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Warnnissorn N, Kanitsap N, Niparuck P, Boonsakan P, Kulalert P, Limvorapitak W, Bhoopat L, Saengboon S, Suriyonplengsaeng C, Chantrathammachart P, Puavilai T, Chuncharunee S. Adding MYC/BCL2 double expression to NCCN-IPI may not improve prognostic value to an acceptable level. Blood Res 2024; 59:2. [PMID: 38485822 PMCID: PMC10903517 DOI: 10.1007/s44313-024-00006-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND MYC/BCL2 double expression (DE) is associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL) receiving rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). This study aimed to determine whether the addition of DE to the National Comprehensive Cancer Network Internal Prognostic Index (NCCN-IPI) could improve the prediction of disease progression in patients with DLBCL treated with R-CHOP. METHODS This confirmatory prognostic factor study retrospectively recruited patients with newly diagnosed DLBCL between January 1, 2014, and January 31, 2018, at Ramathibodi Hospital (RA) and Thammasat University Hospital (TU). The follow-up period ended on July 1, 2022. Tumors expressing MYC ≥ 40% and BCL2 ≥ 50% were classified as DE. We calculated the hazard ratios (HR) for progression-free survival (PFS) from the date of diagnosis to refractory disease, relapse, or death. Discrimination of the 5-year prediction was based on Cox models using Harrell's concordance index (c-index). RESULTS A total of 111 patients had DE (39%), NCCN-IPI (8%), and disease progression (46%). The NCCN-IPI adjusted HR of DE was 1.6 (95% confidence interval [CI]: 0.9-2.8; P = 0.117). The baseline NCCN-IPI c-index was 0.63. Adding DE to the NCCN-IPI slightly increased Harrell's concordance index (c-index) to 0.66 (P = 0.119). CONCLUSIONS Adding DE to the NCCN-IPI may not improve the prognostic value to an acceptable level in resource-limited settings. Multiple independent confirmatory studies from a large cohort of lymphoma registries have provided additional evidence for the clinical utility of DE.
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Affiliation(s)
- Naree Warnnissorn
- Department of Pathology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
| | - Nonglak Kanitsap
- Division of Hematology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paisarn Boonsakan
- Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prapasri Kulalert
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Wasithep Limvorapitak
- Division of Hematology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Lantarima Bhoopat
- Division of Hematology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Supawee Saengboon
- Division of Hematology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | - Pichika Chantrathammachart
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teeraya Puavilai
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Lao Z, Tse EWC, Chuncharunee S, Kwong YL, Wei A, Ko BS, Kim JS, Ng SC, Wang J, Goh YT. Asia-Pacific Leukemia Consortium: An innovative and collaborative initiative to improve care of leukemia and related diseases in the Asia-Pacific region. Asia Pac J Clin Oncol 2023; 19:655-663. [PMID: 37259880 DOI: 10.1111/ajco.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023]
Abstract
The burden of leukemia and related diseases is rapidly growing in Asia. Currently, there is a paucity of regional collaborative groups/initiatives that focus exclusively on the management of leukemia in the Asia-Pacific (APAC) region. The Asia-Pacific Leukemia Consortium (APLC) was established on the 8 September 2021 to understand the status quo, unmet needs, and ways to improve the management of leukemia and related diseases in the APAC region. The APLC working group set up a group of experts from various countries (Singapore, Malaysia, Thailand, Hong Kong, Japan, South Korea, Taiwan, China, and Australia) to discuss on the status of: (i) clinical trials; (ii) disease registry database; (iii) genetic and tissue repository; (iv) patient advocacy and care; and (v) disease prevention and education in the APAC region. Low levels of awareness about leukemia amongst the public, lack of financial support, and limited access to newly approved therapies were identified as barriers to the implementation of effective leukemia management in low- or mid-income Asian countries. Patients often enroll in clinical trials to gain access to novel/approved therapies. The APLC group aims to address the growing threat of leukemia through a collaborative approach to advance disease prevention, research, clinical trials, and education.
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Affiliation(s)
- Zhentang Lao
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Eric Wai Choi Tse
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | | | - Yok Lam Kwong
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Andrew Wei
- Walter and Eliza Hall Institute and Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Bor Sheng Ko
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Tai-Chen Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Soo Chin Ng
- Department of Hematology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Yeow Tee Goh
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
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Limwongse C, Rojnuckarin P, Kupatawintu P, Thongthaisin A, Permpikul P, Kitpoka P, Watanaboonyongcharoen P, Sucharitchan P, Torcharus K, Fucharoen S, Kongpakwattana K, Nerapusee O, Chuncharunee S. How do we translate gaps and unmet needs of blood management for thalassemia into a collaborative implementation framework? Transfus Med 2023; 33:497-502. [PMID: 37775960 DOI: 10.1111/tme.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/15/2023] [Accepted: 09/09/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The mainstay of management for thalassemia is regular blood transfusions. However, gaps and unmet needs of blood services for thalassemia are still not clearly identified and addressed in Thailand, a country prevalent with thalassemia. What can be a collaborative implementation framework that helps advance practices and policies relating to blood management for thalassemia? METHODS The first Blood & Beyond Roundtable Discussion was held in July 2022 to gather the current situation, gaps, and unmet needs of blood services for thalassemia from multidisciplinary experts and thalassemic patients. The Implementation Guide as suggested by the Centre for Effective Services was applied as a tool to consolidate information from the discussions and construct the collaborative implementation framework. RESULTS The National Blood Center and hospitals in Thailand followed the missions specified in the National Blood Policy and the standard guidelines to ensure the best practice of blood management for thalassemia. However, there were six gaps and unmet needs identified from the discussions. After all discussion points were mapped onto the framework, an implementation plan comprised of five specific activities became clear and actionable. CONCLUSION Without the complete information from both experts and patients, the implementation plan would not have been successfully constructed. The method that we employed to translate all information into the framework can be adapted by other countries to develop their own specific framework efficiently.
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Affiliation(s)
| | | | | | | | - Parichart Permpikul
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pimpan Kitpoka
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Kitti Torcharus
- Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Suthat Fucharoen
- Thalassemia Research Center, Mahidol University, Bangkok, Thailand
| | | | - Osot Nerapusee
- Faculty of Pharmaceutical Science, Chulalongkorn University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Thanhakun R, Wudhikarn K, Bunworasate U, Rattanathammethee T, Norasetthada L, Kanya P, Chaloemwong J, Wongkhantee S, Phiphitaporn P, Chansung K, Jit-Ueakul D, Laoruangroj C, Prayongratana K, Wong P, Julamanee J, Lekhakula A, Chuncharunee S, Niparuck P, Kanitsap N, Makruasi N, Suwanban T, Praditsuktavorn P, Khuhapinant A, Intragumtornchai T. Endothelial activation and stress index as a prognostic factor of diffuse large B-cell lymphoma: the report from the nationwide multi-center Thai Lymphoma Study Group. Ann Hematol 2023; 102:3533-3541. [PMID: 37718327 DOI: 10.1007/s00277-023-05437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
Several prognostic models have been introduced to predict outcomes of patients with diffuse large B-cell lymphoma (DLBCL). Endothelial activation and stress index (EASIX) is a surrogate of endothelial dysfunction which has been shown to predict outcomes of patients with various hematologic malignancies. However, the prognostic implication of EASIX for DLBCL is limited and warrants exploration. We conducted a retrospective study enrolling adult DLBCL patients including a discovery cohort from the single-centered university hospital database and a validation cohort from the independent nationwide multi-center registry. EASIX scores were calculated using creatinine, lactate dehydrogenase, and platelet levels. The receiver operating characteristic curve analysis was used to determine optimal cutoff. Statistical analysis explored the impact of EASIX on survival outcomes. A total of 323 patients were included in the discovery cohort. The optimal EASIX cutoff was 1.07 stratifying patients into low (53.9%) and high EASIX (46.1%) groups. Patients with high EASIX had worse 2-year progression-free survival (PFS) (53.4% vs. 81.5%, p<0.001) and overall survival (OS) (64.4% vs. 88.7%, p<0.001) than patients with low EASIX. Multivariate analysis revealed that older age, bulky disease, impaired performance status, and high EASIX were associated with an unfavorable OS. In the validation cohort of 499 patients, the optimal EASIX cutoff was 1.04. Similar to the discovery cohort, high EASIX score was associated with high-risk diseases, worse PFS, and inferior OS. In conclusion, EASIX score was significantly associated with survival outcomes and may be used as a simple prognostic tool to better risk-classify DLBCL.
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Affiliation(s)
- Ronakrit Thanhakun
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kitsada Wudhikarn
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Udomsak Bunworasate
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | | | - Lalita Norasetthada
- Division of Hematology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Piyapong Kanya
- Division of Hematology, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand
| | | | | | - Pisa Phiphitaporn
- Division of Hematology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kanchana Chansung
- Division of Hematology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dusit Jit-Ueakul
- Division of Hematology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chonlada Laoruangroj
- Division of Hematology, Faculty of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Kannadit Prayongratana
- Division of Hematology, Faculty of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Peerapon Wong
- Division of Hematology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Jakrawadee Julamanee
- Hematology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Arnuparp Lekhakula
- Hematology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pimjai Niparuck
- Division of Hematology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nonglak Kanitsap
- Division of Hematology, Faculty of Medicine, Thammasart University, Bangkok, Thailand
| | - Nisa Makruasi
- Division of Hematology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Tawatchai Suwanban
- Division of Hematology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | | | - Archrob Khuhapinant
- Division of Hematology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanin Intragumtornchai
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
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Leung TW, Damodaran P, Torres R, Chuncharunee S, Chu MY, Gamilla Z, Lim NR, Luna J, Huang JP, Li WH, Tran TN, Sathar J, Jaisamrarn U. Expert consensus on improving iron deficiency anemia management in obstetrics and gynecology in Asia. Int J Gynaecol Obstet 2023; 163:495-509. [PMID: 37096333 DOI: 10.1002/ijgo.14804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023]
Abstract
Iron deficiency anemia (IDA) is a major health burden among women in Asia. Key issues in IDA management in Asia are under-diagnosis and under-treatment. The lack of Asia-specific guidelines, and suboptimal utilization of treatment compounds the management of IDA. To address these gaps, a panel of 12 experts in obstetrics, gynecology, and hematology from six regions in Asia convened to review current practices and clinical evidence and provide practical guidance on IDA diagnosis and management in Asian women. The Delphi approach was used to obtain objective opinions and attain consensus on statements pertaining to awareness, diagnosis, and management of IDA. In total, 79 statements attained consensus and are summarized to provide guidance on raising awareness of IDA and approaches for improved diagnosis and treatment of IDA among women in various settings: pregnancy, postpartum, heavy menstrual bleeding, gynecologic cancers, and perioperative care. This clinician-led consensus integrates appropriate recommendations based on clinical evidence and best practices and is intended to guide decision making in the management of iron deficiency/IDA in women. The expert panel raises a call for timely diagnosis and utilization of appropriate treatment, including use of high-dose intravenous iron, stringent blood management, and interdisciplinary collaboration, for optimization of IDA management among women in Asia.
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Affiliation(s)
- Tsin Wah Leung
- Department of Obstetrics & Gynecology, Kwong Wah Hospital, Hong Kong, China
| | - Premitha Damodaran
- Department of Obstetrics & Gynecology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Rosalio Torres
- Section of Hematology, Makati Medical Center & Cardinal Santos Medical Center, San Juan, The Philippines
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Man Yee Chu
- Department of Obstetrics and Gynecology, Queen Mary Hospital, Hong Kong, China
| | - Zaida Gamilla
- Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Manila, The Philippines
| | | | - Jericho Luna
- Division of Gynecologic Oncology, Philippine General Hospital, Manila, The Philippines
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wai Hou Li
- Division of Obstetrics and Gynecology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Thang Nhat Tran
- Department of Obstetrics and Gynecology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - Jameela Sathar
- Department of Hematology, Ampang Hospital, Selangor, Malaysia
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Tse E, Kwong YL, Goh YT, Bee PC, Ng SC, Tan D, Caguioa P, Nghia H, Dumagay T, Norasetthada L, Chuncharunee S, Radhakrishnan V, Bagal B, Atmakusuma TD, Mulansari NA. Expert consensus on the management of chronic lymphocytic leukaemia in Asia. Clin Exp Med 2023; 23:2895-2907. [PMID: 36795237 PMCID: PMC10543526 DOI: 10.1007/s10238-023-01007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023]
Abstract
In recent years, considerable progress has been made in the standard treatment for chronic lymphocytic leukaemia (CLL) due to the availability of new potent drugs. However, the majority of data on CLL were derived from Western populations, with limited studies and guidelines on the management of CLL from an Asian population perspective. This consensus guideline aims to understand treatment challenges and suggest appropriate management approaches for CLL in the Asian population and other countries with a similar socio-economic profile. The following recommendations are based on a consensus by experts and an extensive literature review and contribute towards uniform patient care in Asia.
