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Esmaeili B, Bayat B, Fazlollahi MR, Moradi L, Kalantari A, Nourbakhsh SMK, Pourpak Z. Identification of Antibodies against Neutrophil Surface Antigens in Two Iranian Patients with Autoimmune Neutropenia. Iran J Allergy Asthma Immunol 2021; 20:771-777. [PMID: 34920660 DOI: 10.18502/ijaai.v20i6.8029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/27/2021] [Indexed: 06/14/2023]
Abstract
Autoimmune neutropenia is a type of immune-mediated neutropenia, caused by antibody-induced neutrophil destruction. Here we report two cases (3-year-old boy and 9-year-old girl) with suspected autoimmune neutropenia. The presence of neutrophil antibodies in sera of these patients was investigated using standard neutrophil antibody screening tests such as granulocyte immunofluorescence test (GIFT), granulocyte agglutination test (GAT), and lymphocyte immunofluorescence test (LIFT). A positive reactivity with two panel cells was found in GIFT. No reactivities with panel cells were observed in GAT and LIFT. To the best of our knowledge, this is the first report for detecting the neutrophil reactive antibodies using genotyped neutrophils in patients with autoimmune neutropenia in Iran. The final diagnosis of our patients was primary autoimmune neutropenia for the boy and autoimmune neutropenia associated with familial Mediterranean fever for the girl.
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Affiliation(s)
- Behnaz Esmaeili
- Immunology, Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran.
| | - Behnaz Bayat
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany.
| | - Mohamad Reza Fazlollahi
- Immunology, Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran.
| | - Leila Moradi
- Immunology, Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran.
| | - Arash Kalantari
- Department of Pediatrics, Vali-e-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohammad Kazem Nourbakhsh
- Department of Pediatrics, Vali-e-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Pourpak
- Immunology, Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran.
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Choi JW, Fujii T. The Prevalence of Low Plasma Neutrophil Gelatinase-Associated Lipocalin Level in Systemic Inflammation and its Relationship with Proinflammatory Cytokines, Procalcitonin, Nutritional Status, and Leukocyte Profiles. Clin Lab 2019; 65. [PMID: 31232043 DOI: 10.7754/clin.lab.2019.181235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The significance of low plasma neutrophil gelatinase-associated lipocalin (NGAL) level in systemic inflammation has not been investigated. The aim of this study was to investigate low plasma NGAL level in systemic inflammation and its relationship with proinflammatory cytokines, procalcitonin (PCT), leukocyte profiles, nutritional status, and kidney function. METHODS Patients with systemic inflammation were evaluated by measuring NGAL, PCT, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), serum creatinine (sCr), and clinical scores. RESULTS Of 191 patients, 30 (15.7%) had low NGAL levels (< 68 ng/mL), and 102 (53.4%) had elevated NGAL levels (> 150 ng/mL). Among the 30 patients with low NGAL levels, 26 (86.7%) had normal kidney function and 24 (80.0%) had low-grade inflammation. In comparison with healthy individuals, patients with low NGAL levels had higher levels of TNF-α, IL-6, PCT, and hsCRP but not absolute neutrophil count (ANC). Neutropenia was more often observed in subjects with low NGAL levels than in those with elevated NGAL levels (16.7% versus 1.9%, p < 0.001). In the low NGAL group, plasma NGAL was significantly associated with ANC (r = 0.312, p < 0.001) but not cytokines, sCr, nutritional parameters, and clinical scores. Receiver operating characteristic (ROC) curve analysis demonstrated that the diagnostic ability of the ANC for identifying low NGAL levels was superior to that of PCT and TNF-α [0.82 (95% CI, 0.75 - 0.89) versus 0.67 (95% CI, 0.56 - 0.79) and 0.66 (95% CI, 0.54 - 0.78), respectively, p < 0.001]. CONCLUSIONS Low plasma NGAL level in systemic inflammation was more closely linked to the non-increment of the ANC than proinflammatory cytokines, PCT, and nutritional status, particularly in patients with low-grade inflammation who had preserved kidney function.
