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Wang YL, Zhai QJ, Wang ZH, Yang X, Wang JL, Zhu HL. A retrospective study of ovarian tissue cryopreservation in female patients with hematological diseases for fertility preservation. Arch Gynecol Obstet 2024:10.1007/s00404-024-07484-4. [PMID: 38575798 DOI: 10.1007/s00404-024-07484-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/16/2024] [Indexed: 04/06/2024]
Abstract
PURPOSES To investigate the effect and safety of ovarian tissue cryopreservation (OTC) for fertility preservation in female patients with hematological diseases. METHODS We designed a retrospective study. The clinical data of patients with hematological diseases undergoing OTC admitted to Peking University People's Hospital from April 2017 to January 2023 were analyzed and summarized. RESULTS A total of 24 patients were included in the study, including 19 patients with malignant hematological diseases and 5 patients with non-malignant hematological diseases. The former included 14 patients with acute leukemia, 1 patient with chronic leukemia, and 4 patients with myelodysplastic syndrome, while the latter 5 patients were aplastic anemia (AA). 16 patients had received chemotherapy before OTC. The average age of 24 patients was 22.80 ± 6.81 years. The average anti-Mullerian hormone (AMH) was 1.97 ± 2.12 ng/mL, and the average follicle-stimulating hormone (FSH) was 7.01 ± 4.24 IU/L in examination before OTC. FSH was greater than 10.0 IU/L in 4 cases. The pre-OTC laboratory tests showed that the average white blood cell (WBC) count was (3.33 ± 1.35) × 109/L, the average hemoglobin was 91.42 ± 22.84 g/L, and the average platelet was (147.38 ± 114.46) × 109/L. After injection of recombinant human granulocyte colony-stimulating factor (rhG-CSF), blood transfusion, and iron supplementation in pre-OTC treatment, the average WBC count was (4.91 ± 3.07) × 109/L, the average hemoglobin was 98.67 ± 15.43 g/L, and the average platelet was (156.38 ± 103.22) × 109/L. Of the 24 patients, 22 underwent laparoscopic bilateral partial oophorectomy and oophoroplasty, and 2 underwent laparoscopic unilateral oophorectomy. The average duration of OTC was 59.54 ± 17.58 min, and the average blood loss was 32.1 ± 41.6 mL. The maximum blood loss was 200 mL. There was no significant difference in WBC count and hemoglobin concentration after OTC compared to pre-OTC period. Only the platelet count after OTC surgery was significantly different from that before surgery ([134.54 ± 80.84 vs. 156.38 ± 103.22] × 109/L, p < 0.05). None of the 24 patients had serious complications after OTC. 2 patients had mild infection symptoms, but both recovered well. 23 patients underwent hematopoietic stem cell transplantation (HSCT) after OTC. The median and interquartile range from OTC to the pretreatment of HSCT was 33 (57) days, and the median and interquartile range from OTC to HSCT was 41 (57) days. Seven of them began pretreatment of HSCT within 20 days and began HSCT within 30 days after OTC. All patients were followed up. Of the 23 patients who underwent HSCT after surgery, 22 presented with amenorrhea and 1 with scanty menstrual episodes. Seven patients underwent hormone replacement therapy (HRT) after HSCT. A patient with AA underwent ovarian tissue transplantation (OTT) 3 years after HSCT and resumed regular menstruation 6 months after OTT. CONCLUSIONS Ovarian tissue cryopreservation has a promising future in fertility protection in patients with hematological diseases. However, patients with hematological malignancies often have received gonadotoxic therapy before OTC, which may be accompanied by myelosuppression while patients with non-malignant hematological diseases often present with severe hemocytopenia. So perioperative complete blood count of patients should be paid attention to. There was no significant difference in the WBC count and hemoglobin concentration in patients with hematological diseases before and after OTC surgery, and the platelet count decreased slightly within the normal range. Infection is the most common post-OTC complication, and HSCT pretreatment can be accepted as early as the 10th day after OTC. OTC has no adverse effects on patients with hematological diseases and does not delay HSCT treatment. For young patients with hematological diseases, OTC is an effective method of fertility preservation.
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Affiliation(s)
- Yi-Ling Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Qing-Jie Zhai
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Zhao-Hua Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Jian-Liu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Hong-Lan Zhu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China.
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Vieira IB, Sette NSV, de Oliveira CA, Correia MITD, Duarte CK, Generoso SV. Comparison of pre- and posttransplant energy expenditure in patients undergoing hematopoietic stem cell transplantation and evaluation of associated factors. Nutrition 2024; 118:112260. [PMID: 37980778 DOI: 10.1016/j.nut.2023.112260] [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: 07/11/2023] [Revised: 09/17/2023] [Accepted: 10/01/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Patients undergoing hematopoietic stem cell transplantation may present with metabolic alterations that can have an effect on their energy expenditure and nutritional status. This project aimed to compare the pre- and posttransplant energy expenditures of patients undergoing hematopoietic stem cell transplantation as well as related factors. METHODS This prospective study was conducted at a single center. Patients, undergoing autograft or allograft, were evaluated before transplantation and on the 10th and 17th d posttransplantation. Energy expenditure was measured by indirect calorimetry. Diet intake was assessed by a 24-h dietary recall. Infectious and noninfectious complications were analyzed between days 1 to 10 after transplantation and days 11 to 17 after transplantation. Paired model analyses were carried out to identify the pretransplantation and posttransplantation periods. RESULTS Twenty patients were evaluated with a mean age of 45.6 ± 17.2 y; a majority were male sex (65%), and the most frequent diagnoses were chronic myeloid leukemia (25%) and multiple myeloma (25%). Energy expenditure increased by 15% posttransplantation, and the energy requirement per kilogram of weight was 23 kcal/kg at day 10 after transplantation. Throughout the posttransplantation period, 45% of the patients required nutritional therapy. Negative energy and negative protein balance were observed at all analyzed times. Phase angle (P = 0.018), fever (P = 0.014), mucositis grades I to II (P = 0.018), and the total number of infectious and noninfectious events (P = 0.043) were associated with an increase in energy expenditure at day 10 after transplantation. CONCLUSIONS Energy expenditure increased after transplantation compared with pretransplantation in 50% of patients. Phase angle, fever, grades I to II mucositis, and infectious and noninfectious events were associated with increased energy expenditure at day 10 after transplantation.
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Affiliation(s)
- Izabella Barbosa Vieira
- Nutrition and Health Program, Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nayara Salgado Vieira Sette
- Food Sciences, Department of Food, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Camila Kummel Duarte
- Nutrition and Health Program, Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Simone Vasconcelos Generoso
- Nutrition and Health Program, Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Zhen S, Lin Q, Chen Z, Shen Y, Chen X, Pang A, Yang D, Zhang R, Ma Q, He Y, Wei J, Zhai W, Jiang E, Han M, Wang J, Feng S. Ceftazidime-avibactam in the treatment of bacteremia due to carbapenem-resistant gram-negative bacteria in hematological patients: Experience in a single center. J Infect Chemother 2024:S1341-321X(24)00011-4. [PMID: 38215820 DOI: 10.1016/j.jiac.2024.01.007] [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: 08/15/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Limited experience exists with ceftazidime-avibactam (CAZ-AVI) in treating bacteremia caused by carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) in hematological patients. METHODS We performed a single-center, retrospective, observational study including patients who received CAZ-AVI for bacteremia due to CRE or CRPA between 2018 and 2022. The primary outcome was 30-day survival. We conducted a multivariable analysis to identify predictors of survival. RESULTS 56 patients were included and 57 (41 CRE and 16 CRPA) strains were isolated. 35 strains produced carbapenemase, including 25 metallo-beta-lactamase (MBL) and 10 serine-beta-lactamase. 48 patients (85.7 %) received combination therapy. All patients with MBL-CRE bacteremia (n = 24) received combination therapy with aztreonam (AZT). The susceptibility rates to CAZ-AVI were only 26.8 % (11/41) in CRE and 80.0 % (8/10) in CRPA. The 30-day survival rates were 85.0 % (34/40) in the CRE group and 81.3 % (13/16) in the CRPA group. In patients with MBL-CRE bacteremia, the 30-day survival was as high as 91.7 % (22/24) due to combination with AZT. Ceftazidime did not influence the activity of aztreonam-avibactam against MBL-CRE in-vitro. Multivariable cox analysis revealed neutropenia >14 days (P = 0.002, HR: 34.483, 95%CI: 3.846-333.333) and a higher Pitt bacteremia score (P = 0.005, HR: 2.074, 95%CI: 1.253-3.436) were risk factors for 30-day survival. CONCLUSIONS CAZ-AVI is highly effective in treating bacteremia due to CRPA and serine-beta-lactamase CRE. The combination of avibactam with AZT is highly effective in treating bacteremia due to AZT-resistant MBL producers.
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Affiliation(s)
- Sisi Zhen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Qingsong Lin
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Zhangjie Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yuyan Shen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Xin Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Aiming Pang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Donglin Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Rongli Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Qiaoling Ma
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yi He
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Jialin Wei
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Weihua Zhai
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China.
| | - Erlie Jiang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Mingzhe Han
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China.
