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László T, Kotmayer L, Fésüs V, Hegyi L, Gróf S, Nagy Á, Kajtár B, Balogh A, Weisinger J, Masszi T, Nagy Z, Farkas P, Demeter J, Istenes I, Szász R, Gergely L, Sulák A, Borbényi Z, Lévai D, Schneider T, Pettendi P, Bodai E, Szerafin L, Rejtő L, Bátai Á, Dömötör MÁ, Sánta H, Plander M, Szendrei T, Hamed A, Lázár Z, Pauker Z, Radványi G, Kiss A, Körösmezey G, Jakucs J, Dombi PJ, Simon Z, Klucsik Z, Gurzó M, Tiboly M, Vidra T, Ilonczai P, Bors A, Andrikovics H, Egyed M, Székely T, Masszi A, Alpár D, Matolcsy A, Bödör C. Low-burden TP53 mutations represent frequent genetic events in CLL with an increased risk for treatment initiation. J Pathol Clin Res 2024; 10:e351. [PMID: 37987115 PMCID: PMC10766018 DOI: 10.1002/cjp2.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/21/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
TP53 aberrations predict chemoresistance and represent a contraindication for the use of standard chemoimmunotherapy in chronic lymphocytic leukaemia (CLL). Recent next-generation sequencing (NGS)-based studies have identified frequent low-burden TP53 mutations with variant allele frequencies below 10%, but the clinical impact of these low-burden TP53 mutations is still a matter of debate. In this study, we aimed to scrutinise the subclonal architecture and clinical impact of TP53 mutations using a sensitive, NGS-based mutation analysis in a 'real-world' cohort of 901 patients with CLL. In total, 225 TP53 mutations were identified in 17.5% (158/901) of the patients; 48% of these alterations represented high-burden mutations, while 52% were low-burden TP53 mutations. Low-burden mutations as sole alterations were identified in 39% (62/158) of all mutated cases with 82% (51/62) of these being represented by a single low-burden TP53 mutation. Patients harbouring low-burden TP53 mutations had significantly lower time to first treatment compared to patients with wild-type TP53. Our study has expanded the knowledge on the frequency, clonal architecture, and clinical impact of low-burden TP53 mutations. By demonstrating that patients with sole low-burden TP53 variants represent more than one-third of patients with TP53 mutations and have an increased risk for treatment initiation, our findings strengthen the need to redefine the threshold of TP53 variant reporting to below 10% in the routine diagnostic setting.
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Affiliation(s)
- Tamás László
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - Lili Kotmayer
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - Viktória Fésüs
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
- Kaposi Mór University Teaching Hospital of County SomogyKaposvárHungary
| | - Lajos Hegyi
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - Stefánia Gróf
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - Ákos Nagy
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - Béla Kajtár
- Department of PathologyUniversity of Pécs Medical SchoolPécsHungary
| | - Alexandra Balogh
- Department of Internal Medicine and HematologySemmelweis UniversityBudapestHungary
| | - Júlia Weisinger
- Department of Internal Medicine and HematologySemmelweis UniversityBudapestHungary
| | - Tamás Masszi
- Department of Internal Medicine and HematologySemmelweis UniversityBudapestHungary
| | - Zsolt Nagy
- Department of Internal Medicine and HematologySemmelweis UniversityBudapestHungary
| | - Péter Farkas
- Department of Internal Medicine and HematologySemmelweis UniversityBudapestHungary
| | - Judit Demeter
- Department of Internal Medicine and OncologySemmelweis UniversityBudapestHungary
| | - Ildikó Istenes
- Department of Internal Medicine and OncologySemmelweis UniversityBudapestHungary
| | - Róbert Szász
- Division of Hematology, Department of Internal MedicineUniversity of DebrecenDebrecenHungary
| | - Lajos Gergely
- Division of Hematology, Department of Internal MedicineUniversity of DebrecenDebrecenHungary
| | - Adrienn Sulák
- 2nd Department of Internal Medicine and Cardiology CenterUniversity of SzegedSzegedHungary
| | - Zita Borbényi
- 2nd Department of Internal Medicine and Cardiology CenterUniversity of SzegedSzegedHungary
| | - Dóra Lévai
- Hematology and Lymphoma UnitNational Institute of OncologyBudapestHungary
| | - Tamás Schneider
- Hematology and Lymphoma UnitNational Institute of OncologyBudapestHungary
| | - Piroska Pettendi
- Hetényi Géza Hospital and Clinic of County Jász‐Nagykun‐SzolnokSzolnokHungary
| | - Emese Bodai
