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Anžej Doma S, Sever M, Jakoš G, Podgornik H. FLAG/FLAG-Ida Regimen in Secondary and Relapsed/Refractory Acute Myeloid Leukemia-Even in the Era of New Treatment Modalities Still a Significant Player. J Clin Med 2024; 13:1842. [PMID: 38610607 PMCID: PMC11012572 DOI: 10.3390/jcm13071842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Relapsed/refractory (r/r) and secondary acute myeloid leukemia are highlighted by chemoresistance and poor outcomes. The aim of the study was to assess the efficacy and toxicity of fludarabine, cytarabine, and granulocyte-colony stimulation factor (FLAG) with or without idarubicin (-Ida) and to discuss novel therapies in this setting. (2) Methods: Clinical and cytogenetic data on 130 consecutive patients with r/r and secondary AML treated at our center were retrospectively analyzed. (3) Results: There were 48, 56, and 26 patients with relapsed, refractory, and secondary AML, respectively. The median age was 60 years. The overall response was achieved in 70% of patients. The median overall survival (OS) time for the whole group was 9.4 months. In total, 47% of patients proceeded to allogeneic hematopoietic stem cell transplantation (aHSCT) and these patients had significantly prolonged OS compared to the others (63 months vs. 4.2 months; p < 0.001). Among the variables, including age, FLT3 mutation status, European LeukemiaNet (ELN) 2022 classification risk, FLAG vs. FLAG-Ida, and aHSCT, a multivariate analysis revealed that only aHSCT significantly influenced overall survival. (4) Conclusions: FLAG(-Ida) chemotherapy remains an effective salvage chemotherapy for patients with r/r and secondary AML with a plan of proceeding to aHSCT.
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Affiliation(s)
- Saša Anžej Doma
- Hematology Department, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia (H.P.)
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - Matjaž Sever
- Hematology Department, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia (H.P.)
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - Gorazd Jakoš
- Hematology Department, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia (H.P.)
| | - Helena Podgornik
- Hematology Department, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia (H.P.)
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000 Ljubljana, Slovenia
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Rener K, Anžej Doma S, Fink M, Podgornik H, Preložnik Zupan I. Management and Outcomes of Invasive Procedures in Individuals with Hemophilia A on Emicizumab Prophylaxis: A Single Center Experience. Hematol Rep 2023; 15:597-607. [PMID: 37987318 PMCID: PMC10660500 DOI: 10.3390/hematolrep15040062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/12/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
Prophylactic treatment with emicizumab has become an important and effective bleeding prevention for people with hemophilia A (PwHA). Perioperative management of PwHA using emicizumab prophylaxis is still challenging due to a lack of experience. Medical records of perioperative management and outcomes were reviewed, and data were collected for adult PwHA receiving emicizumab and undergoing surgical procedures between August 2019 and July 2022 at the University Medical Center Ljubljana. Twelve surgical procedures were performed in eight PwHA (one with FVIII inhibitors) while on emicizumab prophylaxis. Three minor procedures included cataract surgery, cystoscopic lithotripsy, and percutaneous coronary intervention. Nine major surgeries included four osteosyntheses, necrectomy of chronic osteomyelitis with new ankle arthrodesis, two below-knee amputations, total knee replacement, and placement of ventriculostomy after a spontaneous intraventricular hemorrhage. No major bleeds, thrombotic events or deaths, or new inhibitors appeared. Our real-world experience demonstrates that minor and major surgeries can be performed safely in PwHA on emicizumab prophylaxis. Additional data are needed to optimize dosing/duration of additional hemostatic agents in diverse invasive procedures and complex clinical situations.
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Affiliation(s)
- Karla Rener
- Department of Hematology, University Medical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; (K.R.); (S.A.D.); (M.F.); (H.P.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Saša Anžej Doma
- Department of Hematology, University Medical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; (K.R.); (S.A.D.); (M.F.); (H.P.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Martina Fink
- Department of Hematology, University Medical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; (K.R.); (S.A.D.); (M.F.); (H.P.)
| | - Helena Podgornik
- Department of Hematology, University Medical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; (K.R.); (S.A.D.); (M.F.); (H.P.)