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Wu Y, Jiang S, Li D, Wu Y, Li Q, Wang X, Liu B, Bao H, Wu D, Hu X. Clinical Efficacy and Safety of Colistin Sulfate in the Treatment of Carbapenem-Resistant Organism Infections in Patients with Hematological Diseases. Infect Dis Ther 2024; 13:141-154. [PMID: 38212555 PMCID: PMC10828183 DOI: 10.1007/s40121-023-00909-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Carbapenem-resistant organisms (CRO) have emerged as a significant worldwide issue. However, the availability of efficacious antibiotics for treating CRO infections remains limited. Polymyxins, including colistin sulfate, represent the last-line therapeutic option against CRO infections. This study aims to retrospectively evaluate the clinical effectiveness and safety of colistin sulfate in managing CRO infections among patients with hematological diseases. METHODS Between April 2022 and January 2023, a total of 118 hematological patients diagnosed with CRO infection were treated with colistin sulfate at Suzhou Hongci Hospital of Hematology. The assessment encompassed the clinical efficacy, bacterial clearance rate, adverse reactions, and 30-day all-cause mortality. RESULTS The study found that the total effective rate of colistin sulfate in the treatment of CRO infection was 74.6%, with a bacterial clearance rate of 72.6%. Throughout the treatment, nephrotoxicity occurred in 7.6% of cases, neurotoxicity in 2.5% of cases, and the 30-day all-cause mortality rate was 22.9%. Multivariate logistic analysis revealed that the treatment course and combination medication with other antimicrobials were independent factors affecting the clinical efficacy of colistin sulfate. CONCLUSION Our study demonstrates that the treatment of colistin sulfate can achieve high clinical efficacy and microbial responses, with a low risk of nephrotoxicity. This study provides evidence of the positive clinical efficacy and safety of colistin sulfate treatment in these patients. High-quality randomized controlled trials are still needed to further confirm the beneficial role of colistin sulfate.
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Affiliation(s)
- Yuanbing Wu
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Shanshan Jiang
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Dongyang Li
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Yaxue Wu
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Qian Li
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Xing Wang
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Bin Liu
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Haiyan Bao
- Department of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China
| | - Depei Wu
- Department of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.
| | - Xiaohui Hu
- Department of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.
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Sahu S, Poplawska M, Lim SH, Dutta D. CRISPR-based precision medicine for hematologic disorders: Advancements, challenges, and prospects. Life Sci 2023; 333:122165. [PMID: 37832631 DOI: 10.1016/j.lfs.2023.122165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/22/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
The development of programmable nucleases to introduce defined alterations in genomic sequences has been a powerful tool for precision medicine. While several nucleases such as zinc-finger nucleases (ZFN), transcriptor activator-like effector nucleases (TALEN), and meganucleases have been explored, the advent of CRISPR/Cas9 technology has revolutionized the field of genome engineering. In addition to disease modeling, the CRISPR/Cas9 technology has contributed to safer and more effective treatment strategies for hematologic diseases and personalized T-cell-based therapies. Here we discuss the applications of the CRISPR technology in the treatment of hematologic diseases, their efficacy, and ongoing clinical trials. We examine the obstacles to their successful use and the approaches investigated to overcome these challenges. Finally, we provide our perspectives to improve this genome editing tool for targeted therapies.
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Affiliation(s)
- Sounak Sahu
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, 1050 Boyles Street, Building 560, Room 32-04, Frederick, MD 21702, USA.
| | - Maria Poplawska
- Department of Medicine (Division of Hematology and Oncology), State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Seah H Lim
- Department of Medicine (Division of Hematology and Oncology), State University of New York Upstate Medical University, 750 E Adams, Syracuse, NY 13210, USA
| | - Dibyendu Dutta
- Department of Medicine (Division of Hematology and Oncology), State University of New York Upstate Medical University, 750 E Adams, Syracuse, NY 13210, USA.
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Chen X, Xiao J, Wang X, Lu X, An J, Zhao J, Wei J, Wei J, He S, Tian W. Lack of surgical resection is associated with increased early mortality in hematological patients complicated with rhino-orbital-cerebral mucormycosis. Ann Hematol 2023; 102:2933-2942. [PMID: 37421505 DOI: 10.1007/s00277-023-05349-5] [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: 03/06/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
Rhino-orbital-cerebral mucormycosis (ROCM), which is an acute fatal infectious disease with a high mortality rate, is increasingly being diagnosed in patients with hematological diseases worldwide. We aimed to investigate the clinical characteristics, treatment, and prognosis of hematological diseases complicated by ROCM. Our sample comprised a total of 60 ROCM patients with hematological diseases. The most common primary disease was acute lymphoblastic leukemia (ALL) (n=27, 45.0%), while 36 patients (60.0%) were diagnosed with a clear type of pathogen, all belonging to the Mucorales, most commonly Rhizopus (41.7%). Of the 32 patients (53.3%) who died, 19 (59.3%) died of mucormycosis, and 84.2% (n=16) of those died within 1 month. Forty-eight cases (80.0%) received antifungal treatment combined with surgical therapy, 12 of whom (25.0%) died of mucormycosis, amounting to a mortality rate that was significantly lower than in patients who received antifungal therapy alone (n=7, 58.3%) (P=0.012). The median neutrophil value of patients who underwent surgery was 0.58 (0.11-2.80) 103/μL, the median platelet value was 58.00 (17.00-93.00) 103/μL, and no surgery-related deaths were reported. Multivariate analysis showed that patient's advanced age (P=0.012, OR=1.035 (1.008-1.064)) and lack of surgical treatment (P=0.030, OR=4.971 (1.173-21.074)) were independent prognostic factors.In this study, hematological diseases associated with ROCM have a high mortality rate. Lack of surgical treatment is an independent prognostic factor for death from mucormycosis. Surgery may therefore be considered in patients with hematological disease even if their neutrophil and platelet values are lower than normal.
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Affiliation(s)
- Xinyue Chen
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Juan Xiao
- Department of Hematology, Beijing Jingdu Children's Hospital, Beijing, 102208, China
| | - Xinwei Wang
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Xinyi Lu
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China
| | - Jing An
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Jie Zhao
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China
| | - Junni Wei
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Jia Wei
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030000, Shanxi, China
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Shaolong He
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China.
| | - Weiwei Tian
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China.
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China.
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Lan Z, Lv Z, Zuo W, Xiao Y. From bench to bedside: The promise of sotatercept in hematologic disorders. Biomed Pharmacother 2023; 165:115239. [PMID: 37516019 DOI: 10.1016/j.biopha.2023.115239] [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: 05/30/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023] Open
Abstract
Sotatercept (ACE-011) is an activin receptor IIA-Fc (ActRIIA-Fc) fusion protein currently under investigation for its potential in the treatment of hematologic diseases. By impeding the activities of the overexpressed growth and differentiation factor 11 (GDF11), activin A, and other members of the transforming growth factor-β (TGF-β) superfamily, commonly found in hematologic disorders, sotatercept aims to restore the normal functioning of red blood cell maturation and osteoblast differentiation. This action is anticipated to enhance anemia management and hinder the progression of myeloma. Simultaneously, comprehensive research is ongoing to investigate sotatercept's pharmacokinetics and potential adverse reactions, thus laying a robust foundation for its prospective clinical use. In this review, we provide a detailed overview of TGF-β pathways in physiological and hematologic disorder contexts, outline the potential mechanism of sotatercept, and delve into its pharmacokinetics and clinical research advancements in various hematologic diseases. A particular emphasis is given to the relationship between sotatercept dosage and its efficacy or associated adverse reactions.
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Affiliation(s)
- Zehao Lan
- Department of Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha 410011, China; Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Zhaohua Lv
- Department of Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha 410011, China; Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Wanyun Zuo
- Department of Hematology, Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha 410011, China.
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Bianchino G, Grieco V, Pietrantuono G, Russi S, Del Vecchio L, Falco G, Notarangelo T. Comparative analyses of DNA extraction methods for whole blood quantification of HCMV DNAemia in patients with hematological diseases: false negative cases in manual method. Heliyon 2023; 9:e18740. [PMID: 37554809 PMCID: PMC10404732 DOI: 10.1016/j.heliyon.2023.e18740] [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: 04/27/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
Human cytomegalovirus (HCMV) DNA quantitation in whole blood (WB) by real-time or quantitative polymerase chain reaction (qPCR) is a highly sensitive and reproducible diagnostic procedure for monitoring HCMV DNAemia (DNAemia is the detection of DNA in samples of plasma, whole blood, isolated peripheral blood leukocytes or in buffy-coat specimens) in patients. We provided a comparative analysis of HCMV DNA extraction performance by two different techniques, one performed by an automated extractor and the other by a manual method. We observed that the automated extraction method allowed HCMV DNA detection in the presence of weak viremia while no differences are observed when the viral load is greater. Therefore, automated DNA extraction is a suitable and recommended protocol not only for early detection of HCMV infection but also for more accurate monitoring of HCMV DNAemia during post-therapy follow-up.
