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Hoelzer D, Bassan R, Boissel N, Roddie C, Ribera JM, Jerkeman M. ESMO Clinical Practice Guideline interim update on the use of targeted therapy in acute lymphoblastic leukaemia. Ann Oncol 2024; 35:15-28. [PMID: 37832649 DOI: 10.1016/j.annonc.2023.09.3112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- D Hoelzer
- ONKOLOGIKUM Frankfurt am Museumsufer, Frankfurt, Germany
| | - R Bassan
- Hematology Unit, Ospedale dell'Angelo e Ospedale SS, Giovanni e Paolo, Mestre-Venezia, Italy
| | - N Boissel
- Hematology Department, Saint-Louis Hospital, APHP, Institut de Recherche Saint-Louis, Université de Paris Cité, Paris, France
| | - C Roddie
- Research Department of Haematology, UCL Cancer Institute, London, UK
| | - J M Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M Jerkeman
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
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2
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González-Gil C, Morgades M, Lopes T, Fuster-Tormo F, García-Chica J, Zhao R, Montesinos P, Torrent A, Diaz-Beya M, Coll R, Hermosín L, Mercadal S, González-Campos J, Zamora L, Artola T, Vall-Llovera F, Tormo M, Gil-Cortés C, Barba P, Novo A, Ribera J, Bernal T, De Ugarriza PL, Queipo MP, Martínez-Sánchez P, Giménez A, González-Martínez T, Cladera A, Cervera J, Fernández-Martín R, Ardaiz MÁ, Vidal MJ, Baena Á, López-Bigas N, Bigas A, Maciejewski J, Orfao A, Ribera JM, Genescà E. Genomics improves risk stratification of adults with T-cell acute lymphoblastic leukemia patients enrolled in measurable residual disease-oriented trials. Haematologica 2022; 108:969-980. [PMID: 36325893 PMCID: PMC10071117 DOI: 10.3324/haematol.2022.281196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/04/2022] [Indexed: 11/06/2022] Open
Abstract
Genetic information has been crucial to understand the pathogenesis of T-cell acute lymphoblastic leukemia (T-ALL) at diagnosis and at relapse, but still nowadays has a limited value in a clinical context. Few genetic markers are associated with the outcome of T-ALL patients, independently of measurable residual disease (MRD) status after therapy. In addition, the prognostic relevance of genetic features may be modulated by the specific treatment used. We analyzed the genetic profile of 145 T-ALL patients by targeted deep sequencing. Genomic information was integrated with the clinical-biological and survival data of a subset of 116 adult patients enrolled in two consecutive MRD-oriented trials of the Spanish PETHEMA (Programa Español de Tratamientos en Hematología) group. Genetic analysis revealed a mutational profile defined by DNMT3A/ N/KRAS/ MSH2/ U2AF1 gene mutations that identified refractory/resistant patients. Mutations in the DMNT3A gene were also found in the nonleukemic cell fraction of patients with T-ALL, revealing a possible mutational-driven clonal hematopoiesis event to prime T-ALL in elderly. The prognostic impact of this adverse genetic profile was independent of MRD status on day +35 of induction therapy. The combined WOG signature and MRD on day +35 allowed risk-stratification of T-ALL into standard or high-risk groups with significantly different 5-year overall survival (OS) (95% confidence interval [CI]) of 52% (37-67 %) and 17% (1-33%), respectively. These results confirm the relevance of the tumor genetic profile in predicting patient outcome in adult T-ALL and highlight the need for novel gene-targeted chemotherapeutic schedules to improve the OS of poor-prognosis T-ALL patients.
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Affiliation(s)
- Celia González-Gil
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Mireia Morgades
- Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Thaysa Lopes
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Francisco Fuster-Tormo
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Jesús García-Chica
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Ran Zhao
- Department of Quantitative Health Sciences and Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Anna Torrent
- Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Marina Diaz-Beya
- Servei d'Hematologia Clínica, Hospital Clínic de Barcelona, Barcelona
| | - Rosa Coll
- Institut Català d'Oncologia (ICO), Hospital Josep Trueta, Girona
| | - Lourdes Hermosín
- Servicio Hematología Clínica, Hospital de Jerez, Jerez de la Frontera
| | - Santiago Mercadal
- Servei d'Hematologia Clínica, Hospital Duran i Reynals-ICO, Hospitalet del Llobregat
| | | | - Lurdes Zamora
- Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Teresa Artola
- Servicio Hematología Clínica, Hospital Universitario de Donostia, Donostia
| | | | - Mar Tormo
- Hospital Clínico Universitario, Instituto de investigación INCLIVA, Valencia
| | | | - Pere Barba
- Servicio Hematología Clínica, Hospital Universitari de la Vall d'Hebron, Barcelona
| | - Andrés Novo
- Servicio Hematología Clínica, Hospital Son Espases, Palma de Mallorca
| | - Jordi Ribera
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Teresa Bernal
- Servicio Hematología Clínica, Hospital Central de Asturias, Instituto de Investigación Sanitario del Principado de Asturias (ISPA), Instituto Oncológico Universitario del Principado de Asturias (IUOPA), Oviedo
| | - Paula López De Ugarriza
- Servicio Hematología Clínica, Hospital Central de Asturias, Instituto de Investigación Sanitario del Principado de Asturias (ISPA), Instituto Oncológico Universitario del Principado de Asturias (IUOPA), Oviedo
| | - María-Paz Queipo
- Servicio Hematología Clínica, Hospital Virgen de la Victoria, Málaga
| | | | - Alicia Giménez
- Servicio Hematología Clínica, Hospital 12 de Octubre, Madrid
| | | | - Antonia Cladera
- Servicio Hematología Clínica, Hospital Son LLátzer, Palma de Mallorca
| | - José Cervera
- Hospital Universitari i Politècnic La Fe, Valencia
| | - Rosa Fernández-Martín
- Servicio Hematología Clínica, Hospital Insular de Gran Canarias, Las Palmas de Gran Canaria
| | | | | | - Ángela Baena
- Servicio Hematología Clínica, Complejo Hospitalario de Jaén, Jaén
| | - Nuria López-Bigas
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology, Barcelona
| | - Anna Bigas
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Program in Cancer Research, Institut-Hospital del Mar d'Investigacions Mèdiques, CIBERONC, Barcelona
| | - Jaroslaw Maciejewski
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Alberto Orfao
- Centro de Investigación del Cáncer (IBMCC-CSIC/USAL), Departamento de Medicina, Universidad de Salamanca, Instituto Biosanitario de Salamanca, CIBERONC, Salamanca
| | - Josep Maria Ribera
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Eulalia Genescà
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona.
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González-Gil C, Ribera J, Ribera JM, Genescà E. The Yin and Yang-Like Clinical Implications of the CDKN2A/ARF/CDKN2B Gene Cluster in Acute Lymphoblastic Leukemia. Genes (Basel) 2021; 12:genes12010079. [PMID: 33435487 PMCID: PMC7827355 DOI: 10.3390/genes12010079] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 11/20/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/13/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a malignant clonal expansion of lymphoid hematopoietic precursors that exhibit developmental arrest at varying stages of differentiation. Similar to what occurs in solid cancers, transformation of normal hematopoietic precursors is governed by a multistep oncogenic process that drives initiation, clonal expansion and metastasis. In this process, alterations in genes encoding proteins that govern processes such as cell proliferation, differentiation, and growth provide us with some of the clearest mechanistic insights into how and why cancer arises. In such a scenario, deletions in the 9p21.3 cluster involving CDKN2A/ARF/CDKN2B genes arise as one of the oncogenic hallmarks of ALL. Deletions in this region are the most frequent structural alteration in T-cell acute lymphoblastic leukemia (T-ALL) and account for roughly 30% of copy number alterations found in B-cell-precursor acute lymphoblastic leukemia (BCP-ALL). Here, we review the literature concerning the involvement of the CDKN2A/B genes as a prognosis marker of good or bad response in the two ALL subtypes (BCP-ALL and T-ALL). We compare frequencies observed in studies performed on several ALL cohorts (adult and child), which mainly consider genetic data produced by genomic techniques. We also summarize what we have learned from mouse models designed to evaluate the functional involvement of the gene cluster in ALL development and in relapse/resistance to treatment. Finally, we examine the range of possibilities for targeting the abnormal function of the protein-coding genes of this cluster and their potential to act as anti-leukemic agents in patients.
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Affiliation(s)
- Celia González-Gil
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), 08916 Badalona, Spain; (C.G.-G.); (J.R.); (J.M.R.)
| | - Jordi Ribera
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), 08916 Badalona, Spain; (C.G.-G.); (J.R.); (J.M.R.)
| | - Josep Maria Ribera
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), 08916 Badalona, Spain; (C.G.-G.); (J.R.); (J.M.R.)
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Eulàlia Genescà
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), 08916 Badalona, Spain; (C.G.-G.); (J.R.); (J.M.R.)
- Correspondence: ; Tel.: +34-93-557-28-08
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Domingo-Domenech E, Duarte RF, Boumedil A, Onida F, Gabriel I, Finel H, Arcese W, Browne P, Beelen D, Kobbe G, Veelken H, Arranz R, Greinix H, Lenhoff S, Poiré X, Ribera JM, Thompson J, Zuckerman T, Mufti GJ, Cortelezzi A, Olavarria E, Dreger P, Sureda A, Montoto S. Allogeneic hematopoietic stem cell transplantation for advanced mycosis fungoides and Sézary syndrome. An updated experience of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2021; 56:1391-1401. [PMID: 33420392 DOI: 10.1038/s41409-020-01197-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment option in advanced-stage mycosis fungoides (MF) and Sézary syndrome (SS). This study presents an updated analysis of the initial experience of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation (EBMT) describing the outcomes after allo-HSCT for MF and SS, with special emphasis on the impact of the use of unrelated donors (URD). METHODS AND PATIENTS Eligible for this study were patients with advanced-stage MF or SS who underwent a first allo-HSCT from matched HLA-identical related or URD between January/1997 and December/2011. Sixty patients have been previously reported. RESULTS 113 patients were included [77 MF (68%)]; 61 (54%) were in complete or partial remission, 86 (76%) received reduced-intensity protocols and 44 (39%) an URD allo-HSCT. With a median follow up for surviving patients of 73 months, allo-HSCT resulted in an estimated overall survival (OS) of 38% at 5 years, and a progression-free survival (PFS) of 26% at 5 years. Multivariate analysis demonstrated that advanced-phase disease (complete remission/partial remission >3, primary refractory or relapse/progression in patients that had received 3 or more lines of systemic treatment prior to transplant or the number of treatment lines was not known), a short interval between diagnosis and transplant (<18 months) were independent adverse prognostic factors for PFS; advanced-phase disease and the use of URDs were independent adverse prognostic factors for OS. CONCLUSIONS This extended series supports that allo-HSCT is able to effectively rescue over one third of the population of patients with advanced-stage MF/SS. High relapse rate is still the major cause of failure and needs to be improved with better strategies before and after transplant. The negative impact of URD is a matter of concern and needs to be further elucidated in future studies.
