be alert to recognize this side effect promptly. Moreover, CDI due to lymphoma can occasionally be reversible. Therefore, the dosage of desmopressin should be adapted during or after the treatment of lymphoma.
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Affiliation(s)
- Epameinondas Koumpis
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Lydia Kyriazopoulou
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Stelios Tigas
- Department of Endocrinology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Eleni Kapsali
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Eleftheria Hatzimichael
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
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3
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Hatzimichael E, Timotheatou D, Koumpis E, Benetatos L, Makis A. Luspatercept: A New Tool for the Treatment of Anemia Related to β-Thalassemia, Myelodysplastic Syndromes and Primary Myelofibrosis. Diseases 2022; 10:diseases10040085. [PMID: 36278584 PMCID: PMC9624301 DOI: 10.3390/diseases10040085] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Anemia is a common feature of both benign and malignant hematologic diseases. Beta-thalassemia (β-thalassemia) syndromes are a group of hereditary disorders characterized by ineffective erythropoiesis, due to a genetic deficiency in the synthesis of the beta chains of hemoglobin, often accompanied by severe anemia and the need for red blood cell (RBC) transfusions. Myelodysplastic syndromes (MDS) are characterized by cytopenia(s) and ineffective hematopoiesis, despite a hypercellular bone marrow. Primary myelofibrosis (PMF) is a clonal myeloproliferative neoplasm characterized by reactive fibrosis of the bone marrow, accompanied by extramedullary hematopoiesis. Luspatercept, previously known as ACE-536, is a fusion protein that combines a modified activin receptor IIB (ActRIIB), a member of the transforming growth factor-β (TGF-β) superfamily, with the Fc domain of human immunoglobulin G (IgG1). It has shown efficacy in the treatment of anemia due to beta β-thalassemia, MDS and PMF and recently gained approval by the Federal Drug Agency (FDA) and the European Medicines Agency (EMA) for transfusion-dependent (TD) patients with β-thalassemia and very low to intermediate-risk patients with MDS with ringed sideroblasts who have failed to respond to, or are ineligible for, an erythropoiesis-stimulating agent. In this review, we describe the key pathways involved in normal hematopoiesis and the possible mechanism of action of luspatercept, present its development and data from the most recent clinical trials in β-thalassemia, MDS and PMF, and discuss its potential use in the treatment of these hematological disorders.
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Affiliation(s)
- Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
- Correspondence:
| | | | - Epameinondas Koumpis
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
| | | | - Alexandros Makis
- Department of Child Health, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
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4
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Liapis K, Papadopoulos V, Vrachiolias G, Stavroulaki E, Misidou C, Kourakli A, Galanopoulos A, Papoutselis MK, Papageorgiou S, Diamantopoulos PT, Pappa V, Viniou NA, Tsokanas D, Vassilakopoulos TP, Hatzimichael E, Koumpis E, Papathanasiou K, Bouronikou E, Ximeri M, Pontikoglou C, Megalakaki A, Zikos P, Panayiotidis P, Dimou M, Karakatsanis SJ, Vardi A, Kontopidou F, Charchalakis N, Adamopoulos I, Papadaki HA, Symeonidis A, Ioannis K. Myelodysplastic Syndromes (MDS) Presenting with Isolated Thrombocytopenia: Characteristics, Outcomes, and Clinical Presentation Differences from Immune Thrombocytopenic Purpura (ITP). Blood 2021; 138:1535-1535. [DOI: https:/doi.org/10.1182/blood-2021-149630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Introduction: Less than 5% of patients with MDS present with thrombocytopenia as an isolated abnormality (MDS-IT). There have been few systematic studies on MDS-IT and data regarding its course and prognosis are conflicting. Previous studies have defined MDS-IT based on the IPSS thresholds (Hb ≥10 g/dL; ANC ≥1.8×10 9/L; PLT <100×10 9/L). However, these were developed for prognostic, not diagnostic purposes which means that mild anemia and/or neutropenia might be present concomitantly with "isolated" thrombocytopenia. We aimed to investigate the characteristics, overall survival (OS), and leukemia-free survival (LFS) of patients with MDS-IT.