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Affiliation(s)
- Gabriella Bianchino
- IRCCS CROB, Centro di Riferimento Oncologico della Basilicata, 85028, Rionero in Vulture (PZ), Italy
| | - Vitina Grieco
- IRCCS CROB, Centro di Riferimento Oncologico della Basilicata, 85028, Rionero in Vulture (PZ), Italy
| | - Giuseppe Pietrantuono
- IRCCS CROB, Centro di Riferimento Oncologico della Basilicata, 85028, Rionero in Vulture (PZ), Italy
| | - Sabino Russi
- IRCCS CROB, Centro di Riferimento Oncologico della Basilicata, 85028, Rionero in Vulture (PZ), Italy
| | - Luigi Del Vecchio
- Biotecnologie Avanzate, CEINGE, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, “Federico II” University of Naples, Italy
| | - Geppino Falco
- Department of Biology, University of Naples Federico II, 80126, Naples, Italy
- Biogem, Istituto di Biologia e Genetica Molecolare, Via Camporeale, 83031, Ariano Irpino (AV), Italy
| | - Tiziana Notarangelo
- IRCCS CROB, Centro di Riferimento Oncologico della Basilicata, 85028, Rionero in Vulture (PZ), Italy
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Fattizzo B, Rampi N, Barcellini W. Vaccinations in hematological patients in the era of target therapies: Lesson learnt from SARS-CoV-2. Blood Rev 2023; 60:101077. [PMID: 37029066 PMCID: PMC10043962 DOI: 10.1016/j.blre.2023.101077] [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: 01/30/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023]
Abstract
Novel targeting agents for hematologic diseases often exert on- or off-target immunomodulatory effects, possibly impacting on response to anti-SARS-CoV-2 vaccinations and other vaccines. Agents that primarily affect B cells, particularly anti-CD20 monoclonal antibodies (MoAbs), Bruton tyrosine kinase inhibitors, and anti-CD19 chimeric antigen T-cells, have the strongest impact on seroconversion. JAK2, BCL-2 inhibitors and hypomethylating agents may hamper immunity but show a less prominent effect on humoral response to vaccines. Conversely, vaccine efficacy seems not impaired by anti-myeloma agents such as proteasome inhibitors and immunomodulatory agents, although lower seroconversion rates are observed with anti-CD38 and anti-BCMA MoAbs. Complement inhibitors for complement-mediated hematologic diseases and immunosuppressants used in aplastic anemia do not generally affect seroconversion rate, but the extent of the immune response is reduced under steroids or anti-thymocyte globulin. Vaccination is recommended prior to treatment or as far as possible from anti-CD20 MoAb (at least 6 months). No clearcut indications for interrupting continuous treatment emerged, and booster doses significantly improved seroconversion. Cellular immune response appeared preserved in several settings.
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Affiliation(s)
- Bruno Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Nicolò Rampi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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10
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Kelkar M, Kadanthode M, Mohanty S, Verma A. Effect of low-level laser therapy on post-extraction hemostasis in patients with hemophilia - A prospective cohort study. J Craniomaxillofac Surg 2023:S1010-5182(23)00074-4. [PMID: 37355374 DOI: 10.1016/j.jcms.2023.05.003] [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: 07/24/2022] [Revised: 02/15/2023] [Accepted: 05/21/2023] [Indexed: 06/26/2023] Open
Abstract
Dental extraction in hemophiliacs can be complicated by perilous bleeding. Although developments in local hemostatics and factor replacement have made outpatient extraction feasible, there is no standard protocol for preventing hemorrhagic exigency. Low-level laser therapy (LLLT) has firmly established role in hemostasis due to its ability to seal vessels, but this function has not been conclusively established in hemophiliac patients. The objective of our study was to evaluate the effectiveness of LLLT as compared with the standard protocol alone in achieving post-extraction hemostasis. A prospective interventional cohort study was designed and consisted of 60 patients with hemophilia A or B, who reported to the Maulana Azad Institute of Dental Sciences, New Delhi between October 2021 and March 2022. These were divided equally into test and control groups, both following the standard protocol. In the test group, extraction sockets were exposed to LLLT. The study assessed time required, instance of rebleeding, and additional methods employed for hemostasis in each group. The results showed a 22.42% reduction in average time taken to achieve hemostasis in the test group as compared with the control group. The tranexamic acid pack was replaced in two cases in both groups after 60 min of procedure. Three cases in the control group required suturing, and one case required cauterization. Rebleeding occurred in four cases in the test group and in 13 cases among the controls. Postoperative factor was infused in three and 12 cases in the test and control groups, respectively. The authors believe that perioperative use of LLLT should be encouraged because it demonstrated a significantly reduced time for hemostasis among hemophilia patients.
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Affiliation(s)
- Monica Kelkar
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India
| | - Mithilesh Kadanthode
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India.
| | - Sujata Mohanty
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India
| | - Anjali Verma
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India
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Hagihara M, Hayashi H, Nakajima S, Imai Y, Nakano H, Uchida T, Inoue M, Miyawaki M, Ikeda N, Konuma R, Atsuta Y, Tanaka M, Imamura A. [Outcomes of COVID-19 due to omicron variant infection complicated with hematological disorders]. Rinsho Ketsueki 2023; 64:3-8. [PMID: 36775303 DOI: 10.11406/rinketsu.64.3] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
When the omicron variant became the most dominant severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) variant causing coronavirus disease 2019 (COVID-19) in Japan, 11 patients with hematological diseases infected with this new variant were treated at our institution. Among them, four of the five patients who had been treated with chemotherapy progressed to moderate-II COVID-19, and two of them died. In contrast, five of the six patients who did not receive the treatment remained at mild to moderate-I stage of COVID-19, except for a single case progressing to moderate-II COVID-19. While all four patients infused with anti-coronavirus monoclonal antibodies within 8 days after the onset survived, the other two patients, being withheld from treatment or treated later, died. In these two cases, anti-SARS-Cov-2 immunoglobulin G antibodies remained at low titers. Although the omicron variant is considered a less harmful SARS-Cov-2 variant, patients with hematological disorders, particularly those who are immunosuppressed caused by chemotherapy, should be continuously cared for as they remain at a higher risk of severe COVID-19 due to insufficient or delayed anti-viral humoral immunity development. Thus, the rapid introduction of antiviral monoclonal antibodies together with anti-viral reagents may rescue these patients.
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Affiliation(s)
| | | | | | - Yui Imai
- Department of Hematology, Eiju General Hospital
| | | | | | | | | | | | - Ryosuke Konuma
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital
| | - Yuya Atsuta
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital
| | - Masaru Tanaka
- Division of Infectious Disease, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital
| | - Akifumi Imamura
- Division of Infectious Disease, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital
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Zhang Y, Zhou D, Xia H, Wang J, Yang H, Xu L, Huang K, Fang J. Metagenomic next-generation sequencing for detection of pathogens in children with hematological diseases complicated with infection. Mol Cell Probes 2023; 67:101889. [PMID: 36513243 DOI: 10.1016/j.mcp.2022.101889] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/04/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Infection is one of the most common causes of death in children with hematological diseases. Here, we aim to investigate the value of metagenomic next-generation sequencing (mNGS) in the detection of causative pathogens in children with hematological diseases. METHODS In this retrospective study, specimens from children with hematological diseases, who were admitted to Sun Yat-Sen University between June 2019 and September 2021, were collected for culture and mNGS. RESULTS A total of 67 pediatric patients were enrolled, and 96 specimens were collected. The positive rate of mNGS was significantly higher than that of culture (57.2% vs 12.5%, P < 0.01). The concordance (90.9%, 10/11) between the positive results of the two methods was high. mNGS detected more cases with Pneumocystis jeroveci, Aspergillus flavus, viruses, and some rare pathogens than culture. Mixed infections were detected by mNGS in 16 cases. Clinical anti-infective treatment was adjusted according to the results of mNGS, the conditions of most patients improved. CONCLUSION Compared to culture, mNGS shows great advantages in diagnosing bacterial, fungal, viral, and mixed infections in children with hematologic diseases, positively impacting clinical care. mNGS can be used as a complement to culture for pathogen detection.
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Affiliation(s)
- Yating Zhang
- Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, SunYat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dunhua Zhou
- Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, SunYat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Han Xia
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, 100176, China
| | - Jian Wang
- Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, SunYat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Huaqing Yang
- Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, SunYat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Luhong Xu
- Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, SunYat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ke Huang
- Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, SunYat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianpei Fang
- Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, SunYat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Ma L, Shen J, Jiang H, Qian S, Zhang J, Lan J, Zhou H, Lang W, Mei C, Zhou X, Zhu L, Xu G, Ye L, Hu C, Ren Y, Yang X, Jin J, Ye X, Tong H. Empirical polymyxin B therapy in febrile neutropenic patients with hematological diseases: A prospective, multicenter, observational clinical study. J Infect 2023; 86:406-409. [PMID: 36702310 DOI: 10.1016/j.jinf.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Affiliation(s)
- Liya Ma
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Jianping Shen
- Department of Hematology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Huifang Jiang
- Department of Hematology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Shenxian Qian
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province, China
| | - Jin Zhang
- Department of Hematology, The Affiliated Shaoyifu Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jianping Lan
- Department of Hematology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Hua Zhou
- Department of Respiratory, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Wei Lang
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Chen Mei
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Xinping Zhou
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Lixia Zhu
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Gaixiang Xu
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Li Ye
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Chao Hu
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Yanling Ren
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Xiudi Yang
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China
| | - Xiujin Ye
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China.