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Yang M, Choi SJ, Lee J, Lee DG, Kim YJ, Park YJ, Oh EJ. Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies. PLoS One 2019; 14:e0225765. [PMID: 31821331 PMCID: PMC6903763 DOI: 10.1371/journal.pone.0225765] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background Serum procalcitonin (PCT) and C-reactive protein (CRP) are biomarkers of infection. In patients with hematologic disorders with or without hematopoietic stem cell transplantation (HSCT), it is difficult to distinguish bloodstream infections from aseptic causes of febrile episodes. The objective of this study was to investigate diagnostic values of PCT and CRP in predicting systemic bacterial infection in patients with hematologic malignancies. Methods Clinical and laboratory data of 614 febrile episode cases from 511 patients were analyzed. Febrile episodes were classified into four groups: (1) culture-positive bacterial infection by Gram-positive cocci (GPC), (2) culture-positive bacterial infection by Gram-negative bacilli (GNB), (3) fungal infection, and (4) viral infection or a noninfectious etiology. Results Of 614 febrile cases, systemic bacterial infections were confirmed in 99 (16.1%) febrile episodes, including 38 (6.2%) GPC and 61 (9.9%) GNB infections. PCT levels were significantly higher in GNB infectious episodes than those in febrile episodes caused by fungal infection (0.58 ng/mL (95% CI: 0.26–1.61) vs. 0.22 ng/mL (0.16–0.38), P = 0.047). Bacterial infectious episodes showed higher PCT and CRP levels than non-bacterial events (PCT: 0.49 (0.26–0.93) ng/mL vs. 0.20 (0.18–0.22) ng/mL, P < 0.001; CRP: 76.6 (50.5–92.8) mg/L vs. 58.0 (51.1–66.5) mg/L, P = 0.036). For non-neutropenic febrile episodes, both PCT and CRP discriminated bacteremia from non-bacteremia. However, in neutropenic febrile episodes, PCT only distinguished bacteremia from non-bacteremia. In non-neutropenic episode, both PCT and CRP showed good diagnostic accuracy (AUC: 0.757 vs. 0.763). In febrile neutropenia, only PCT discriminated bacteremia from non-bacterial infection (AUC: 0.624) whereas CRP could not detect bacteremia (AUC: 0.500, 95% CI: 0.439–0.561, P > 0.05). Conclusions In this single-center observational study, PCT was more valuable than CRP for discriminating between bacteremia and non-bacteremia independent of neutropenia or HSCT.
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Affiliation(s)
- Mina Yang
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Laboratory Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seung Jun Choi
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewoong Lee
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Gun Lee
- Department of Internal Medicine, Division of infection, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Yeon-Joon Park
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jee Oh
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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Campagne O, Zhong B, Nair S, Lin T, Huang J, Onar-Thomas A, Robinson G, Gajjar A, Stewart CF. Exposure-Toxicity Association of Cyclophosphamide and Its Metabolites in Infants and Young Children with Primary Brain Tumors: Implications for Dosing. Clin Cancer Res 2019; 26:1563-1573. [PMID: 31796512 DOI: 10.1158/1078-0432.ccr-19-2685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/17/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To characterize the population pharmacokinetics of cyclophosphamide, active 4-hydroxy-cyclophosphamide (4OH-CTX), and inactive carboxyethylphosphoramide mustard (CEPM), and their associations with hematologic toxicities in infants and young children with brain tumors. To use this information to provide cyclophosphamide dosing recommendations in this population. PATIENTS AND METHODS Patients received four cycles of a 1-hour infusion of 1.5 g/m2 cyclophosphamide. Serial samples were collected to measure cyclophosphamide, 4OH-CTX, and CEPM plasma concentrations. Population pharmacokinetic modeling was performed to identify the patient characteristics influencing drug disposition. Associations between drug exposures and metrics reflecting drug-induced neutropenia, erythropenia, and thrombocytopenia were investigated. A Bayesian approach was developed to predict 4OH-CTX exposure using only cyclophosphamide and CEPM plasma concentrations. RESULTS Data from 171 patients (0.07-4.9 years) were adequately fitted by a two-compartment (cyclophosphamide) and one-compartment model (metabolites). Young infants (<6 months) exhibited higher mean 4OH-CTX exposure than did young children (138.4 vs. 107.2 μmol/L·h, P < 0.0001). No genotypes exhibited clinically significant influence on drug exposures. Worse toxicity metrics were significantly associated with higher 4OH-CTX exposures. Dosing simulations suggested decreased cyclophosphamide dosage to 1.2 g/m2 for young infants versus 1.5 g/m2 for children to attain similar 4OH-CTX exposure. Bayesian-modeled 4OH-CTX exposure predictions were precise (mean absolute prediction error 14.8% ± 4.2%) and had low bias (mean prediction error 4.9% ± 5.1%). CONCLUSIONS A 4OH-CTX exposure-toxicity association was established, and a decreased cyclophosphamide dosage for young infants was suggested to reduce toxicity in this population. Bayesian modeling to predict 4OH-CTX exposure may reduce clinical processing-related costs and provide insights into further exposure-response associations.