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva cesta 7, 1000 Ljubljana, Slovenia
| | - Irena Preložnik Zupan
- Department of Hematology, University Medical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; (K.R.); (S.A.D.); (M.F.); (H.P.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Anžej Doma S, Doma A. Lymphoplasmacytic lymphoma relapse presenting as isolated multifocal subcutaneous adipose tissue infiltrates on 18F-FDG PET/CT. Acta Radiol Open 2023; 12:20584601231173052. [PMID: 37179796 PMCID: PMC10170594 DOI: 10.1177/20584601231173052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
Lymphoplasmacytic lymphoma (LPL)/Waldenström macroglobulinemia (WM) is an uncommon mature B cell lymphoma usually involving the bone marrow and, less commonly, the spleen and/or lymph nodes. This case presents a pathology-confirmed isolated extramedullary relapse of LPL, located in subcutaneous adipose tissue, 5 years after successful treatment of WM.
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Affiliation(s)
- Saša Anžej Doma
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Doma
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Nuclear Medicine, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Belčič Mikič T, Vratanar B, Pajič T, Anžej Doma S, Debeljak N, Preložnik Zupan I, Sever M, Zver S. Is It Possible to Predict Clonal Thrombocytosis in Triple-Negative Patients with Isolated Thrombocytosis Based Only on Clinical or Blood Findings? J Clin Med 2021; 10:jcm10245803. [PMID: 34945099 PMCID: PMC8706709 DOI: 10.3390/jcm10245803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022] Open
Abstract
JAK2, MPL, and CALR mutations define clonal thrombocytosis in about 90% of patients with sustained isolated thrombocytosis. In the remainder of patients (triple-negative patients) diagnosing clonal thrombocytosis is especially difficult due to the different underlying conditions and possible inconclusive bone marrow biopsy results. The ability to predict patients with sustained isolated thrombocytosis with a potential clonal origin has a prognostic value and warrants further examination. The aim of our study was to define a non-invasive clinical or blood parameter that could help predict clonal thrombocytosis in triple-negative patients. We studied 237 JAK2 V617-negative patients who were diagnosed with isolated thrombocytosis and referred to the haematology service. Sixteen routine clinical and blood parameters were included in the logistic regression model which was used to predict the type of thrombocytosis (reactive/clonal). Platelet count and lactate dehydrogenase (LDH) were the only statistically significant predictors of clonal thrombocytosis. The platelet count threshold for the most accurate prediction of clonal or reactive thrombocytosis was 449 × 109/L. Other tested clinical and blood parameters were not statistically significant predictors of clonal thrombocytosis. The level of LDH was significantly higher in CALR-positive patients compared to CALR-negative patients. We did not identify any new clinical or blood parameters that could distinguish clonal from reactive thrombocytosis. When diagnosing clonal thrombocytosis triple-negative patients are most likely to be misdiagnosed. Treatment in patients with suspected triple negative clonal thrombocytosis should not be delayed if cardiovascular risk factors or pregnancy coexist, even in the absence of firm diagnostic criteria. In those cases the approach “better treat more than less” should be followed.
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Affiliation(s)
- Tanja Belčič Mikič
- Department of Haematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (T.P.); (S.A.D.); (I.P.Z.); (M.S.); (S.Z.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
| | - Bor Vratanar
- Institute of Biomedical Statistics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Tadej Pajič
- Department of Haematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (T.P.); (S.A.D.); (I.P.Z.); (M.S.); (S.Z.)