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, 58# Chengzhan Road, Hangzhou, Zhejiang Province, China.
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Zhang JY, Li Y, Ma YS, Sun XJ, Liu YZ, Yin YK, Hu B, Su MH, Li QL, Mi YC, Li DP. Clinical characteristics and prognostic factors in intracranial hemorrhage patients with hematological diseases. Ann Hematol 2022. [PMID: 36178488 DOI: 10.1007/s00277-022-04982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/14/2022] [Indexed: 11/01/2022]
Abstract
The clinical characteristics and prognosis of intracranial hemorrhage (ICH) in patients with hematological diseases remain controversial. This study aimed to describe the clinical characteristics and explore the prognostic factors in such patients. A total of 238 ICH patients with a hematological disease were recruited from the Institute of Hematology and Blood Diseases Hospital, China, from January 2015 to April 2020. The Cox proportional hazards model was used to identify the prognostic factors for 30-day mortality in ICH patients with a hematological disease. There were 123 cases of acute leukemia (AL), 20 of myelodysplasia/myeloproliferative neoplasm, 35 of aplastic anemia (AA), 29 of immune thrombocytopenia (ITP), 19 of congenital/acquired coagulation factor deficiency, and 12 of other hematological diseases. Furthermore, 121 patients presented with a multi-site hemorrhage (MSH), 58 with a single-site hemorrhage in the brain parenchyma (PCH), 23 with a subarachnoid hemorrhage, 33 with a subdural hemorrhage (SH), and three with an epidural hemorrhage. The Cox proportional hazards model indicated association of SH (vs PCH, hazard ratio [HR]: 0.230; 95% confidence interval [CI]: 0.053-0.996; P = 0.049), low white blood cells (≤ 100 × 109/L vs > 100 × 109/L, HR: 0.56; 95% CI: 0.348-0.910; P = 0.019), AA (vs AL, HR: 0.408; 95% CI: 0.203-0.821; P = 0.012), and ITP (vs AL, HR: 0.197; 95% CI: 0.061-0.640; P = 0.007) with improved 30-day mortality. However, increased age (HR: 1.012; 95% CI: 1.001-1.022; P = 0.034), MSH (vs PCH, HR: 1.891; 95% CI: 1.147-3.117; P = 0.012), and a disturbance of consciousness (HR: 1.989; 95% CI: 1.269-3.117; P = 0.003) were associated with increased risk of 30-day mortality. In conclusion, in this study, we revealed the clinical characteristics of Chinese ICH patients with a hematological disease. Moreover, we identified risk factors (age, white blood cells, AA, ITP, SH, MSH, and a disturbance of consciousness) that may influence 30-day mortality.
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Hao SF, Wang YH, Li LJ, Wang HQ, Song J, Wu YH, Qu W, Wang GJ, Wang XM, Liu H, Xing LM, Guan J, Shao ZH, Fu R. [Clinical application value of peripheral blood metagenomic next-generation sequencing test for patients with hematological diseases accompanied by fever]. Zhonghua Xue Ye Xue Za Zhi 2022; 43:766-70. [PMID: 36709171 DOI: 10.3760/cma.j.issn.0253-2727.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To investigate the clinical application value of peripheral blood metagenomic next-generation sequencing (mNGS) test for patients with hematological diseases accompanied by fever. Methods: The blood mNGS results and clinical data of inpatients with hematological diseases accompanied by fever treated in the Hematology Department of Tianjin Medical University General Hospital in March 2020 to June 2021were retrospectively analyzed. A total of 90 patients with 98 cases of specimens were included. The pathogen distribution characteristics and mNGS test performance were analyzed. Results: The positive rate of peripheral blood mNGS was significantly higher than that of traditional examination (68.37% vs 37.76%, P<0.001) and blood culture (68.37% vs 9.18%, P<0.001) . Viral, bacterial, and fungal infections accounted for 38.81%, 14.93%, and 2.99% in patients with single-pathogen infections, respectively. Polymicrobial infections accounted for 43.28%, in which viral and bacterial coinfections were the most common type (25.37%) . There were 55 virus-positive cases (82.09%) , 30 bacteria-positive cases (44.78%) , and 14 fungus-positive cases (20.90%) . The clinical approval rate of peripheral blood mNGS was 64.63% (63/98) . The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of peripheral blood mNGS were 75.68%, 36.07%, 41.79%, and 70.97%, respectively, and the overall consistency rate with traditional examination was 51.02%. Of the 22 pulmonary infection cases with no detectable pathogens by conventional tests, the pathogens were identified by peripheral blood mNGS in 14 cases, 10 of which were clinically approved. Conclusion: The positive rate of peripheral blood mNGS was significantly higher than that of blood culture and traditional laboratory examination. Peripheral blood mNGS had a high clinical recognition rate, sensitivity, and NPV in the detection of pathogens in patients with hematological diseases accompanied by fever.
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Porteus MH, Pavel-Dinu M, Pai SY. A Curative DNA Code for Hematopoietic Defects: Novel Cell Therapies for Monogenic Diseases of the Blood and Immune System. Hematol Oncol Clin North Am 2022; 36:647-665. [PMID: 35773054 PMCID: PMC9365196 DOI: 10.1016/j.hoc.2022.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew H Porteus
- Department of Pediatrics, Division of Stem Cell Transplantation and Regenerative Medicine, Stanford Medical School, Lokey Stem Cell Research Building, G3040B, MC 5462, 265 Campus Drive, Stanford, CA 94305, USA.
| | - Mara Pavel-Dinu
- Department of Pediatrics, Division of Stem Cell Transplantation and Regenerative Medicine, Stanford Medical School, Lokey Stem Cell Research Building, G3045, MC 5175, 265 Campus Drive, Stanford, CA 94305, USA.
| | - Sung-Yun Pai
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, 10 Center Drive, MSC 1102, Bethesda, MD 20892, USA
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Xu C, Lin Q, Zhao Y, Zhu G, Jiang E, Li S, Mi Y, Zheng Y, Zhang F, Zhu X, Xiao Z, Han M, Wang J, Feng S. Clinical characteristics and risk factors of Aeromonas bloodstream infections in patients with hematological diseases. BMC Infect Dis 2022; 22:303. [PMID: 35351036 PMCID: PMC8962005 DOI: 10.1186/s12879-022-07277-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze the clinical features, risk factors and outcomes of Aeromonas bloodstream infections (BSIs) in patients with hematological diseases to establish an effective optimal therapy against it. METHODS A retrospective study was performed by reviewing medical records of patients admitted to a tertiary blood disease hospital in China. Patients with hematological diseases who suffered from Aeromonas bacteremia during January 2002 to December 2020 were enrolled in this study. RESULTS A total of 63 patients who developed Aeromonas bacteremia were enrolled in the study, and 91.9% of patients were neutropenic at the onset of BSIs. The major complications were skin and soft tissue infection (SSTI) (22.2%), followed by gastroenteritis (19.0%) and pneumonia (14.3%). High carbapenem resistance rates (70.8% for imipenem, 71.4% for meropenem) were note among the cases. Furthermore, Aeromonas strains isolated from five individuals developed resistance to quinolone, β-lactams and tigecycline during the therapy. The 30-day mortality rate was 15.9%, while bacteremia with SSTI showed a much worse prognosis, with 50.0% (7/14) of the patients dying within 30 days of initiating the therapy. In the multivariate analysis, SSTI (OR = 28.72; 95% CI, 1.50-551.30; P = 0.026) and shock (OR = 47.58; 95% CI,1.06-2126.80; P = 0.046) were independent risk factors for mortality. CONCLUSIONS Aeromonas bacteremia usually occurred in patients with neutropenic status, and patients with SSTIs were more likely to show a worse prognosis. Carbapenems should be avoided in patients with Aeromonas BSIs and SSTIs given high resistance rate.
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Affiliation(s)
- Chunhui Xu
- Clinical Laboratory, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
| | - Qingsong Lin
- Clinical Laboratory, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
| | - Yuanqi Zhao
- Hematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Guoqing Zhu
- Clinical Laboratory, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
| | - Erlie Jiang
- Hematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Shangzhu Li
- General Medical Center for Blood diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yingchang Mi
- Leukemia Center, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yizhou Zheng
- Anemia Center, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Fengkui Zhang
- Anemia Center, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaofan Zhu
- Pediatric Hematology Center, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zhijian Xiao
- Myelodysplastic Syndromes Center, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Mingzhe Han
- Hematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Jianxiang Wang
- Leukemia Center, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Sizhou Feng
- Hematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosysterm, Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 288 Nanjing Road, Tianjin, China.