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Affiliation(s)
- Eric Tse
- Division of Haematology, Medical Oncology and Haematopoietic Stem Cell Transplant, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China.
| | - Yok Lam Kwong
- 2.Division of Haematology, Medical Oncology and Haematopoietic Stem Cell Transplant, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Ping Chong Bee
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Chin Ng
- Subang Jaya Medical Centre (SJMC), Selangor, Malaysia
| | - Daryl Tan
- Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Priscilla Caguioa
- Section of Haematology, St Luke's Medical Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Huynh Nghia
- Blood Transfusion and Haematology Hospital (BTH), Ho Chi Minh, Vietnam
| | - Teresita Dumagay
- Division of Haematology, Department of Medicine, Philippine General Hospital, Manila, Philippines
| | - Lalita Norasetthada
- Division of Haematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suporn Chuncharunee
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Centre, Parel, India
| | - Tubagus Djumhana Atmakusuma
- Haematology-Medical Oncology Division, Dr. Cipto Mangunkusumo National General Hospital/ Universitas Indonesia, Jakarta, Indonesia
| | - Nadia Ayu Mulansari
- Haematology-Medical Oncology Division, Dr. Cipto Mangunkusumo National General Hospital/ Universitas Indonesia, Jakarta, Indonesia
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Surabotsophon M, Laohachavalit P, Ponglikitmongkol S, Chuncharunee S, Sudsang T, Thanachartwet V, Sahassananda D, Hunsawong T, Klungthong C, Fernandez S, Kalayanarooj S, Desakorn V, Leelasetakul S. Secondary dengue serotype 1 infection causing dengue shock syndrome with rhombencephalitis and bleeding associated with refractory thrombocytopenia: A case report. Heliyon 2023; 9:e17419. [PMID: 37441400 PMCID: PMC10333608 DOI: 10.1016/j.heliyon.2023.e17419] [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: 05/26/2022] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
Background Dengue has a wide spectrum of manifestations, from an asymptomatic condition to dengue shock syndrome. Extensive plasma leakage, severe bleeding, or both, could lead to dengue shock syndrome, a common cause of death in dengue-infected patients. Thrombocytopenia is a common laboratory finding in dengue, which correlates with the disease severity and rapidly resolves during the recovery phase. Therefore, refractory thrombocytopenia is rare in patients with dengue. Rhombencephalitis is an inflammatory disease affecting the hindbrain, rarely associated with dengue. We report the second case of dengue-associated rhombencephalitis, wherein the patient developed dengue shock syndrome and severe bleeding associated with refractory thrombocytopenia. Case report A 47-year-old Thai female with secondary dengue serotype 1 infection developed dengue shock syndrome with rhombencephalitis, manifested as altered sensorium and status epilepticus in the critical phase. Cerebrospinal fluid analysis showed pleocytosis with predominantly mononuclear cells and high protein levels. Magnetic resonance imaging of the brain showed multifocal brain signal abnormalities involving the medulla oblongata, pons, midbrain, bilateral hippocampi, thalami, posterior limb of internal capsules, external capsules, and deep hemispheric white matter. The patient had partial neurological recovery following rhombencephalitis for one month. During the recovery phase, severe bleeding with refractory thrombocytopenia and acute kidney injury were observed. Methylprednisolone with eltrombopag was administered, which resulted in an increased the platelet count, cessation of bleeding and recovery of kidney function within 4 days. Conclusions Dengue is a potential cause of rhombencephalitis. Dengue-associated rhombencephalitis develops during the critical phase, with only partial neurological recovery. However, severe bleeding and refractory thrombocytopenia were also observed during the recovery phase. Methylprednisolone with a thrombopoietin receptor agonist could be an effective treatment for increasing platelet count and stopping bleeding in dengue.
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Affiliation(s)
- Manoon Surabotsophon
- Pulmonary and Critical Care Unit, Department of Medicine, Ramkhamhaeng Hospital, Bangkok 10240, Thailand
| | - Poonsak Laohachavalit
- Endocrine Unit, Department of Medicine, Ramkhamhaeng Hospital, Bangkok 10240, Thailand
| | | | - Suporn Chuncharunee
- Division of Haematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Thanwa Sudsang
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Vipa Thanachartwet
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Duangjai Sahassananda
- Information Technology Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Taweewun Hunsawong
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS) Bangkok 10400, Thailand
| | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS) Bangkok 10400, Thailand
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS) Bangkok 10400, Thailand
| | - Siripen Kalayanarooj
- Dengue Center of Excellence, Queen Sirikit National Institute of Child Health, Ministry of Public Health (MOPH), Bangkok 10400, Thailand
| | - Varunee Desakorn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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8
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Viprakasit V, Hamdy MM, Hassab HMA, Sherief LM, Al-Bagshi M, Khattab M, Chuncharunee S, Dung PC, Küpesiz A, Shekhawat A, Sonawane Y, Perez LT, Slader C, Taher AT. Patient preference for deferasirox film-coated versus dispersible tablet formulation: a sequential-design phase 2 study in patients with thalassemia. Ann Hematol 2023:10.1007/s00277-023-05240-3. [PMID: 37227493 DOI: 10.1007/s00277-023-05240-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/17/2023] [Indexed: 05/26/2023]
Abstract
Iron chelation therapy (ICT) is the mainstay of treatment in patients with thalassemia requiring blood transfusions. This phase 2 JUPITER study evaluated patient preference between film-coated tablet (FCT) and dispersible tablet (DT) in transfusion-dependent thalassemia (TDT) or non-TDT (NTDT) patients treated with both formulations in a sequential manner. The primary endpoint was patient-reported preference for FCT over DT, while secondary outcomes included patient reported outcomes (PROs) evaluated by overall preference, and by age, thalassemia transfusion status, and previous ICT status. Out of 183 patients screened, 140 and 136 patients completed the treatment periods 1 and 2 of the core study, respectively. At week 48, the majority of patients preferred FCT over DT (90.3 vs. 7.5%; difference of percentage: 0.83 [95% confidence interval (CI), 0.75-0.89; P < 0.0001]). FCT scored better on secondary PROs and showed less severe gastrointestinal symptoms than DT, except in the change of modified Satisfaction with Iron Chelation Therapy (mSICT) preference scores, which were similar for both the formulations. Patients with TDT had stable ferritin levels, while it showed a downward trend up to week 48 in patients with NTDT on deferasirox treatment. Overall, 89.9% of patients reported ≥ 1 adverse event (AE), of which 20.3% experienced ≥ 1 serious AE. The most common treatment-emergent AEs were proteinuria, pyrexia, urine protein/creatinine ratio increase, diarrhea, upper respiratory tract infections, transaminase increase, and pharyngitis. Overall, this study reinforced the observations from the previous study by showing a distinct patient preference for FCT over DT formulation and further supported the potential benefits of life-long compliance with ICT.
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Affiliation(s)
- Vip Viprakasit
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, 10700, Thailand
| | - Mona M Hamdy
- Clinical Research Center, Cairo University, Cairo, 11562, NA, Egypt
| | - Hoda M A Hassab
- Pediatric Department & Clinical Research Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Laila M Sherief
- Faculty of Medicine, Zagazig University, Zagazig Sharqia, 44519, Egypt
| | | | - Mohammed Khattab
- Centre d'Hématologie Et d'oncologie Pédiatrique - CHU Ibn Sina Rabat, 10102, Rabat, Morocco
| | | | - Phu Chi Dung
- Hochiminh City Blood Transfusion Hematology Hospital, Ho Chi Minh City, 700000, Vietnam
| | | | | | - Yamini Sonawane
- Novartis Healthcare Private Limited, Hyderabad, India, 500081
| | | | | | - Ali T Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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9
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Warnnissorn N, Kanitsap N, Niparuck P, Boonsakan P, Kulalert P, Limvorapitak W, Bhoopat L, Saengboon S, Chantrathammachart P, Puavilai T, Chuncharunee S. External validation and comparison of IPI, R-IPI, and NCCN-IPI in diffuse large B-cell lymphoma patients treated with R-CHOP to predict 2-year progression-free survival. Hematology 2022; 27:1237-1245. [DOI: 10.1080/16078454.2022.2147916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Naree Warnnissorn
- Department of Pathology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Nonglak Kanitsap
- Hematology Division, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paisarn Boonsakan
- Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prapasri Kulalert
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Wasithep Limvorapitak
- Hematology Division, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Lantarima Bhoopat
- Hematology Division, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Supawee Saengboon
- Hematology Division, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pichika Chantrathammachart
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teeraya Puavilai
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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10
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Polprasert C, Kongkiatkamon S, Niparuck P, Rattanathammethee T, Wudhikarn K, Chuncharunee S, Kobbuaklee S, Suksusut A, Lanamtieng T, Lawasut P, Asawapanumas T, Bunworasate U, Rojnuckarin P. Genetic mutations associated with blood count abnormalities in myeloid neoplasms. Hematology 2022; 27:765-771. [PMID: 35766510 DOI: 10.1080/16078454.2022.2094134] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Myelodysplastic syndromes (MDS) predominantly present with varying degrees of cytopenia, while myelodysplastic syndromes/myeloproliferative neoplasms (MDS/MPN) exhibit proliferative features. Genetic defects underlying different complete blood count (CBC) alterations remain to be defined. OBJECTIVE We aimed to evaluate mutations and impacts on abnormal blood counts in MDS and MDS/MPN. METHOD MDS and MDS/MPN patients were recruited and sequenced by targeted next-generation sequencing. Clinical parameters, especially CBC, were evaluated for the association with genetic abnormalities and clinical outcomes. RESULTS A total of 168 patients with myeloid neoplasms were recruited (92 cases of low-risk MDS, 57 cases of high-risk MDS and 19 cases of MDS/MPN). Compared to low-risk MDS and MDS/MPN, patients with high-risk MDS were presented with more severe neutropenia with 17.5% showing absolute neutrophil counts (ANC) lower than 0.5 × 109/L. Patients with MDS/MPN more commonly harboured mutations and had a higher number of mutations per case than low-risk MDS (94.7% vs. 56.5%; p < 0.001 and 3 vs. 1; p < 0.001, respectively). Patients with SF3B1 mutations showed lower haemoglobin levels than wild-type (7.9 vs. 8.4 g/dL, p = 0.02), but were associated with normal platelet counts (286 vs. 93 × 109/L; p < 0.001). Patients with U2AF1 mutations were associated with more severe leukopenia than wild-type (3 vs. 4.18 × 109/L; p = 0.02). KRAS mutations were associated with monocytosis (p < 0.001). Multivariate analysis revealed high-risk MDS, MDS/MPN, severe neutropenia (ANC < 0.5 × 109/L), and mutations in ASXL1 and SETBP1 were associated with inferior survival outcomes. CONCLUSION Certain mutations were related to more severe anaemia, lower white blood cell count or monocytosis in Asian MDS and MDS/MPN patients.
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Affiliation(s)
- Chantana Polprasert
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Sunisa Kongkiatkamon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Pimjai Niparuck
- Department of Medicine, Faculty of Medicine, Mahidol University Ramathibodi hospital, Bangkok, Thailand
| | | | - Kitsada Wudhikarn
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Department of Medicine, Faculty of Medicine, Mahidol University Ramathibodi hospital, Bangkok, Thailand
| | - Sirorat Kobbuaklee
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Amornchai Suksusut
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Theerin Lanamtieng
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Panisinee Lawasut
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Thiti Asawapanumas
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Udomsak Bunworasate
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Ponlapat Rojnuckarin
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
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11
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Polprasert C, Niparuck P, Rattanathammethee T, Chuncharunee S, Kobbuaklee S, Songserm K, Suksusut A, Trithiphen S, Lanamtieng T, Kongkiatkamon S, Chanswangphuwana C, Lawasut P, Bunworasate U, Rojnuckarin P. Excellent Prognosis of Low-Risk Myelodysplastic Syndromes (MDS) Without Detectable Myeloid-Related Mutations. Clin Lymphoma Myeloma Leuk 2022; 22:e293-e299. [PMID: 34840089 DOI: 10.1016/j.clml.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Unexplained cytopenia (UC) and low-risk myelodysplastic syndrome (MDS) are distinguished mainly by morphologic dysplasia, which sometimes shows inter-observer discrepancy. We hypothesized that gene mutations are strong prognostic factors for these low-risk patients. MATERIALS AND METHODS We enrolled patients from 4 medical centers with unexplained cytopenia of at least 1 lineage. Diagnosis of low-risk MDS was made according to WHO 2016 classification and a revised international prognostic scoring system (R-IPSS) score of ≤ 3.5. DNA was extracted from bone marrow or blood and sequenced by targeted next generation sequencing (NGS). RESULTS One hundred twenty-one patients were recruited: 25% with UC and 75% with low-risk MDS. Complete blood counts were similar, but low-risk MDS patients carried higher numbers of mutations (1 vs. 0; P = .04) than UC patients. Overall, the most frequent mutated genes were TET2 (14.6%), SF3B1 (12.2%), and ASXL1 (9.7%). Survival rates of low-risk MDS patients versus UC patients were not significantly different. UC patients and low-risk MDS patients without genetic abnormalities showed superior 5-year progression free survival compared to MDS patients with mutations (100% vs. 76.0%; P = .005). Overall, ASXL1 mutations were associated with decreased 4-year overall survival compared to wild-type (59% vs. 31%; P = .01). In a multivariate analysis, ASXL1 and DNMT3A mutations in low-risk MDS patients were associated with a higher risk of disease progression with hazard ratios of 7.88 (95% CI 1.76-35.32, P = .01) and 7.45 (95% CI 1.61-34.46, P = .01), respectively. CONCLUSION Mutation detection is important for proper risk stratification of patients presenting with idiopathic cytopenia.