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Affiliation(s)
- E Domingo-Domenech
- Hematology Department, Institut Català d'Oncologia. Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain.
| | - R F Duarte
- Hematology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - A Boumedil
- EBMT Central Registry Office, Paris, France
| | - F Onida
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico IRCCS, Milano, Italy
| | - I Gabriel
- Department of Hematology, Imperial College, Hammersmith Hospital, London, United Kingdom
| | - H Finel
- EBMT Central Registry Office, Paris, France
| | - W Arcese
- Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - P Browne
- St's James Hospital, Dublin, Ireland
| | - D Beelen
- University Hospital, Department of Bone Marrow Transplantation, Essen, Germany
| | - G Kobbe
- Heinrich Heine University, Medical F, Department of Hematology, Düsseldorf, Germany
| | - H Veelken
- Leiden University Medical Center, Leiden, The Netherlands
| | - R Arranz
- Hematology Department, Hospital La Princesa, Madrid, Spain
| | - H Greinix
- Division of Hematology, Medical University Graz, Graz, Austria
| | - S Lenhoff
- Skanes University Hospital, Department of Hematology, Lund, Sweden
| | - X Poiré
- Cliniques Universitaires St. Luc, Department of Hematology, Brussels, Belgium
| | - J M Ribera
- Hematology Department, Institut Català d'Oncologia, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - J Thompson
- Albert's Stem Cell Transplantation Center, Pretoria, South Africa
| | - T Zuckerman
- Ramban Medical Center, Department of Hematology and Bone Marrow Transplantation, Haifa, Israel
| | - G J Mufti
- GKT School of Medicine, Dept. of Haematological Medicine, King's Denmark Hill Campus, London, United Kingdom
| | - A Cortelezzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico IRCCS, Milano, Italy
| | - E Olavarria
- Department of Hematology, Imperial College, Hammersmith Hospital, London, United Kingdom
| | - P Dreger
- Universitaetsklinkum Heidelberg, Heidelberg, Germany
| | - A Sureda
- Hematology Department, Institut Català d'Oncologia. Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - S Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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Piñana JL, Martino R, García-García I, Parody R, Morales MD, Benzo G, Gómez-Catalan I, Coll R, De La Fuente I, Luna A, Merchán B, Chinea A, de Miguel D, Serrano A, Pérez C, Diaz C, Lopez JL, Saez AJ, Bailen R, Zudaire T, Martínez D, Jurado M, Calbacho M, Vázquez L, Garcia-Cadenas I, Fox L, Pimentel AI, Bautista G, Nieto A, Fernandez P, Vallejo JC, Solano C, Valero M, Espigado I, Saldaña R, Sisinni L, Ribera JM, Jimenez MJ, Trabazo M, Gonzalez-Vicent M, Fernández N, Talarn C, Montoya MC, Cedillo A, Sureda A. Risk factors and outcome of COVID-19 in patients with hematological malignancies. Exp Hematol Oncol 2020; 9:21. [PMID: 32864192 PMCID: PMC7445734 DOI: 10.1186/s40164-020-00177-z] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [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: 07/16/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023] Open
Abstract
Background Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined. Patients and methods This was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confirmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020. Results We included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n = 58) or allogeneic stem cell transplantation (allo-SCT) (n = 65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1–93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p = 0.02). Prognostic factors identified for day 45 overall mortality (OM) by logistic regression multivariate analysis included age > 70 years [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2–3.8, p = 0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6–5.2, p < 0.0001); ECOG 3–4 (OR, 2.56, 95% CI 1.4–4.7, p = 0.003); neutropenia (< 0.5 × 109/L) (OR 2.8, 95% CI 1.3–6.1, p = 0.01); and a C-reactive protein (CRP) > 20 mg/dL (OR 3.3, 95% CI 1.7–6.4, p < 0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2–0.89 and OR 0.31, 95% CI 0.11–0.87, respectively, p = 0.02) whereas the use of hidroxycloroquine did not show significant improvement in OM (OR 0.64, 95% CI 0.37–1.1, P = 0.1). Conclusions In most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of inflammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19.
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Affiliation(s)
- José Luis Piñana
- Hematology División, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain.,Division of Clinical Hematology, Hospital Universitario la Fe de Valencia, Avda Fernando Abril Martorell, 106 CP 46026 Valencia, Spain
| | - Rodrigo Martino
- Hematology División, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Rocío Parody
- Hematology División, Institut Català Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | | | - Gonzalo Benzo
- Hematology División, Hospital La Princesa, Madrid, Spain
| | | | - Rosa Coll
- Hematology División, Institut Català Oncologia-Hospital Josep Trueta, Girona, Spain
| | | | - Alejandro Luna
- Hematology División, Hospital Ramon y Cajal, Madrid, Spain
| | - Beatriz Merchán
- Hematology División, Hospital de Guadalajara, Guadalajara, Spain
| | | | - Dunia de Miguel
- Hematology División, Hospital de Guadalajara, Guadalajara, Spain
| | - Ana Serrano
- Hematology División, Hospital de Albacete, Albacete, Spain
| | - Carmen Pérez
- Hematology División, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Carola Diaz
- Hematology División, Hospital Carlos Haya, Malaga, Spain
| | - José Luis Lopez
- Hematology División, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - Rebeca Bailen
- Hematology División, Hospital Gregorio Marañon, Madrid, Spain
| | - Teresa Zudaire
- Hematology División, Hospital de Navarra, Navarra, Spain
| | | | - Manuel Jurado
- Hematology División, Hospital Virgen de la Nieves, Granada, Spain
| | - María Calbacho
- Hematology División, Hospital 12 de Octubre, Madrid, Spain
| | - Lourdes Vázquez
- Hematology División, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Laura Fox
- Hematology División, Hospital Vall d`Hebron, Barcelona, Spain
| | - Ana I Pimentel
- Hematology División, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain
| | | | | | | | | | - Carlos Solano
- Hematology División, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marta Valero
- Hematology División, Hospital Arnau de Vilanova, Valencia, Spain
| | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen del Rocío/University of Sevilla, CSIC/Institute of Biomedicine of Sevilla, Sevilla, Spain
| | | | - Luisa Sisinni
- Pediatric Hematology-Oncology División, Hospital la Paz, Madrid, Spain
| | - Josep Maria Ribera
- Hematology División, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Badalona, Spain
| | - Maria Jose Jimenez
- Hematology División, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Badalona, Spain
| | - Maria Trabazo
- Pediatric División, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Noemí Fernández
- Hematology División, Hospital Marqués de Valdecilla, Santander, Spain
| | - Carme Talarn
- Hematology División, Hospital Joan XXIII, Tarragona, Spain
| | | | - Angel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH), Madrid, Spain
| | - Anna Sureda
- Hematology División, Institut Català Oncologia-Hospital Duran i Reynals, Barcelona, Spain
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Fernández GI, Ribera JM, Sabater LA. Tuberculosis during lenalidomide maintenance in a patient with multiple myeloma. Med Clin (Barc) 2020; 156:258-259. [PMID: 32165007 DOI: 10.1016/j.medcli.2019.12.010] [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: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Gladys Ibarra Fernández
- Servicio de Hematología, ICO-Badalona, Hospital Germans Trias i Pujol, Badalona, Spain; Instituto de Investigación contra la Leucemia Josep Carreras. Universitat Autònoma de Barcelona, Spain.
| | - Josep Maria Ribera
- Servicio de Hematología, ICO-Badalona, Hospital Germans Trias i Pujol, Badalona, Spain; Instituto de Investigación contra la Leucemia Josep Carreras. Universitat Autònoma de Barcelona, Spain
| | - Laura Abril Sabater
- Servicio de Hematología, ICO-Badalona, Hospital Germans Trias i Pujol, Badalona, Spain; Instituto de Investigación contra la Leucemia Josep Carreras. Universitat Autònoma de Barcelona, Spain
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7
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Gökbuget N, Dombret H, Giebel S, Brüggemann M, Doubek M, Foa R, Hoelzer D, Kim C, Martinelli G, Parovichnikova E, Maria Ribera J, Schoonen M, Tuglus C, Zugmaier G, Bassan R. Blinatumomab vs historic standard-of-care treatment for minimal residual disease in adults with B-cell precursor acute lymphoblastic leukaemia. Eur J Haematol 2020; 104:299-309. [PMID: 31876009 PMCID: PMC7079006 DOI: 10.1111/ejh.13375] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Survival outcomes from a single-arm phase 2 blinatumomab study in patients with minimal residual disease (MRD)-positive B-cell precursor (BCP)-acute lymphoblastic leukaemia (ALL) were compared with those receiving standard of care (SOC) in a historic data set. METHODS The primary analysis comprised adult Philadelphia chromosome (Ph)-negative patients in first complete haematologic remission (MRD ≥ 10-3 ). Relapse-free survival (RFS) and overall survival (OS) were compared between blinatumomab- and SOC-treatment groups. Baseline differences between groups were adjusted by propensity scores. RESULTS The primary analysis included 73 and 182 patients from the blinatumomab and historic data sets, respectively. When weighted by age to the blinatumomab-treatment group, median RFS was 7.8 months and median OS was 25.9 months in the SOC-treated group. In the blinatumomab study, median RFS was 35.2 months; median OS was not evaluable. Propensity score weighting achieved balance with seven baseline prognostic factors. With adjustment for haematopoietic stem cell transplantation (HSCT) status, a 50% reduction in risk of relapse or death was observed with blinatumomab vs SOC. Median RFS, unadjusted for HSCT status, was 35.2 months with blinatumomab and 8.3 months with SOC. CONCLUSIONS These analyses suggest that blinatumomab improves RFS, and possibly OS, in adults with MRD-positive Ph-negative BCP-ALL vs SOC.
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Affiliation(s)
| | - Hervé Dombret
- Hôpital Saint-Louis, University Paris Diderot, Paris, France
| | - Sebastian Giebel
- Maria Sklodowska-Curie Institute-Oncology Center, Gliwice, Poland
| | | | - Michael Doubek
- University Hospital and CEITEC Masaryk University, Brno, Czech Republic
| | - Robin Foa
- 'Sapienza' University of Rome, Rome, Italy
| | | | - Christopher Kim
- Center for Observational Research, Amgen Inc, Thousand Oaks, CA, USA
| | | | | | - Josep Maria Ribera
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute, Barcelona, Spain
| | | | | | | | - Renato Bassan
- UOC Ematologia, Ospedale dell'Angelo, Mestre-Venezia, Italy
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8
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Mercadal S, Sancho JM, Climent F, Tapia G, Pomares H, Carro I, Sorigué M, Pané M, Domingo-Doménech E, Encuentra M, Aguilera C, Oliveira AC, Andrade M, Fernández de Sevilla A, Ribera JM, González-Barca E, Sureda A. Long-term outcome comparing histological grades of follicular lymphoma patients treated with immunochemotherapy as first-line therapy: A retrospective analysis from two institutions. Eur J Haematol 2019; 104:198-206. [PMID: 31769545 DOI: 10.1111/ejh.13359] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To clarify the impact of histological grades in follicular lymphoma. METHODS We retrospectively analysed 250 patients diagnosed with FL treated with chemoimmunotherapy: 188 patients were grades 1-2 and 62 grade 3A. RESULTS In our series, grade 3A FL patients were older, higher proportion of localised disease and lower bone marrow infiltration at diagnosis comparing grades 1-2 FL patients. Estimated six-year progression-free survival and time to progression showed no differences between both groups [grade 3A: 56% (95%CI: 39%-73%) and 51% (95%CI: 41%-61%) vs grades 1-2:55% (95%CI: 46%-63%) and 57% (95%CI: 49%-65%), P = .782 and P = .521, respectively]. Estimated six-year overall survival was lower, 76% (95%CI: 64%-88%) for the grade 3A group than grades 1-2 83% (95%CI: 77%-89%); P = .044. In addition to that, cumulative incidence curves of death not related to lymphoma at 10 years between groups were as follows: [0.26 (95%CI: 0.25-0.27) and 0.05 (95%CI: 0.04-0.06) for G3AFL and G1-2FL, respectively], P = .010. Grade 3A FL showed in PFS curve no relapses after 6 years. These results were absolutely reproduced in 199 patients receiving R-CHOP regimen as induction. CONCLUSIONS Our results indicate similar long-term outcomes in terms of progression-free survival and time to progression in grades 1-2 and 3A. No relapses were observed in G3AFL group after 6 years.
