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Kovacsova F, Folber F, Weinbergerova B, Stepanova R, Kabut T, Tomiska M, Krejci M, Mayer J. Low incidence of severe acute and chronic graft-versus-host disease in a long-term retrospective study with ATG Grafalon routine use. Ann Hematol 2023; 102:3587-3591. [PMID: 37783854 PMCID: PMC10640449 DOI: 10.1007/s00277-023-05479-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
Since 2006, combined graft-versus-host disease (GVHD) prophylaxis with ATG Grafalon has been our department's base of peri-transplant supportive care. This recent retrospective study included 398 patients who underwent their first allogeneic hematopoietic stem cell transplantation after receiving a defined dose of ATG Grafalon. Our observations recorded reduced incidence of severe acute and chronic GVHD without negative impact on overall survival in a nonselected group with standard and uniform GVHD prophylaxis.
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Affiliation(s)
- Flora Kovacsova
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic.
- School of Medicine, Masaryk University, Brno, Czech Republic.
| | - Frantisek Folber
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Barbora Weinbergerova
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Radka Stepanova
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Kabut
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Miroslav Tomiska
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Marta Krejci
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
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Weinbergerova B, Mayer J, Kabut T, Hrabovsky S, Prochazkova J, Kral Z, Herout V, Pacasova R, Zdrazilova-Dubska L, Husa P, Bednar P, Ruzek D, Lengerova M. Successful early treatment combining remdesivir with high-titer convalescent plasma among COVID-19-infected hematological patients. Hematol Oncol 2021; 39:715-720. [PMID: 34396566 PMCID: PMC8426890 DOI: 10.1002/hon.2908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Barbora Weinbergerova
- Department of Internal Medicine-Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine-Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Tomas Kabut
- Department of Internal Medicine-Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Stepan Hrabovsky
- Department of Internal Medicine-Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Jirina Prochazkova
- Department of Internal Medicine-Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Zdenek Kral
- Department of Internal Medicine-Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Vladimir Herout
- Department of Respiratory Diseases, Masaryk University, Brno, Czech Republic.,Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic
| | - Rita Pacasova
- Transfusion and Tissue Department, Masaryk University, Brno, Czech Republic.,Transfusion and Tissue Department, University Hospital Brno, Brno, Czech Republic
| | - Lenka Zdrazilova-Dubska
- Department of Clinical Microbiology and Immunology, University Hospital Brno, Brno, Czech Republic
| | - Petr Husa
- Department of Infectious Diseases, Masaryk University, Brno, Czech Republic.,Department of Infectious Diseases, University Hospital Brno, Brno, Czech Republic
| | - Petr Bednar
- Veterinary Research Institute, Brno, Czech Republic.,Faculty of Science, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Daniel Ruzek
- Veterinary Research Institute, Brno, Czech Republic.,Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - Martina Lengerova
- Department of Internal Medicine-Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
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Weinbergerova B, Kabut T, Kocmanova I, Lengerova M, Pospisil Z, Kral Z, Mayer J. Bronchoalveolar lavage fluid and serum 1,3-β-D-glucan testing for invasive pulmonary aspergillosis diagnosis in hematological patients: the role of factors affecting assay performance. Sci Rep 2020; 10:17963. [PMID: 33087853 PMCID: PMC7578802 DOI: 10.1038/s41598-020-75132-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/19/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023] Open
Abstract
Invasive fungal disease (IFD) early diagnosis improves hematological patient survival. Non-culture-based methods may reduce diagnostic time to identify IFD. As complex data on the value of 1,3-β-D-glucan (BDG) from bronchoalveolar lavage fluid (BALF) compared to serum for the most frequent invasive pulmonary aspergillosis (IPA) diagnosis are scarce, particularly including evaluation of potential factors adversely affecting BDG assay, we provided prospective single-center analysis evaluating 172 episodes of pulmonary infiltrates with BDG detection in BALF and serum samples collected in parallel among hematological patients from 2006 to 2015. Proven and probable IPA were documented in 13.4% of the episodes. Sensitivity (SEN), specificity (SPE), positive and negative predictive value (PPV; NPV), and diagnostic odds ratio (DOR) of the BDG assay using standard (80 pg/ml) cut-off for BALF were: 56.5%; 83.2%; 34.2%; 92.5%, and 6.5, respectively, and for serum were: 56.5%; 82.6%; 33.3%; 92.5%, and 6.2, respectively. The same BDG assay parameters employing a calculated optimal cut-off for BALF (39 pg/ml) were: 78.3%; 72.5%; 30.5%; 95.6%, and 9.5, respectively; and for serum (40 pg/ml) were: 73.9%; 69.1%; 27.0%; 94.5%, and 6.3, respectively. While identifying acceptable SEN, SPE, and DOR, yet low PPV of both BALF and serum BDG assay for IPA diagnosis, neither the combination of both materials nor the new optimal BDG cut-off led to significant test quality improvement. Absolute neutrophil count and aspirated BALF volume with a significant trend affected BDG assay performance. The BDG test did not outperform galactomannan assay.