- Clinical Institute for Genomic Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Clinical Biochemistry, Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Saša Anžej Doma
- Department of Haematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (T.P.); (S.A.D.); (I.P.Z.); (M.S.); (S.Z.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nataša Debeljak
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Irena Preložnik Zupan
- Department of Haematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (T.P.); (S.A.D.); (I.P.Z.); (M.S.); (S.Z.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Matjaž Sever
- Department of Haematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (T.P.); (S.A.D.); (I.P.Z.); (M.S.); (S.Z.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Samo Zver
- Department of Haematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (T.P.); (S.A.D.); (I.P.Z.); (M.S.); (S.Z.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Kristan A, Pajič T, Maver A, Režen T, Kunej T, Količ R, Vuga A, Fink M, Žula Š, Podgornik H, Anžej Doma S, Preložnik Zupan I, Rozman D, Debeljak N. Identification of Variants Associated With Rare Hematological Disorder Erythrocytosis Using Targeted Next-Generation Sequencing Analysis. Front Genet 2021; 12:689868. [PMID: 34349782 PMCID: PMC8327209 DOI: 10.3389/fgene.2021.689868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/16/2021] [Indexed: 12/28/2022] Open
Abstract
An erythrocytosis is present when the red blood cell mass is increased, demonstrated as elevated hemoglobin and hematocrit in the laboratory evaluation. Congenital predispositions for erythrocytosis are rare, with germline variants in several genes involved in oxygen sensing (VHL, EGLN1, and EPAS1), signaling for hematopoietic cell maturation (EPOR and EPO), and oxygen transfer (HBB, HBA1, HBA2, and BPGM) that were already associated with the eight congenital types (ECYT1–8). Screening for variants in known congenital erythrocytosis genes with classical sequencing approach gives a correct diagnosis for only up to one-third of the patients. The genetic background of erythrocytosis is more heterogeneous, and additional genes involved in erythropoiesis and iron metabolism could have a putative effect on the development of erythrocytosis. This study aimed to detect variants in patients with yet unexplained erythrocytosis using the next-generation sequencing (NGS) approach, targeting genes associated with erythrocytosis and increased iron uptake and implementing the diagnostics of congenital erythrocytosis in Slovenia. Selected 25 patients with high hemoglobin, high hematocrit, and no acquired causes were screened for variants in the 39 candidate genes. We identified one pathogenic variant in EPAS1 gene and three novel variants with yet unknown significance in genes EPAS1, JAK2, and SH2B3. Interestingly, a high proportion of patients were heterozygous carriers for two variants in HFE gene, otherwise pathogenic for the condition of iron overload. The association between the HFE variants and the development of erythrocytosis is not clearly understood. With a targeted NGS approach, we determined an actual genetic cause for the erythrocytosis in one patient and contributed to better management of the disease for the patient and his family. The effect of variants of unknown significance on the enhanced production of red blood cells needs to be further explored with functional analysis. This study is of great significance for the improvement of diagnosis of Slovenian patients with unexplained erythrocytosis and future research on the etiology of this rare hematological disorder.
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Affiliation(s)
- Aleša Kristan
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Pajič
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Clinical Biochemistry, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Aleš Maver
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadeja Režen
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Kunej
- Department of Animal Science, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Količ
- Kemomed Research and Development, Kemomed Ltd., Ljubljana, Slovenia
| | - Andrej Vuga
- Kemomed Research and Development, Kemomed Ltd., Ljubljana, Slovenia
| | - Martina Fink
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Špela Žula
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Helena Podgornik
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Saša Anžej Doma
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Irena Preložnik Zupan
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Damjana Rozman
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Debeljak
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Anžej Doma S, Kristan A, Debeljak N, Preložnik Zupan I. Congenital erythrocytosis - A condition behind recurrent thromboses: A case report and literature review. Clin Hemorheol Microcirc 2021; 79:417-421. [PMID: 34092623 PMCID: PMC8764587 DOI: 10.3233/ch-211120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Congenital erythrocytosis (CE) is an extremely rare disease and an infrequent cause of heamoglobin and haematocrit elevation. Genetic testing of CE is not widely available. Patients in whom a cause of erythrocytosis is not identified are classified as idiopathic erythrocytosis (IE) patients. In some types of CE thrombotic events have been reported but there is little hard evidence to advise on management in asymptomatic patients. Similarly is true for patients with IE. We describe a young patient who suffered several thromboembolic complications before the diagnosis of CE type 4 was established.