Methods: We identified patients who had PLT <150 ×10 9/L, Hb >13 g/dL (men) or >12 g/dL (women), and ANC ≥1.8 ×10 9/L, registered in the Hellenic National Registry of Myelodysplastic and Hypoplastic Syndromes which includes 2792 patients (analysis cut-off date; July 7, 2016). Patients were divided into 4 groups: group 1 had PLT 149-100 ×10 9/L; group 2, 99-50 ×10 9/L; group 3, <50 ×10 9/L; and group 4, <25 ×10 9/L. We also collected data from the Hellenic National ITP Registry which includes 1317 adult patients with ITP.
Results: A total of 77 patients (45 men; 32 women) with MDS-IT were identified (2.9% of total MDS cohort). Of these, 28.6% were classified in group 1; 49.4% in group 2; 14.3% in group 3; and 7.8% in group 4. Median PLT count was 87 ×10 9/L (12-139 ×10 9/L), WBC count 4.6 ×10 9/L, and Hb 13.6 g/dL. Bone marrow (BM) blasts ranged from 0-9% (median, 2%). Median follow-up was 51.0 months (41.6-60.4), during which 15 (19.5%) patients died. AML developed in 9 patients (11.7%). Histologically, MDS with multilineage dysplasia (MLD) was seen in 77.6% whereas MDS with excess blasts (EB) and MDS with single lineage dysplasia (SLD) comprised 10.7% and 11.9% of cases, respectively. Most patients (73.5%) had lower-risk MDS on the IPSS-R (i.e. IPSS-R ≤3.5). Of the 59 patients with cytogenetic data, 83.1% had favorable, 13.5% intermediate, and 3.4% poor risk cytogenetics. Most (40) had a normal karyotype followed by isolated del(20q) (6). All patients with del(20q) showed a characteristic set of clinical features: age >60 years, blasts 0-3%, bilineage (erythroid/megakaryocytic) dysplasia, and increased reticulin fibrosis. There were no significant differences between any of the 4 PLT groups regarding age, sex, IPSS-R, cytogenetics, BM blasts, and histology.
Median OS was 109 months (95% CI 103-115) and LFS 108 months (101-115). Our results showed no significant difference in OS (P=0.891) and LFS (P=0.871) between the 4 PLT groups. As compared with total MDS cohort, MDS-IT occurred at younger age (64.7 vs. 72.4 years, P<0.001). In a Kaplan-Meier analysis, patients with MDS-IT had markedly longer OS and LFS than patients in the total MDS cohort, even after adjustment for age, sex, IPSS-R, blasts, and PLT (P=0.013 for OS; P=0.017 for LFS) (Figure 1A). There were no differences in the top causes of death: infection was the commonest cause followed by disease progression and cardiovascular disease. Major bleeding comprised 10.3% of deaths in MDS-IT vs. 12.7% in total MDS cohort (P=0.217).
In comparing MDS-IT with ITP, the median age at diagnosis was 66.0 years for MDS-IT and 49.0 years for ITP (P<0.001).MDS-IT was uncommon in patients <50 or >80 years. Its incidence reached a peak between the ages of 70-79 years, whereas ITP occurred at a more constant level over time (Figure 1B). Women predominated in ITP and men in MDS-IT (P=0.007). Overall, ITP was associated with more marked thrombocytopenia than MDS-IT (15.0 ×10 9/L vs. 87.0 ×10 9/L) (P<0.001). Median WBC count was higher in ITP (7.6 ×10 9/L vs. 4.6 ×10 9/L; P<0.001). Median Hb was similar in the 2 groups. Patients with ITP had longer OS than MDS-IT (P<0.001).
Conclusions: In one of the largest reported series, we conclude that MDS-IT is associated with MDS-MLD, favorable cytogenetics, lower-risk IPSS-R, high survival rate, and a low risk of AML evolution. Our data suggest that the superior prognosis in MDS-IT than general MDS may have intrinsic genomic underpinnings as survival curves remained unchanged after correcting for age, sex, blasts and IPSS-R. Importantly, no significant differences in OS and LFS were noted between the 4 PLT subgroups, suggesting that the degree of thrombocytopenia does not correlate with mortality in MDS-IT. From the diagnostic standpoint, age <50 or >80 years and PLT <25 ×10 9/L favored a diagnosis of ITP over MDS-IT.
Figure 1 Figure 1.