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Affiliation(s)
- Santiago Mercadal
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona, Spain
| | - Fina Climent
- Department of Pathology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Helena Pomares
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Itziar Carro
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Marc Sorigué
- Department of Hematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona, Spain
| | - Maria Pané
- Department of Pathology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Eva Domingo-Doménech
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Maite Encuentra
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Carmen Aguilera
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ana Carla Oliveira
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Marcio Andrade
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Alberto Fernández de Sevilla
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Josep Maria Ribera
- Department of Hematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona, Spain
| | - Eva González-Barca
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Anna Sureda
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
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9
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Valiollahi E, Ribera JM, Genescà E, Behravan J. Genome-wide identification of microRNA signatures associated with stem/progenitor cells in Philadelphia chromosome-positive acute lymphoblastic leukemia. Mol Biol Rep 2019; 46:1295-1306. [PMID: 30712246 DOI: 10.1007/s11033-019-04600-5] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/15/2019] [Indexed: 12/19/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is a malignant transformation with uncontrolled proliferation of lymphoid precursor cells within bone marrow including a dismal prognosis after relapse. Survival of a population of quiescent leukemia stem cells (LSCs, also termed leukemia-initiating cells (LICs)) after treatment is one of the relapse reasons in Ph+ ALL patient. MicroRNAs (miRNAs) are known as highly conserved 19-24 nucleotides non-protein-coding small RNAs that regulate the expression of human genes. miRNAs are often involved in the tuning of hematopoiesis. Therefore, the deregulation of miRNA expression and function in hematopoietic cells can cause cancer and promote its progression. This is the first comprehensive analysis of miRNA expression differences between CD34+CD38- LSCs and CD34+CD38+ leukemic progenitors (LPs) from the same Ph+ B-ALL bone marrow samples using high-throughput sequencing technologies. We identified multiple differentially expressed miRNAs including hsa-miR-3143, hsa-miR-6503-3p, hsa-miR-744-3p, hsa-miR-1226-3p, hsa-miR-10a-5p, hsa-miR-4658 and hsa-miR-493-3p related to LSC and LP populations which have regulatory functions in stem-cell associated biological processes. The deregulation of these miRNAs could affect leukemogenesis, clonogenic and stemness capacities in these subpopulations of Ph+ B-ALL. Therefore, identification of these LSC associated miRNAs may improve the diagnosis and management of B-ALL. These findings may also lead to future strategies to eliminate the presence of resistant LSCs, either by induction of apoptosis or by sensitizing these cells to chemotherapy.
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Affiliation(s)
- Ehsan Valiollahi
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Josep Maria Ribera
- Josep Carreras Research Institute (IJC), ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Eulàlia Genescà
- Josep Carreras Research Institute (IJC), ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.
| | - Javad Behravan
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
- School of Pharmacy, University of Waterloo, 200 University Ave, Waterloo, N2L 3G1, Canada.
- Theraphage Inc, Waterloo, ON, Canada.
- Mediphage Bioceuticals, Inc, 661 University Avenue, Suite 1300, MaRS Centre, West Tower, Toronto, M5G0B7, Canada.
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10
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Genescà E, Lazarenkov A, Morgades M, Berbis G, Ruíz-Xivillé N, Gómez-Marzo P, Ribera J, Juncà J, González-Pérez A, Mercadal S, Guardia R, Artola MT, Moreno MJ, Martínez-López J, Zamora L, Barba P, Gil C, Tormo M, Cladera A, Novo A, Pratcorona M, Nomdedeu J, González-Campos J, Almeida M, Cervera J, Montesinos P, Batlle M, Vives S, Esteve J, Feliu E, Solé F, Orfao A, Ribera JM. Frequency and clinical impact of CDKN2A/ARF/CDKN2B gene deletions as assessed by in-depth genetic analyses in adult T cell acute lymphoblastic leukemia. J Hematol Oncol 2018; 11:96. [PMID: 30041662 PMCID: PMC6057006 DOI: 10.1186/s13045-018-0639-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/09/2018] [Indexed: 01/14/2023] Open
Abstract
Recurrent deletions of the CDKN2A/ARF/CDKN2B genes encoded at chromosome 9p21 have been described in both pediatric and adult acute lymphoblastic leukemia (ALL), but their prognostic value remains controversial, with limited data on adult T-ALL. Here, we investigated the presence of homozygous and heterozygous deletions of the CDKN2A/ARF and CDKN2B genes in 64 adult T-ALL patients enrolled in two consecutive trials from the Spanish PETHEMA group. Alterations in CDKN2A/ARF/CDKN2B were detected in 35/64 patients (55%). Most of them consisted of 9p21 losses involving homozygous deletions of the CDKNA/ARF gene (26/64), as confirmed by single nucleotide polymorphism (SNP) arrays and interphase fluorescence in situ hybridization (iFISH). Deletions involving the CDKN2A/ARF/CDKN2B locus correlated with a higher frequency of cortical T cell phenotype and a better clearance of minimal residual disease (MRD) after induction therapy. Moreover, the combination of an altered copy-number-value (CNV) involving the CDKN2A/ARF/CDKN2B gene locus and undetectable MRD (≤ 0.01%) values allowed the identification of a subset of T-ALL with better overall survival in the absence of hematopoietic stem cell transplantation.
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Affiliation(s)
- E Genescà
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain. .,ALL Research Group, Josep Carreras Leukaemia Research Institute (IJC), Camí de les Escoles s/n. Edifici IJC, 08916, Badalona, Spain.
| | - A Lazarenkov
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - M Morgades
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - G Berbis
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - N Ruíz-Xivillé
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - P Gómez-Marzo
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - J Ribera
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - J Juncà
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - A González-Pérez
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Research Program on Biomedical Informatics, Universitat Pompeu Fabra, Barcelona, Spain
| | - S Mercadal
- Clinical Hematology Service, Hospital Duran i Reynals-ICO, Hospitalet del LLobregat, Barcelona, Spain
| | - R Guardia
- Clinical Hematology Service, Hospital Josep Trueta-ICO, Girona, Spain
| | - M T Artola
- Clinical Hematology Service, Hospital Universitario de Donostia, Donostia, Spain
| | - M J Moreno
- Clinical Hematology Service, Hospital Vírgen de la Victoria, Málaga, Spain
| | - J Martínez-López
- Hematology Department, Hospital 12 de Octubre, CNIO, Universidad Complutense, Madrid, Spain
| | - L Zamora
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - P Barba
- Clinical Hematology Service, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - C Gil
- Clinical Hematology Service, Hospital General de Alicante, Alicante, Spain
| | - M Tormo
- Clinical Hematology Service, Hospital Clínico de Valencia, Valencia, Spain
| | - A Cladera
- Clinical Hematology Service, Hospital Son Llàtzer, Palma, Spain
| | - A Novo
- Clinical Hematology Service, Hospital Son Espases, Palma, Spain
| | - M Pratcorona
- Clinical Hematology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Nomdedeu
- Clinical Hematology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J González-Campos
- Clinical Hematology Service, Hospital Vírgen del Rocío, Sevilla, Spain
| | - M Almeida
- Banco Nacional de ADN Carlos III, Universidad de Salamanca, Salamanca, Spain
| | - J Cervera
- Biobanco de la Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - P Montesinos
- Clinical Hematology Service, Hospital La Fe, Valencia, Spain
| | - M Batlle
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - S Vives
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - J Esteve
- Clinical Hematology Service, Hospital Clínic de Barcelona, Barcelona, Spain
| | - E Feliu
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - F Solé
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - A Orfao
- Centro de Investigación del Cáncer (IBMCC-CSIC/USAL) (CIC), Hospital Clínico Universitario de Salamanca (HUS), Instituto Bio-Sanitario de Salamanca (IBSAL), CIBERONC, Salamanca, Spain
| | - J M Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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11
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Anadón C, van Tetering G, Ferreira HJ, Moutinho C, Martínez-Cardús A, Villanueva A, Soler M, Heyn H, Moran S, Castro de Moura M, Setien F, Vidal A, Genescà E, Ribera JM, Nomdedeu JF, Guil S, Esteller M. Epigenetic loss of the RNA decapping enzyme NUDT16 mediates C-MYC activation in T-cell acute lymphoblastic leukemia. Leukemia 2017; 31:1622-1625. [PMID: 28344317 PMCID: PMC5501321 DOI: 10.1038/leu.2017.99] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- C Anadón
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - G van Tetering
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - H J Ferreira
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - C Moutinho
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - A Martínez-Cardús
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - A Villanueva
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - M Soler
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - H Heyn
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - S Moran
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - M Castro de Moura
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - F Setien
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - A Vidal
- Department of Pathological Anatomy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - E Genescà
- Hematology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Ribera
- Hematology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J F Nomdedeu
- Department of Haematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - S Guil
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - M Esteller
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain.,Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain.,Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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12
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Juncà J, Garcia O, Garcia-Caro M, Vila J, Zamora L, Cabezón M, Alonso E, de la Banda E, Rodríguez-Hernández I, Ribera JM, Millá F. CD34 expression and the outcome of nucleophosmin 1-mutated acute myeloid leukemia. Ann Hematol 2016; 95:1949-1954. [PMID: 27595757 DOI: 10.1007/s00277-016-2811-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
Abstract
CD34 positivity has been considered as an adverse prognostic factor in acute myeloid leukemia (AML). Although nucleophosmin 1-mutated (NPM1m) AML is usually CD34 negative, this marker may be expressed at diagnosis or acquired at relapse in a variable number of cases. Our objective was to ascertain if CD34 expression has any influence on the general outcome of this form of acute leukemia. Analysis of clinical outcome (complete remissions, relapses, disease-free survival, and overall survival) was performed depending on the degree of expression of CD34 determined by flow cytometry, in 67 adult patients with NPM1m AML. CD34 expression did not have any influence on the variables analyzed whatever the percentage of blasts expressing this marker. In contrast to other forms of AML, CD34 expression is not an unfavorable prognostic factor in NPM1m AML, neither at diagnosis nor at relapse.
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Affiliation(s)
- Jordi Juncà
- Hematology Laboratory/Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona (Barcelona), Spain.