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Affiliation(s)
- Saša Anžej Doma
- Hematology Department, UMC Ljubljana, Slovenia.,Department of Internal medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Aleša Kristan
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Debeljak
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Irena Preložnik Zupan
- Hematology Department, UMC Ljubljana, Slovenia.,Department of Internal medicine, Faculty of Medicine, University of Ljubljana, Slovenia
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Anžej Doma S, Drnovšek E, Kristan A, Fink M, Sever M, Podgornik H, Belčič Mikič T, Debeljak N, Preložnik Zupan I. Diagnosis and management of non-clonal erythrocytosis remains challenging: a single centre clinical experience. Ann Hematol 2021; 100:1965-1973. [PMID: 34013406 PMCID: PMC8285333 DOI: 10.1007/s00277-021-04546-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/19/2021] [Accepted: 05/01/2021] [Indexed: 12/31/2022]
Abstract
Erythrocytosis has a diverse background. While polycythaemia vera has well defined criteria, the diagnostic approach and management of other types of erythrocytosis are more challenging. The aim of study was to retrospectively analyse the aetiology and management of non-clonal erythrocytosis patients referred to a haematology outpatient clinic in an 8-year period using a 3-step algorithm. The first step was inclusion of patients with Hb > 185 g/L and/or Hct > 0.52 in men and Hb > 165 g/L and/or Hct > 0.48 in women on two visits ≥ two months apart, thus confirming true erythrocytosis. Secondly, polycythaemia vera was excluded and secondary causes of erythrocytosis (SE) identified. Thirdly, idiopathic erythrocytosis patients (IE) were referred to next-generation sequencing for possible genetic background evaluation. Of the 116 patients, 75 (65%) are men and 41 (35%) women, with non-clonal erythrocytosis 34/116 (29%) had SE, 15/116 (13%) IE and 67/116 (58%) stayed incompletely characterized (ICE). Patients with SE were significantly older and had significantly higher Hb and Hct compared to patients with IE. Most frequently, SE was attributed to obstructive sleep apnoea and smoking. Phlebotomies were performed in 56, 53 and 40% of patients in the SE, IE, and ICE group, respectively. Approx. 70% of patients in each group received aspirin. Thrombotic events were registered in 12, 20 and 15% of SE, IE and ICE patients, respectively. Congenital erythrocytosis type 4 (ECYT4) was diagnosed in one patient. The study demonstrates real-life management of non-clonal erythrocytosis which could be optimized using a 3-step diagnostic algorithm.
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Affiliation(s)
- Saša Anžej Doma
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Eva Drnovšek
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Aleša Kristan
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Martina Fink
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Matjaž Sever
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Helena Podgornik
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000, Ljubljana, Slovenia
| | - Tanja Belčič Mikič
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Nataša Debeljak
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Irena Preložnik Zupan
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia.
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Kristan A, Gašperšič J, Režen T, Kunej T, Količ R, Vuga A, Fink M, Žula Š, Anžej Doma S, Preložnik Zupan I, Pajič T, Podgornik H, Debeljak N. Genetic analysis of 39 erythrocytosis and hereditary hemochromatosis-associated genes in the Slovenian family with idiopathic erythrocytosis. J Clin Lab Anal 2021; 35:e23715. [PMID: 33534944 PMCID: PMC8059723 DOI: 10.1002/jcla.23715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/10/2020] [Accepted: 01/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Erythrocytosis is a condition with an excessive number of erythrocytes, accompanied by an elevated haemoglobin and/or haematocrit value. Congenital erythrocytosis has a diverse genetic background with several genes involved in erythropoiesis. In clinical practice, nine genes are usually examined, but in approximately 70% of patients, no causative mutation can be identified. In this study, we screened 39 genes, aiming to identify potential disease-driving variants in the family with erythrocytosis of unknown cause. PATIENTS AND METHODS Two affected family members with elevated haemoglobin and/or haematocrit and negative for acquired causes and one healthy relative from the same family were selected for molecular-genetic analysis of 24 erythrocytosis and 15 hereditary haemochromatosis-associated genes with targeted NGS. The identified variants were further analysed for pathogenicity using various bioinformatic tools and review of the literature. RESULTS Of the 12 identified variants, two heterozygous variants, the missense variant c.471G>C (NM_022051.2) (p.(Gln157His)) in the EGLN1 gene and the intron variant c.2572-13A>G (NM_004972.3) in the JAK2 gene, were classified as low-frequency variants in European population. None of the two variants were present in a healthy family member. Variant c.2572-13A>G has potential impact on splicing by one prediction tool. CONCLUSION For the first time, we included 39 genes in the erythrocytosis clinical panel and identified two potential disease-driving variants in the Slovene family studied. Based on the reported functional in vitro studies combined with our bioinformatics analysis, we suggest further functional analysis of variant in the JAK2 gene and evaluation of a cumulative effect of both variants.