Disclosures
Viniou: Sandoz: Research Funding; Takeda: Research Funding; Novartis: Honoraria, Research Funding; Sanofi: Research Funding; Janssen: Honoraria, Research Funding; Pfizer: Research Funding; Abbvie: Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Roche: Research Funding; Astellas: Research Funding; Celgene: Research Funding. Vassilakopoulos: Dr. Reddy's: Research Funding; Amgen: Honoraria, Research Funding; GlaxoSmithKline: Honoraria, Other: Travel; AbbVie: Consultancy, Honoraria; Integris: Honoraria; Pfizer: Research Funding; Roche: Consultancy, Honoraria, Other: Travel; Takeda: Consultancy, Honoraria, Other: Travel, Research Funding; Genesis Pharma: Consultancy, Honoraria, Other: Travel; Merck: Honoraria, Research Funding; Novartis: Consultancy, Honoraria; Karyopharm: Research Funding; AstraZeneca: Honoraria. Hatzimichael: Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; MSD: Consultancy, Honoraria; Gilead: Honoraria; Janssen Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Genesis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria; Pharmathen- Innovis: Honoraria; GSK: Honoraria; Bristol Myersr Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees. Symeonidis: Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi/Genzyme: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Demo: Research Funding; MSD: Consultancy, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; WinMedica: Research Funding; Astellas: Consultancy, Research Funding; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GSK: Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GenesisPharma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Affiliation(s)
- Konstantinos Liapis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Emily Stavroulaki
- Department of Hematology, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Christina Misidou
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Rio, Patras, Greece
| | | | | | - Sotirios Papageorgiou
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Vassiliki Pappa
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tsokanas
- Department of Clinical Hematology, G. Gennimatas General Hospital, Athens, Greece
| | - Theodoros P. Vassilakopoulos
- Department of Haematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | - Eleni Bouronikou
- Department of Hematology, Larisa University Hospital, Larisa, Greece
| | - Maria Ximeri
- University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | | | | | - Panagiotis Zikos
- Department of Hematology, "Agios Andreas" General Hospital of Patras, Patras, Greece
| | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Anna Vardi
- Hematology Department and HCT Unit, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - Flora Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokrateio General Hospital, Athens, Greece
| | | | - Ioannis Adamopoulos
- Hematology and Thalassemia Unit, Kalamata General Hospital, Kalamata, Greece
| | | | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Rio, Patras, Greece
| | - Kotsianidis Ioannis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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5
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Liapis K, Papadopoulos V, Vrachiolias G, Stavroulaki E, Misidou C, Kourakli A, Galanopoulos A, Papoutselis MK, Papageorgiou S, Diamantopoulos PT, Pappa V, Viniou NA, Tsokanas D, Vassilakopoulos TP, Hatzimichael E, Koumpis E, Papathanasiou K, Bouronikou E, Ximeri M, Pontikoglou C, Megalakaki A, Zikos P, Panayiotidis P, Dimou M, Karakatsanis SJ, Vardi A, Kontopidou F, Charchalakis N, Adamopoulos I, Papadaki HA, Symeonidis A, Ioannis K. Myelodysplastic Syndromes (MDS) Presenting with Isolated Thrombocytopenia: Characteristics, Outcomes, and Clinical Presentation Differences from Immune Thrombocytopenic Purpura (ITP). Blood 2021. [DOI: https://doi.org/10.1182/blood-2021-149630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction: Less than 5% of patients with MDS present with thrombocytopenia as an isolated abnormality (MDS-IT). There have been few systematic studies on MDS-IT and data regarding its course and prognosis are conflicting. Previous studies have defined MDS-IT based on the IPSS thresholds (Hb ≥10 g/dL; ANC ≥1.8×10 9/L; PLT <100×10 9/L). However, these were developed for prognostic, not diagnostic purposes which means that mild anemia and/or neutropenia might be present concomitantly with "isolated" thrombocytopenia. We aimed to investigate the characteristics, overall survival (OS), and leukemia-free survival (LFS) of patients with MDS-IT.