| | - Olga Garcia
- Hematology Laboratory/Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona (Barcelona), Spain
| | - Montse Garcia-Caro
- Hematology Laboratory/Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona (Barcelona), Spain
| | - Jordi Vila
- Hematology Laboratory/Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona (Barcelona), Spain
| | - Lurdes Zamora
- Hematology Laboratory/Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona (Barcelona), Spain
| | - Marta Cabezón
- Hematology Laboratory/Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona (Barcelona), Spain
| | - Esther Alonso
- Hematology Laboratory, Hospital de Bellvitge, Hospitalet de Llobregat (Barcelona), Spain
| | - Esmeralda de la Banda
- Hematology Laboratory, Hospital de Bellvitge, Hospitalet de Llobregat (Barcelona), Spain
| | - Inés Rodríguez-Hernández
- Hematology Laboratory/Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona (Barcelona), Spain
| | - Josep Maria Ribera
- Hematology Laboratory/Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona (Barcelona), Spain
| | - Fuensanta Millá
- Hematology Laboratory/Service, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona (Barcelona), Spain
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13
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Nomdedéu JF, Puigdecanet E, Bussaglia E, Hernández JJ, Carricondo M, Estivill C, Martí-Tutusaus JM, Tormo M, Zamora L, Serrano E, Perea G, de Llano MPQ, García A, Sánchez-Ortega I, Ribera JM, Nonell L, Aventin A, Solé F, Brunet MS, Sierra J. Feasibility of the AML profiler (Skyline™ Array) for patient risk stratification in a multicentre trial: a preliminary comparison with the conventional approach. Hematol Oncol 2016; 35:778-788. [PMID: 27140599 DOI: 10.1002/hon.2304] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/15/2016] [Accepted: 03/31/2016] [Indexed: 12/11/2022]
Abstract
Deoxyribonucleic acid microarrays allow researchers to measure mRNA levels of thousands of genes in a single experiment and could be useful for diagnostic purposes in patients with acute myeloid leukaemia (AML). We assessed the feasibility of the AML profiler (Skyline™ Array) in genetic stratification of patients with de novo AML and compared the results with those obtained using the standard cytogenetic and molecular approach. Diagnostic bone marrow from 31 consecutive de novo AML cases was used to test MLL-PTD, FLT3-ITD and TKD, NPM1 and CEBPAdm mutations. Purified RNA was used to assess RUNX1-RUNX1T1, PML-RARα and CBFβ-MYH11 rearrangements. RNA remnants underwent gene expression profiling analysis using the AML profiler, which detects chromosomal aberrations: t(8;21), t(15;17), inv(16), mutations (CEBPAdm, ABD-NPM1) and BAALC and EVI1 expression. Thirty cases were successfully analysed with both methods. Five cases had FLT3-ITD. In one case, a t(8;21) was correctly detected by both methods. Four cases had inv(16); in one, the RNA quality was unsatisfactory and it was not hybridized, and in the other three, the AML profiler detected the genetic lesion - this being a rare type I translocation in one case. Two cases with acute promyelocytic leukaemia were diagnosed by both methods. Results for NPM1 mutations were concordant in all but two cases (2/11, non-ABD mutations). Analysis of costs and turnaround times showed that the AML profiler was no more expensive than the conventional molecular approach. These results suggest that the AML profiler could be useful in multicentre trials to rapidly identify patients with AML with a good prognosis. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Josep F Nomdedéu
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Puigdecanet
- Servei d'Analisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Elena Bussaglia
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Maite Carricondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Camino Estivill
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Mar Tormo
- Hematology Department, Hospital Clínico de Valencia, INCLIVA, Valencia, Spain
| | - Lurdes Zamora
- Hematology Department, Institut Recerca contra la Leucemia Josep Carreras (IJC), ICO Badalona Hospital Germans Trias i Pujol, Badalona, Spain
| | - Elena Serrano
- Bioinformatic Platform, IIB Sant Pau, Barcelona, Spain
| | - Granada Perea
- Laboraotory Service, UDIAT-CD, Parc Taulí Hospital Universitari, Sabadell, Spain
| | | | - Antoni García
- Hematology Department, Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Josep Maria Ribera
- Hematology Department, Institut Recerca contra la Leucemia Josep Carreras (IJC), ICO Badalona Hospital Germans Trias i Pujol, Badalona, Spain
| | - Lara Nonell
- Servei d'Analisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Anna Aventin
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francesc Solé
- Hematology Department, Institut Recerca contra la Leucemia Josep Carreras (IJC), ICO Badalona Hospital Germans Trias i Pujol, Badalona, Spain
| | - Maria Salut Brunet
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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14
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Hoelzer D, Bassan R, Dombret H, Fielding A, Ribera JM, Buske C. Acute lymphoblastic leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27:v69-v82. [PMID: 27056999 DOI: 10.1093/annonc/mdw025] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- D Hoelzer
- ONKOLOGIKUM Frankfurt am Museumsufer, Frankfurt, Germany
| | - R Bassan
- Hematology Unit, Ospedale dell'Angelo e Ospedale SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - H Dombret
- Institut Universitaire d'Hematologie Hopital St Louis, Paris, France
| | - A Fielding
- Cancer Institute, University College London, London, UK
| | - J M Ribera
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - C Buske
- CCC Ulm, Institut für Experimentelle Tumorforschung, Universitätsklinikum Ulm, Ulm, Germany
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15
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Díaz-Beyá M, Brunet S, Nomdedéu J, Cordeiro A, Tormo M, Escoda L, Ribera JM, Arnan M, Heras I, Gallardo D, Bargay J, Queipo de Llano MP, Salamero O, Martí JM, Sampol A, Pedro C, Hoyos M, Pratcorona M, Castellano JJ, Nomdedeu M, Risueño RM, Sierra J, Monzó M, Navarro A, Esteve J. The expression level of BAALC-associated microRNA miR-3151 is an independent prognostic factor in younger patients with cytogenetic intermediate-risk acute myeloid leukemia. Blood Cancer J 2015; 5:e352. [PMID: 26430723 PMCID: PMC4635188 DOI: 10.1038/bcj.2015.76] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 07/21/2015] [Accepted: 08/03/2015] [Indexed: 12/14/2022] Open
Abstract
Acute myeloid leukemia (AML) is a heterogeneous disease whose prognosis is mainly related to the biological risk conferred by cytogenetics and molecular profiling. In elderly patients (⩾60 years) with normal karyotype AML miR-3151 have been identified as a prognostic factor. However, miR-3151 prognostic value has not been examined in younger AML patients. In the present work, we have studied miR-3151 alone and in combination with BAALC, its host gene, in a cohort of 181 younger intermediate-risk AML (IR-AML) patients. Patients with higher expression of miR-3151 had shorter overall survival (P=0.0025), shorter leukemia-free survival (P=0.026) and higher cumulative incidence of relapse (P=0.082). Moreover, in the multivariate analysis miR-3151 emerged as independent prognostic marker in both the overall series and within the unfavorable molecular prognostic category. Interestingly, the combined determination of both miR-3151 and BAALC improved this prognostic stratification, with patients with low levels of both parameters showing a better outcome compared with those patients harboring increased levels of one or both markers (P=0.003). In addition, we studied the microRNA expression profile associated with miR-3151 identifying a six-microRNA signature. In conclusion, the analysis of miR-3151 and BAALC expression may well contribute to an improved prognostic stratification of younger patients with IR-AML.
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Affiliation(s)
- M Díaz-Beyá
- Hematology Department, IDIBAPS, Hospital Clinic, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - S Brunet
- Josep Carreras Leukaemia Research Institute, Barcelona, Spain.,Hematology Department and Biological Hematology Laboratory, Hospital de Sant Pau, Barcelona, IIB-Sant Pau Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - J Nomdedéu
- Josep Carreras Leukaemia Research Institute, Barcelona, Spain.,Hematology Department and Biological Hematology Laboratory, Hospital de Sant Pau, Barcelona, IIB-Sant Pau Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - A Cordeiro
- Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, Barcelona, Spain
| | - M Tormo
- Hematology Department, Hospital Clínico, Valencia, Spain
| | - L Escoda
- Hematology Department, Hospital Joan XXIII, Tarragona, Spain
| | - J M Ribera
- Josep Carreras Leukaemia Research Institute, Barcelona, Spain.,Hematology Department, Institut Català d'Oncologia (ICO)-Hospital Germans Trias i Pujol, Badalona, Spain
| | - M Arnan
- ICO, Hematology Department, Hospital Duran i Reynals, l'Hospitalet de Llobregat, Barcelona, Spain
| | - I Heras
- Hematology Department, Hospital Morales Meseguer, Murcia, Spain
| | - D Gallardo
- Hematology Department, ICO Josep Trueta, Girona, Spain
| | - J Bargay
- Hematology Department, Hospital de Son Llàtzer, Palma de Mallorca Hematology, Palma de Mallorca, Spain
| | | | - O Salamero
- Hematology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - J M Martí
- Hematology Department, Hospital Mutua de Terrassa, Barcelona, Spain
| | - A Sampol
- Hematology Department, Hospital de Son Llàtzer, Palma of Mallorca, Spain
| | - C Pedro
- Hematology Department, Hospital de Mar, Barcelona, Spain
| | - M Hoyos
- Hematology Department and Biological Hematology Laboratory, Hospital de Sant Pau, Barcelona, IIB-Sant Pau Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - M Pratcorona
- Hematology Department, IDIBAPS, Hospital Clinic, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - J J Castellano
- Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, Barcelona, Spain
| | - M Nomdedeu
- Hematology Department, IDIBAPS, Hospital Clinic, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - R M Risueño
- Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - J Sierra
- Josep Carreras Leukaemia Research Institute, Barcelona, Spain.,Hematology Department and Biological Hematology Laboratory, Hospital de Sant Pau, Barcelona, IIB-Sant Pau Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - M Monzó
- Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, Barcelona, Spain
| | - A Navarro
- Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Esteve
- Hematology Department, IDIBAPS, Hospital Clinic, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
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16
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Barba P, Martino R, Martinez-Cuadron D, Olga G, Esquirol A, Gil-Cortés C, Gonzalez J, Fernandez-Avilés F, Valcárcel D, Guardia R, Duarte RF, Hernandez-Rivas JM, Abella E, Montesinos P, Ribera JM. Impact of transplant eligibility and availability of a human leukocyte antigen-identical matched related donor on outcome of older patients with acute lymphoblastic leukemia. Leuk Lymphoma 2015; 56:2812-8. [DOI: 10.3109/10428194.2015.1014365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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17
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Berbis G, Ribera J, Ribera JM, Genescà E. Implications of basic research in clinical practice: toward a personalized medicine in T-cell Acute Lymphoblastic Leukemia (T-ALL). Mol Biol 2015. [DOI: 10.4172/2168-9547.1000142] [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: 11/09/2022]
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18
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Fernández-Sojo J, Vives S, Oliveras Vilà T, Ribera JM. Derrame pericárdico exudativo y oligoartritis en un paciente recién diagnosticado de síndrome mielodisplásico. Med Clin (Barc) 2014; 143:43-4. [DOI: 10.1016/j.medcli.2013.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
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19
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Ruggeri A, Sanz G, Bittencourt H, Sanz J, Rambaldi A, Volt F, Yakoub-Agha I, Ribera JM, Mannone L, Sierra J, Mohty M, Solano C, Nabhan S, Arcese W, Gluckman E, Labopin M, Rocha V. Comparison of outcomes after single or double cord blood transplantation in adults with acute leukemia using different types of myeloablative conditioning regimen, a retrospective study on behalf of Eurocord and the Acute Leukemia Working Party of EBMT. Leukemia 2013; 28:779-86. [PMID: 24005245 DOI: 10.1038/leu.2013.259] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/08/2013] [Accepted: 08/14/2013] [Indexed: 01/13/2023]
Abstract
We report outcomes after single (s) and double (d) umbilical cord blood transplantation (UCBT) after myeloablative conditioning (MAC) regimen for 239 patients transplanted for acute leukemia in first complete remission (CR1). All sUCBT patients received a total nucleated cell dose >2.5 × 10(7)/kg. Conditioning regimen for sUCBT was total body irradiation (TBI)12 Gy- or busulfan (BU)-based ± fludarabine (Flu) (n=68, group 1), thiotepa+BU+Flu (TBF) (n=88, group 2), and for dUCBT it was TBI12 Gy+cyclophosphamide ± Flu (n=83, group 3). dUCBT recipients were younger, received higher cell dose and less frequently antithymocyte globulin. In multivariate analysis, we found similar neutrophil recovery among the three groups; however, acute graft-versus-host disease II-IV was higher in dUCBT compared with others. Non-relapse mortality and relapse incidence were not statistically different among the three groups. Leukemia-free survival was 30% for sUCBT using TBI- or BU-based MAC compared with 48% for sUCBT TBF and 48% for dUCBT (P=0.02 and P=0.03, respectively), and it was not statistically different between sUCBT with TBF and dUCBT. In conclusion, use of sUCBT with adequate cell dose (>2.5 × 10(7)/kg) and a specific conditioning regimen in the MAC setting results in similar outcomes as dUCBT. The choice of TBF conditioning regimen for sUCBT may improve results, and whether this regimen may be effective in dUCBT should be further analyzed.