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Affiliation(s)
- Chantana Polprasert
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Pimjai Niparuck
- Department of Medicine, Faculty of Medicine, Mahidol University Ramathibodi hospital, Bangkok, Thailand
| | | | - Suporn Chuncharunee
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
| | - Sirorat Kobbuaklee
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Kritanan Songserm
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Amornchai Suksusut
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sasinipa Trithiphen
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Theerin Lanamtieng
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sunisa Kongkiatkamon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Chantiya Chanswangphuwana
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Panisinee Lawasut
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Udomsak Bunworasate
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Ponlapat Rojnuckarin
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand.
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12
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Sasiprapha T, Pussadhamma B, Sibmooh N, Sriwantana T, Pienvichit P, Chuncharunee S, Yingchoncharoen T. Efficacy and safety of inhaled nitrite in addition to sildenafil in thalassemia patients with pulmonary hypertension: A 12-week randomized, double-blind placebo-controlled clinical trial. Nitric Oxide 2022; 120:38-43. [PMID: 35026396 DOI: 10.1016/j.niox.2021.12.009] [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: 10/14/2021] [Revised: 12/03/2021] [Accepted: 12/30/2021] [Indexed: 01/19/2023]
Abstract
Pulmonary hypertension is a significant complication in thalassemia patients. Recent studies showed that inhaled nebulized nitrite could rapidly decrease pulmonary artery pressure. We conducted a multicenter, randomized, double-blind, placebo-controlled trial in thalassemia patients with symptomatic pulmonary hypertension diagnosed by right heart catheterization. Eleven patients were recruited; five were assigned to the nitrite group and six to the placebo group. Patients were treated with the optimal doses of sildenafil for pulmonary hypertension and randomly assigned into the placebo or nitrite groups. Patients in the nitrite group were given inhaled nebulized 30 mg sodium nitrite twice a day for 12 weeks. The clinical outcomes measured at week 12 were the changes in 6-min walk distance (6MWD), mean pulmonary artery pressure (MPAP), and N-terminal pro B-type natriuretic peptide. The MPAP estimated by echocardiography was significantly reduced from 33.6 ± 7.5 mmHg to 25.8 ± 6.0 mmHg (mean difference = 7.76 ± 3.69 mmHg, p = 0.009 by paired t-test). Furthermore, 6MWD was slightly increased from 382.0 ± 54.0 m to 432 ± 53.9 m (mean difference = 50.0 ± 42.8 m, p = 0.059 by paired t-test) in the nitrite group. At week 12, the nitrite group had lower MPAP than the placebo group (25.8 ± 6.0 vs. 45.7 ± 18.5 mmHg, p = 0.048 by unpaired t-test). No significant difference in 6MWD and N-terminal pro B-type natriuretic peptide between the two groups was observed at week 12. There was no hypotension or other significant adverse effects in the nitrite group.
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Affiliation(s)
- Thinnakrit Sasiprapha
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Burabha Pussadhamma
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine Srinagarind Hospital, Khonkaen University, Thailand
| | - Nathawut Sibmooh
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 111, Bang Pla, Bang Phli, Samut Prakan, Thailand
| | - Thanaporn Sriwantana
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 111, Bang Pla, Bang Phli, Samut Prakan, Thailand
| | - Pavit Pienvichit
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Suporn Chuncharunee
- Hematology Unit, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Teerapat Yingchoncharoen
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
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13
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Rungwittayatiwat S, Boonsakan P, Chantrathammachart P, Puavilai T, Pukiat S, Phusanti S, Boonyawat K, Wacharapornin P, Angchaisuksiri P, Ungkanont A, Chuncharunee S, Niparuck P. Treatment Outcomes and Clinical Relevance in Patients with Double Expressor DLBCL. Mediterr J Hematol Infect Dis 2021; 13:e2021063. [PMID: 34804437 PMCID: PMC8577552 DOI: 10.4084/mjhid.2021.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Double-expressor lymphoma (DEL) was found to account for 20-30% of DLBCL. We conducted this study to analyze the survival, the clinical presentation, and the factors associated with treatment outcomes in DEL-DLBCL. METHODS A retrospective study of 291 patients diagnosed with DLBCL during January 2015 - December 2018 was conducted. RESULTS Of the 291 patients, the median age was 63 years, germinal center B cell-like DLBCL (GCB) and non-GCB subtypes were found in 32% and 68%, respectively. DEL was found in 46% of 264 patients with available immunohistochemistry staining for MYC protein. Patients with DEL was significantly more common in elderly patients (p= 0.017) and non-GCB subtype (p= 0.006). High serum lactate dehydrogenase (LDH) levels and high Ki-67 index were significantly found in DEL patients than non-DEL patients (p= 0.024 and p= 0.04, respectively). The 3y-OS rate was shorter in the DEL group than in the non-DEL group, 58.7% versus 78.9% (p=0.026), whereas no significant difference in 3y-DFS was identified between these groups (58.4% versus 67.7%, p= 0.343). Independent factors affecting OS and DFS in DEL patients were ECOG 3-4, high LDH levels, extranodal involvement> 1 site, high IPI, and stage III-IV in univariate analysis. CONCLUSIONS High incidence of DEL was observed in this study, especially in patients aged 60 years or older and non-GCB subtype. Patients with DEL showed dismal DFS and OS.
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Affiliation(s)
- Sirapat Rungwittayatiwat
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paisarn Boonsakan
- Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichika Chantrathammachart
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teeraya Puavilai
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sulada Pukiat
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sithakom Phusanti
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Medicine, Chakri Naruebodindra Medical Institute, Mahidol University, Bangkok, Thailand
| | - Kochawan Boonyawat
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pathawut Wacharapornin
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Artit Ungkanont
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Medicine, Chakri Naruebodindra Medical Institute, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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14
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Niparuck P, Police P, Noikongdee P, Siriputtanapong K, Limsuwanachot N, Rerkamnuaychoke B, Chuncharunee S, Siriboonpiputtana T. TP53 mutation in newly diagnosed acute myeloid leukemia and myelodysplastic syndrome. Diagn Pathol 2021; 16:100. [PMID: 34717674 PMCID: PMC8557522 DOI: 10.1186/s13000-021-01162-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives TP53 mutation is found frequently in therapy related acute myeloid leukemia (AML)/ myelodysplastic syndrome (MDS), AML and MDS patients with monosomy or complex karyotype. However, the prevalence and treatment outcome in TP53 mutated AML/MDS patients in Asian population are scarce. We therefore conducted this study to analyze the prevalence and the treatment outcomes of TP53 mutation in AML and MDS-EB patients. Methods Patients with newly diagnosed AML and MDS-EB were recruited, extraction of deoxyribonucleic acid from bone marrow samples were done and then performing TP53 mutation analysis, using MassArray® System (Agena Bioscience, CA, USA). Results A total of 132 AML/MDS patients were recruited, patients with de novo AML, secondary AML, MDS-EB1, MDS-EB2 and T-AML/MDS were seen in 66, 13, 9, 9 and 3%, respectively. TP53 mutation was found in 14 patients (10.6%), and prevalence of TP53 mutation in T-AML/MDS, secondary AML, de novo AML and MDS-EB patients were 50, 17.6, 9.2 and 8%, respectively. Three patients had double heterozygous TP53 mutation. Mutated TP53 was significantly detected in patients with monosomy and complex chromosome. Common TP53 mutation were R290C, T220C, A249S and V31I which V31I mutation was reported only in Taiwanese patients. Most variant allele frequency (VAF) of TP53 mutation in the study were greater than 40%. Three year-overall survival (OS) in the whole population was 22%, 3y-OS in AML and MDS-EB patients were 22 and 27%, respectively. The 1y-OS in patients with TP53-mutant AML/MDS were shorter than that in TP53 wild-type patients, 14% versus 50%, P = 0.001. In multivariate analysis, factors affecting OS in 132 AML/MDS patients was mutant TP53 (P = 0.023, HR = 1.20–7.02), whereas, WBC count> 100,000/μL (P = 0.004, HR = 1.32–4.16) and complex karyotype (P = 0.038, HR = 1.07–9.78) were associated with shorter OS in AML patients. Discussion In this study, the prevalence of TP53 mutation in de novo AML and MDS-EB patients were low but it had impact on survival. Patients with monosomy or complex karyotype had more frequent TP53 mutation.
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Affiliation(s)
- Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pornnapa Police
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phichchapha Noikongdee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanchana Siriputtanapong
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nittaya Limsuwanachot
- Human Genetics Laboratory, Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Budsaba Rerkamnuaychoke
- Human Genetics Laboratory, Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Siriboonpiputtana
- Human Genetics Laboratory, Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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15
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Kamseng P, Siriboonpiputtana T, Puavilai T, Chuncharunee S, Paisooksantivatana K, Chareonsirisuthigul T, Junking M, Chiraphapphaiboon W, Yenchitsomanus PT, Rerkamnuaychoke B. Targeting UCHL1 Induces Cell Cycle Arrest in High-Risk Multiple Myeloma with t(4;14). Pathol Oncol Res 2021; 27:606567. [PMID: 34257568 PMCID: PMC8262241 DOI: 10.3389/pore.2021.606567] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022]
Abstract
Multiple myeloma (MM) patients considered to be at high cytogenetic risk commonly fail to respond to standard treatment. A thorough understanding of the molecular mechanism of MM development is, therefore, needed. We endeavored to explore the transcriptional signature among different subgroups of newly diagnosed MM using gene chip-based expression microarray. Bone marrow samples of 15 newly diagnosed Thai MM patients were included. The chromosomal translocation t(4;14) was the most frequently identified genetic alteration in the high-risk subgroup. Cluster analysis from expression profiling demonstrated that high-risk MM have a distinctly different expression pattern compared to standard-risk patients. The most significant differentially expressed gene was UCHL1. Functional enrichment analysis by Gene Set Enrichment Analysis, FUNRICH, and Gene Ontology Panther pathway revealed the gene sets involved in cell cycle control to be enriched in the t(4;14) high-risk group. Interestingly, among the well-established downstream targets of UCHL1, only CCND2 was significantly expressed in the t(4;14) high-risk group. Suppression of UCHL1 protein level by LDN-5744 inhibitor could arrest the cell cycle in G1 phase in cell lines. These findings shed light on the molecular mechanism of UCHL1 in t(4;14) high-risk MM and support the evidence that alteration of the UCHL1 pathway may play a role in the pathogenesis of high-risk MM.
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Affiliation(s)
- Parin Kamseng
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Teeraya Puavilai
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Karan Paisooksantivatana
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Takol Chareonsirisuthigul
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mutita Junking
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wannasiri Chiraphapphaiboon
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pa-Thai Yenchitsomanus
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Budsaba Rerkamnuaychoke
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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16
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Wudhikarn K, Bunworasate U, Julamanee J, Lekhakula A, Ekwattanakit S, Khuhapinant A, Niparuck P, Chuncharunee S, Numbenjapon T, Prayongratana K, Kanitsap N, Wongkhantee S, Makruasi N, Wong P, Norasetthada L, Nawarawong W, Sirijerachai C, Chansung K, Suwanban T, Praditsuktavorn P, Intragumtornchai T. Event-free survival at 12 months is a strong surrogate endpoint for stage 1 diffuse large B cell lymphoma: a report from Nation Wide Registry Thai Lymphoma Study Group. Leuk Lymphoma 2020; 61:2614-2621. [PMID: 32573294 DOI: 10.1080/10428194.2020.1780586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Event-free survival at 12 months (EFS12) is a surrogate endpoint for long-term outcomes in many histologic lymphoma subtypes. However, most reports have primarily investigated the implication of EFS12 in advanced-stage non-Hodgkin lymphoma (NHL). There are limited data regarding the significance of EFS12 in early-stage NHL. Herein, we evaluated the prognostic significance of EFS12 in patients with stage 1 diffuse large B-cell lymphoma (DLBCL). Out of 282 patients with stage 1 DLBCL who received intensive therapy, 227 (80.5%) achieved EFS12. The 4-year overall survival (OS) was 91.4% and 4.0% for patients who achieved and failed to achieve EFS12, respectively. Multivariable analyses demonstrated response to treatment and achievement of EFS12 as independent predictors for OS. In conclusion, our study demonstrated EFS12 as a powerful prognostic factor for stage 1 DLBCL. Further validation in more extensive prospective studies is warranted.