- Hetényi Géza Hospital and Clinic of County Jász‐Nagykun‐SzolnokSzolnokHungary
| | - László Szerafin
- Hospitals of County Szabolcs‐Szatmár‐Bereg and University Teaching HospitalNyíregyházaHungary
| | - László Rejtő
- Hospitals of County Szabolcs‐Szatmár‐Bereg and University Teaching HospitalNyíregyházaHungary
| | - Árpád Bátai
- Fejér County Szent György University Teaching HospitalSzékesfehérvárHungary
| | - Mária Á Dömötör
- Fejér County Szent György University Teaching HospitalSzékesfehérvárHungary
| | - Hermina Sánta
- Fejér County Szent György University Teaching HospitalSzékesfehérvárHungary
| | - Márk Plander
- Markusovszky University Teaching HospitalSzombathelyHungary
| | - Tamás Szendrei
- Markusovszky University Teaching HospitalSzombathelyHungary
| | - Aryan Hamed
- Petz Aladár University Teaching HospitalGyőrHungary
| | - Zsolt Lázár
- Petz Aladár University Teaching HospitalGyőrHungary
| | - Zsolt Pauker
- Borsod‐Abaúj‐Zemplén County Hospital and University Teaching HospitalMiskolcHungary
| | - Gáspár Radványi
- Borsod‐Abaúj‐Zemplén County Hospital and University Teaching HospitalMiskolcHungary
| | - Adrienn Kiss
- Military Hospital – State Health CentreBudapestHungary
| | | | | | | | | | - Zsolt Klucsik
- Bács‐Kiskun County Teaching HospitalKecskemétHungary
| | - Mihály Gurzó
- Bács‐Kiskun County Teaching HospitalKecskemétHungary
| | | | - Tímea Vidra
- Soproni Erzsébet Teaching Hospital and Rehabilitation InstituteSopronHungary
| | | | - András Bors
- Central Hospital of Southern Pest – National Institute of Hematology and InfectologyBudapestHungary
| | - Hajnalka Andrikovics
- Central Hospital of Southern Pest – National Institute of Hematology and InfectologyBudapestHungary
| | - Miklós Egyed
- Kaposi Mór University Teaching Hospital of County SomogyKaposvárHungary
| | - Tamás Székely
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - András Masszi
- Department of Internal Medicine and HematologySemmelweis UniversityBudapestHungary
- Hematology and Lymphoma UnitNational Institute of OncologyBudapestHungary
| | - Donát Alpár
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - András Matolcsy
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
- Department of Laboratory MedicineKarolinska InstituteSolnaSweden
| | - Csaba Bödör
- HCEMM‐SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
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Nagy Á, Bátai B, Kiss L, Gróf S, Király PA, Jóna Á, Demeter J, Sánta H, Bátai Á, Pettendi P, Szendrei T, Plander M, Körösmezey G, Alizadeh H, Kajtár B, Méhes G, Krenács L, Timár B, Csomor J, Tóth E, Schneider T, Mikala G, Matolcsy A, Alpár D, Masszi A, Bödör C. Parallel testing of liquid biopsy (ctDNA) and tissue biopsy samples reveals a higher frequency of EZH2 mutations in follicular lymphoma. J Intern Med 2023; 294:295-313. [PMID: 37259686 DOI: 10.1111/joim.13674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Recent genomic studies revealed enhancer of zeste homolog 2 (EZH2) gain-of-function mutations, representing novel therapeutic targets in follicular lymphoma (FL) in around one quarter of patients. However, these analyses relied on single-site tissue biopsies and did not investigate the spatial heterogeneity and temporal dynamics of these alterations. OBJECTIVES We aimed to perform a systematic analysis of EZH2 mutations using paired tissue (tumor biopsies [TB]) and liquid biopsies (LB) collected prior to treatment within the framework of a nationwide multicentric study. METHODS Pretreatment LB and TB samples were collected from 123 patients. Among these, 114 had paired TB and LB, with 39 patients characterized with paired diagnostic and relapse samples available. The EZH2 mutation status and allele burden were assessed using an in-house-designed, highly sensitive multiplex droplet digital PCR assay. RESULTS EZH2 mutation frequency was found to be 41.5% in the entire cohort. In patients with paired TB and LB samples, EZH2 mutations were identified in 37.8% of the patients with mutations exclusively found in 5.3% and 7.9% of TB and LB samples, respectively. EZH2 mutation status switch was documented in 35.9% of the patients with paired diagnostic and relapse samples. We also found that EZH2 wild-type clones may infiltrate the bone marrow more frequently compared to the EZH2 mutant ones. CONCLUSION The in-depth spatio-temporal analysis identified EZH2 mutations in a considerably higher proportion of patients than previously reported. This expands the subset of FL patients who most likely would benefit from EZH2 inhibitor therapy.