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Affiliation(s)
- A Ruggeri
- 1] Eurocord, Hôpital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France [2] Rome Transplant Network, University Tor Vergata, Rome, Italy
| | - G Sanz
- Hospital Universitario La Fe, Valencia, Spain
| | | | - J Sanz
- Hospital Universitario La Fe, Valencia, Spain
| | - A Rambaldi
- Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - F Volt
- Eurocord, Hôpital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France
| | | | - J M Ribera
- ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Badalona, Spain
| | | | - J Sierra
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - M Mohty
- Hospital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, UPMC Univ Paris 06, UMR-S 938, CEREST-TC EBMT, Paris, France
| | - C Solano
- Hospital Clínico Universitario, Valencia, Spain
| | - S Nabhan
- Eurocord, Hôpital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France
| | - W Arcese
- Rome Transplant Network, University Tor Vergata, Rome, Italy
| | - E Gluckman
- Eurocord, Hôpital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France
| | - M Labopin
- Hospital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, UPMC Univ Paris 06, UMR-S 938, CEREST-TC EBMT, Paris, France
| | - V Rocha
- 1] Eurocord, Hôpital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France [2] Churchill Hospital, Oxford University Hospitals, Oxford, UK
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20
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Siegloch K, Schmitz N, Wu HS, Friedrichs B, van Imhoff GW, Montoto S, Holler E, Ribera JM, Delage R, Dührsen U, Castillo N, Castillo ND, Harrison B, Dreger P, Sureda A. Hematopoietic stem cell transplantation in patients with lymphomatoid granulomatosis: a European group for blood and marrow transplantation report. Biol Blood Marrow Transplant 2013; 19:1522-5. [PMID: 23948061 DOI: 10.1016/j.bbmt.2013.07.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 07/18/2013] [Indexed: 12/25/2022]
Abstract
Lymphomatoid granulomatosis (LG) is a very rare, Epstein-Barr virus-associated lymphoproliferative disorder of B cells. Prognosis is poor, particularly after relapse and no curative treatment exists. We report the results of high-dose therapy and autologous stem cell transplantation (ASCT) or reduced-intensity conditioning and allogeneic stem cell transplantation (alloSCT) in patients with multiply relapsed LG. A European Group for Blood and Marrow Transplantation survey identified 10 patients who had received 9 ASCT and 4 alloSCT. All patients had active disease at the time of transplantation. With a median follow-up of 5.1 (range, 1.4 to 6.3) years, 6 patients are alive and disease-free. Two ASCT patients died of septicemia early after transplantation, and 1 committed suicide after being in continuous complete remission 19 months after ASCT. Another patient allografted 4 years after ASCT remained disease-free but died of severe graft-versus-host disease 3 months after alloSCT. High-dose therapy followed by ASCT and alloSCT are effective therapeutic options and should be considered in all patients with refractory and multiply relapsed LG.
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Affiliation(s)
- Kristina Siegloch
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany
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21
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Barba P, Sampol A, Calbacho M, Gonzalez J, Serrano J, Martínez-Sánchez P, Fernández P, García-Boyero R, Bueno J, Ribera JM. Clofarabine-based chemotherapy for relapsed/refractory adult acute lymphoblastic leukemia and lymphoblastic lymphoma. The Spanish experience. Am J Hematol 2012; 87:631-4. [PMID: 22431002 DOI: 10.1002/ajh.23167] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/09/2012] [Accepted: 02/14/2012] [Indexed: 11/11/2022]
Abstract
The present study reports the Spanish PETHEMA group experience in 31 heavily pretreated relapsed/refractory acute lymphoblastic leukemia (ALL) and lymphoma (LL) patients treated with clofarabine-based regimens. The complete remission (CR) rate was 31% (median CR duration of 3 months [range 2–28]) and the overall survival probability at 1 year was 10% (95%CI 4–16%). Responses were seen in B and T lineage diseases and in patients with adverse cytogenetics. Hematological and infectious grade >3 toxicities were found in 100 and 67% of the patients, respectively, with 7 (23%) treatment-related deaths. Other organ toxicities were infrequent. Clofarabine-based chemotherapy regimens might induce CRs in ALL and LL patients, but hematological toxicity and infections may limit their use in heavily pretreated patients.
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Affiliation(s)
- Pere Barba
- Hematology Departments of Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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22
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Nomdedéu J, Hoyos M, Carricondo M, Esteve J, Bussaglia E, Estivill C, Ribera JM, Duarte R, Salamero O, Gallardo D, Pedro C, Aventin A, Brunet S, Sierra J. Adverse impact of IDH1 and IDH2 mutations in primary AML: experience of the Spanish CETLAM group. Leuk Res 2012; 36:990-7. [PMID: 22520341 DOI: 10.1016/j.leukres.2012.03.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/13/2012] [Accepted: 03/23/2012] [Indexed: 02/02/2023]
Abstract
The study of genetic lesions in AML cells is helpful to define the prognosis of patients with this disease. This study analyzed the frequency and clinical impact of recently described gene alterations, isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2) mutations, in a series of homogeneously treated patients with primary (de novo) AML. Two-hundred and seventy-five patients enrolled in the CETLAM 2003 protocol were analyzed. IDH1 and IDH2 mutations were investigated by well-established melting curve-analysis and direct sequencing (R140 IDH2 mutations). To establish the percentage of the mutated allele a pyrosequencing method was used. Patients were also studied for NPM, FLT3, MLL, CEBPA, TET2 and WT1 mutations. IDH1 or IDH2 mutations were identified in 23.3% AML cases and in 22.5% of those with a normal karyotype. In this latter group, mutations were associated with short overall survival. This adverse effect was even more evident in patients with the NPM or CEBPA mutated/FLT3 wt genotype. In all the cases analyzed, the normal allele was detected, suggesting that both mutations act as dominant oncogenes. No adverse clinical impact was observed in cases with TET2 mutations. IDH1 and IDH2 mutations are common genetic alterations in normal karyotype AML. Favourable genotype NPM or CEBPA mutated/FLT3 wt can be further categorized according to the IDH1 and IDH2 mutational status.
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Affiliation(s)
- J Nomdedéu
- Hematology Department, Hosptial de Santa Creu i Sant Pau, Barcelona, Spain.
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23
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Vilas-Zornoza A, Agirre X, Abizanda G, Moreno C, Segura V, De Martino Rodriguez A, José-Eneriz ES, Miranda E, Martín-Subero JI, Garate L, Blanco-Prieto MJ, García de Jalón JA, Rio P, Rifón J, Cigudosa JC, Martinez-Climent JA, Román-Gómez J, Calasanz MJ, Ribera JM, Prósper F. Preclinical activity of LBH589 alone or in combination with chemotherapy in a xenogeneic mouse model of human acute lymphoblastic leukemia. Leukemia 2012; 26:1517-26. [PMID: 22307227 DOI: 10.1038/leu.2012.31] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [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]
Abstract
Histone deacetylases (HDACs) have been identified as therapeutic targets due to their regulatory function in chromatin structure and organization. Here, we analyzed the therapeutic effect of LBH589, a class I-II HDAC inhibitor, in acute lymphoblastic leukemia (ALL). In vitro, LBH589 induced dose-dependent antiproliferative and apoptotic effects, which were associated with increased H3 and H4 histone acetylation. Intravenous administration of LBH589 in immunodeficient BALB/c-RAG2(-/-)γc(-/-) mice in which human-derived T and B-ALL cell lines were injected induced a significant reduction in tumor growth. Using primary ALL cells, a xenograft model of human leukemia in BALB/c-RAG2(-/-)γc(-/-) mice was established, allowing continuous passages of transplanted cells to several mouse generations. Treatment of mice engrafted with T or B-ALL cells with LBH589 induced an in vivo increase in the acetylation of H3 and H4, which was accompanied with prolonged survival of LBH589-treated mice in comparison with those receiving vincristine and dexamethasone. Notably, the therapeutic efficacy of LBH589 was significantly enhanced in combination with vincristine and dexamethasone. Our results show the therapeutic activity of LBH589 in combination with standard chemotherapy in pre-clinical models of ALL and suggest that this combination may be of clinical value in the treatment of patients with ALL.
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24
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Cobo E, Cortés J, Ribera JM, Cardellach F, Selva-O'Callaghan A, Kostov B, García L, Cirugeda L, Altman DG, González JA, Sànchez JA, Miras F, Urrutia A, Fonollosa V, Rey-Joly C, Vilardell M. Effect of using reporting guidelines during peer review on quality of final manuscripts submitted to a biomedical journal: masked randomised trial. BMJ 2011; 343:d6783. [PMID: 22108262 PMCID: PMC3222149 DOI: 10.1136/bmj.d6783] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the effect of an additional review based on reporting guidelines such as STROBE and CONSORT on quality of manuscripts. DESIGN Masked randomised trial. Population Original research manuscripts submitted to the Medicina Clínica journal from May 2008 to April 2009 and considered suitable for publication. CONTROL GROUP conventional peer reviews alone. Intervention group: conventional review plus an additional review looking for missing items from reporting guidelines. Outcomes Manuscript quality, assessed with a 5 point Likert scale (primary: overall quality; secondary: average quality of specific items in paper). Main analysis compared groups as allocated, after adjustment for baseline factors (analysis of covariance); sensitivity analysis compared groups as reviewed. Adherence to reviewer suggestions assessed with Likert scale. RESULTS Of 126 consecutive papers receiving conventional review, 34 were not suitable for publication. The remaining 92 papers were allocated to receive conventional reviews alone (n=41) or additional reviews (n=51). Four papers assigned to the conventional review group deviated from protocol; they received an additional review based on reporting guidelines. We saw an improvement in manuscript quality in favour of the additional review group (comparison as allocated, 0.25, 95% confidence interval -0.05 to 0.54; as reviewed, 0.33, 0.03 to 0.63). More papers with additional reviews than with conventional reviews alone improved from baseline (22 (43%) v eight (20%), difference 23.6% (3.2% to 44.0%), number needed to treat 4.2 (from 2.3 to 31.2), relative risk 2.21 (1.10 to 4.44)). Authors in the additional review group adhered more to suggestions from conventional reviews than to those from additional reviews (average increase 0.43 Likert points (0.19 to 0.67)). CONCLUSIONS Additional reviews based on reporting guidelines improve manuscript quality, although the observed effect was smaller than hypothesised and not definitively demonstrated. Authors adhere more to suggestions from conventional reviews than to those from additional reviews, showing difficulties in adhering to high methodological standards at the latest research phases. To boost paper quality and impact, authors should be aware of future requirements of reporting guidelines at the very beginning of their study. Trial registration and protocol Although registries do not include trials of peer review, the protocol design was submitted to sponsored research projects (Instituto de Salud Carlos III, PI081903).
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Affiliation(s)
- E Cobo
- Medicina Clínica, Elsevier-Barcelona, Barcelona 08021, Spain.
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25
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Sureda A, Canals C, Arranz R, Caballero D, Ribera JM, Brune M, Passweg J, Martino R, Valcárcel D, Besalduch J, Duarte R, León A, Pascual MJ, García-Noblejas A, López Corral L, Xicoy B, Sierra J, Schmitz N. Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma. Results of the HDR-ALLO study - a prospective clinical trial by the Grupo Español de Linfomas/Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Haematologica 2011; 97:310-7. [PMID: 21993674 DOI: 10.3324/haematol.2011.045757] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although Hodgkin's lymphoma is a highly curable disease with modern chemotherapy protocols, some patients are primary refractory or relapse after first-line chemotherapy or even after high-dose therapy and autologous stem cell transplantation. We investigated the potential role of allogeneic stem cell transplantation in this setting. DESIGN AND METHODS In this phase II study 92 patients with relapsed Hodgkin's lymphoma and an HLA-identical sibling, a matched unrelated donor or a one antigen mismatched, unrelated donor were treated with salvage chemotherapy followed by reduced intensity allogeneic transplantation. Fourteen patients showed refractory disease and died from progressive lymphoma with a median overall survival after trial entry of 10 months (range, 6-17). Seventy-eight patients proceeded to allograft (unrelated donors, n=23). Fifty were allografted in complete or partial remission and 28 in stable disease. Fludarabine (150 mg/m(2) iv) and melphalan (140 mg/m(2) iv) were used as the conditioning regimen. Anti-thymocyte globulin was additionally used as graft-versus-host-disease prophylaxis for recipients of grafts from unrelated donors. RESULTS The non-relapse mortality rate was 8% at 100 days and 15% at 1 year. Relapse was the major cause of failure. The progression-free survival rate was 47% at 1 year and 18% at 4 years from trial entry. For the allografted population, the progression-free survival rate was 48% at 1 year and 24% at 4 years. Chronic graft-versus-host disease was associated with a lower incidence of relapse. Patients allografted in complete remission had a significantly better outcome. The overall survival rate was 71% at 1 year and 43% at 4 years. CONCLUSIONS Allogeneic stem cell transplantation can result in long-term progression-free survival in heavily pre-treated patients with Hodgkin's lymphoma. The reduced intensity conditioning approach significantly reduced non-relapse mortality; the high relapse rate represents the major remaining challenge in this setting. The HDR-Allo trial was registered in the European Clinical Trials Database (EUDRACT, https://eudract.ema.europa.eu/) with number 02-0036.