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Shang YX, Zheng Z, Wang M, Guo HX, Chen YJ, Wu Y, Li X, Li Q, Cui JY, Ren XX, Wang LR. Diagnostic performance of Neutrophil CD64 index, procalcitonin, and C-reactive protein for early sepsis in hematological patients. World J Clin Cases 2022; 10:2127-2137. [PMID: 35321184 PMCID: PMC8895178 DOI: 10.12998/wjcc.v10.i7.2127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/17/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with hematological diseases are immunosuppressed due to various factors, including the disease itself and treatments, such as chemotherapy and immunotherapy, and are susceptible to infection. Infections in these patients often progress rapidly to sepsis, which is life-threatening.
AIM To evaluate the diagnostic efficacy of the neutrophil CD64 (nCD64) index, compared to procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP), for the identification of early sepsis in patients with hematological diseases.
METHODS This was a prospective analysis of patients with hematological diseases treated at the Fuxing Hospital affiliated with Capital Medical University, between March 2014 and December 2018. The nCD64 index was quantified by flow cytometry and the Leuko64 assay software. The factors which may affect the nCD64 index levels were compared between patients with different infection statuses (local infection, sepsis, and no infection), and the control group and the nCD64 index levels were compared among the groups. The diagnostic efficacy of the nCD64 index, PCT, and hs-CRP for early sepsis was evaluated among patients with hematological diseases.
RESULTS A total of 207 patients with hematological diseases (non-infected group, n = 50; locally infected group, n = 67; sepsis group, n = 90) and 26 healthy volunteers were analyzed. According to the absolute neutrophil count (ANC), patients with hematological diseases without infection were divided into the normal ANC, ANC reduced, and ANC deficiency groups. There was no statistically significant difference in the nCD64 index between these three groups (P = 0.586). However, there was a difference in the nCD64 index among the non-infected (0.74 ± 0.26), locally infected (1.47 ± 1.10), and sepsis (2.62 ± 1.60) groups (P < 0.001). The area under the diagnosis curve of the nCD64 index, evaluated as the difference between the sepsis and locally infected group, 0.777, which was higher than for PCT (0.735) and hs-CRP (0.670). The positive and negative likelihood ratios were also better for the nCD64 index than either PCT and hs-CRP.
CONCLUSION Our results indicate the usefulness of the nCD64 index as an inflammatory marker of early sepsis in hematological patients.
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Affiliation(s)
- Yu-Xi Shang
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
| | - Zhi Zheng
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Min Wang
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
| | - Hui-Xia Guo
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
| | - Yi-Juan Chen
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
| | - Yue Wu
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
| | - Xing Li
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
| | - Qian Li
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
| | - Jian-Ying Cui
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
| | - Xiao-Xiao Ren
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
| | - Li-Ru Wang
- Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
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Kılıçaslan E, Erdoğan Özünal I, Elibol T, Öztürk E. Are Hematologic Patients Trojan Horse for COVID-19? Indian J Hematol Blood Transfus 2021; 38:529-535. [PMID: 34667375 PMCID: PMC8517942 DOI: 10.1007/s12288-021-01498-7] [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: 06/07/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) which is caused by severe acute respiratory distress syndrome virus (SARS-CoV-2) continues to affect people all around the world. This study aimed to compare the SARS-CoV-2 viral shedding time between patients diagnosed with hematologic diseases (HD) and a control group. A total of 110 patients were enrolled in this retrospective study; 55 patients with a diagnosis of HD and 55 sex and comorbidity matched controls without a diagnosis of HD, who caught COVID-19 at the same period. Thirty-eight patients were hospitalized in each group. Viral shedding time, COVID-19 severity, need for intensive care unit support, and mortality rates were compared between groups. Median viral shedding time was 24 days in hospitalized HD patients and 12 days in the hospitalized control group (p < 0.01) as 20 days in outpatient HD patients and 10 days in the outpatient control group (p = 0.02). Viral shedding time was longer in severe + critical COVID-19 cases in the whole cohort (median 22 days in severe + critical, and 12 days in mild + moderate) (p < 0.01). Severe + critical COVID-19 was more common in the HD group than the control group (47.2% versus 25.4%, respectively) (p = 0.017). Twenty-five patients were dead in the whole cohort. One patient was in the control group and 24 patients were in the HD group, therefore the mortality rate for the HD group was 43.6%. Because of statistically significant longer viral shedding time, longer-term isolation may be necessary for hematologic patients diagnosed with COVID-19.
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Affiliation(s)
- Emrah Kılıçaslan
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Işıl Erdoğan Özünal
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Tayfun Elibol
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Erman Öztürk
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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20
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Su J, Han J, Song J. A benchmark bone marrow aspirate smear dataset and a multi-scale cell detection model for the diagnosis of hematological disorders. Comput Med Imaging Graph 2021; 90:101912. [PMID: 33892388 DOI: 10.1016/j.compmedimag.2021.101912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/22/2021] [Accepted: 03/26/2021] [Indexed: 01/18/2023]
Abstract
Research on pathological diagnosis of hematopoietic disorders based on bone marrow aspirate smear images has attracted more and more attention with the development of deep learning methods. However, high quality bone marrow aspirate smear image datasets are not readily available because of the time, the efforts, and the medical knowledge required in the acquisition and manual annotation images. In order to facilitate the research of automated diagnosis of hematological disorders, we constructed a high quality Bone Marrow Aspirate Smear Image Dataset (BMASID), which contains 230 bone marrow aspirate smear images, all with the corresponding labeled images. We used additional clinical images as testing data, which are more challenging because of image noise, cell overlap, cell adhesion, blurred borders of cells and ambiguous types of cells. We also proposed a Cell Recognition Network (CRNet) that was trained on this benchmark dataset. CRNet is comprised of a cell detector to locate and recognize cells in the bone marrow aspirate images, and a cell classifier to classify the types of cells. New anchors and novel evaluation metrics are proposed and applied in CRNet. Benchmark evaluations of the proposed CRNet demonstrated the satisfactory performance of our state-of-the-art methods. Experimental results show that the detection precision by detector is more than 83%, and it is better when compared with other detection methods. After the cell type confirmation by the cell classifier, the precision is more than 95%. Compared with the most popular evaluation metrics Intersection over Union (IoU) and the newly proposed Generalized Intersection over Union (GIoU) used in the object detection benchmarks, our evaluation metrics are more suitable for the cell detection task with ambiguous cell boundaries. The proposed bone marrow aspirate smear image dataset and the proposed evaluation metrics can be used in the training and the evaluation of cell detection models, which contributes to future research in the pathological analysis and auxiliary diagnostic methods of hematological disorders. The codes are available at: https://github.com/SuJie-Med/hematolgical-disorders.
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Affiliation(s)
- Jie Su
- School of Computer Science and Engineering, University of Jinan, Jinan, China; Shandong Provincial Key Laboratory of Network Based Intelligent Computing, University of Jinan, China.
| | - Jinjun Han
- School of Computer Science and Engineering, University of Jinan, Jinan, China; Shandong Provincial Key Laboratory of Network Based Intelligent Computing, University of Jinan, China
| | - Jinming Song
- Department of Hematopathology and Lab Medicines, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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21
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Chinese Association Hematologists., Chinese Invasive Fungal Infection Working Group. [The Chinese guidelines for the diagnosis and treatment of invasive fungal disease in patients with hematological disorders and cancers (the 6th revision)]. Zhonghua Nei Ke Za Zhi 2020; 59:754-63. [PMID: 32987477 DOI: 10.3760/cma.j.cn112138-20200627-00624] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Chinese Invasive Fungal Infection Working Group published the first edition of guidelines for the diagnosis and treatment of IFD in patients with hematological disorders and cancers in 2005, and has been revised several editions thereafter. Recently, new treatments such as targeted therapy have emerged in the field of hematological cancers. These advances are modifying the definition of high-risk IFD, the epidemiology of IFD, and the strategies in IFD diagnosis and treatment. Meanwhile, diagnostic methods of IFD were evaluated in a lot of clinical studies. Therefore, the Chinese Working Group of Invasive Fungal Infections issued the latest Chinese guideline, based on Infectious Diseases Group of the European Organisation for Research and Treatment of Cancer (EORTC-IDG) and the American Mycoses Study Group (MSG) standards, the Infectious Diseases Society of America (IDSA) guidelines and the European Conference on Infections in Leukemia (ECIL) guidelines. The IFD is still classified as Proven, Probable, Possible and Undefined; the management strategies include prophylaxis, empirical antifungal therapy, diagnostic-driven antifungal therapy and targeted anti-fungal therapy. The major revisions include the epidemiology of IFD, in vitro susceptibility tests of anti-fungal drugs, and therapeutic drug concentration monitoring.