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Affiliation(s)
- Kitsada Wudhikarn
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Udomsak Bunworasate
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakrawadee Julamanee
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Arnuparp Lekhakula
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Supachai Ekwattanakit
- Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Archrob Khuhapinant
- Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pimjai Niparuck
- Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tontanai Numbenjapon
- Department of Internal Medicine, Faculty of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Kannadit Prayongratana
- Department of Internal Medicine, Faculty of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nonglak Kanitsap
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - Somchai Wongkhantee
- Department of Internal Medicine, Khonkaen Regional Hospital, Khon Kaen, Thailand
| | - Nisa Makruasi
- Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Peerapon Wong
- Department of Internal Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Lalita Norasetthada
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Weerasak Nawarawong
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chittima Sirijerachai
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kanchana Chansung
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Pannee Praditsuktavorn
- Department of Internal Medicine, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Tanin Intragumtornchai
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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17
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Wudhikarn K, Bunworasate U, Julamanee J, Lekhakula A, Ekwattanakit S, Khuhapinant A, Niparuck P, Chuncharunee S, Numbenjapon T, Prayongratana K, Kanitsap N, Wongkhantee S, Makruasri N, Wong P, Norasetthada L, Nawarawong W, Sirijerachai C, Chansung K, Suwanban T, Praditsuktavorn P, Intragumtornchai T. Event free survival at 24 months is a strong surrogate prognostic endpoint of peripheral T cell lymphoma. Hematol Oncol 2019; 37:578-585. [PMID: 31702065 DOI: 10.1002/hon.2687] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
Event free survival at 24 months (EFS24) has been described as a powerful predictor for outcome in several subtypes of B cell lymphoma. However, it was limitedly described in T cell lymphoma. We explored the implication of EFS24 as a predictor marker for peripheral T cell lymphoma (PTCL). We reviewed 293 systemic PTCL patients at 13 nationwide major university hospitals in Thailand from 2007 to 2014. The median event free survival (EFS) and overall survival (OS) of PTCL patients in our cohort was 16.3 and 27.7 months with corresponding 2-year EFS and 2-year OS of 45.8% and 51.9%, respectively. A total of 118 patients achieved EFS24 (no events during the first 24 mo). Patients who achieved EFS24 had better OS than patients who did not (2-y OS 92% vs 18.8%; HR, 0.1; P < .001). The standardized mortality ratio of patients achieving EFS24 was 18.7 (95% CI, 14.6-22.8). Multivariable analysis demonstrated performance status, histologic subtype, remission status, and EFS24 achievement as independent predictors for OS. Our study affirmed the value of EFS24 as a powerful prognostic factor for PTCL. Further validation in prospective study setting is warranted.
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Affiliation(s)
- Kitsada Wudhikarn
- Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Udomsak Bunworasate
- Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Supachai Ekwattanakit
- Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Archrob Khuhapinant
- Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pimjai Niparuck
- Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tontanai Numbenjapon
- Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Kannadit Prayongratana
- Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nonglak Kanitsap
- Department of Internal Medicine, Thammasart University, Bangkok, Thailand
| | - Somchai Wongkhantee
- Department of Internal Medicine, Khonkaen Regional Hospital, Khon Kaen, Thailand
| | - Nisa Makruasri
- Department of Internal Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Peerapon Wong
- Department of Internal Medicine, Naresuan University, Phitsanulok, Thailand
| | - Lalita Norasetthada
- Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Weerasak Nawarawong
- Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Kanchana Chansung
- Department of Internal Medicine, Khon Kaen University, Khon Kaen, Thailand
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18
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Polprasert C, Takeda J, Niparuck P, Rattanathammethee T, Pirunsarn A, Suksusut A, Kobbuaklee S, Wudhikarn K, Lawasut P, Kongkiatkamon S, Chuncharunee S, Songserm K, Phowthongkum P, Bunworasate U, Nannya Y, Yoshida K, Makishima H, Ogawa S, Rojnuckarin P. Novel DDX41 variants in Thai patients with myeloid neoplasms. Int J Hematol 2019; 111:241-246. [PMID: 31713024 DOI: 10.1007/s12185-019-02770-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 12/24/2022]
Abstract
Germline DDX41 mutations were recently reported to cause MDS/AML and donor-derived leukemia after transplantation. While previously described in Western countries, DDX41 variants have not been reported in a Southeast Asian population. We performed targeted sequencing of blood or bone marrow samples from 109 Thai patients with myeloid malignancies. Among the 109 patients (75 MDS, 8 MPN, 11 MDS/MPN and 15 AML), the most frequent mutations were in ASXL1 (17.4%), TET2 (16.5%) and SRSF2 (12.8%), respectively. DDX41 variants were detectable in six (5.5%) cases. Four patients exhibited three presumable germline DDX41 mutations: p.S21fs (n = 2), p.F235fs (n = 1), and p.R339H (n = 1). While p.S21fs was previously reported in myeloid neoplasm, the latter two variants have not been described. Two of these cases harbored concomitant probable germline/somatic DDX41 mutations (p.S21fs/p.R525H and p.R339H/p.K494T), while the other two patients carried only somatic mutations (p.R525H and p.F438L). The p.K494T and p.F438L variants have not been previously reported. In patients with DDX41 alterations, the diagnoses were MDS with excess blasts (4), secondary AML (1) and low-risk MDS (1). In conclusion, we identified DDX41 variants in Thai patients with myeloid malignancies in which these variants could be used to assess predisposition to MDS in Southeast Asia.
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Affiliation(s)
- Chantana Polprasert
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
- Research Collaborations in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
| | - June Takeda
- Department of Pathology and Tumor Biology, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8510, Japan
| | - Pimjai Niparuck
- Department of Medicine, Faculty of Medicine, Mahidol University Ramathibodi Hospital, Bangkok, Thailand
| | | | - Arunrat Pirunsarn
- Department of Medicine, Buddhasothorn Hospital, Chachengsao, Thailand
| | - Amornchai Suksusut
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Sirorat Kobbuaklee
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
- Research Collaborations in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
| | - Kitsada Wudhikarn
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
- Research Collaborations in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
| | - Panisinee Lawasut
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
- Research Collaborations in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
| | - Sunisa Kongkiatkamon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
- Research Collaborations in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Department of Medicine, Faculty of Medicine, Mahidol University Ramathibodi Hospital, Bangkok, Thailand
| | - Kritanan Songserm
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Prasit Phowthongkum
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Udomsak Bunworasate
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
- Research Collaborations in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
| | - Yasuhito Nannya
- Department of Pathology and Tumor Biology, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8510, Japan
| | - Kenichi Yoshida
- Department of Pathology and Tumor Biology, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8510, Japan
| | - Hideki Makishima
- Department of Pathology and Tumor Biology, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8510, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8510, Japan.
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
- Department of Medicine, Centre for Haematology and Regenerative Medicine, Karolinska Institute, Solnavägen 1, 171 77, Solna, Stockholm, Sweden.
| | - Ponlapat Rojnuckarin
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
- Research Collaborations in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand.
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19
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Sasiprapha T, Pussadhamma B, Sibmooh N, Chuncharunee S, Sritara P, Yingchoncharoen T. P3672Effects of inhaled nitrite in addition to sildenafil in thalassemia patients with pulmonary hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0527] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension is the major morbidity and mortality in patients with thalassemia. Recent studies have found that inhaled nebulized nitrite can significantly decrease pulmonary pressure in immediate response, but data are needed to determine its clinical benefits.
Methods
We conducted a multicenter, randomized, double-blind, placebo-controlled trial including thalassemia patients with symptomatic pulmonary hypertension, diagnosed by right heart catheterization and were currently treated with sildenafil. Patients continued the optimum dose of sildenafil and were randomly assigned into 2 groups; the treatment group and the control group. The treatment group was given 30 mg of inhaled nebulized nitrite twice a day for 3 months while the control group was given inhaled normal saline. The outcomes were the improvement of clinical and echocardiographic parameters at 1 and 3 months.
Results
A total of 12 patients were recruited, 5 were assigned to the treatment group and 7 to the control group. The median of sildenafil in both group were 60 mg/day. Treatment with the inhaled nebulized nitrite in addition to sildenafil significantly reduced the mean pulmonary artery pressure at 3 months when compared to placebo (median −7.30 mmHg in treatment group vs +2.30 mmHg in control group, P=0.016). In the treatment group, the median 6-minute walk distance was significantly increased from 380 m to 427 m. at 1 month (P=0.043) but there was no significant difference in the median change of 6-minute walk distance when compared to control group at 3 months (+48 m. in treatment group vs +17.5 m. in control group, P=0.286). No significant difference in NT-proBNP change between the two groups was detected. There were no hypotension or other major adverse effects in the treatment group.
Clinical and Echoparemeters Outcome
Conclusions
The addition of inhaled nebulized nitrite to sildenafil can decrease mean pulmonary pressure and has a tendency to improve six minutes walk distance in thalassemia patients with pulmonary hypertension.
Acknowledgement/Funding
Cooley's anemia foundation, Mahidol university research funding
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Affiliation(s)
- T Sasiprapha
- Ramathibodi Hospital of Mahidol University, Bangkok, Thailand
| | | | - N Sibmooh
- Ramathibodi Hospital of Mahidol University, Bangkok, Thailand
| | - S Chuncharunee
- Ramathibodi Hospital of Mahidol University, Bangkok, Thailand
| | - P Sritara
- Ramathibodi Hospital of Mahidol University, Bangkok, Thailand
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20
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Niparuck P, Boonsakan P, Sutthippingkiat T, Pukiat S, Chantrathammachart P, Phusanti S, Boonyawat K, Puavilai T, Angchaisuksiri P, Ungkanont A, Chuncharunee S, Atichartakarn V. Treatment outcome and prognostic factors in PCNSL. Diagn Pathol 2019; 14:56. [PMID: 31189479 PMCID: PMC6563360 DOI: 10.1186/s13000-019-0833-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/26/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives Standard treatment with a thiotepa-based regimen in countries with a limited resource is less feasible. Aims of the study were to evaluate the treatment outcome, and identify the prognostic factors in patients with primary central nervous system lymphoma (PCNSL). Methods We conducted a retrospective study of 43 patients diagnosed with PCNSL, DLBCL subtype, who were treated with either HDMTX-based regimen, whole brain radiotherapy (WBRT), or both between 2010 and 2017. Results There were 43 patients with a median age of 65 years (range 34–89 years). Protein expression of CD10, Bcl6, MUM1, Bcl2 and MYC were found in 19, 86, 91, 91 and 23%, respectively. Both germinal center B cell (GCB) and double-expressor (MYC+/Bcl2+) lymphomas were found in 21%. Multiple brain lesions and maximum tumor diameter (MTD) ≥5 cm were seen in 27 and 10 patients, respectively. Chemotherapy combined with WBRT, chemotherapy and WBRT were given to 20, 14 and 9 patients, respectively. Overall complete remission (CR) rate was 55.8%. Those receiving a combined-modality therapy had a higher CR rate than those treated with either chemotherapy (75% versus 36%, p = 0.036) or WBRT (75% versus 44%, p = 0.109). Median follow-up time was 17 months, and a 7-year overall survival (OS) was 40%. Features associated with a prolonged OS were an ECOG score ≤ 2 (p = 0.001), multiple brain lesions (p = 0.010), multiple area of brain involvement (p = 0.023), MTD < 5 cm (p = 0.004), GCB subtype (p = 0.003) and positive CD10 staining (p = 0.007). Expression of Bcl2 protein was associated with a significantly worse OS in the non-GCB DLBCL patients. Discussion The factors affecting treatment outcomes in PCNSL were cell of origin of DLBCL, lesion characteristics, patients’ status and treatment regimen.
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Affiliation(s)
- Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Paisarn Boonsakan
- Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Taksayut Sutthippingkiat
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sulada Pukiat
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichika Chantrathammachart
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sithakom Phusanti
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, ChakriNaruebodindra Medical Institute, Mahidol University, Bangkok, Thailand
| | - Kochawan Boonyawat
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teeraya Puavilai
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Artit Ungkanont
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, ChakriNaruebodindra Medical Institute, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vichai Atichartakarn
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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21
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Chuncharunee S, Teawtrakul N, Siritanaratkul N, Chueamuangphan N. Review of disease-related complications and management in adult patients with thalassemia: A multi-center study in Thailand. PLoS One 2019; 14:e0214148. [PMID: 30893381 PMCID: PMC6426207 DOI: 10.1371/journal.pone.0214148] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/07/2019] [Indexed: 11/18/2022] Open
Abstract
Disease-related complications and management are different among patients with thalassemia. This study was aimed to review the prevalence, clinical risk factors for the complications and the management in patients with thalassemia in Thailand. A multicenter cross-sectional study was conducted in patients with thalassemia aged ≥ 18 years old. Thalassemia-related complications and management were reviewed. The clinical parameters significantly associated with the complications were analyzed by logistic regression methods. The prevalence of thalassemia-related complications was 100% in patients with transfusion-dependent thalassemia (TDT) and 58.8% in patients with non-transfusion-dependent thalassemia (NTDT). Advanced age was statistically associated with extramedullary hematopoiesis in both TDT and NTDT patients. Splenectomy was a significant risk factor for pulmonary hypertension in both groups of patients. Severe iron overload started earlier in patients with TDT than NTDT and was associated with diabetes mellitus (adjusted odds ratio (AOR) = 6.2, p-value = 0.02). Disease-related complications are more prevalent in patients with TDT than patients with NTDT. Splenectomy and advanced age were important risk factors for developing major complications in both groups. Early screening and management for specific disease-related complications should be considered in patients with thalassemia according to their clinical risk factors.