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Affiliation(s)
- Aleša Kristan
- Medical Centre for Molecular BiologyFaculty of MedicineInstitute of Biochemistry and Molecular GeneticsUniversity of LjubljanaLjubljanaSlovenia
| | - Jernej Gašperšič
- Medical Centre for Molecular BiologyFaculty of MedicineInstitute of Biochemistry and Molecular GeneticsUniversity of LjubljanaLjubljanaSlovenia
| | - Tadeja Režen
- Centre for Functional Genomics and Bio‐ChipsFaculty of MedicineInstitute of Biochemistry and Molecular GeneticsUniversity of LjubljanaLjubljanaSlovenia
| | - Tanja Kunej
- Department of Animal ScienceBiotechnical FacultyUniversity of LjubljanaLjubljanaSlovenia
| | - Rok Količ
- Kemomed Research and DevelopmentKemomed LtdKranjSlovenia
| | - Andrej Vuga
- Kemomed Research and DevelopmentKemomed LtdKranjSlovenia
| | - Martina Fink
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Špela Žula
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Saša Anžej Doma
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Irena Preložnik Zupan
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Department of Internal MedicineFaculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Tadej Pajič
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Clinical Institute of Genomic MedicineUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Helena Podgornik
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Chair of Clinical BiochemistryFaculty of PharmacyUniversity of LjubljanaLjubljanaSlovenia
| | - Nataša Debeljak
- Medical Centre for Molecular BiologyFaculty of MedicineInstitute of Biochemistry and Molecular GeneticsUniversity of LjubljanaLjubljanaSlovenia
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Anžej Doma S, Škerget M, Pajič T, Sever M. Improved survival of AML patients by addition of cladribine to standard induction chemotherapy. Ann Hematol 2020; 99:519-525. [DOI: 10.1007/s00277-020-03923-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/14/2020] [Indexed: 12/18/2022]
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Debeljak N, Lazarevič J, Miskič D, Vermiglio L, Kopitar A, Solarovič A, Sever M, Fink M, Pajič T, Anžej Doma S, Moškon M, Preložnik Zupan I. Opredelitev eritrocitoz in predlog diagnostičnega algoritma v Sloveniji. ACTA ACUST UNITED AC 2019. [DOI: 10.6016/zdravvestn.2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Eritrocitoza je stanje s povečano maso eritrocitov v telesu. Odrazi se s povečanim hematokritom, zvečano koncentracijo hemoglobina in povečanim številom eritrocitov v krvi. Ločimo absolutno in relativno eritrocitozo. Absolutne oblike pa nato delimo na primarne in sekundarne ter obe skupini še na prirojene in pridobljene. Opredelitev diagnoze pri bolniku je mnogokrat težavna, zato pomemben delež bolnikov ostane diagnostično neopredeljen; govorimo o idiopatični eritrocitozi. Namen prispevka je izboljšati diagnosticiranje in vključiti nove genetske preiskave v klinično prakso v Sloveniji.
Predlagamo razširjen in natančen algoritem za obravnavo eritrocitoz. Opisujemo razvrstitev različnih oblik eritrocitoz, klinično sliko, genetsko ozadje prirojenih eritrocitoz, diagnostične metode in možnosti zdravljenja. Pregledali smo tudi podatke o 5-letnem obdobju obravnave pridobljenih genetskih različic v JAK2 v Sloveniji. Gre za prvo laboratorijsko testiranje z namenom opredeliti vrsto eritrocitoz. S tem smo pridobili osnovni vpogled v razširjenost bolezni v Sloveniji.
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Doma SA, Hillarp A, Pajič T, Andoljšek D, Černelč P, Preldžnik Zupan I. Concurrent acquired inhibitors to factor VIII and IX, a laboratory artifact: a case report. Biochem Med (Zagreb) 2016; 26:279-84. [PMID: 27346976 PMCID: PMC4910271 DOI: 10.11613/bm.2016.033] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/21/2016] [Indexed: 11/23/2022] Open
Abstract
Acquired inhibitors to coagulation factors other than factor VIII are extremely rare. We describe a case of a 59-year-old woman with abnormal bleeding, diagnosed with concurrent inhibitor antibodies to factor VIII and IX by Bethesda testing. We demonstrate that anti-FVIII antibodies of a very high titre are capable of disturbing the aPTT-based Bethesda assay, resulting in falsely-positive antibodies to factor IX. The case also illustrates the usefulness of the immunological assay (ELISA) in complementing the inhibitor diagnosis.
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Affiliation(s)
- Saša Anžej Doma
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
| | - Andreas Hillarp
- Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden ; at the time of the investigation working at the Coagulation laboratory of Malmö Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmö, Sweden
| | - Tadej Pajič
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
| | - Dušan Andoljšek
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
| | - Peter Černelč
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
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