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Affiliation(s)
- Anna Sureda
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Arnan M, Gudiol C, Calatayud L, Liñares J, Dominguez MÁ, Batlle M, Ribera JM, Carratalà J, Gudiol F. Risk factors for, and clinical relevance of, faecal extended-spectrum β-lactamase producing Escherichia coli (ESBL-EC) carriage in neutropenic patients with haematological malignancies. Eur J Clin Microbiol Infect Dis 2010; 30:355-60. [PMID: 21052757 DOI: 10.1007/s10096-010-1093-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 10/05/2010] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to assess the risk factors for, and the clinical relevance of, faecal carriage by extended-spectrum β-lactamase producing Escherichia coli (ESBL-EC) in neutropenic cancer patients (NCP). An observational prospective multicentre cohort study was conducted over 2 years at two teaching hospitals. Patients with acute leukaemia or undergoing stem cell transplantation were included during neutropenia episodes. Rectal swabs were obtained at hospital admission and weekly thereafter until discharge or death. ESBL-EC colonized episodes were compared with non-colonized episodes. ESBL-EC strains were studied by PCR and isoelectric focusing, and molecular typing was performed by pulsed field gel electrophoresis (PFGE). Among 217 episodes of neutropenia, the prevalence of ESBL-EC faecal carriage was 29% (14% at hospital admission). Multivariate analysis identified previous antibiotics as the only independent risk factor for ESBL-EC faecal colonization (OR 5.38; 95% CI 2.79-10.39). Analysis of ESBL-EC isolates revealed a polyclonal distribution with CTX-M predominance (81.3%). E. coli bacteraemia was mainly caused by non-ESBL producing strains and its rate was similar in both groups (13% vs. 11%). We found no association between ESBL-EC carriage and an increased risk of ESBL-EC bacteremia or a negative influence on other clinical outcomes, including length of hospitalisation, early and overall mortality rates. ESBL-EC faecal colonization is frequent in NCP but difficult to identify by epidemiological or clinical features on presentation. Prior antibiotic therapy is the major associated risk factor. In this setting colonization does not appear to have a significant clinical relevance. Thus, routine testing for ESBL-EC faecal carriage does not seem to be beneficial.
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Affiliation(s)
- M Arnan
- Hematology Department, Hospital Duran i Reynals, l´Hospitalet de Llobregat, Barcelona, Spain
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Nomdedeu J, Bussaglia E, Villamor N, Martinez C, Esteve J, Tormo M, Estivill C, Queipo MP, Guardia R, Carricondo M, Hoyos M, Llorente A, Juncà J, Gallart M, Domingo A, Bargay J, Mascaró M, Moraleda JM, Florensa L, Ribera JM, Gallardo D, Brunet S, Aventin A, Sierra J. Immunophenotype of acute myeloid leukemia with NPM mutations: prognostic impact of the leukemic compartment size. Leuk Res 2010; 35:163-8. [PMID: 20542566 DOI: 10.1016/j.leukres.2010.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/12/2010] [Accepted: 05/17/2010] [Indexed: 11/26/2022]
Abstract
NPM mutations are the most common genetic abnormalities found in non-promyelocytic AML. NPM-positive patients usually show a normal karyotype, a peculiar morphologic appearance with frequent monocytic traits and good prognosis in the absence of an associated FLT3 mutation. This report describes the immunophenotypic and genetic characteristics of a consecutive series of NPM-mutated de novo AML patients enroled in the CETLAM trial. Eighty-three patients were included in the study. Complete immunophenotype was obtained using multiparametric flow cytometry. Associated genetic lesions (FLT3, MLL, CEBPA and WT1 mutations) were studied by standardized methods. Real-time PCR was employed to assess the minimal residual status. The most common pattern was CD34-CD15+ and HLA-DR+. Small CD34 populations with immunophenotypic aberrations (CD15 and CD19 coexpression, abnormal SSC) were detected even in CD34 negative samples. Nearly all cases expressed CD33 (strong positivity), CD13 and CD117, and all were CD123+. The stem cell marker CD110 was also positive in most cases. Biologic parameters such as a high percentage of intermediate CD45+ (blast gate) (>75% nucleated cells), CD123+ and FLT3-ITD mutations were associated with a poor outcome. Quantitative PCR positivity had no prognostic impact either after induction or at the end of chemotherapy. Only PCR positivity (greater than 10 copies) detected in patients in haematological remission was associated with an increased relapse rate. Further studies are required to determine whether the degree of leukemic stem cell expansion (CD45+CD123+cells) increases the risk of acquisition of FLT3-ITD and/or provides selective advantages.
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Affiliation(s)
- J Nomdedeu
- Department of Hematology and Laboratory, Hospital de la Santa Creu I Sant Pau, Avda Sant Antoni M Claret 167, 08025 Barcelona, Spain.
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Giebel S, Stella-Holowiecka B, Krawczyk-Kulis M, Gökbuget N, Hoelzer D, Doubek M, Mayer J, Piatkowska-Jakubas B, Skotnicki AB, Dombret H, Ribera JM, Piccaluga PP, Czerw T, Kyrcz-Krzemien S, Holowiecki J. Status of minimal residual disease determines outcome of autologous hematopoietic SCT in adult ALL. Bone Marrow Transplant 2009; 45:1095-101. [PMID: 19855438 DOI: 10.1038/bmt.2009.308] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of autologous hematopoietic SCT (autoHSCT) in the treatment of high-risk (HR) adult ALL is controversial. In this study, we retrospectively analyzed the results of autoHSCT according to the status of minimal residual disease (MRD) at transplantation, as a joint analysis of the European Study Group for Adult ALL (EWALL). Data on 123 recipients of autoHSCT, aged 31 (16-59) years, with B-lineage (n=77) or T-lineage (n=46) ALL were included. In a cohort of Ph-negative ALL, the probability of leukemia-free survival at 5 years was higher for patients with MRD <0.1% compared with those with MRD > or = 0.1% (57 vs 17%, P=0.0002). The difference was significant for T-lineage ALL (62 vs 8%, P=0.001), and a tendency was observed for B-lineage ALL (54 vs 26%, P=0.17). In a multivariate analysis, adjusted for other potential prognostic factors, high MRD level remained the only independent factor associated with increased risk of failure (risk ratio, 2.8; P=0.0005). We conclude that MRD determines the outcome of autoHSCT in HR adult ALL. Our results suggest the need to reevaluate the role of this treatment option in prospective trials.
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29
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Prat C, Sancho JM, Domínguez J, Xicoy B, Giménez M, Ferrà C, Blanco S, Lacoma A, Ribera JM, Ausina V. Evaluation of procalcitonin, neopterin, C-reactive protein, IL-6 and IL-8 as a diagnostic marker of infection in patients with febrile neutropenia. Leuk Lymphoma 2009; 49:1752-61. [DOI: 10.1080/10428190802258956] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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30
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Mercadal S, Briones J, Xicoy B, Pedro C, Escoda L, Estany C, Camós M, Colomo L, Espinosa I, Martínez S, Ribera JM, Martino R, Gutiérrez-García G, Montserrat E, López-Guillermo A. Intensive chemotherapy (high-dose CHOP/ESHAP regimen) followed by autologous stem-cell transplantation in previously untreated patients with peripheral T-cell lymphoma. Ann Oncol 2008; 19:958-63. [PMID: 18303032 DOI: 10.1093/annonc/mdn022] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Mercadal
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
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Macías J, Robles NR, Herrera J, Ayus JC, Calabria F, Domínguez A, Ferder L, Grande Villoria J, Guillén F, Ingaramo R, Juncos L, López-Dóriga P, López Novoa JM, Martell N, Martínez Maldonado M, Núñez A, Prado F, Pupi LM, Ribera JM, Roldán C, Rodicio JL, Ruilope LM, Rodrigo A, Waisman G. [Recommendations for diagnosis and treatment of aged hypertensives]. Nefrologia 2007; 27:270-8. [PMID: 17725447] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Affiliation(s)
- J Macías
- Unidad de Hipertensión Arterial, Hospital Infanta Cristina, Ctra. de Portugal, Badajoz
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Gutiérrez NC, Castellanos MV, Martín ML, Mateos MV, Hernández JM, Fernández M, Carrera D, Rosiñol L, Ribera JM, Ojanguren JM, Palomera L, Gardella S, Escoda L, Hernández-Boluda JC, Bello JL, de la Rubia J, Lahuerta JJ, San Miguel JF. Prognostic and biological implications of genetic abnormalities in multiple myeloma undergoing autologous stem cell transplantation: t(4;14) is the most relevant adverse prognostic factor, whereas RB deletion as a unique abnormality is not associated with adverse prognosis. Leukemia 2006; 21:143-50. [PMID: 17024116 DOI: 10.1038/sj.leu.2404413] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fluorescence in situ hybridization (FISH) has become a powerful technique for prognostic assessment in multiple myeloma (MM). However, the existence of associations between cytogenetic abnormalities compels us to re-assess the value of each abnormality. A total of 260 patients with MM at the time of diagnosis, enrolled in the GEM-2000 Spanish transplant protocol, have been analyzed by FISH in order to ascertain the independent influence on myeloma prognosis of IGH translocations, as well as RB and P53 deletions. Survival analyses showed that patients with t(4;14), RB or P53 deletions had a significantly shorter survival than patients without these abnormalities. However, patients with RB deletions without other abnormalities in FISH analysis, displayed a similar outcome to those patients without genetic changes by FISH (46 vs 54 months, P=0.3). In the multivariate analysis the presence of t(4;14), RB deletion associated with other abnormalities, age >60 years, high proportion of S-phase cells and advanced stage of the disease according to the International Staging System retained their independent prognostic influence. In summary, RB deletion as a sole abnormality does not lead to a shortening in the survival of MM patients, whereas t(4;14) confers the worst prognosis in MM patients treated with high-dose chemotherapy.