Methods: We identified patients who had PLT <150 ×10 9/L, Hb >13 g/dL (men) or >12 g/dL (women), and ANC ≥1.8 ×10 9/L, registered in the Hellenic National Registry of Myelodysplastic and Hypoplastic Syndromes which includes 2792 patients (analysis cut-off date; July 7, 2016). Patients were divided into 4 groups: group 1 had PLT 149-100 ×10 9/L; group 2, 99-50 ×10 9/L; group 3, <50 ×10 9/L; and group 4, <25 ×10 9/L. We also collected data from the Hellenic National ITP Registry which includes 1317 adult patients with ITP.
Results: A total of 77 patients (45 men; 32 women) with MDS-IT were identified (2.9% of total MDS cohort). Of these, 28.6% were classified in group 1; 49.4% in group 2; 14.3% in group 3; and 7.8% in group 4. Median PLT count was 87 ×10 9/L (12-139 ×10 9/L), WBC count 4.6 ×10 9/L, and Hb 13.6 g/dL. Bone marrow (BM) blasts ranged from 0-9% (median, 2%). Median follow-up was 51.0 months (41.6-60.4), during which 15 (19.5%) patients died. AML developed in 9 patients (11.7%). Histologically, MDS with multilineage dysplasia (MLD) was seen in 77.6% whereas MDS with excess blasts (EB) and MDS with single lineage dysplasia (SLD) comprised 10.7% and 11.9% of cases, respectively. Most patients (73.5%) had lower-risk MDS on the IPSS-R (i.e. IPSS-R ≤3.5). Of the 59 patients with cytogenetic data, 83.1% had favorable, 13.5% intermediate, and 3.4% poor risk cytogenetics. Most (40) had a normal karyotype followed by isolated del(20q) (6). All patients with del(20q) showed a characteristic set of clinical features: age >60 years, blasts 0-3%, bilineage (erythroid/megakaryocytic) dysplasia, and increased reticulin fibrosis. There were no significant differences between any of the 4 PLT groups regarding age, sex, IPSS-R, cytogenetics, BM blasts, and histology.
Median OS was 109 months (95% CI 103-115) and LFS 108 months (101-115). Our results showed no significant difference in OS (P=0.891) and LFS (P=0.871) between the 4 PLT groups. As compared with total MDS cohort, MDS-IT occurred at younger age (64.7 vs. 72.4 years, P<0.001). In a Kaplan-Meier analysis, patients with MDS-IT had markedly longer OS and LFS than patients in the total MDS cohort, even after adjustment for age, sex, IPSS-R, blasts, and PLT (P=0.013 for OS; P=0.017 for LFS) (Figure 1A). There were no differences in the top causes of death: infection was the commonest cause followed by disease progression and cardiovascular disease. Major bleeding comprised 10.3% of deaths in MDS-IT vs. 12.7% in total MDS cohort (P=0.217).
In comparing MDS-IT with ITP, the median age at diagnosis was 66.0 years for MDS-IT and 49.0 years for ITP (P<0.001).MDS-IT was uncommon in patients <50 or >80 years. Its incidence reached a peak between the ages of 70-79 years, whereas ITP occurred at a more constant level over time (Figure 1B). Women predominated in ITP and men in MDS-IT (P=0.007). Overall, ITP was associated with more marked thrombocytopenia than MDS-IT (15.0 ×10 9/L vs. 87.0 ×10 9/L) (P<0.001). Median WBC count was higher in ITP (7.6 ×10 9/L vs. 4.6 ×10 9/L; P<0.001). Median Hb was similar in the 2 groups. Patients with ITP had longer OS than MDS-IT (P<0.001).
Conclusions: In one of the largest reported series, we conclude that MDS-IT is associated with MDS-MLD, favorable cytogenetics, lower-risk IPSS-R, high survival rate, and a low risk of AML evolution. Our data suggest that the superior prognosis in MDS-IT than general MDS may have intrinsic genomic underpinnings as survival curves remained unchanged after correcting for age, sex, blasts and IPSS-R. Importantly, no significant differences in OS and LFS were noted between the 4 PLT subgroups, suggesting that the degree of thrombocytopenia does not correlate with mortality in MDS-IT. From the diagnostic standpoint, age <50 or >80 years and PLT <25 ×10 9/L favored a diagnosis of ITP over MDS-IT.
Figure 1 Figure 1.