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22
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Kumar P, Aggarwal M, Dhawan R, Dass J, Kumar G, Sharma V, Mirza S, Senapati J, Ganju N, Vaid T, Vijayran M, Panda T, Pragna GS, Krishna SS, Khandelwal A, Verghese R, Tyagi S, Seth T, Mahapatra M. Tele-Medicine Services in Hematological Practice During Covid Pandemic: Its Feasibility and Difficulties. Indian J Hematol Blood Transfus 2020; 37:528-533. [PMID: 33250594 PMCID: PMC7678769 DOI: 10.1007/s12288-020-01385-7] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
In COVID 19 pandemic, delivery and access of health care services have become challenging. Telemedicine services can be considered for management of patients with hematological diseases. This study included all patients who enrolled for telemedicine facility for hematology from May 15 to July 15, 2020. Patient’s demographic and disease related parameters were recorded during the teleconsultation call. Overall satisfaction of attending doctor and patients were also recorded. A total of 1187 teleconsultation appointments were taken, of which 944 (79.6%) were successfully attended. Median age of patients was 38 years (range- 0.5–78 years), with 38% females. 55% of successful calls were from patients suffering a malignant hematological disorder. 24% had an active complaint pertaining to their disease or treatment. Of these, 162 (17%) were asked for a physical consultation. A significant association was found between the requirement of physical consultation and diagnosis (p < 0.001), absence of active complaint (< 0.0001) and education level of responder (p = 0.008). Patients understand that teleconsultation is helpful in preventing COVID-19 infection (71.4%) and avoids outpatient department rush (14.5%) associated with physical appointments; and around 80% patients were satisfied with the teleconsult. With the emergence of COVID 19, many localities under partial lockdown with constant fear of contacting virus amongst patients and health care providers, we can clearly see the advantages as well as feasibility of telemedicine services for our patients. The acute surge in telemedicine could be harnessed in the future to provide comprehensive and integrated care to patients of hematological disorders.
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Affiliation(s)
- Pradeep Kumar
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Mukul Aggarwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Dhawan
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Jasmita Dass
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Kumar
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishnu Sharma
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Saleem Mirza
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Jayastu Senapati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Ganju
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tejasvini Vaid
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Mona Vijayran
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tribikram Panda
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - G Stitha Pragna
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Sahitya Sri Krishna
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Khandelwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Renjith Verghese
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Gale RP. COVID-19 in Patients with Hematologic Disorders Undergoing Therapy: Perspective of a Large Referral Hematology Center in Rome. Acta Haematol 2020; 143:574-582. [PMID: 32155631 PMCID: PMC7573911 DOI: 10.1159/000510769] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022]
Abstract
Introduction Patients with cancer may be more susceptible to and have higher morbidity and mortality rates from COVID-19 than the general population, while epidemiologic data specifically addressed to hematologic patients are limited. To investigate whether patients with hematologic diseases undergoing therapy are at increased risk for acquiring SARS CoV-2 infection compared to the general population, a retrospective study was carried out at a referral hematologic center in Rome, Italy, during the period of the greatest epidemic spread (March 8 to May 14, 2020). Methods All adult and pediatric patients with a diagnosis of a neoplastic or a nonneoplastic hematologic disease who underwent treatment (chemotherapy or immunosuppressive or supportive therapy) during the study period or in the previous 6 months were considered. The prevalence of COVID-19 in the overall outpatient and inpatient population undergoing hematologic treatment compared to that of the general population was analyzed. The measures taken to manage patients during the epidemic period are described. Results Overall, 2,513 patients with hematological diseases were considered. Out of 243 (9.7%) patients who were screened for SARS CoV-2, three of 119 (2.5%) outpatients with fever or respiratory symptoms and none of 124 asymptomatic patients were diagnosed with COVID-19. Three further patients were diagnosed with COVID-19 and managed in other hospitals in Rome. As of May 14, 2020, the prevalence of COVID-19 in our hematologic population accounted for 0.24% (95% CI 0.23–0.25; 6 of 2,513 patients: 1 case in every 419 patients) as compared to 0.12% (7,280 of 5,879,082 residents; 1 case in every 807 residents) in the general population (p = 0.14). Three of 6 patients diagnosed with COVID-19 required critical care and 2 died while still positive for SARS CoV-2. Out of 225 healthcare providers on duty at our Institution during the study period, 2 (0.9%) symptomatic cases were diagnosed with COVID-19. Conclusion In our experience, the prevalence of COVID-19 in hematologic patients, mainly affected by malignancies, was not significantly higher compared to that of the general population. Definition of adapted strategies for healthcare services, while continuing to administer the standard hematologic treatments, represents the crucial challenge for the management of hematologic diseases in the COVID-19 era.
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Affiliation(s)
- Robert Peter Gale
- Centre forHaematology, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom,
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24
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Barreto LM, Ravetti CG, Athaíde TB, Bragança RD, Pinho NC, Chagas LV, de Lima Bastos F, Nobre V. Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes. J Intensive Care 2020; 8:68. [PMID: 32922803 PMCID: PMC7475950 DOI: 10.1186/s40560-020-00484-x] [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: 06/23/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background The usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate. Aim To analyze the rate of noninvasive ventilation failure and the main characteristics associated with this endpoint in oncohematological patients with acute respiratory failure (ARF). Methods A ventilatory support protocol was developed and implemented before the onset of the study. According to the PaO2/FiO2 (P/F) ratio and clinical judgment, patients received supplementary oxygen therapy, NIMV, or invasive mechanical ventilation (IMV). Results Eighty-two patients were included, average age between 52.1 ± 16 years old; 44 (53.6%) were male. The tested protocol was followed in 95.1% of cases. Six patients (7.3%) received IMV, 59 (89.7%) received NIMV, and 17 (20.7%) received oxygen therapy. ICU mortality rates were significantly higher in the IMV (83.3%) than in the NIMV (49.2%) and oxygen therapy (5.9%) groups (P < 0.001). Among the 59 patients who initially received NIMV, 30 (50.8%) had to eventually be intubated. Higher SOFA score at baseline (1.35 [95% CI = 1.12-2.10], P = 0.007), higher respiratory rate (RR) (1.10 [95% CI = 1.00-1.22], P = 0.048), and sepsis on admission (16.9 [95% CI = 1.93-149.26], P = 0.011) were independently associated with the need of orotracheal intubation among patients initially treated with NIMV. Moreover, NIMV failure was independently associated with ICU (P < 0.001) and hospital mortality (P = 0.049), and mortality between 6 months and 1 year (P < 0.001). Conclusion The implementation of a NIMV protocol is feasible in patients with hematological neoplasia admitted to the ICU, even though its benefits still remain to be demonstrated. NIMV failure was associated with higher SOFA and RR and more frequent sepsis, and it was also related to poor prognosis.
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Affiliation(s)
- Lídia Miranda Barreto
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,NIIMI (Interdisciplinary Nucleus of Investigation in Intensive Medicine), Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190/533, Santa Efigênia, Belo Horizonte, Minas Gerais 30130-100 Brazil
| | - Cecilia Gómez Ravetti
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,NIIMI (Interdisciplinary Nucleus of Investigation in Intensive Medicine), Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190/533, Santa Efigênia, Belo Horizonte, Minas Gerais 30130-100 Brazil
| | | | - Renan Detoffol Bragança
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,NIIMI (Interdisciplinary Nucleus of Investigation in Intensive Medicine), Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190/533, Santa Efigênia, Belo Horizonte, Minas Gerais 30130-100 Brazil
| | - Nathália Costa Pinho
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Vieira Chagas
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Vandack Nobre
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,NIIMI (Interdisciplinary Nucleus of Investigation in Intensive Medicine), Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190/533, Santa Efigênia, Belo Horizonte, Minas Gerais 30130-100 Brazil
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25
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Chen XC, Xu J, Wu DP. Clinical characteristics and implications of mixed candida/bacterial bloodstream infections in patients with hematological diseases. Eur J Clin Microbiol Infect Dis 2020; 39:1445-1452. [PMID: 32170543 DOI: 10.1007/s10096-020-03863-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/29/2020] [Accepted: 03/05/2020] [Indexed: 01/01/2023]
Abstract
The incidence of mixed candida/bacterial blood infections (BSIs) has been reported to account for 20% of all cases of candidaemia. However, its clinical characteristics and implications in patients with hematological diseases are not clear. We conducted a retrospective case-control study of hematological patients complicated with candidaemia over the past 5-year period to identify the risk factors and clinical implications of mixed candidia/bacterial BSIs (case group) vs. monobacterial candidiasis (control group). Of all 65 enrolled patients with candidaemia, 20 cases (30.8%) met the diagnostic criteria for mixed candida/bacterial BSIs. Candida tropicalis was the most common candida species in all patients. Klebsiella pneumoniae was the most detected bacteria (35%) in case group. Previous hospital stay ≥ 28 days, organic damage during candidaemia, and positive procalcitonin (PCT) test were the risk factors of mixed candida/bacterial BSIs. Cumulative mortality of all patients enrolled was 26.2% at day 30, with significant differences between case and control group. In multivariate analysis, organic damage and granulocyte recovery were the two predictive factors for 30-day mortality. Mixed candida/bacterial BSIs are fatal complications of infection which account for a considerable part of candidaemia; multicenter and large-scale clinical studies are required in the future.