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Affiliation(s)
- Barbora Weinbergerova
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic.
| | - Tomas Kabut
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic
| | - Iva Kocmanova
- Department of Clinical Microbiology, University Hospital, Brno, Czech Republic
| | - Martina Lengerova
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic.,CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Zdenek Pospisil
- Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Zdenek Kral
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic.,CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic.,CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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Svoboda M, Navrátil J, Palácová M, Fabian P, Bareková L, Kabut T, Coufal O, Fait V, Jurácek J, Selingerová I. Abstract P1-07-16: Triple-negative breast cancer: A single-centre retrospective cohort study of 408 TNBC cases with a focus on elderly patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-07-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: TNBC represents a heterogeneous group of breast cancers that do not express ER-α, PgR and Her-2 receptors. Generally, these tumors are aggressive and more common in younger women. The aim of our study was to create a representative set of patients with TNBC, which could be analyzed and the data gathered to build basic epidemiological, molecular and clinical characteristics of Czech patients with TNBC. In particular, we focused on older patients (≥70 and ≥75 y.o.). Methods: We retrospectively studied a consecutive cohort of 408 patients diagnosed and/or treated for TNBC at the Masaryk Memorial Cancer Institute between 2004 and 2010. Some clinical-pathologic/molecular correlations were performed to identify prognostically different groups of patients.
Results: The median age of patients was 56 years (25–88). A total of 9.3% of TNBC cases were diagnosed in patients under the age of 34, another 15,2% and 15,0% of cases were in the age group of 35 to 44 years and ≥70 years, respectively. In the group of patients aged ≥70 years (61), 59 % (36) were ≥75 y.o. Incidence of CK5/6+ and BRCA1 mutated tumors decreased with increasing age of patients, while the number of AR+ tumors increased (Chi-square test for trends: p=0,0245, p=0,0049 and p=0,0047, respectively). We confirmed the aggressive nature of this disease: in the follow-up period (median 77,2 months) we observed a relapse in 27,2 % (111) of patients: 71 % of deaths due to disease progression occured within 2 years after diagnosis of the disease. Patients ≥70 and especially ≥75 years of age had, together with patients ≤30 y.o., the highest risk of death due to tumor progression. DFS and OS of patients ≥75 y.o. was significantly worse in comparison with other patients (OS: p=0,035, HR 0,515; DFS: p=0,0077, HR 0,475). Simultaneously, adjuvant chemotherapy and anthracyclines were much less frequently administered in this age group (p<0,0001), despite the fact that the distribution of clinical stages did not differ among the age groups. In the whole cohort, the most important negative prognostic factors in relation to disease specific OS were: higher clinical stage and pT (both p<0.0001), pN–positive status (p<0.0001), absence or early withholding of chemotherapy (p<0.0001) and minimal disease response to neoadjuvant treatment (TRG4-TRG5) (p=0.005). High levels of BCL2 expression predicted poor OS in basal-like TNBC patients treated with adjuvant anthracycline-based regimens (p=0.033, HR 3.04). Contrariwise, longer OS was associated with the presence of tumor infiltrating lymphocytes (p=0,0004, HR 2,40).
Conclusion: TNBC is an aggressive form of breast cancer, which may occur in patients of all ages, but more frequently in younger patients. Early detection and intensive treatment od these tumors gives a high chance of cure. Patients ≥70 and especially ≥75 years of age, together with patients ≤30 y.o., are at the highest risk of death due to tumor progression. While in younger patients it is likely due to the aggressiveness of disease, in older patients, in particular, because of an absence of adjuvant systemic therapy. The introduction of targeted therapies could potentially improve prognosis in both groups of patients (eg. PARP inhibitors, antiandrogens).
Supported by IGA MZ CR: NT14599-3.
Citation Format: Svoboda M, Navrátil J, Palácová M, Fabian P, Bareková L, Kabut T, Coufal O, Fait V, Jurácek J, Selingerová I. Triple-negative breast cancer: A single-centre retrospective cohort study of 408 TNBC cases with a focus on elderly patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-16.
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Affiliation(s)
- M Svoboda
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - J Navrátil
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - M Palácová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - P Fabian
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - L Bareková
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - T Kabut
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - O Coufal
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - V Fait
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - J Jurácek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - I Selingerová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
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