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Affiliation(s)
- Suporn Chuncharunee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nattiya Teawtrakul
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
- * E-mail:
| | - Noppadol Siritanaratkul
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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22
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Niparuck P, Limsuwanachot N, Pukiat S, Chantrathammachart P, Rerkamnuaychoke B, Magmuang S, Phusanti S, Boonyawat K, Puavilai T, Angchaisuksiri P, Ungkanont A, Chuncharunee S. Cytogenetics and FLT3-ITD mutation predict clinical outcomes in non transplant patients with acute myeloid leukemia. Exp Hematol Oncol 2019; 8:3. [PMID: 30729065 PMCID: PMC6354374 DOI: 10.1186/s40164-019-0127-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/21/2019] [Indexed: 12/27/2022] Open
Abstract
Background Cytogenetic abnormalities and mutated genes indicate the role of consolidation therapy with hematopoietic stem cell transplantation (HSCT) or chemotherapy in acute myeloid leukemia (AML). In this study, we conducted a retrospective study in adult AML patients with newly diagnosed with de novo AML who did not undergo HSCT, to study long term relapse free survival (RFS) and overall survival (OS) after consolidation chemotherapy. Methods We recruited 141 consecutive AML patients during January 2010–June 2017, the patients received induction chemotherapy with standard dose Ara-C and Idarubicin (7 + 3 or 5 + 2 regimen) followed by intermediate (IDAC) or high dose Ara-c (HiDAC) consolidation therapy. Results Normal karyotype, complex, favorable, intermediate and adverse chromosomal aberrations were found in 59%, 16%, 5%, 14% and 6%, respectively. Mutated NPM1, FLT3-ITD and CEBPA genes in CN-AML were seen in 33%, 18% and 19%, respectively. A 5 year follow up, 5y-RFS was 16% and 5y-OS was 14% in the whole study population. 5y-RFS and 5y-OS in patients completed 4 cycles of consolidation therapy were 25% and 40%, respectively. Adverse cytogenetic risk and mutated FLT3-ITD were significantly associated with poor RFS (9 and 15 months, respectively) and OS (14 and 16 months, respectively), whereas patients with mutant NPM1 had favorable outcomes (RFS/OS = 51/63 months). Patients receiving 4 cycles of consolidation therapy had significantly impacts on median RFS and OS compared with those treated with 1 or 2 cycles; 15 versus 11 months (p = 0.006) and 31 versus 15 months (p < 0.001), respectively. Conclusions Cytogenetic and mutation tests for FLT3-ITD, NPM1 and CEBPA genes were meaningful for predicting outcomes in adult AML patients. Adverse cytogenetic abnormalities and FLT3-ITD mutation showed dismal RFS and OS.
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Affiliation(s)
- Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nittaya Limsuwanachot
- Human Genetics Laboratory, Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sulada Pukiat
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichika Chantrathammachart
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Budsaba Rerkamnuaychoke
- Human Genetics Laboratory, Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sutada Magmuang
- Human Genetics Laboratory, Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sithakom Phusanti
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,3Department of Medicine, Chakri Naruebodindra Medical Institute, Mahidol University, Bangkok, Thailand
| | - Kochawan Boonyawat
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teeraya Puavilai
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Artit Ungkanont
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,3Department of Medicine, Chakri Naruebodindra Medical Institute, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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23
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Bacigalupo A, Oneto R, Schrezenmeier H, Hochsmann B, Dufour C, Kojima S, Zhu X, Chen X, Issaragrisil S, Chuncharunee S, Chul Jeong D, Giammarco S, Teresa Van Lint M, Zheng Y, Vallejo C. First line treatment of aplastic anemia with thymoglobuline in Europe and Asia: Outcome of 955 patients treated 2001-2012. Am J Hematol 2019; 94:165. [PMID: 30561167 DOI: 10.1002/ajh.25138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Andrea Bacigalupo
- Istituto di Ematologia, Universita’ Cattolica, Fondazione Universitaria Policlinico Gemelli; Roma Italy
| | - Rosi Oneto
- Istituto di Ematologia, Universita’ Cattolica, Fondazione Universitaria Policlinico Gemelli; Roma Italy
| | | | | | - Carlo Dufour
- Hematology Unity, IstitutoGiannina Gaslini; Genova Italy
| | - Seiji Kojima
- Graduate School of Medicine, Department of Pediatric Hematology, Nagoya University; Nagoya Japan
| | - Xiaofan Zhu
- Pediatric Department; Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Blood Disease Hospital; Tianjin China
| | - Xiaojuan Chen
- Pediatric Department; Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Blood Disease Hospital; Tianjin China
| | | | | | - Dae Chul Jeong
- Pediatric Department; The Catholic University of Korea; Seoul Korea
| | - Sabrina Giammarco
- Istituto di Ematologia, Universita’ Cattolica, Fondazione Universitaria Policlinico Gemelli; Roma Italy
| | | | - Yizhou Zheng
- Hematology Department; Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Blood Disease Hosoital; Tianjin China
| | - Carlos Vallejo
- Hospital Universitario de Donostia; San Sebastian Spain and PETHEMA- Spain
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24
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Manakeng K, Prasertphol P, Phongpao K, Chuncharunee S, Tanyong D, Worawichawong S, Svasti S, Chaichompoo P. Elevated levels of platelet- and red cell-derived extracellular vesicles in transfusion-dependent β-thalassemia/HbE patients with pulmonary arterial hypertension. Ann Hematol 2018; 98:281-288. [PMID: 30334069 DOI: 10.1007/s00277-018-3518-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/06/2018] [Indexed: 12/21/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a serious complication in β-thalassemia. The mechanism of PAH development is believed to be through chronic platelet activation and red cell (RBC) membrane abnormality contributing to a hypercoagulable state and thrombosis, which consequently leads to the development of PAH. Extracellular vesicles (EVs) shed from the plasma membrane of platelets and RBCs are found to be associated with thrombotic risk. This study aimed to investigate the involvement of phosphatidylserine (PS)-bearing cells and EVs in accelerating the progression of the hypercoagulable state in transfusion-dependent thalassemia (TDT) patients. Fresh whole blood samples from splenectomized TDT-β-thalassemia/HbE patients (11 with PAH and 14 without PAH) and 15 normal subjects were analyzed for platelet activation by measuring P-selectin expression using flow cytometry and the number of dense granular using an electron microscope. The amounts of PS-bearing RBCs, large RBC-EVs, platelets, and medium EVs were determined by flow cytometry. Platelet activation in PAH patients was not significantly different from other groups; however, the amounts of PS-bearing large RBC-EVs, platelets, and medium platelet-derived EVs were significantly increased in PAH patients as compared to normal subjects, but they were not different from patients without PAH. This could be affected by antiplatelet therapy that reduced the levels of platelet activation and the amount of PS-bearing cells, including EVs, in PAH patients as well as in patients without PAH.
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Affiliation(s)
- Kanchana Manakeng
- Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand.,Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Phongsak Prasertphol
- Electron Microscopy Unit, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kunwadee Phongpao
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Dalina Tanyong
- Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Electron Microscopy Unit, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Saovaros Svasti
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand.,Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Pornthip Chaichompoo
- Department of Pathobiology, Faculty of Science, Mahidol University, 272 RamaVI Rd., Ratchathewi, Bangkok, 10400, Thailand.
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25
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Walewski J, Hellmann A, Siritanaratkul N, Ozsan GH, Ozcan M, Chuncharunee S, Goh AS, Jurczak W, Koren J, Paszkiewicz-Kozik E, Wang B, Singh S, Huebner D, Engert A, von Tresckow B. Prospective study of brentuximab vedotin in relapsed/refractory Hodgkin lymphoma patients who are not suitable for stem cell transplant or multi-agent chemotherapy. Br J Haematol 2018; 183:400-410. [PMID: 30168134 DOI: 10.1111/bjh.15539] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 01/22/2023]
Abstract
Some patients with relapsed/refractory Hodgkin lymphoma (HL) are not considered suitable for stem cell transplant (SCT) and have a poor prognosis. This phase IV study (NCT01990534) evaluated brentuximab vedotin (1·8 mg/kg intravenously once every 3 weeks) in 60 patients (aged ≥18 years) with CD30-positive relapsed/refractory HL, a history of ≥1 prior systemic chemotherapy regimen, who were considered unsuitable for SCT/multi-agent chemotherapy. Primary endpoint was overall response rate (ORR) per independent review facility (IRF). Secondary endpoints included duration of response (DOR), progression-free survival (PFS) per IRF, overall survival (OS), proportion proceeding to SCT and safety. The ORR was 50%, with 12% CR; 47% proceeded to SCT. Median DOR was 4·6 months and median duration of CR was 6·1 months. After a median follow-up of 6·9 and 16·6 months, median PFS and OS were 4·8 months (95% confidence interval, 3·0-5·3) and not reached, respectively; estimated OS rate was 86% at 12 months. Most common adverse events (≥10%) were peripheral neuropathy (35%), pyrexia (18%), diarrhoea and neutropenia (each 10%). Brentuximab vedotin showed notable activity with a safety profile consistent with known toxicities, and may act as a bridge to SCT, enabling high-risk patients who achieve suboptimal response to frontline/salvage chemotherapy/radiotherapy to receive potentially curative SCT.
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Affiliation(s)
- Jan Walewski
- Department of Lymphoid Malignancy, Maria Sklodowska-Curie Institute - Oncology Centre, Warszawa, Poland
| | - Andrzej Hellmann
- Department of Haematology, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | - Muhit Ozcan
- Department of Haematology, Ankara University School of Medicine, Ankara, Turkey
| | - Suporn Chuncharunee
- Oncology Centre, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ai Sim Goh
- Department of Medicine, Hospital Pulau Pinang, Pulau Pinang, Malaysia
| | - Wojciech Jurczak
- Department of Haematology, Jagiellonian University, Kraków, Poland
| | - Jan Koren
- Department of Haematology, Charles University, Prague, Czech Republic
| | - Ewa Paszkiewicz-Kozik
- Department of Lymphoid Malignancy, Maria Sklodowska-Curie Institute - Oncology Centre, Warszawa, Poland
| | - Bingxia Wang
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Shalini Singh
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Dirk Huebner
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Andreas Engert
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
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26
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Rujirachaivej P, Siriboonpiputtana T, Rerkamnuaychoke B, Magmuang S, Chareonsirisuthigul T, Boonsakan P, Petvises S, Sirirat T, Niparuck P, Chuncharunee S. The Frequency of SF3B1 Mutations in Thai Patients with Myelodysplastic Syndrome. Asian Pac J Cancer Prev 2018; 19:1825-1831. [PMID: 30049194 PMCID: PMC6165635 DOI: 10.22034/apjcp.2018.19.7.1825] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Genetic mutations in genes encoding critical component of RNA splicing machinery including SF3B1 are frequently identified and recognized as the pathogenesis in the development of myelodysplatic syndrome (MDS). In this study, PCR sequencings specific for SF3B1 exon 13, 14, 15, and 16 were performed to analyse genomic DNA isolated from bone marrow samples of 72 newly diagnosed MDS patients. We found that 10 of 72 (14%) patients harbor SF3B1 missense mutations including E622D (1/72), R625C/G (2/72), H662Q (1/72), K666T (1/72), K700E (4/72) and G740E (1/72), respectively. Mutations were predominantly located on exon 14 and 15 of SF3B1 coding sequence. Interestingly, patients with SF3B1 mutations exhibited higher platelet counts (195×109/L VS. 140×109/L, p-value = 0.025) as well as lower hemoglobin levels (81 g/L VS. 92 g/L, p-value = 0.009) and associated with ring sideroblast phenotype (p-value < 0.001) when compared with patients without the SF3B1 mutation. In summary, we reported the frequency of SF3B1 mutations in Thai patients with different subtypes of MDS. SF3B1 mutations were predominantly occurred in MDS-RS and considered as favourable prognosis value. This study further highlighted the clinical important of SF3B1 mutations analysis for the classification of MDS.
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Affiliation(s)
- Punchita Rujirachaivej
- Division of Hematology, Clinical Pathology Laboratory, HRH Princess Maha Chakri Sirindhorn Medical Center, Nakhon, Nayok,Thailand.
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27
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Yingchoncharoen T, Rakyhao T, Chuncharunee S, Sritara P, Pienvichit P, Paiboonsukwong K, Sathavorasmith P, Sirirat K, Sriwantana T, Srihirun S, Sibmooh N. Inhaled nebulized sodium nitrite decreases pulmonary artery pressure in β-thalassemia patients with pulmonary hypertension. Nitric Oxide 2018; 76:174-178. [DOI: 10.1016/j.niox.2017.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 01/19/2023]
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28
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Bacigalupo A, Oneto R, Schrezenmeier H, Hochsmann B, Dufour C, Kojima S, Zhu X, Chen X, Issaragrisil S, Chuncharunee S, Jeong DC, Giammarco S, Van Lint MT, Zheng Y, Vallejo C. First line treatment of aplastic anemia with thymoglobuline in Europe and Asia: Outcome of 955 patients treated 2001-2012. Am J Hematol 2018; 93:643-648. [PMID: 29498107 PMCID: PMC6667908 DOI: 10.1002/ajh.25081] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
The aim of this study was to assess the outcome of patients with aplastic anemia (AA), receiving rabbit anti‐thymocyte globulin (Thymoglobulin, SANOFI) and cyclosporin, as first line treatment. Eligible were 955 patients with AA, treated first line with Thymoglobulin, between 2001 and 2008 (n = 492), or between 2009 and 2012 (n = 463). The median age of the patients was 21 years (range 1‐84). Mortality within 90 days was 5.7% and 2.4%, respectively in the two time periods (P = .007).The actuarial 10‐year survival for the entire population was 70%; transplant free survival was 64%. Predictors of survival in multivariate analysis, were severity of the disease, patients age and the interval between diagnosis and treatment. Survival was 87% vs 61% for responders at 6 months versus nonresponders (P < .0001). The 10‐year survival of nonresponders at 6 months, undergoing a subsequent transplant (n = 110), was 64%, vs 60% for patient not transplantated (n = 266) (P = .1). The cumulative incidence of response was 37%, 52%, 65% respectively, at 90, 180, and 365 days. In multivariate analysis, negative predictors of response at 6 months, were older age, longer interval diagnosis treatment, and greater severity of the disease. In conclusion, early mortality is low after first line treatment of AA with Thymoglobulin, and has been further reduced after year 2008. Patients age, together with interval diagnosis—treament and severity of the disease, remain strong predictors of response and survival.