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Affiliation(s)
- Xiao-Chen Chen
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jie Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - De-Pei Wu
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China. .,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China. .,Department of Hematology, the First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation, Soochow University, Shizi Street 188, Suzhou, 215006, China.
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26
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Huang Q, Liu Q, Yin T, Hu L, Ding H, Liu S, Jiang Y. Effect of proton pump inhibitors on voriconazole concentrations in Chinese patients with malignant hematological diseases. Eur J Clin Pharmacol 2020; 76:833-842. [PMID: 32157329 DOI: 10.1007/s00228-020-02841-z] [Citation(s) in RCA: 4] [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] [Received: 10/23/2019] [Accepted: 01/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the influence of three proton pump inhibitors (PPIs) on plasma voriconazole (VOR) concentrations and characterize potential drug-drug interactions (DDIs) between VOR and three PPIs (omeprazole, lansoprazole, and pantoprazole) in Chinese patients with malignant hematological diseases. METHODS A simple and reliable 2D-HPLC with internal quality control method was used to ensure accurate concentration measurements. A total of 194 patients in this retrospective study were divided into control (N = 59), omeprazole (OME, N = 57), lansoprazole (LAN, N = 26), and pantoprazole (PAN, N = 52) groups for comparison of plasma VOR trough concentrations. To further validate our retrospective analysis of clinical data, we used molecular docking simulation to analyze the binding affinity of PPIs to the cytochrome P450 2C19 (CYP2C19) and cytochrome P450 3A4 (CYP3A4) enzymes that are integral to the metabolism of PPIs and VOR. RESULTS Our findings indicated that VOR trough concentrations were significantly higher in patient on PPIs compared with those who were not (P = 0.012). Patients on LAN (P < 0.01) or OME (P < 0.05) had significantly elevated VOR concentrations compared with the control group, whereas those on PAN did not. Although VOR trough concentrations were not significantly elevated with PAN, more patients in the PAN group reached therapeutic VOR concentrations than in any other group. CONCLUSION In conclusion, our retrospective data analysis and molecular docking simulations results indicate that LAN and OME interact with VOR via CYP2C19 and CYP3A4 to increase VOR plasma concentrations. This study helps with selection of PPIs in Chinese patients with malignant hematological cancer administered VOR.
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Affiliation(s)
- Qi Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.,Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Institute for Rational and Safe Medication Practices, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Qiong Liu
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Tao Yin
- Department of Pharmacy, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.,Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Institute for Rational and Safe Medication Practices, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Lin Hu
- Department of Pharmacy, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.,Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Institute for Rational and Safe Medication Practices, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hanjun Ding
- School of Pharmacy, Hubei University of Science and Technology, Xianning, 437100, China
| | - Shao Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. .,Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Institute for Rational and Safe Medication Practices, Xiangya Hospital, Central South University, Changsha, 410008, China.
| | - Yueping Jiang
- Department of Pharmacy, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. .,Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Institute for Rational and Safe Medication Practices, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Xu CH, Lin QS, Lyu YX, Zhu GQ, Tian ZY, Wang C, Sun FJ, Yao HJ, Wang C. [Clinical features and laboratory data analysis of Aeromonas bacteremia with hematological diseases]. Zhonghua Xue Ye Xue Za Zhi 2020; 40:1035-1039. [PMID: 32023737 PMCID: PMC7342681 DOI: 10.3760/cma.j.issn.0253-2727.2019.12.013] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
目的 分析患有血液系统疾病患者气单胞菌血流感染的临床及实验室特征,为该类患者气单胞菌感染的防治提供依据。 方法 回顾性分析中国医学科学院血液病医院2014年1月至2018年12月5年发生气单胞菌血症的血液系统疾病患者,收集患者临床感染特征、菌株耐药性、发生季节、治疗及转归情况等相关信息。 结果 共42例血液病患者发生气单胞菌血流感染,其中39例(92.9%)血流感染发生于粒细胞缺乏(粒缺)期,平均发热时间为4(1~27)d,22例(52.4%)患者症状仅为发热,6例(14.3%)伴消化道症状(腹痛、腹泻、恶心、上消化道出血),8例(19.0%)伴肺部感染,13例(31.0%)伴皮肤软组织感染。7例(16.7%)患者死亡,且均伴皮肤软组织感染。气单胞菌对碳青霉烯类抗菌药物的耐药率为68.3%~70.7%,而对头孢菌素类、喹诺酮类及氨基糖苷类抗菌药物的耐药率均小于10%。 结论 血液系统疾病合并气单胞菌血流感染主要发生在粒缺期,主要以发热为主,当伴有皮肤软组织感染时死亡率高。抗菌药物选择应依据药敏结果,避免使用碳青霉烯类抗菌药物。
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Affiliation(s)
- C H Xu
- Institute of Hematology & Blood Diseases Hospital, CAMS&PUMC, National Clinical Research Center for Hematological Disorders, Tianjin 300020, China
| | - Q S Lin
- Institute of Hematology & Blood Diseases Hospital, CAMS&PUMC, National Clinical Research Center for Hematological Disorders, Tianjin 300020, China
| | - Y X Lyu
- Institute of Hematology & Blood Diseases Hospital, CAMS&PUMC, National Clinical Research Center for Hematological Disorders, Tianjin 300020, China
| | - G Q Zhu
- Institute of Hematology & Blood Diseases Hospital, CAMS&PUMC, National Clinical Research Center for Hematological Disorders, Tianjin 300020, China
| | - Z Y Tian
- Institute of Hematology & Blood Diseases Hospital, CAMS&PUMC, National Clinical Research Center for Hematological Disorders, Tianjin 300020, China
| | - C Wang
- Institute of Hematology & Blood Diseases Hospital, CAMS&PUMC, National Clinical Research Center for Hematological Disorders, Tianjin 300020, China
| | - F J Sun
- Institute of Hematology & Blood Diseases Hospital, CAMS&PUMC, National Clinical Research Center for Hematological Disorders, Tianjin 300020, China
| | - H J Yao
- Institute of Hematology & Blood Diseases Hospital, CAMS&PUMC, National Clinical Research Center for Hematological Disorders, Tianjin 300020, China
| | - C Wang
- Institute of Hematology & Blood Diseases Hospital, CAMS&PUMC, National Clinical Research Center for Hematological Disorders, Tianjin 300020, China
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Qi Y, Zhao MF, Deng Q, Geng L. [Mucormycosis in patients with hematological diseases: seven cases reports and literature review]. Zhonghua Xue Ye Xue Za Zhi 2019; 40:943-947. [PMID: 31856445 PMCID: PMC7342367 DOI: 10.3760/cma.j.issn.0253-2727.2019.11.011] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
目的 探讨血液病合并毛霉菌病患者的临床特征、诊治与转归,提高对该病的认识。 方法 回顾性分析2012年9月至2018年9月7例血液病合并毛霉菌病患者的临床资料,分析其临床特征、治疗过程和转归。 结果 7例血液病合并毛霉菌病患者中,男4例,女3例,中位年龄36(19~79)岁。基础疾病:急性髓系白血病2例,急性B淋巴细胞白血病、外周T细胞淋巴瘤、慢性髓性白血病急髓变、骨髓增殖性肿瘤及重型再生障碍性贫血(移植后)各1例。毛霉菌病临床类型:4例为肺型,1例为鼻眶脑型,1例为皮肤型,1例为播散型。7例患者均通过活检组织病理确诊。治疗药物为两性霉素B、两性霉素B脂质体及泊沙康唑。手术治疗4例,其中3例术中彻底清除病变组织,1例仅行局限性清除。治愈2例,好转1例,死亡4例。 结论 血液病合并毛霉菌病患者临床表现及影像学表现多样,死亡率高,确诊主要依赖于组织病理学。早期诊断、控制基础疾病、改善免疫抑制状态、尽早行有效的抗真菌药物治疗及彻底的手术清创治疗是提高血液病合并毛霉菌病患者生存率的关键。
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Affiliation(s)
- Y Qi
- Department of Hematology, Tianjin First Central Hospital, The First Central Clinical College of Tianjin Medical University 300192, China
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Weber S, Hogardt M, Reinheimer C, Wichelhaus TA, Kempf VAJ, Kessel J, Wolf S, Serve H, Steffen B, Scheich S. Bloodstream infections with vancomycin-resistant enterococci are associated with a decreased survival in patients with hematological diseases. Ann Hematol 2019; 98:763-773. [PMID: 30666433 DOI: 10.1007/s00277-019-03607-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
Enterococcus species are commensals of the human gastrointestinal tract with the ability to cause invasive infections. For patients with hematological diseases, enterococcal bloodstream infections (BSI) constitute a serious clinical complication which may even be aggravated if the pathogen is vancomycin-resistant. Therefore, we analyzed the course of BSI due to vancomycin-susceptible enterococci (VSE) in comparison to vancomycin-resistant enterococci (VRE) on patient survival. In this retrospective single-center study, BSI were caused by VRE in 47 patients and by VSE in 43 patients. Baseline patient characteristics were similar in both groups. Concerning infection-related characteristics, an increased CRP value and an increased rate of prior colonization with multidrug-resistant organisms were detected in the VRE BSI group. More enterococcal invasive infections were found in the VSE group. The primary endpoint, overall survival (OS) at 30 days after BSI, was significantly lower in patients with VRE BSI compared to patients with VSE BSI (74.5% vs. 90.7%, p = 0.039). In a multivariate regression analysis, VRE BSI and a Charlson comorbidity index higher than 4 were independent factors associated with 30-day mortality. Moreover, we found that VRE with an additional teicoplanin resistance showed a trend towards an even lower OS.