Disclosures
Viniou: Sandoz: Research Funding; Takeda: Research Funding; Novartis: Honoraria, Research Funding; Sanofi: Research Funding; Janssen: Honoraria, Research Funding; Pfizer: Research Funding; Abbvie: Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Roche: Research Funding; Astellas: Research Funding; Celgene: Research Funding. Vassilakopoulos: Dr. Reddy's: Research Funding; Amgen: Honoraria, Research Funding; GlaxoSmithKline: Honoraria, Other: Travel; AbbVie: Consultancy, Honoraria; Integris: Honoraria; Pfizer: Research Funding; Roche: Consultancy, Honoraria, Other: Travel; Takeda: Consultancy, Honoraria, Other: Travel, Research Funding; Genesis Pharma: Consultancy, Honoraria, Other: Travel; Merck: Honoraria, Research Funding; Novartis: Consultancy, Honoraria; Karyopharm: Research Funding; AstraZeneca: Honoraria. Hatzimichael: Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; MSD: Consultancy, Honoraria; Gilead: Honoraria; Janssen Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Genesis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria; Pharmathen- Innovis: Honoraria; GSK: Honoraria; Bristol Myersr Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees. Symeonidis: Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi/Genzyme: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Demo: Research Funding; MSD: Consultancy, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; WinMedica: Research Funding; Astellas: Consultancy, Research Funding; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GSK: Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GenesisPharma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Affiliation(s)
- Konstantinos Liapis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Emily Stavroulaki
- Department of Hematology, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Christina Misidou
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Rio, Patras, Greece
| | | | | | - Sotirios Papageorgiou
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Vassiliki Pappa
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tsokanas
- Department of Clinical Hematology, G. Gennimatas General Hospital, Athens, Greece
| | - Theodoros P. Vassilakopoulos
- Department of Haematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | - Eleni Bouronikou
- Department of Hematology, Larisa University Hospital, Larisa, Greece
| | - Maria Ximeri
- University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | | | | | - Panagiotis Zikos
- Department of Hematology, "Agios Andreas" General Hospital of Patras, Patras, Greece
| | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Anna Vardi
- Hematology Department and HCT Unit, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - Flora Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokrateio General Hospital, Athens, Greece
| | | | - Ioannis Adamopoulos
- Hematology and Thalassemia Unit, Kalamata General Hospital, Kalamata, Greece
| | | | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Rio, Patras, Greece
| | - Kotsianidis Ioannis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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Papakonstantinou I, Koumpis E, Fytsili E, Panteli A, Milionis H, Papoudou-Bai A, Kapsali E, Hatzimichael E. Leishmaniasis mimicking multiple myeloma. Int J Lab Hematol 2021; 44:44-46. [PMID: 34322992 DOI: 10.1111/ijlh.13667] [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: 04/30/2021] [Revised: 06/06/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ioannis Papakonstantinou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Epameinondas Koumpis
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eugenia Fytsili
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Aikaterini Panteli
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Kapsali
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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7
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Koumpis E, Tassi I, Malea T, Papathanasiou K, Papakonstantinou I, Serpanou A, Tsolas E, Kapsali E, Vassilakopoulos TP, Papoudou-Bai A, Hatzimichael E. CD56 expression in multiple myeloma: Correlation with poor prognostic markers but no effect on outcome. Pathol Res Pract 2021; 225:153567. [PMID: 34352440 DOI: 10.1016/j.prp.2021.153567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
CD56 or neural cell adhesion molecule (NCAM) is a membrane glycoprotein expressed on neural cells, muscle tissues and myeloma cells. Expression of CD56 has been studied in patients with multiple myeloma (MM) with controversial results. The scope of this study was to examine the expression of CD56 in MM patients at diagnosis and investigate its association with clinicopathologic parameters. We retrospectively collected and analyzed data from 109 patients with MM diagnosed over the last decade (January 2010 to June 2020). Expression of CD56 was assessed by immunohistochemistry in bone marrow biopsies and investigated its association with a variety of clinicopathological parameters. For the statistical analysis χ2 test and Mann-Whitney U tests were used to compare categorical and continuous variables in CD56+ and CD56- patients, respectively. Statistical analysis was performed using SPSS 21.0 for Windows (SPSS, Chicago, IL). Based on the expression of CD56 the patient population was divided to CD56+ patients and CD56- patients; Sixty-eight patients were CD56 + and 41 patients were CD56-. Absence of CD56 expression was associated with unfavorable prognostic parameters such as elevated lactate dehydrogenase (LDH) and β2-microglobulin levels, advanced stage according to the International Staging System (ISS) and clonal bone marrow plasma cell infiltration ≥ 60%, but no effect on outcome, while the expression of CD56 was associated with well differentiated neoplastic plasma cells. Our study confirmed that lack of CD56 expression is a possible marker of poor prognosis in patients with MM. The detection of CD56 expression by either immunohistochemistry or flow cytometry is simple and cheap, and it could be incorporated in future prognostic or predictive scores. Prospective studies are needed in order to evaluate the role of expression of CD56 as a predictive biomarker in the era of novel regimens.