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Affiliation(s)
- Andrea Bacigalupo
- Istituto di EmatologiaUniversita’ Cattolica, Fondazione Universitaria Policlinico GemelliRoma Italy
| | - Rosi Oneto
- Istituto di EmatologiaUniversita’ Cattolica, Fondazione Universitaria Policlinico GemelliRoma Italy
| | | | | | - Carlo Dufour
- Hematology Unity, Istituto Giannina GasliniGenova Italy
| | - Seiji Kojima
- Graduate School of Medicine, Department of Pediatric Hematology, Nagoya UniversityNagoya Japan
| | - Xiaofan Zhu
- Pediatric Department, Chinese Academy of Medical Sciences (CAMS)Peking Union Medical College (PUMC), Blood Disease HospitalTianjin China
| | - Xiaojuan Chen
- Pediatric Department, Chinese Academy of Medical Sciences (CAMS)Peking Union Medical College (PUMC), Blood Disease HospitalTianjin China
| | | | | | - Dae Chul Jeong
- Pediatric DepartmentThe Catholic University of KoreaSeoul Korea
| | - Sabrina Giammarco
- Istituto di EmatologiaUniversita’ Cattolica, Fondazione Universitaria Policlinico GemelliRoma Italy
| | | | - Yizhou Zheng
- Hematology Department, Chinese Academy of Medical Sciences (CAMS)Peking Union Medical College (PUMC),Blood Disease HosoitalTianjin China
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29
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Limsuwanachot N, Rerkamnuaychoke B, Chuncharunee S, Pauwilai T, Singdong R, Rujirachaivej P, Chareonsirisuthigul T, Siriboonpiputtana T. Clinical and hematological relevance of JAK2 V617F and CALR mutations in BCR-ABL-negative ET patients. Hematology 2017; 22:599-606. [DOI: 10.1080/10245332.2017.1312736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- N. Limsuwanachot
- Human Genetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - B. Rerkamnuaychoke
- Human Genetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S. Chuncharunee
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - T. Pauwilai
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - R. Singdong
- Faculty of Medical Technology, Nakhonratchasima College, Nakhonratchasima, Thailand
| | - P. Rujirachaivej
- Division of Hematology, Clinical Pathology Laboratory, HRH Princess Maha Chakri Sirindhorn Medical Center, Nakhon Nayok, Thailand
| | - T. Chareonsirisuthigul
- Human Genetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - T. Siriboonpiputtana
- Human Genetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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30
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Intragumtornchai T, Bunworasate U, Wudhikarn K, Lekhakula A, Julamanee J, Chansung K, Sirijerachai C, Norasetthada L, Nawarawong W, Khuhapinant A, Siritanaratanakul N, Numbenjapon T, Prayongratana K, Chuncharunee S, Niparuck P, Suwanban T, Kanitsap N, Wongkhantee S, Pornvipavee R, Wong P, Makruasi N, Wannakrairot P, Assanasen T, Sukpanichnant S, Boonsakan P, Kanoksil W, Ya-in C, Kayasut K, Mitranun W, Warnnissorn N. Non-Hodgkin lymphoma in South East Asia: An analysis of the histopathology, clinical features, and survival from Thailand. Hematol Oncol 2017; 36:28-36. [DOI: 10.1002/hon.2392] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/23/2017] [Accepted: 02/07/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Tanin Intragumtornchai
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chulalongkorn Universit; Bangkok Thailand
| | - Udomsak Bunworasate
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chulalongkorn Universit; Bangkok Thailand
| | - Kitsada Wudhikarn
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chulalongkorn Universit; Bangkok Thailand
| | - Arnuparp Lekhakula
- Division of Hematology, Department of Medicine, Faculty of Medicine; Prince of Songkhla University; Songkhla Thailand
| | - Jakrawadi Julamanee
- Division of Hematology, Department of Medicine, Faculty of Medicine; Prince of Songkhla University; Songkhla Thailand
| | - Kanchana Chansung
- Division of Hematology, Department of Medicine, Faculty of Medicine; Kon Kaen University; Kon Kaen Thailand
| | - Chittima Sirijerachai
- Division of Hematology, Department of Medicine, Faculty of Medicine; Kon Kaen University; Kon Kaen Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Weerasak Nawarawong
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Archrob Khuhapinant
- Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Noppadol Siritanaratanakul
- Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Tontanai Numbenjapon
- Division of Hematology, Department of Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - Kannadit Prayongratana
- Division of Hematology, Department of Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Tawatchai Suwanban
- Division of Hematology, Department of Medicine; Rajvithi Hospital; Bangkok Thailand
| | - Nongluk Kanitsap
- Division of Hematology, Department of Medicine, Faculty of Medicine; Thammasat University; Pathum Thani Thailand
| | - Somchai Wongkhantee
- Division of Hematology, Department of Medicine; Kon Kaen Hospital; Kon Kaen Thailand
| | - Rutchanid Pornvipavee
- Division of Hematology; Bangkok Metropolitan Administration Medical College; Bangkok Thailand
| | - Peerapon Wong
- Division of Hematology, Faculty of Medicine; Naresuan University; Pittsanulok Thailand
| | - Nisa Makruasi
- Division of Hematology, Department of Medicine, Faculty of Medicine; Srinakharinwirot University; Nakohn Nayok Thailand
| | - Pongsak Wannakrairot
- Department of Pathology, Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Thamathorn Assanasen
- Department of Pathology, Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Sanya Sukpanichnant
- Department of Pathology, Faculty of Medicine, Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Paisarn Boonsakan
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Wasana Kanoksil
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Charin Ya-in
- Department of Pathology, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Kanita Kayasut
- Department of Pathology, Faculty of Medicine; Prince of Songkhla University; Songkhla Thailand
| | - Winyu Mitranun
- Department of Pathology, Faculty of Medicine; Prince of Songkhla University; Songkhla Thailand
| | - Naree Warnnissorn
- Departmentof Pathology, Faculty of Medicine; Thammasat University; Pathum Thani Thailand
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31
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Sirirat T, Chuncharunee S, Nipaluk P, Siriboonpiputtana T, Chareonsirisuthigul T, Limsuwannachot N, Rerkamnuaychoke B. Mutation Analysis of Isocitrate Dehydrogenase (IDH1/2) and DNA Methyltransferase 3A (DNMT3A) in Thai Patients with Newly Diagnosed Acute Myeloid Leukemia. Asian Pac J Cancer Prev 2017; 18:413-420. [PMID: 28345823 PMCID: PMC5454736 DOI: 10.22034/apjcp.2017.18.2.413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Acute myeloid leukemia (AML) is a clonal hematopoietic stem/progenitor cell disorder which features several genetic mutations. Recurrent genetic alterations identified in AML are recognized as causes of the disease, finding application as diagnostic, prognostic and monitoring markers, with potential use as targets for cancer therapy. Here, we performed a pyrosequencing technique to investigate common mutations of IDH1, IDH2 and DNMT3A in 81 newly diagnosed AML patients. The prevalences of IDH1, IDH2 and DNMT3A mutations were 6.2%, 18.5%, and 7.4%, respectively. In addition, exclusive mutations in IDH1 codon 132 (R132H, R132C, R132G and R132S) were identified in all IDH1-mutated cases indicating that these are strongly associated with AML. Interestingly, higher median blast cell counts were significantly associated with IDH1/2 and DNMT3A mutations. In summary, we could establish a routine robust pyrosequencing method to detect common mutations in IDH1/2 and DNMT3A and demonstrate the frequency of those mutations in adult Thai AML patients.
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Affiliation(s)
- Tanasan Sirirat
- Doctoral Program in Clinical Pathology, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University. Bangkok, 10400, Thailand.
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32
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Wudhikarn K, Bunworasate U, Julamanee J, Lekhakula A, Chuncharunee S, Niparuck P, Ekwattanakit S, Khuhapinant A, Norasetthada L, Nawarawong W, Makruasi N, Kanitsap N, Sirijerachai C, Chansung K, Wong P, Numbenjapon T, Prayongratana K, Suwanban T, Wongkhantee S, Praditsuktavorn P, Intragumtornchai T. Secondary central nervous system relapse in diffuse large B cell lymphoma in a resource limited country: result from the Thailand nationwide multi-institutional registry. Ann Hematol 2016; 96:57-64. [DOI: 10.1007/s00277-016-2848-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 10/02/2016] [Indexed: 02/02/2023]
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33
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Singdong R, Siriboonpiputtana T, Chareonsirisuthigul T, Kongruang A, Limsuwanachot N, Sirirat T, Chuncharunee S, Rerkamnuaychoke B. Characterization and Prognosis Significance of JAK2 (V617F), MPL, and CALR Mutations in Philadelphia-Negative Myeloproliferative Neoplasms. Asian Pac J Cancer Prev 2016; 17:4647-4653. [PMID: 27892678 PMCID: PMC5454611 DOI: 10.22034/apjcp.2016.17.10.4647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: The discovery of somatic acquired mutations of JAK2 (V617F) in Philadelphia-negative myeloproliferative neoplasms (Ph-negative MPNs) including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) has not only improved rational disease classification and prognostication but also brings new understanding insight into the pathogenesis of diseases. Dosage effects of the JAK2 (V617F) allelic burden in Ph-negative MPNs may partially influence clinical presentation, disease progression, and treatment outcome. Material and Methods: Pyrosequencing was performed to detect JAK2 (V617F) and MPL (W515K/L) and capillary electrophoresis to identify CALR exon 9 mutations in 100 samples of Ph-negative MPNs (38.0 PV, 55 ET, 4 PMF, and 3 MPN-U). Results: The results showed somatic mutations of JAK2 (V617F) in 94.7% of PV, 74.5% of ET, 25.0% of PMF, and all MPN-U. A high proportion of JAK2 (V617F) mutant allele burden (mutational load > 50.0%) was predominantly observed in PV when compared with ET. Although a high level of JAK2 (V617F) allele burden was strongly associated with high WBC counts in both PV and ET, several hematological parameters (hemoglobin, hematocrit, and platelet count) were independent of JAK2 (V617F) mutational load. MPL (W515K/L) mutations could not be detected whereas CALR exon 9 mutations were identified in 35.7% of patients with JAK2 negative ET and 33.3% with JAK2 negative PMF. Conclusions: The JAK2 (V617F) allele burden may be involved in progression of MPNs. Furthermore, a high level of JAK2 (V617F) mutant allele appears strongly associated with leukocytosis in both PV and ET.
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Affiliation(s)
- Roongrudee Singdong
- Human Genetic Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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Chuncharunee S, Wong R, Rojnuckarin P, Chang CS, Chang KM, Lu MY, Hwang WL, Koh LP, Chen TY, Leung AY, Norasetthada L, Wang SC, Chang MC, Wu KH, Issaragrisil S. Efficacy of rabbit antithymocyte globulin as first-line treatment of severe aplastic anemia: an Asian multicenter retrospective study. Int J Hematol 2016; 104:454-61. [PMID: 27376944 DOI: 10.1007/s12185-016-2053-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 02/01/2023]
Abstract
Due to the unavailability of horse antithymocyte globulin (ATG) in many markets worldwide, patients with severe aplastic anemia (SAA) are limited to the use of rabbit ATG. We aimed to analyze hematologic response and overall survival (OS) of Asian patients treated with rabbit ATG as first-line therapy of SAA. We retrospectively reviewed the medical records of 97 consecutive patients who received rabbit ATG as first-line treatment of SAA from 2006 to 2012 at centers in four Asian countries. The primary endpoint was 6- and 12-month overall response rates (ORR) for patients receiving rabbit ATG within the recommended dose range (2.5-3.75 mg/kg/day). Secondary endpoints included ORR in patients receiving any dose of rabbit ATG and 2-year OS. For patients who received rabbit ATG within the recommended dose range, 6- and 12-month ORRs were 17.4 and 63.6 %, respectively. For patients who received any dose of rabbit ATG, 6- and 12-month ORRs were 24.3 and 68.6 %, respectively. The 2-year OS rate was 86.3 %. Rabbit ATG is effective for treatment of SAA in Asian patients. The 12-month ORR and 2-year OS with rabbit ATG were comparable to historical results obtained with horse ATG.
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Affiliation(s)
| | - Raymond Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital and Sir Y. K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Ponlapat Rojnuckarin
- Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | | | - Meng-Yao Lu
- National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Li Hwang
- Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Tsai-Yun Chen
- National Cheng Kung University Hospital, Tainan, Taiwan
| | | | | | | | | | - Kang-Hsi Wu
- China Medical University Hospital, Taichung, Taiwan
| | - Surapol Issaragrisil
- Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, 10700, Thailand.