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Affiliation(s)
- Ákos Nagy
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Bence Bátai
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Laura Kiss
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Stefánia Gróf
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Péter Attila Király
- Hematology and Lymphoma Unit, National Institute of Oncology, Budapest, Hungary
| | - Ádám Jóna
- Department of Hematology, Faculty of Medicine, Medical School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Demeter
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Hermina Sánta
- Szent György Hospital of County Fejér, Székesfehérvár, Hungary
| | - Árpád Bátai
- Szent György Hospital of County Fejér, Székesfehérvár, Hungary
| | - Piroska Pettendi
- Hetényi Géza Hospital, Clinic of County Jász-Nagykun-Szolnok, Szolnok, Hungary
| | - Tamás Szendrei
- Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Márk Plander
- Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Gábor Körösmezey
- Department of Medicine, Military Hospital - Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Hussain Alizadeh
- 1st Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Béla Kajtár
- Department of Pathology, Medical School, Clinical Centre, University of Pécs, Pécs, Hungary
| | - Gábor Méhes
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Krenács
- Laboratory of Tumor Pathology and Molecular Diagnostics, Szeged, Hungary
| | - Botond Timár
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Judit Csomor
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Erika Tóth
- Department of Surgical and Molecular Pathology, National Institute of Oncology, Budapest, Hungary
| | - Tamás Schneider
- Hematology and Lymphoma Unit, National Institute of Oncology, Budapest, Hungary
| | - Gábor Mikala
- Department of Hematology and Stem Cell Transplantation, National Institute for Hematology and Infectious Diseases, South Pest Central Hospital, Budapest, Hungary
| | - András Matolcsy
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
- Department of Laboratory Medicine, Karolinska Institutet, Solna, Sweden
| | - Donát Alpár
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - András Masszi
- Hematology and Lymphoma Unit, National Institute of Oncology, Budapest, Hungary
| | - Csaba Bödör
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
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Gángó A, Mózes R, Boha Z, Kajtár B, Timár B, Király PA, Kiss R, Fésüs V, Nagy N, Demeter J, Körösmezey G, Borbényi Z, Marton I, Szőke A, Masszi T, Farkas P, Várkonyi J, Plander M, Pósfai É, Egyed M, Pál K, Radványi G, Hamed A, Csomor J, Matolcsy A, Alpár D, Bödör C. Quantitative assessment of JAK2 V617F and CALR mutations in Philadelphia negative myeloproliferative neoplasms. Leuk Res 2018; 65:42-48. [DOI: 10.1016/j.leukres.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/15/2017] [Accepted: 12/30/2017] [Indexed: 02/09/2023]
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4
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Gaál-Weisinger J, Mucsi O, Körösmezey G, Szili B, Eid H, Kiss R, Bödör C, Tárkányi I, Nagy Z, Demeter J. [Novelties and experience with tyrosine kinase inhibitor therapy in chronic myeloid leukemia]. Magy Onkol 2017; 61:67-74. [PMID: 28273190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/03/2017] [Indexed: 06/06/2023]
Abstract
The introduction of tyrosine kinase inhibitor (TKI) treatment has resulted in dramatically improved survival in chronic myeloid leukemia (CML). With the new generation of TKIs the majority of patients reach optimal molecular response. Due to the improving survival and the need for lifelong treatment, the safety profile of the various TKIs and the comorbidities of patients have to be considered. More than half of our CML patients had comorbidities that could have influenced the choice of therapy. Because of the high prevalence of cardiovascular comorbidities, cardiovascular risk assessment plays an important role in the care of CML patients. The aim of this article is to summarize the current national and international guidelines of the treatment in CML and to show the importance of comorbidities and cardiovascular risk assessment in our CML patients.