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Affiliation(s)
- Epameinondas Koumpis
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Iliana Tassi
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Theodora Malea
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina Papathanasiou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Papakonstantinou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Anastasia Serpanou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Evangelos Tsolas
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Kapsali
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
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8
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Papakonstantinou I, Kosmidou M, Papathanasiou K, Koumpis E, Kapsali E, Milionis H, Vassilakopoulos TP, Papoudou-Bai A, Hatzimichael E. Paraneoplastic Intrahepatic Cholestasis in Supradiaphragmatic Classical Hodgkin Lymphoma Successfully Treated With Brentuximab Vedotin: A Case Report and Review of the Literature. In Vivo 2021; 35:1951-1957. [PMID: 34182468 DOI: 10.21873/invivo.12462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hepatic dysfunction in patients with classical Hodgkin lymphoma (cHL) is of multifactorial aetiology. Prompt evaluation with laboratory tests and imaging methods is sufficient for diagnosis in most cases. Intrahepatic cholestasis and vanishing bile duct syndrome (VBDS) may complicate cHL as rare paraneoplastic phenomena. Liver biopsy provides crucial evidence of cholestasis, and ductopenia, if present, confirms the diagnosis of VBDS. CASE REPORT We report on a cHL patient that presented with jaundice and bulky mediastinal disease and unfold the therapeutic dilemmas we confronted. Marked hyperbilirubinemia was successfully reversed with brentuximab vedotin (BV) at a dose of 1.2 mg/kg and the patient was subsequently treated with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) at full doses, achieving complete metabolic response. A literature review of intrahepatic cholestasis in cHL is also presented based on currently available data with focus on treatment options and clinicopathologic associations. CONCLUSION VBDS and intrahepatic cholestasis are rare and potentially fatal complications of cHL. Their prompt recognition and appropriate treatment can dramatically affect cHL patients' outcome. BV, used at a reduced dose as a bridging therapy, should be considered as a high-priority treatment plan in these challenging cases.
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Affiliation(s)
- Ioannis Papakonstantinou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Kosmidou
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina Papathanasiou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Epameinondas Koumpis
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Kapsali
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece;
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9
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Koumpis E, Papathanasiou K, Papakonstantinou I, Tassi I, Serpanou A, Kapsali E, Hatzimichael E. Rifampicin-Induced Thrombocytopenia: A Case Report and Short Review of the Literature. EMJ 2021. [DOI: 10.33590/emj/20-00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Thrombocytopenia may be associated with a variety of conditions and risks depending on its severity, ranging from mild epistaxis to life-threating bleeding. Many drugs or herbal remedies can cause thrombocytopenia by either inhibiting platelet production and/or enhancing their destruction from the peripheral blood mediated via an immunological mechanism implicating drug-dependent antibodies. The latter entity is called drug-induced immune thrombocytopenia: a life-threatening, under-recognised condition, which is often a diagnostic challenge. Rifampicin is a widely used, well-tolerated, and effective bactericidal drug. Adverse events, except for gastrointestinal effects, headache, skin rash, and pruritus, are uncommon. The authors herein report on a patient with isolated thrombocytopenia with a recent medical history of brucellosis on rifampicin and doxycycline. Thrombocytopenia was proved to be rifampicin-induced. Also presented is a short review of the literature on this rare subject, which should be of great importance to clinicians.