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Limsuwanachot N, Siriboonpiputtana T, Karntisawiwat K, Chareonsirisuthigul T, Chuncharunee S, Rerkamnuaychoke B. Multiplex RT-PCR Assay for Detection of Common Fusion Transcripts in Acute Lymphoblastic Leukemia and Chronic Myeloid Leukemia Cases. Asian Pac J Cancer Prev 2016; 17:677-84. [PMID: 26925663 DOI: 10.7314/apjcp.2016.17.2.677] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is a heterogeneous disease which requires a risk-stratified approach for appropriate treatment. Specific chromosomal translocations within leukemic blasts are important prognostic factors that allow identification of relevant subgroups. In this study, we developed a multiplex RT-PCR assay for detection of the 4 most frequent translocations in ALL (BCR-ABL, TEL-AML1, MLL-AF4, and E2A- PBX1). MATERIALS AND METHODS A total of 214 diagnosed ALL samples from both adult and pediatric ALL and 14 cases of CML patients (154 bone marrow and 74 peripheral blood samples) were assessed for specific chromosomal translocations by cytogenetic and multiplex RT-PCR assays. RESULTS The results showed that 46 cases of ALL and CML (20.2%) contained the fusion transcripts. Within the positive ALL patients, the most prevalent cryptic translocation observed was mBCR-ABL (p190) at 8.41%. In addition, other genetic rearrangements detected by the multiplex PCR were 4.21% TEL-AML1 and 2.34% E2A-PBX1, whereas MLL-AF4 exhibited negative results in all tested samples. Moreover, MBCR-ABL was detected in all 14 CML samples. In 16 samples of normal karyotype ALL (n=9), ALL with no cytogentic result (n=4) and CML with no Philadelphia chromosome (n=3), fusion transcripts were detected. CONCLUSIONS Multiplex RT-PCR provides a rapid, simple and highly sensitive method to detect fusion transcripts for prognostic and risk stratification of ALL and CML patients.
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Affiliation(s)
- Nittaya Limsuwanachot
- Human Genetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand E-mail :
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Srihirun S, Tanjararak N, Chuncharunee S, Sritara P, Kaewvichit R, Fucharoen S, Pattanapanyasat K, Sibmooh N. Platelet hyperactivity in thalassemia patients with elevated tricuspid regurgitant velocity and the association with hemolysis. Thromb Res 2015; 135:121-6. [DOI: 10.1016/j.thromres.2014.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 01/19/2023]
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Chueamuangphan N, Wongtheptian W, Patumanond J, Sukonthasarn A, Chuncharunee S, Tawichasri C, Nawarawong W. Effect of acetylsalicylic acid on thalassemia with pulmonary arterial hypertension. Int J Gen Med 2014; 7:525-9. [PMID: 25506240 PMCID: PMC4259867 DOI: 10.2147/ijgm.s71644] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To compare pulmonary artery systolic pressure (PASP) between thalassemic patients with pulmonary arterial hypertension (PAH) for whom acetylsalicylic acid (ASA) was and was not prescribed after 1 year. METHODS A retrospective cohort study was conducted at the hematological outpatient clinic at Chiang Rai Hospital, Chiang Rai, Thailand. All new cases of thalassemia with PAH from January 2007 to January 2012 were studied at the first month and at 12 months. The patients were classified into two groups. In one group, ASA 81 mg daily was prescribed for 1 year, whereas in another group no ASA was prescribed, due to its contraindications, which included bleeding, gastrointestinal side effects, and thrombocytopenia. PASP, estimated by a Doppler echocardiography, was measured by the same cardiologist. Propensity score adjustment was used to control confounding variables by indication and contraindication. Multivariable regression analysis was used to evaluate the effects of ASA. RESULTS Of the 63 thalassemia patients with PAH, there were 47 (74.6%) in the ASA group and 16 (25.4%) in the no ASA group. ASA, as compared with no ASA, did not significantly reduce PASP (adjusted difference -0.95; 95% confidence interval -16.99 to 15.10; P=0.906). CONCLUSION Low-dose ASA may not have a beneficial effect on PASP after 1 year of treatment of PAH in thalassemia.
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Affiliation(s)
- Nonlawan Chueamuangphan
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ; Department of Medicine, Chiang Rai Hospital, Chiang Rai, Thailand
| | | | - Jayanton Patumanond
- Clinical Epidemiology Program, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - Apichard Sukonthasarn
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suporn Chuncharunee
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Weerasak Nawarawong
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Teawtrakul N, Pussadhamma B, Ungprasert P, Prayalaw P, Fucharoen S, Jetsrisuparb A, Pongudom S, Sirijerachai C, Chansung K, Wanitpongpun C, Thongbuaban S, Thinkhamrop B, Chuncharunee S. A risk score for predicting pulmonary hypertension in patients with non-transfusion-dependent thalassemia in northeastern Thailand: The E-SAAN score. Hematology 2014; 20:416-21. [DOI: 10.1179/1607845414y.0000000211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Nattiya Teawtrakul
- Division of HematologyDepartment of Internal Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Burabha Pussadhamma
- Division of Cardiovascular systemDepartment of Internal Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Phuangpaka Ungprasert
- Division of Cardiovascular systemDepartment of Internal Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Patcharawadee Prayalaw
- Center for Research and Development of Medical Diagnostic LaboratoriesFaculty of Associated Medical Science, Khon Kaen University, Khon Kaen, Thailand
| | - Supan Fucharoen
- Center for Research and Development of Medical Diagnostic LaboratoriesFaculty of Associated Medical Science, Khon Kaen University, Khon Kaen, Thailand
| | - Arunee Jetsrisuparb
- Division of HematologyDepartment of Pedriatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | | | - Chittima Sirijerachai
- Division of HematologyDepartment of Internal Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Kanchana Chansung
- Division of HematologyDepartment of Internal Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Chinadol Wanitpongpun
- Division of HematologyDepartment of Internal Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | | | - Bandit Thinkhamrop
- Department of Biostatistics and DemographyFaculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Suporn Chuncharunee
- Division of HematologyDepartment of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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San-Miguel JF, Hungria VTM, Yoon SS, Beksac M, Dimopoulos MA, Elghandour A, Jedrzejczak WW, Günther A, Nakorn TN, Siritanaratkul N, Corradini P, Chuncharunee S, Lee JJ, Schlossman RL, Shelekhova T, Yong K, Tan D, Numbenjapon T, Cavenagh JD, Hou J, LeBlanc R, Nahi H, Qiu L, Salwender H, Pulini S, Moreau P, Warzocha K, White D, Bladé J, Chen W, de la Rubia J, Gimsing P, Lonial S, Kaufman JL, Ocio EM, Veskovski L, Sohn SK, Wang MC, Lee JH, Einsele H, Sopala M, Corrado C, Bengoudifa BR, Binlich F, Richardson PG. Panobinostat plus bortezomib and dexamethasone versus placebo plus bortezomib and dexamethasone in patients with relapsed or relapsed and refractory multiple myeloma: a multicentre, randomised, double-blind phase 3 trial. Lancet Oncol 2014; 15:1195-206. [DOI: 10.1016/s1470-2045(14)70440-1] [Citation(s) in RCA: 506] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Taher AT, Porter JB, Viprakasit V, Kattamis A, Chuncharunee S, Sutcharitchan P, Siritanaratkul N, Origa R, Karakas Z, Habr D, Zhu Z, Cappellini MD. Defining serum ferritin thresholds to predict clinically relevant liver iron concentrations for guiding deferasirox therapy when MRI is unavailable in patients with non-transfusion-dependent thalassaemia. Br J Haematol 2014; 168:284-90. [PMID: 25212456 DOI: 10.1111/bjh.13119] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 05/20/2014] [Accepted: 07/26/2014] [Indexed: 12/19/2022]
Abstract
Liver iron concentration (LIC) assessment by magnetic resonance imaging (MRI) remains the gold standard to diagnose iron overload and guide iron chelation therapy in patients with non-transfusion-dependent thalassaemia (NTDT). However, limited access to MRI technology and expertise worldwide makes it practical to also use serum ferritin assessments. The THALASSA (assessment of Exjade(®) in non-transfusion-dependent THALASSemiA patients) study assessed the efficacy and safety of deferasirox in iron-overloaded NTDT patients and provided a large data set to allow exploration of the relationship between LIC and serum ferritin. Using data from screened patients and those treated with deferasirox for up to 2 years, we identified clinically relevant serum ferritin thresholds (for when MRI is unavailable) for the initiation of chelation therapy (>800 μg/l), as well as thresholds to guide chelator dose interruption (<300 μg/l) and dose escalation (>2000 μg/l). (clinicaltrials.gov identifier: NCT00873041).
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Affiliation(s)
- Ali T Taher
- American University of Beirut, Beirut, Lebanon
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Chueamuangphan N, Patumanond J, Wongtheptien W, Nawarawong W, Sukonthasarn A, Chuncharunee S, Tawichasri C. Benefits of chronic blood transfusion in hemoglobin E/β thalassemia with pulmonary arterial hypertension. Int J Gen Med 2014; 7:411-6. [PMID: 25170276 PMCID: PMC4145826 DOI: 10.2147/ijgm.s66610] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/23/2022] Open
Abstract
Objective The aim of the research reported here was to compare pulmonary artery systolic pressure (PASP) and 6-minute walk distance after 1 year of follow-up in hemoglobin E/β thalassemia (E/β-Thal) with pulmonary arterial hypertension (PAH) patients who received chronic blood transfusions versus those who received occasional transfusions. Methods A nonrandomized clinical trial was conducted at the Hematological Outpatient Clinic of Chiang Rai Hospital, Thailand. All adult cases of E/β-Thal with PAH (defined as PASP >35 mmHg by Doppler echocardiography) were evaluated and followed for the next 12 months. The patients were classified into two groups by patient preference. Group 1 patients received chronic blood transfusions – one to two units of leukocyte-poor packed red cells every 2–4 weeks – over 1 year to maintain pre-transfusion hemoglobin levels of ≥7.0 g/dL. Group 2 patients received occasional transfusions over the course of 1 year, with more than 4 weeks between transfusions. All patients were treated with iron chelation when serum ferritin levels were ≥1,000 μg/dL. PASP and the 6-minute walk distance were evaluated at baseline and at 6 and 12 months. Propensity score adjustment was used to control for confounding by indication and contraindication. Multivariable regression analysis was used to evaluate the effects of chronic blood transfusion. Results There were 16 (53.3%) patients in Group 1 and 14 (46.7%) in Group 2. At 12 months, patients in Group 1 had a greater reduction in PASP than those in Group 1 (adjusted mean difference, −16.83; 95% confidence interval, −26.35 to −7.32; P=0.001). The 6-minute walk distance at 12 months in Group 1 patients was greater than that in Group 2 patients (adjusted mean difference, 46.55; 95% confidence interval, 18.08 to 75.02; P=0.001). Conclusion This study found evidence that chronic blood transfusions may have beneficial effects in PAH in thalassemia patients over 1 year.
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Affiliation(s)
- Nonlawan Chueamuangphan
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ; Department of Medicine, Chiang Rai Hospital, Chiang Rai, Thailand
| | - Jayanton Patumanond
- Clinical Epidemiology Program, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | | | - Weerasak Nawarawong
- Department of Medicine Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichard Sukonthasarn
- Department of Medicine Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suporn Chuncharunee
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Taher AT, Porter JB, Viprakasit V, Kattamis A, Chuncharunee S, Sutcharitchan P, Siritanaratkul N, Origa R, Karakas Z, Habr D, Zhu Z, Cappellini MD. Approaching low liver iron burden in chelated patients with non-transfusion-dependent thalassemia: the safety profile of deferasirox. Eur J Haematol 2014; 92:521-6. [PMID: 24460655 PMCID: PMC4232858 DOI: 10.1111/ejh.12270] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Accepted: 01/10/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Patients with non-transfusion-dependent thalassemia (NTDT) often develop iron overload and related complications, and may require iron chelation. However, the risk of over-chelation emerges as patients reach low, near-normal body iron levels and dose adjustments may be needed. In the THALASSA study, the threshold for chelation interruption was LIC <3 mg Fe/g dw (LIC<3); 24 patients receiving deferasirox for up to 2 yr reached this target. A post hoc analysis was performed to characterize the safety profile of deferasirox as these patients approached LIC<3. METHODS THALASSA was a randomized, double-blind, placebo-controlled study of two deferasirox regimens (5 and 10 mg/kg/d) versus placebo in patients with NTDT. Patients randomized to deferasirox or placebo in the core could enter a 1-yr extension, with all patients receiving deferasirox (extension starting doses based on LIC at end-of-core and prior chelation response). The deferasirox safety profile was assessed between baseline and 6 months before reaching LIC<3 (Period 1), and the 6 months immediately before achieving LIC<3 (Period 2). RESULTS Mean ± SD deferasirox treatment duration up to reaching LIC<3 was 476 ± 207 d, and deferasirox dose was 9.7 ± 3.0 mg/kg/d. The exposure-adjusted AE incidence regardless of causality was similar in periods 1 (1.026) and 2 (1.012). There were no clinically relevant differences in renal and hepatic laboratory parameters measured close to the time of LIC<3 compared with measurements near the previous LIC assessment. CONCLUSIONS The deferasirox safety profile remained consistent as patients approached the chelation interruption target, indicating that, with appropriate monitoring and dose adjustments in relation to iron load, low iron burdens may be reached with deferasirox with minimal risk of over-chelation.