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Affiliation(s)
| | - Orsolya Mucsi
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Gábor Körösmezey
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Balázs Szili
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Hanna Eid
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Richárd Kiss
- I. Sz. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem, Budapest, Hungary
| | - Csaba Bödör
- I. Sz. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem, Budapest, Hungary
| | - Ilona Tárkányi
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Zsolt Nagy
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Judit Demeter
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
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5
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Körösmezey G, Gyõri G, Rudas G, Eid H, Nagy Z, Demeter J. [Treatment options and limitations in the management of myelofibrosis]. Magy Onkol 2017; 61:47-55. [PMID: 28273188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/12/2016] [Indexed: 06/06/2023]
Abstract
Primary myelofibrosis has the worst outcome among classical chronic myeloproliferative neoplasms. The past decade has brought numerous discoveries elucidating the role of proliferative mutations in disease pathogenesis. Mutations of the genes JAK2, MPL and CALR are present in about 90 percent of all primary myelofibrosis cases. The prognosis of myelofibrosis is considered heterogeneous, the expected survival of patients may range from one year to more than a decade based on several prognostic factors. Estimated survival can be assessed based on clinical prognostic scores. The aim of treatment is to reduce mortality and to alleviate the main aspects of disease-associated morbidity, e.g. anemia, splenomegalia and systemic symptoms. The effect of conventionally used cytoreductive agent hydroxyurea is usually transient. Use of allogeneic hematopoietic stem cell transplantation is limited by significant procedure-associated mortality. JAK2 tyrosine kinase inhibitors are the first treatment modality with evidence of improved overall survival, however, even these molecularly targeted therapies have failed to bring complete and permanent remission for the majority of myelofibrosis patients. Further improvement in overall survival for myelofibrosis can be expected from better understanding of the underlying molecular pathology and novel molecular therapeutic targets.
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Affiliation(s)
- Gábor Körösmezey
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Gabriella Gyõri
- Radiológiai és Onkoterápiás Klinika, Semmelweis Egyetem, Budapest, Hungary
| | - Gábor Rudas
- MR Kutatóközpont, Semmelweis Egyetem, Budapest, Hungary
| | - Hanna Eid
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Zsolt Nagy
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Judit Demeter
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
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Sári E, Rajnai H, Dénes K, Bödör C, Csomor J, Körösmezey G, Tárkányi I, Eid H, Nagy Z, Demeter J. [Novelties in the diagnostics and therapy of hairy cell leukemia]. Magy Onkol 2016; 60:137-144. [PMID: 27275640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/15/2016] [Indexed: 06/06/2023]
Abstract
Differential diagnosis of hairy cell leukemia (HCL) and related disorders (hairy cell leukemia variant and splenic marginal zone lymphoma) is of utmost importance since the treatment and prognosis of these lymphomas differ. Since 2011 diagnosis of hairy cell leukemia has been easier because of discovery of the disease defining somatic mutation BRAF V600E mutation, which has been also known as driver mutation in malignant melanoma. The presence of this mutation enabled targeted molecular therapy in HCL as well. As first line therapy purine nucleoside analogues are the gold standard, but refractory/relapsed patient are candidates for targeted BRAF-inhibitor therapy. This manuscript serves as guidance in making diagnosis and standard treatment of HCL, and summarizes newest data about molecular therapy, including our single center experience collected from 75 patients.
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Affiliation(s)
- Eszter Sári
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Hajnalka Rajnai
- I. Sz. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem, MTA-SE Lendület Molekuláris Onkohematológia Kutatócsoport, Budapest, Hungary
| | - Kitti Dénes
- I. Sz. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem, MTA-SE Lendület Molekuláris Onkohematológia Kutatócsoport, Budapest, Hungary
| | - Csaba Bödör
- I. Sz. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem, MTA-SE Lendület Molekuláris Onkohematológia Kutatócsoport, Budapest, Hungary
| | - Judit Csomor
- I. Sz. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem, MTA-SE Lendület Molekuláris Onkohematológia Kutatócsoport, Budapest, Hungary
| | - Gábor Körösmezey
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Ilona Tárkányi
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Hanna Eid
- I. Sz. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem, MTA-SE Lendület Molekuláris Onkohematológia Kutatócsoport, Budapest, Hungary
| | - Zsolt Nagy
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Judit Demeter
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
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