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Affiliation(s)
- Epameinondas Koumpis
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina Papathanasiou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Papakonstantinou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Iliana Tassi
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Anastasia Serpanou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Kapsali
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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10
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Kosmeri C, Koumpis E, Tsabouri S, Siomou E, Makis A. Hematological manifestations of SARS-CoV-2 in children. Pediatr Blood Cancer 2020; 67:e28745. [PMID: 33009893 PMCID: PMC7646039 DOI: 10.1002/pbc.28745] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022]
Abstract
Infection from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), though mainly a respiratory disease, can impair many systems, including causing hematological complications. Lymphopenia and hypercoagulability have been reported in adults with coronavirus disease 2019 (COVID-19) and are considered markers of poor prognosis. This review summarizes the hematological findings in children with SARS-CoV-2 infection. The majority of infected children had a normal leukocyte count, while the most common white blood cell abnormality was leukopenia. Lymphopenia, which may be a marker of severe disease, was rarer in children than in adults, possibly due to their immature immune system or due to the less severe manifestation of COVID-19 in this age group. Age may have an impact, and in neonates and infants the most common abnormality was lymphocytosis. Abnormalities of red blood cells and platelets were uncommon. Anemia and hypercoagulability were reported mainly in children presenting the novel multisystem inflammatory syndrome (MIS) associated with SARS-CoV-2.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, Faculty of MedicineUniversity of IoanninaIoanninaGreece
| | - Epameinondas Koumpis
- Department of Internal Medicine, Faculty of MedicineUniversity of IoanninaIoanninaGreece
| | - Sophia Tsabouri
- Department of Pediatrics, Faculty of MedicineUniversity of IoanninaIoanninaGreece
| | - Ekaterini Siomou
- Department of Pediatrics, Faculty of MedicineUniversity of IoanninaIoanninaGreece
| | - Alexandros Makis
- Department of Pediatrics, Faculty of MedicineUniversity of IoanninaIoanninaGreece
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11
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Fotopoulos G, Gousia A, Bareta E, Koumpis E, Chrisafi S, Bobos M, Malamou-Mitsi V, Fountzilas G, Pavlidis N, Pentheroudakis G. Prognostic significance of WNT and hedgehog pathway activation markers in cancer of unknown primary. Eur J Clin Invest 2015; 45:1145-52. [PMID: 26269154 DOI: 10.1111/eci.12518] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 08/08/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cancer of unknown primary (CUP) possesses distinct biology and peculiar natural history, in which the roles of the winged and hedgehog signalling pathways are unclear. MATERIALS AND METHODS We constructed tissue microarrays and studied the immunohistochemical (IHC) expression of β-catenin, smoothened (SMO) and the transcription factors TCF, LEF, GLI1 in 87 CUP cases for prognostic significance. RESULTS A low rate of IHC expression of proteins was seen, the cut-off used being any expression in ≥ 1% of tumour cells. At univariate analysis, only nuclear IHC SMO expression displayed a statistically significant association with favourable outcome [median Overall survival (OS) of 19 months in SMO-positive vs. 12 months in SMO-negative cases, P = 0·01]. An activated Wnt pathway, defined as IHC expression of any of nuclear β-catenin, TCF and LEF, was significantly associated with favourable progression free survival (median 9 vs. 5 months, P = 0·037) and OS (median 19 vs. 13 months, P = 0·04). This prognostic impact on OS was mainly driven by nuclear expression of TCF and/or LEF (P = 0·03). No prognostic significance of the hedgehog pathway activation status, defined as IHC expression of SMO or nuclear GLI1, could be established. A favourable prognostic impact of the concurrent activation of both pathways was observed. A trend for association of activated Wnt with response to chemotherapy (responders 67% among activated Wnt cases vs. 35% among nonactivated Wnt cases, P = 0·07) was observed in CUP adenocarcinomas. CONCLUSIONS Activation of the Wnt pathway was a positive prognostic factor in a small CUP series, possibly via enhanced chemosensitivity. Independent validation is warranted.
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Affiliation(s)
- George Fotopoulos
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | - Anna Gousia
- Department of Pathology, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleni Bareta
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | - Epameinondas Koumpis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | - Sofia Chrisafi
- Department of Medical Oncology, Medical School, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Bobos
- Department of Pathology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - George Fountzilas
- Department of Medical Oncology, Medical School, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nicholas Pavlidis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | - George Pentheroudakis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
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