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Affiliation(s)
- Sarah Weber
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany. .,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Michael Hogardt
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claudia Reinheimer
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas A Wichelhaus
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johanna Kessel
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Wolf
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Hubert Serve
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Björn Steffen
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Scheich
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
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Wang RY, Chen YQ, Wu JQ, Wang X, Cao YH, Zhao HZ, Zhu LP. Cryptococcosis in patients with hematological diseases: a 14-year retrospective clinical analysis in a Chinese tertiary hospital. BMC Infect Dis 2017; 17:463. [PMID: 28673256 PMCID: PMC5496217 DOI: 10.1186/s12879-017-2561-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 12/21/2016] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Cryptococcal infection has become a public health challenge globally. However, information about cryptococcal infection in patients with hematological diseases remains relatively rare. Methods HIV-uninfected cryptococcosis cases with hematological diseases admitted to Huashan Hospital from January 2001 to December 2014 were reviewed. Results In total, 33 cryptococcosis patients were enrolled, including 12 malignant and 21 non-malignant hematological cases. Twenty-six patients had central nervous system (CNS) involvement, which was observed more often in patients with non-malignancies than with malignancies (20/21 vs. 6/12, P = 0.001) Most patients (25/26) with CNS infection were confirmed by cerebrospinal fluid (CSF) culture or smear, and 100% (20/20) of them tested positive for the CSF cryptococcal antigen test. Eighteen out of 26 cryptococcal meningitis patients were treated with amphotericin B (AmB)-based therapy, 16 of them with AmB deoxycholate (d-AmB) and 2 patients with liposomal AmB. The clinical success rate was 55.6%. D-AmB was well-tolerated at 0.35–0.59 mg/kg/d (median 0.43 mg/kg/d) and only 12 patients had mild adverse events. Conclusions CNS cryptococcal infection was more frequent in patients with hematological non-malignancies, and cryptococcal antigen test as well as the CSF fungal culture or smear are suggested for early diagnosis. D-AmB could be used as an alternative therapy for CNS-infected patients with hematological diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2561-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rui-Ying Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Yan-Qiong Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Ji-Qin Wu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Xuan Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Ya-Hui Cao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Hua-Zhen Zhao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Li-Ping Zhu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China.
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Metafuni E, Santangelo R, Chiusolo P, Laurenti L, Sorà F, Giammarco S, Sica S. H1N1 Influenza among Hematological Patients: Monocentric Influenza Cases from 2011 to 2016. Mediterr J Hematol Infect Dis 2017; 9:e2017024. [PMID: 28293412 DOI: 10.4084/MJHID.2017.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
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Zhang Q, Ding N, Zhang L, Zhao X, Yang Y, Qu H, Fang X. Biological Databases for Hematology Research. Genomics Proteomics Bioinformatics 2016; 14:333-337. [PMID: 27965103 PMCID: PMC5200935 DOI: 10.1016/j.gpb.2016.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 09/29/2016] [Accepted: 10/13/2016] [Indexed: 01/14/2023]
Abstract
With the advances of genome-wide sequencing technologies and bioinformatics approaches, a large number of datasets of normal and malignant erythropoiesis have been generated and made public to researchers around the world. Collection and integration of these datasets greatly facilitate basic research and clinical diagnosis and treatment of blood disorders. Here we provide a brief introduction of the most popular omics data resources of normal and malignant hematopoiesis, including some integrated web tools, to help users get better equipped to perform common analyses. We hope this review will promote the awareness and facilitate the usage of public database resources in the hematology research.
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Affiliation(s)
- Qian Zhang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China
| | - Nan Ding
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China
| | - Lu Zhang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xuetong Zhao
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yadong Yang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Hongzhu Qu
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China
| | - Xiangdong Fang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China.
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Li H, Li DQ, Li XX, Wang LQ. The association between oxidized low-density lipoprotein antibodies and hematological diseases. Lipids Health Dis 2016; 15:190. [PMID: 27825356 DOI: 10.1186/s12944-016-0360-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/01/2016] [Indexed: 01/18/2023] Open
Abstract
Background The aim of the study is to compare the profiles of antibodies (IgM and IgG) against oxidized low-density lipoprotein (oxLDL) of hematological diseases. Methods The serum antibodies of oxLDL-IgM and oxLDL-IgG for 446 cases with hematological diseases and 90 patients with primary hypertension and 90 healthy controls were measured by enzyme-linked immunosorbent assay (ELISA) in a cross-section survey. The association of serum oxLDL-LgM and oxLDL-IgG with hematological diseases was analyzed by multiple linear regression model. Results Comparing with the hypertension or normal groups, the levels of TCH, TG, LDL-c, HDL-c, oxLDL, and oxLDL-IgG were lower and the levels of ADP and oxLDL-IgM were higher in the hematological diseases group. The levels of oxLDL-IgG antibodies titer were different among hematological diseases group. The results of correlation and multiple regression analysis showed that the seven hematological disease subgroups were positively related to the oxLDL-IgM antibody titer but negatively related to the oxLDL-IgG antibody titer, having been adjusted for potential confounding factors such as age, SBP, DBP, BMI, TCH, TG, ADP, oxLDL, HDL-c, LDL-C. Conclusions Here we show that oxLDL-IgG antibodies titer were lower and of oxLDL-IgM titer were higher than hypertension and healthy individuals. Also oxLDL-IgG titer were different among hematological diseases group.
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Akyol O, Akyol S, Chen CH. Update on ADAMTS13 and VWF in cardiovascular and hematological disorders. Clin Chim Acta 2016; 463:109-118. [PMID: 27746209 DOI: 10.1016/j.cca.2016.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 08/11/2016] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 02/07/2023]
Abstract
Endothelial cells (EC) respond to injury by releasing numerous factors, including von Willebrand factor (VWF). High circulating levels of unusually large VWF multimers (UL-VWFM) have strong procoagulant activity and facilitate platelet adhesion and aggregation by interacting with platelets after an acute event superimposed on peripheral arterial disease and coronary artery disease. ADAMTS13-a disintegrin-like metalloproteinase with thrombospondin motif type 1 member 13-regulates a key physiological process of coagulation in the circulation by cleaving VWF multimers into small, inactive fragments. Low levels of ADAMTS13 in the blood may play a role in cardiovascular and hematological disorders, and clarifying its role may help improve disease management. The genetic, pharmacological, physiological, and pathological aspects related to ADAMTS13/VWF have been extensively investigated. Here, we provide an update on recent findings of the relationship between ADAMTS13 and hematological/cardiovascular disorders, including thrombotic thrombocytopenic purpura, arterial thrombosis, thrombotic microangiopathy, myocardial infarction, ischemic stroke, heart failure, and hypertension.
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Affiliation(s)
- Omer Akyol
- Vascular and Medicinal Research, Texas Heart Institute, Houston, TX, USA; Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Sumeyya Akyol
- Vascular and Medicinal Research, Texas Heart Institute, Houston, TX, USA; Medical Biochemist, TUBITAK/BIDEB Scholar, Ankara, Turkey
| | - Chu-Huang Chen
- Vascular and Medicinal Research, Texas Heart Institute, Houston, TX, USA; Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Vanhee S, Vandekerckhove B. Pluripotent stem cell based gene therapy for hematological diseases. Crit Rev Oncol Hematol 2015; 97:238-46. [PMID: 26381313 DOI: 10.1016/j.critrevonc.2015.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 07/04/2015] [Accepted: 08/26/2015] [Indexed: 01/26/2023] Open
Abstract
Standard treatment for severe inherited hematopoietic diseases consists of allogeneic stem cell transplantation. Alternatively, patients can be treated with gene therapy: gene-corrected autologous hematopoietic stem and progenitor cells (HSPC) are transplanted. By using retro- or lentiviral vectors, a copy of the functional gene is randomly inserted in the DNA of the HSPC and becomes constitutively expressed. Gene therapy is currently limited to monogenic diseases for which clinical trials are being actively conducted in highly specialized centers around the world. This approach, although successful, carries with it inherent safety and efficacy issues. Recently, two technologies became available that, when combined, may enable treatment of genetic defects by HSPC that have the non-functional allele replaced by a functional copy. One technology consists of the generation of induced pluripotent stem cells (iPSC) from patient blood samples or skin biopsies, the other concerns nuclease-mediated gene editing. Both technologies have been successfully combined in basic research and appear applicable in the clinic. This paper reviews recent literature, discusses what can be achieved in the clinic using present knowledge and points out further research directions.
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Affiliation(s)
- Stijn Vanhee
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Belgium
| | - Bart Vandekerckhove
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Belgium.
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