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Affiliation(s)
- N C Gutiérrez
- Servicios de Hematología: Hospital Universitario de Salamanca and Centro de Investigación del Cáncer (CIC), Universidad de Salamanca-CSIC, Spain
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Santaeugenia S, Martí S, Maria Ribera J, Millá F. Trombosis portal como primera manifestación de un síndrome mieloproliferativo crónico oculto. Med Clin (Barc) 2006; 127:598-9. [PMID: 17145021 DOI: 10.1157/13094006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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de Botton S, Sanz MA, Chevret S, Dombret H, Martin G, Thomas X, Mediavilla JD, Recher C, Ades L, Quesnel B, Brault P, Fey M, Wandt H, Machover D, Guerci A, Maloisel F, Stoppa AM, Rayon C, Ribera JM, Chomienne C, Degos L, Fenaux P. Extramedullary relapse in acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Leukemia 2006; 20:35-41. [PMID: 16307026 DOI: 10.1038/sj.leu.2404006] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We analyzed the incidence, presenting features, risk factors of extramedullary (EM) relapse occurring in acute promyelocytic leukemia (APL) treated with all-trans retinoic acid (ATRA) and chemotherapy by using a competing-risk method. In total, 740/ 806 (92%) patients included in three multicenter trials (APL91, APL93 trials and PETHEMA 96) achieved CR, of whom 169 (23%) relapsed, including 10 EM relapses. Nine relapses involved the central nervous system (CNS) and one the skin, of which two were isolated EM relapse. In patients with EM disease, median WBC count was 26950/mm3 (7700-162000). The 3-year cumulative incidence of EM disease at first relapse was 5.0%. Univariate analysis identified age <45 years (P=0.05), bcr3 PML-RARalpha isoform (P= 0.0003) and high WBC counts (> or = 10,000/ mm3) (P<0.0001) as risk factors for EM relapse. In multivariate analysis, only high WBC count remained significant (P= 0.001). Patients with EM relapse had a poorer outcome since median survival from EM relapse was 6.7 months as compared to 26.3 months for isolated BM relapse (P=0.04). In conclusion, EM relapse in APL occurs more frequently in patients with increased WBC counts (> or = 10,000/mm3) and carries a poor prognosis. Whether CNS prophylaxis should be systematically performed in patients with WBC > or = 10,000/mm3 at diagnosis remains to be established.
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Vives S, Sancho JM, Planas R, Ribera JM. Reactivación del virus de la hepatitis B tras cese de la profilaxis con lamivudina en una paciente con linfoma no hodgkiniano tratada con quimioterapia y rituximab. Med Clin (Barc) 2006; 127:39. [PMID: 16796944 DOI: 10.1157/13089874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gallardo D, Pérez-García A, de la Cámara R, Iriondo A, Jiménez-Velasco A, Torres A, Brunet S, Urbano-Ispizúa A, Vallejo C, Encuentra M, Caballero D, Espigado I, Serrano D, Barrenetxea C, Ribera JM, de la Rubia J. Clinical outcome after sex-mismatched allogeneic stem cell transplantation from human lymphocyte antigen-identical sibling donors: influence of stem cell source. Leukemia 2006; 20:1461-4. [PMID: 16728983 DOI: 10.1038/sj.leu.2404263] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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37
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Piernas S, Xicoy B, Grifols JR, Ribera JM. [Autoimmune hemolytic anemia with positive direct antiglobulin test associated with T cell acute lymphoblastic leukemia]. Med Clin (Barc) 2006; 126:678-9. [PMID: 16759573 DOI: 10.1157/13087849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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38
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Serrano A, Xicoy B, Fité E, Ribera JM. [Bone marrow aplasia as an onset form of multisystemic sarcoidosis]. Med Clin (Barc) 2006; 126:638-9. [PMID: 16759559 DOI: 10.1157/13087737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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39
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Vives S, Fernández MT, López de Castro PE, Ribera JM. Sarcoma de células dendríticas interdigitantes de localización pulmonar. Med Clin (Barc) 2006; 126:559. [PMID: 16756917 DOI: 10.1157/13087153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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40
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Perea G, Domingo A, Villamor N, Palacios C, Juncà J, Torres P, Llorente A, Fernández C, Tormo M, Queipo de Llano MP, Bargay J, Gallart M, Florensa L, Vivancos P, Martí JM, Font L, Berlanga J, Esteve J, Bueno J, Ribera JM, Brunet S, Sierra J, Nomdedéu JF. Adverse prognostic impact of CD36 and CD2 expression in adult de novo acute myeloid leukemia patients. Leuk Res 2005; 29:1109-16. [PMID: 16095690 DOI: 10.1016/j.leukres.2005.02.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES A consecutive series of acute myeloid leukemias (AML) patients was analyzed in conditions which reduce the inter-assay variations (the same flow cytometer, the same observers and the same panel of monoclonal antibodies) in order to investigate the prognostic information provided by flow cytometry. DESIGN AND METHODS Two hundred and sixty-six bone marrow (BM) samples from 326 patients enrolled in the LMA-99 protocol from the CETLAM group were studied by multiparametric flow cytometry. Immunophenotyping studies were performed on erythrocyte-lysed BM samples. Antigen expression of leukemic cells was analyzed using triple stainings with fluorochrome-conjugated combinations of monoclonal antibodies. RESULTS CD2 was positive in 21 cases (8%); an associated inv(16) was detected in eight CD2+ cases (38%). Two-year overall survival (OS) rate for CD2+/inv(16)+ patients was 75%, whereas it was 0% for CD2+/inv(16)- patients and 47% for CD2- patients (p=0.0001). CD36 was expressed in 37% of patients (n=98). Two-year leukemia-free survival (LFS) rate was 34% for CD36+ patients and 55% for CD36- patients (p=0.001). In the multivariate analysis, CD2+ (RR=8.4; p=0.0001) and adverse karyotype (RR=10.2; p=0.0001) were associated with a lower CR rate, CD36+ (RR=1.5; p=0.03), CD2+ (RR=2; p=0.04) and adverse karyotype (RR=4; p=0.0001) were associated with a lower OS and CD36+ (RR=2; p=0.002) and adverse karyotype (RR=3.5; p=0.005) predicted a lower LFS. CONCLUSIONS CD2+ patients had a very poor OS when CD2/inv(16)+ cases were excluded. CD36 and CD2 expression at diagnosis can provide prognostically important information in adult de novo AML.
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Affiliation(s)
- G Perea
- Laboratori d'Hematologia, Hospital de la Santa Creu i Sant Pau, Avda Sant Antoni M. Claret, 167, 08025 Barcelona, Spain
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Solé F, Luño E, Sanzo C, Espinet B, Sanz GF, Cervera J, Calasanz MJ, Cigudosa JC, Millà F, Ribera JM, Bureo E, Marquez ML, Arranz E, Florensa L. Identification of novel cytogenetic markers with prognostic significance in a series of 968 patients with primary myelodysplastic syndromes. Haematologica 2005; 90:1168-78. [PMID: 16154839] [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] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The main prognostic factors in myelodysplastic syndromes (MDS) are chromosomal abnormalities, the proportion of blasts in bone marrow and number and degree of cytopenias. A consensus-defined International Prognostic Scoring System (IPSS) for predicting outcome and planning therapy in MDS has been developed, but its prognostic value in a large and independent series remains unproven. Furthermore, the intermediate-risk cytogenetic subgroup defined by the IPSS includes a miscellaneous number of different single abnormalities of uncertain prognostic significance at present. The main aim of the present study was to identify chromosomal abnormalities with a previously unrecognized good or poor prognosis in order to find new cytogenetic markers with predictive value. DESIGN AND METHODS We report the cytogenetic findings in a series of 968 patients with primary MDS from the Spanish Cytogenetics Working Group, Grupo Cooperativo Español de Citogenética Hematológica (GCECGH). RESULTS In this series of 968 MDS patients, we found various cytogenetic aberrations with a new prognostic impact. Complex karyotype, -7/7q- and i(17q) had a poor prognosis; normal karyotype, loss of Y chromosome, deletion 11q, deletion 12p and deletion 20q as single alterations had a good prognosis. Intermediate prognosis aberrations were rearrangements of 3q21q26, trisomy 8, trisomy 9, translocations of 11q and del(17p). Finally, a new group of single or double cytogenetic abnormalities, most of which are considered rare cytogenetic events and are usually included in the intermediate category of the IPSS, showed a trend to poor prognosis. INTERPRETATION AND CONCLUSIONS This study suggests that some specific chromosomal abnormalities could be segregated from the IPSS intermediate-risk cytogenetic prognostic subgroup and included in the low risk or in the poor risk groups.
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Affiliation(s)
- Francesc Solé
- Laboratori de Citogenètica i Biologia Molecular, Hospital del Mar-IMAS, 08003 Barcelona, Spain.
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Plensa E, Ribera JM, Oriol A, Bethencourt C, Parody R, Hernández Ribas JM, Moreno MJ, del Potro E, Tormo M, Rivas C, Besalduch J, Sanz MA, Arias J, Fernández Calvo J, Moraleda JM, Bueno J, Feliu E, Ortega JJ. Prevalencia y significado pronóstico de los marcadores mieloides en adultos con leucemia aguda linfoblástica de alto riesgo. Med Clin (Barc) 2005; 125:241-6. [PMID: 16137483 DOI: 10.1157/13078098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The prognostic value of myeloid antigen expression in adult acute lymphoblastic leukemia (ALL) is controversial. The objective of this study was to evaluate the frequency and prognostic significance of myeloid antigen expression in adults with high risk ALL. PATIENTS AND METHOD Between June 1993 and July 2002, 222 adults patients with high-risk ALL were treated according to the PETHEMA LAL 93 protocol. The frequency of myeloid antigen expression, its association with other clinical and biologic variables and the prognostic significance in terms of complete remission (CR) rate, event free survival (EFS) and overall survival (OS) were analyzed. RESULTS Myeloid antigen expression was present in 96 out of 222 patients (43%). No association was observed between myeloid antigen expression and the main clinical and biologic characteristics of ALL. Response to treatment was slower in patients expressing myeloid antigens, but no differences were found in CR achievement, EFS or OS. The probability of EFS at 10 years for ALL patients without and with myeloid antigen expression was 35% and 34%, respectively, while the probability of OS at 10 years was 30% and 33%, respectively. This absence of differences in EFS and OS probabilities was also observed when only slow responding patients were analyzed. CONCLUSIONS In this study, myeloid antigen expression did not have prognostic influence in adult patients with high risk ALL.
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Affiliation(s)
- Esther Plensa
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Perea G, Altés A, Montoto S, López-Guillermo A, Domingo-Doménech E, Fernández-Sevilla A, Ribera JM, Grau J, Pedro C, Angel Hernández J, Estany C, Briones J, Martino R, Sureda A, Sierra J, Montserrat E. Prognostic indexes in follicular lymphoma: a comparison of different prognostic systems. Ann Oncol 2005; 16:1508-13. [PMID: 15939718 DOI: 10.1093/annonc/mdi269] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The International Prognostic Index (IPI), initially designed for aggressive lymphomas, is also used in follicular lymphoma (FL) and other indolent lymphomas. Two new prognostic indexes have recently been proposed for FL [the Italian Lymphoma Intergroup (ILI) Index and the Follicular Lymphoma International Prognostic Index (FLIPI)]. PATIENTS AND METHODS Three indexes, IPI [age >60 years, extranodal involvement two or more sites, elevated lactate dehydrogenase (LDH), Eastern Cooperative Oncology Group performance status > or =2, stage > or =3], ILI (age >60 years, extranodal involvement two or more sites, elevated LDH, male sex, B symptoms, erythrocyte sedimentation rate > or =30 mm first hour) and FLIPI (age >60 years, stage > or =3, elevated LDH, nodal involvement five or more, haemoglobin level < or =12 g/dl) were calculated in 411 patients with FL. RESULTS Overall concordance between the three indexes was 54%. A total of 126 (31%) patients were included in the high-risk group according to IPI, 131 (32%) according to ILI and 157 (38%) after FLIPI application. Ten-year overall survival rates after applying the prognostic indexes (IPI, ILI and FLIPI) were, respectively: 72%, 71% and 72%, in the low-risk group; 51%, 60% and 49% in the intermediate-risk group; and 24%, 16% and 31% in the high-risk group. CONCLUSIONS In this series, all three indexes, IPI, ILI and FLIPI, were useful to classify FL patients into differentiated risk groups, although the FLIPI identified a larger proportion of high-risk patients than the IPI and ILI.
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Affiliation(s)
- G Perea
- Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain.