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Affiliation(s)
- Ali T Taher
- American University of Beirut, Beirut, Lebanon
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Tanjararak N, Chuncharunee S, Srihirun S, Sibmooh N, Yamwong S, Wattanachai S, Sritara P. SHORT TERM EFFECT OF SILDENAFIL ON PULMONARY ARTERIAL PRESSURE AND PLATELET ACTIVITY THALASSEMIA PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61483-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Atichartakarn V, Chuncharunee S, Archararit N, Udomsubpayakul U, Aryurachai K. Intravascular hemolysis, vascular endothelial cell activation and thrombophilia in splenectomized patients with hemoglobin E/β-thalassemia disease. Acta Haematol 2014; 132:100-7. [PMID: 24525823 DOI: 10.1159/000355719] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 06/11/2013] [Accepted: 09/18/2013] [Indexed: 01/27/2023]
Abstract
The relationship between asplenia and thrombophilia in β-thalassemia disease patients is not yet completely understood. One hundred and ten adult hemoglobin (Hb) E/β-thalassemia (E/β-Thal) disease outpatients, dichotomized according to the presence or absence of the spleen, were prospectively studied for evidence of intravascular hemolysis (IVH) and vascular endothelial cell (EC) activation. Biomarkers of IVH (serum cell-free Hb), EC [soluble E-selectin (sE-selectin) and soluble vascular cell adhesion molecule 1 (sVCAM-1)], platelet and EC [soluble P-selectin (sP-selectin)], inflammation [high-sensitivity C-reactive protein (hs-CRP)], and coagulation [thrombin-antithrombin complexes (TAT)] activation, as well as other selected blood tests were determined. The 61 splenectomized patients had a more severe hemolytic disease and higher levels of cell-free Hb and ferritin (p = 0.003), sE-selectin, sP-selectin, hs-CRP, and TAT (p < 0.05). However, serum levels of sVCAM-1 were not different between the two groups. The findings suggested IVH and EC activation. Together with chronic iron overload and chronic low-grade inflammation activation, the findings extend our understanding of the mechanism of thrombophilia in splenectomized E/β-Thal disease patients.
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Affiliation(s)
- Vichai Atichartakarn
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Teawtrakul N, Ungprasert P, Pussadhamma B, Prayalaw P, Fucharoen S, Jetsrisuparb A, Pongudom S, Sirijerachai C, Chansung K, Wanitpongpun C, Chuncharunee S. Effect of genotype on pulmonary hypertension risk in patients with thalassemia. Eur J Haematol 2014; 92:429-34. [PMID: 24400859 DOI: 10.1111/ejh.12261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Pulmonary hypertension is one of the major complications in patients with non-transfusion-dependent thalassemia (NTDT). Patients with NTDT have distinct genetic subgroups. Therefore, the effects of different genotype groups on pulmonary hypertension risk in patients with NTDT were assessed. METHODS A cross-sectional study was conducted in patients with NTDT aged ≥ 10 yr old at Srinagarind University Hospital and Udonthani Hospital, Thailand. Pulmonary hypertension risk was defined as peak tricuspid regurgitation velocity > 2.9 m/s by trans-thoracic echocardiography. Clinical characteristics and laboratory data that literature has indicated as risk factors for pulmonary hypertension were collected. The effect of genotype group on pulmonary hypertension risk was evaluated by using multivariate logistic regression analysis. RESULTS Of 219 patients, pulmonary hypertension risk was found in 24 patients (10.96%). All patients were categorized into two groups according to genetic data that included: (i) β-thalassemia (139, 63.5%), (ii) α-thalassemia and combined α and β-thalassemia (80, 36.5%). Genotype groups were statistically and significantly associated with pulmonary hypertension risk based on the adjusted odds ratios after adjustment for other factors. Patients with β-thalassemia had a statistically significant higher risk for pulmonary hypertension risk (odds ratio = 9.47, P = 0.036) compared to patients with α-thalassemia and patients with combined α and β-thalassemia. CONCLUSION The genotype group is an independent risk factor for pulmonary hypertension in patients with NTDT. Echocardiography should be routinely recommended for all patients with β-thalassemia. Routine screening in patients with α-thalassemia and combined α and β-thalassemia, however, may not be necessary or should focus on the older population.
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Affiliation(s)
- Nattiya Teawtrakul
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Atichartakarn V, Chuncharunee S, Archararit N, Udomsubpayakul U, Lee R, Tunhasiriwet A, Aryurachai K. Prevalence and risk factors for pulmonary hypertension in patients with hemoglobin E/β-thalassemia disease. Eur J Haematol 2014; 92:346-53. [PMID: 24330103 DOI: 10.1111/ejh.12242] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To find the prevalence and risk factors of pulmonary hypertension (PHT) in adult patients with hemoglobin E/β-thalassemia disease (E/β-Thal). METHODS One hundred and ten clinically stable E/β-Thal outpatients, sixty-one of whom had undergone splenectomy, were prospectively studied using their clinical profiles, selected blood tests, chest roentgenogram, and transthoracic echocardiogram. Based on the pulmonary artery systolic pressure (PASP) values estimated by the echocardiogram of ≥36 mmHg, they were dichotomized into those with (PHT+) and without (PHT-) PHT. RESULTS PHT was found in 41 (37.3%) patients without gender preponderance. It was not due to the left heart and was not severe (PASP = 46.3 ± 10.4 mmHg). PASP was higher in splenectomized patients (48.0 ± 11 vs. 40.3 ± 4.7 mmHg (P = 0.004)). PHT was found in 32 of 61 (52.5%) splenectomized patients, mostly (53%) in the second decade, and rarely (6.3%) during the first 5 yr after splenectomy. PHT+ patients had more hemolysis (P = 0.001-0.04 depending on the parameters), more asplenic cases (P < 0.001), and higher serum soluble vascular cell adhesion molecule-1 (sVCAM-1) and high-sensitivity C-reactive protein levels (P = 0.004 and 0.008, respectively). Strong risk factors by univariate analysis were serum sVCAM-1 levels ≥1600 ng/mL, serum cell-free Hb ≥ 3 mg/dL, asplenia, and amount of NRBCs/100 WBCs >40. CONCLUSIONS Prevalence of PHT in E/β-Thal patients was 37.3% without gender preponderance. Those with severe hemolysis and asplenia invariably had severer PHT. Strong risk factors were asplenia and associated markedly elevated values of sVCAM-1, cell-free Hb, and NRBCs in blood.
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Affiliation(s)
- Vichai Atichartakarn
- Division of Hematology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Siriworadechkul S, Jindadamrongwech S, Chuncharunee S, Aupparakkitanon S. Implication of globin gene expression, hemoglobin F and hemoglobin E levels on β-thalassemia/Hb E disease severity. Ann Clin Lab Sci 2014; 44:437-442. [PMID: 25361929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
One of the factors affecting the degree of severity in β-thalassemia disease is the presence of unmatched α-hemoglobin chains. Thus, the expression levels of globin genes in reticulocytes of β-thalassemia subjects were measured using quantitative RT-PCR, demonstrating that α/β globin mRNA ratio, as well as levels of γ-globin mRNA and Hb F, increased with progressing degree of β globin synthesis defect. The levels of γ-globin mRNA and Hb F could not be directly correlated with severity of β-thalassemia/Hb E disease due to a low statistical power of this analysis. Higher levels of Hb E were present, however, in clinically mild patients, as compared to moderately severe β-thalassemia/Hb E subjects. This suggests that in β-thalassemia/Hb E disease, elevation of Hb E level through enhancing correctly spliced β(E)-globin mRNA offers another approach in ameliorating disease severity. In addition, co-inheritance of α-thalassemia 2 trait in β-thalassemia/Hb E subjects was associated with milder outcome compared with those with the same β-thalassemia genotypes, confirming the notion of the beneficial effect of a more balanced α:β-globin chain ratio.
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Affiliation(s)
- Suwimol Siriworadechkul
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sumalee Jindadamrongwech
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Saranya Aupparakkitanon
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Taher AT, Porter JB, Viprakasit V, Kattamis A, Chuncharunee S, Sutcharitchan P, Siritanaratkul N, Galanello R, Karakas Z, Lawniczek T, Habr D, Ros J, Zhu Z, Cappellini MD. Deferasirox effectively reduces iron overload in non-transfusion-dependent thalassemia (NTDT) patients: 1-year extension results from the THALASSA study. Ann Hematol 2013; 92:1485-93. [PMID: 23775581 PMCID: PMC3790249 DOI: 10.1007/s00277-013-1808-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [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: 03/28/2013] [Accepted: 05/25/2013] [Indexed: 12/16/2022]
Abstract
Patients with non-transfusion-dependent thalassemia (NTDT) often develop iron overload that requires chelation to levels below the threshold associated with complications. This can take several years in patients with high iron burden, highlighting the value of long-term chelation data. Here, we report the 1-year extension of the THALASSA trial assessing deferasirox in NTDT; patients continued with deferasirox or crossed from placebo to deferasirox. Of 133 patients entering extension, 130 completed. Liver iron concentration (LIC) continued to decrease with deferasirox over 2 years; mean change was −7.14 mg Fe/g dry weight (dw) (mean dose 9.8 ± 3.6 mg/kg/day). In patients originally randomized to placebo, whose LIC had increased by the end of the core study, LIC decreased in the extension with deferasirox with a mean change of −6.66 mg Fe/g dw (baseline to month 24; mean dose in extension 13.7 ± 4.6 mg/kg/day). Of 166 patients enrolled, 64 (38.6 %) and 24 (14.5 %) patients achieved LIC <5 and <3 mg Fe/g dw by the end of the study, respectively. Mean LIC reduction was greatest in patients with the highest pretreatment LIC. Deferasirox progressively decreases iron overload over 2 years in NTDT patients with both low and high LIC. Safety profile of deferasirox over 2 years was consistent with that in the core study.
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Affiliation(s)
- Ali T Taher
- American University of Beirut, Beirut, Lebanon,
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Taher AT, Porter JB, Viprakasit V, Kattamis A, Chuncharunee S, Sutcharitchan P, Siritanaratkul N, Galanello R, Karakas Z, Lawniczek T, Habr D, Ros J, Zhang Y, Cappellini MD. Deferasirox demonstrates a dose-dependent reduction in liver iron concentration and consistent efficacy across subgroups of non-transfusion-dependent thalassemia patients. Am J Hematol 2013; 88:503-6. [PMID: 23553596 PMCID: PMC3698696 DOI: 10.1002/ajh.23445] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/19/2013] [Accepted: 03/22/2013] [Indexed: 01/24/2023]
Abstract
The 1-year THALASSA study enrolled 166 patients with various non-transfusion-dependent thalassemia (NTDT) syndromes, degrees of iron burden and patient characteristics, and demonstrated the overall efficacy and safety of deferasirox in reducing liver iron concentration (LIC) in these patients. Here, reduction in LIC with deferasirox 5 and 10 mg/kg/day starting dose groups is shown to be consistent across the following patient subgroups—baseline LIC/serum ferritin, age, gender, race, splenectomy (yes/no), and underlying NTDT syndrome (β-thalassemia intermedia, HbE/β-thalassemia or α-thalassemia). These analyses also evaluated deferasirox dosing strategies for patients with NTDT. Greater reductions in LIC were achieved in patients dose-escalated at Week 24 from deferasirox 10 mg/kg/day starting dose to 20 mg/kg/day. Patients who received an average actual dose of deferasirox >12.5–≤17.5 mg/kg/day achieved a greater LIC decrease compared with the ≥7.5–≤12.5 mg/kg/day and >0–<7.5 mg/kg/day subgroups, demonstrating a dose–response efficacy. LIC reduction across patient subgroups was generally consistent with the primary efficacy analysis with a similar safety profile. Am. J. Hematol. 88:503–506, 2013. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Ali T. Taher
- Hematology and Oncology, Department of Internal Medicine, American University of BeirutBeirut Lebanon
| | - John B. Porter
- UCL Cancer Institute, Department of Haematology, University College LondonLondon United Kingdom
| | - Vip Viprakasit
- Department of Pediatrics and Internal MedicineSiriraj Hospital, Mahidol UniversityBangkok Thailand
| | | | | | - Pranee Sutcharitchan
- Chulalongkorn University and King Chulalongkorn Memorial HospitalBangkok Thailand
| | - Noppadol Siritanaratkul
- Department of Pediatrics and Internal MedicineSiriraj Hospital, Mahidol UniversityBangkok Thailand
| | | | - Zeynep Karakas
- Istanbul University, Istanbul Medical FacultyIstanbul Turkey
| | | | - Dany Habr
- Novartis PharmaceuticalsEast Hanover New Jersey
| | | | - Yiyun Zhang
- Novartis PharmaceuticalsEast Hanover New Jersey
| | - M. Domenica Cappellini
- Department of Internal Medicine, Università di Milano, Ca Granda Foundation IRCCSMilan Italy
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50
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Chuncharunee S, Atichartakarn V, Archararit N, Aryurachai K. Correction of coagulation and inflammation activation by chronic blood transfusion in an asplenic patient with haemoglobin E/β-thalassaemia and pulmonary arterial hypertension. Transfus Med 2013; 23:276-8. [PMID: 23480175 DOI: 10.1111/tme.12025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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