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Arnau C, Cobo E, Ribera JM, Cardellach F, Selva A, Urrutia A. Efecto de la revisión estadística en la calidad de los manuscritos publicados en MEDICINA CLÍNICA: estudio aleatorizado. Med Clin (Barc) 2003; 121:690-4. [PMID: 14651815 DOI: 10.1016/s0025-7753(03)74064-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The statistical review of biomedical articles should result in an improved quality. The objective of this study was to compare the effects of clinical review and joint clinical and statistical review on manuscript quality, in articles submitted to Medicina Clínica (Barcelona), a Spanish weekly journal of internal medicine. METHOD Original papers arriving between May 2000 and February 2001 were randomized either to a clinical review group or a clinical and statistical review group. Two evaluators, blinded to the paper's group, assessed the quality improvement in both groups, from submission to publication using a modified version ot the Goodman et al. scale. The protocol required that final versions arrived before the end of May 2001. RESULTS Final sample size was 43 manuscripts, evaluated before and after peer review. On the intention to treat analysis, the estimated effect of statistical review was 1.35 (95% CI: -0.45 to 3.16) positive, but not statistically significant. The analysis of the reviewers' comments revealed some protocol deviations. Taking into account the spontaneous inclusion of statistical experts in the clinical group, the estimated effect was statistically significant, with a confidence interval of 0.3 to 3.7. CONCLUSION The inclusion of a statistical expert in the peer review process improves manuscript quality, although in the intention to treat analysis the improvement was not statistically significant.
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Affiliation(s)
- Catalina Arnau
- Estadística e Investigación Operativa. Universitat Politècnica de Catalunya. Barcelona. Spain
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Muñoz L, Nomdedéu JF, Villamor N, Guardia R, Colomer D, Ribera JM, Torres JP, Berlanga JJ, Fernández C, Llorente A, Queipo de Llano MP, Sánchez JM, Brunet S, Sierra J. Acute myeloid leukemia with MLL rearrangements: clinicobiological features, prognostic impact and value of flow cytometry in the detection of residual leukemic cells. Leukemia 2003; 17:76-82. [PMID: 12529663 DOI: 10.1038/sj.leu.2402708] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2001] [Accepted: 06/19/2002] [Indexed: 11/09/2022]
Abstract
The MLL gene, located at 11q23 band, is frequently disrupted by different chromosomal rearrangements that occur in a variety of hematological malignancies. MLL rearrangements are associated with distinct clinical features and a poor prognosis. The aim of this study was to analyze the incidence and the prognostic significance of MLL rearrangements in a consecutive series of adult AML patients and to determine the immunophenotypic features of these cases. The identification of abnormal immunophenotypes could be used for the detection of minimal residual disease (MRD). Ninety-three adult patients with de novo acute myeloid leukemia (AML) were analyzed by Southern blot in order to detect MLL rearrangements (MLL+). RT-PCR and genomic long-range PCR were performed to further characterize MLL partial tandem duplication (PTD) in those patients in whom conventional karyotype did not show 11q23 chromosomal translocations. All the patients were homogeneously immunophenotyped at diagnosis. MLL rearrangements were detected in 13 (14%) patients. Four patients (5%) showed 11q23 translocations by karyotypic conventional analysis. Nine patients (10%) revealed PTD of MLL and one patient showed a MLL cleavage pattern. The MLL+ patients usually expressed myeloid and monocytic antigens CD33 (12/13 cases), CD13 (9/13), CD117 (9/13), CD64 (11/13) and in some cases CD14 (4/11). HLA-DR was also positive in (12/13). Eight out of 13 cases expressed the stem cell marker CD34. Only one patient revealed lymphoid marker reactivity (CD7) and CD56 was expressed in 5/13 cases. All the MLL+ patients showed at least one aberrant phenotype at diagnosis, which allowed us to set out a simple panel for the MRD studies. Twenty-seven samples from eight patients in morphologic complete remission (CR) were analyzed using the aberrant immunologic combinations detected at diagnosis. Phenotypically abnormal cells were detected in all the patients who subsequently relapsed, whereas only one patient with MRD+ remained in CR. Owing to the high level of residual leukemic cells, the MLL+ patients showed a short CR duration and a poor survival. In conclusion, immunophenotyping may be a suitable approach to investigating MRD status in AML patients with PTD of the MLL gene.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Antibodies, Monoclonal/immunology
- Antibodies, Neoplasm/immunology
- Antigens, CD/immunology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Blotting, Southern
- Chromosomes, Human, Pair 11/genetics
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Disease-Free Survival
- Flow Cytometry
- Gene Duplication
- Gene Rearrangement
- Histone-Lysine N-Methyltransferase
- Humans
- Immunophenotyping
- Karyotyping
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/pathology
- Middle Aged
- Myeloid-Lymphoid Leukemia Protein
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/genetics
- Neoplasm, Residual/pathology
- Polymerase Chain Reaction
- Prognosis
- Proto-Oncogenes
- Remission Induction
- Transcription Factors
- Translocation, Genetic
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Affiliation(s)
- L Muñoz
- Department of Hematology, Hospital de la Santa Creu, Sant Pau, Barcelona, Spain
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Abella E, Feliu E, Granada I, Millá F, Oriol A, Ribera JM, Sánchez-Planell L, Berga LI, Reverter JC, Rozman C. Bone marrow changes in anorexia nervosa are correlated with the amount of weight loss and not with other clinical findings. Am J Clin Pathol 2002; 118:582-8. [PMID: 12375646 DOI: 10.1309/2y7x-ydxk-006b-xlt2] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The clinical history and biochemical and hematologic variables for 44 consecutive patients diagnosed with anorexia nervosa were recorded. Bone marrow aspirates and biopsy specimens were analyzed by standard morphologic procedures, and bone marrow adipocytes were studied morphometrically. The bone marrow of the 44 patients was classified as normal (5 cases [11%]), hypoplastic or aplastic (17 [39%]), with partial or focal gelatinous degeneration (13 [30%]), or with complete gelatinous degeneration of the bone marrow (GDBM; 9 [20%]). These patterns correlated with amount of weight loss (P = .005) but not other clinical findings. WBC counts were lower in patients with GDBM (P = .0189), but this and other peripheral blood variables did not always reflect the severity of bone marrow damage. Hypoplastic or aplastic bone marrow showed an increase in bone marrow fat fraction due to an increase in adipocyte diameters, while in GDBM, fat fraction and adipocyte diameters decreased. Morphologic changes in bone marrow and stereologic alterations in bone marrow adipocytes may be observed in anorexia nervosa. The extent of damage is related to the amount of weight loss, not to other factors. Peripheral blood cell counts may not reflect the extent of damage. In some patients, this process may be reversible with reestablishment of adequate nutritional intake.
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Affiliation(s)
- E Abella
- Hematology Department, University Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
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Bladé J, San Miguel JF, Fontanillas M, Esteve J, Maldonado J, Alcalá A, Brunet S, García-Conde J, Besalduch J, Moro MJ, Fernández-Calvo J, Conde E, Font L, Gardella S, Carnero M, Carbonell F, Martí JM, Hernández-Martín J, Ortega F, Besses C, Ribera JM, Trujillo J, Escudero ML, Rozman C, Estapé J, Montserrat E. Increased conventional chemotherapy does not improve survival in multiple myeloma: long-term results of two PETHEMA trials including 914 patients. Hematol J 2002; 2:272-8. [PMID: 11920260 DOI: 10.1038/sj.thj.6200115] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2000] [Accepted: 01/06/2001] [Indexed: 11/09/2022]
Abstract
BACKGROUND Melphalan and prednisone (MP) has been the standard treatment for multiple myeloma (MM) for the last 30 years. Combination chemotherapy at conventional doses has not shown a significant prolongation of survival when compared to MP. There are few data comparing conventional chemotherapy at standard doses with conventional treatment at higher doses. We present the long-term outcome of 914 patients from two randomized trials comparing three different dose intensity regimens. METHODS From 1 January, 1985 to 31 December, 1989, 487 patients were randomized between MP (melphalan 9 mg/m(2) p.o. and prednisone 60 mg/m(2) days 1-4) and alternating VCMP (vincristine 1 mg i.v. on day 1, cyclophosphamide 500 mg/m(2) i.v. on day 1, melphalan 6 mg/m(2) p.o. on days 1-4, and prednisone 60 mg/m(2) on days 1-4) and VBAP (vincristine 1 mg i.v. on day 1, BCNU and doxorubicin 30 mg/m(2) i.v. each on day 1, and prednisone 60 mg/m(2) on days 1-4). From 1 January, 1990 to 31 May, 1994, 427 patients were randomized between VCMP/VBAP at the above detailed doses (VCMP/VBAP 'SD') and the same regimen increasing the doses of cyclophosphamide and doxorubicin from 500 to 1200 mg/m(2) and from 30 to 50 mg/m(2), respectively (VCMP/VBAP 'HD'). RESULTS Increasing dose intensity produced a significantly higher partial response rate (31% vs 45% vs 51% for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P < 0.01). However, a significantly early death rate was observed in the HD arm (7.7, 7.5 and 12.1% for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P = 0.05). Median duration of response (20 vs 18 vs 19 months for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P = NS) and median survival (25 vs 31 vs 29 months for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P = NS) were similar in the three groups. MP produced a higher degree of thrombocytopenia than combination chemotherapy at standard (P = 0.002) or high dose (P = 0.01), this leading to a significantly higher dose reduction in the MP arm (P < 0.001 and P = 0.003 for VCMP/VBAP 'SD' and VCMP/VBAP 'HD', respectively). CONCLUSION In these trials the response rate significantly correlated with the regimen intensity. However, no significant differences in response duration and survival were found. This highlights the limited role of conventional chemotherapy in MM and the need for further trials, aimed at determining the impact of new treatment approaches such as high-dose therapy/autotransplantation.
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Affiliation(s)
- J Bladé
- Spanish Cooperative Group for Hematological Malignancies Treatment (PETHEMA), Spanish Society of Hematology. Institut de Investigacions Biomèdiques August Pi i Sunyer. Hospital Clínico. Barcelona. Spain.
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Sancho JM, Pujol M, Ribera JM, Cortel G, Profitós J, Millá F. [Promotion of the blood donation in a hospital: comparison of two approaches]. Med Clin (Barc) 2002; 118:174-6. [PMID: 11851993] [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] [Indexed: 02/23/2023]
Abstract
BACKGROUND Our purpose was to evaluate the results of the promotion of blood donation in patients undergoing stem cell transplantation (SCT) and to compare it with this promotion in remaining in-patients. PATIENTS AND METHODS The hematologist and the blood bank staff informed the patient undergoing SCT about the need for transfusions. Donors were selected for blood or platelet donation. In remaining in-patients, promotion was performed by the blood bank staff by interviewing patients. RESULTS Between January 2000 and May 2001, 48 SCT patients were included: 41 (85%) yielded 453 possible donors. Of them, 306 donated blood, 77 platelets and 82 were excluded. The number of donations was 484 (389 whole blood and 105 platelets), and 25% (n = 98) of patients donated blood subsequently. Among in-patients 1,950 interviews were carried out: 533 (27.3%) yielded 901 donors (p < 0.001). Overall, 1,146 blood donations were obtained and 15% (135) of these donors donated blood subsequently (p < 0.001). CONCLUSION Collaboration of the hematologist in the promotion of blood donation leads to an increase in the rate and frequency of donations.
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Affiliation(s)
- Juan Manuel Sancho
- Centre de Transfusió i Banc de Teixits. Hospital Universitari Germans Trias i Pujol. Badalona. Universitat Autònoma de Barcelona. Spain.
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Manuel Sancho J, Pujol M, Cortel G, Profitós J, Maria Ribera J, Millá F. Promoción de la donación de sangre en un hospital: comparación de dos sistemas. Med Clin (Barc) 2002. [DOI: 10.1016/s0025-7753(02)72324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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