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Affiliation(s)
- Olivia Campagne
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Bo Zhong
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sreenath Nair
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tong Lin
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jie Huang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Giles Robinson
- Division of Neuro-Oncology, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Division of Neuro-Oncology, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Clinton F Stewart
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee.
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Aota K, Kani K, Yamanoi T, Momota Y, Ninomiya M, Yumoto H, Azuma M. Management of tooth extraction in a patient with ELANE gene mutation-induced cyclic neutropenia: A case report. Medicine (Baltimore) 2019; 98:e17372. [PMID: 31574885 PMCID: PMC6775366 DOI: 10.1097/md.0000000000017372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cyclic neutropenia (CyN) is a rare hematological disease, and patients with CyN often experience an early onset of severe periodontitis and are forced to undergo tooth extraction. Here, we report a case of a patient with CyN who showed different periodicity and oscillations of neutrophil count compared with her mother, despite sharing the same novel genetic mutation. PATIENT CONCERNS A 17-year-old Japanese girl who had been diagnosed with CyN shortly after birth presented to our hospital with a complaint of mobility of her teeth and gingivitis. Upon presentation, an intraoral examination was performed and revealed redness and swelling of the marginal and attached gingiva. Radiographs revealed extreme resorption of the alveolar bone and apical lesions in her mandibular lateral incisors. The patient's hematologic data demonstrated a lack of blood neutrophils (0/μL). The patient had no history of dental extraction, and her mother also had a history of CyN. DIAGNOSES The patient was diagnosed with severe periodontitis that was associated with CyN. Gene testing showed a novel heterozygous mutation in exon 4 of the ELANE gene (c.538delC, p.Leu180Ser fsX11). INTERVENTIONS Based on the clinical findings, we planned to extract the patient's mandibular lateral incisors. Although the tooth extraction was scheduled considering the cyclic variation in neutrophil count, the patient's neutrophil count was 0/μL on the day before the planned extraction. Therefore, granulocyte-colony stimulating factor (G-CSF) was administered to increase the patient's neutrophil count. On the day of the patient's admission for the tooth extraction, she presented with fever (body temperature, 38.5°C), tonsillitis, and stomatitis. The extraction was subsequently delayed, and the patient was administered antibiotics and G-CSF for 4 days. At this time, the neutrophil count increased to 750/μL, and the tooth extraction was carried out safely. OUTCOMES The postoperative course was uneventful, and the healing process at the extraction site was excellent. CONCLUSION There is a possibility that the periodicity and oscillations of neutrophil count may change with growth in patients with CyN. Therefore, it is important to frequently examine and treat patients with fluctuating neutrophil levels for the management of invasive dental treatment in patients with CyN.
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Affiliation(s)
| | | | | | | | - Masami Ninomiya
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiromichi Yumoto
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Furuya Y. Early neutropenia on day 8 treated with adjuvant Docetaxel-based chemotherapy in early breast cancer patients: Putative mechanisms within the neutrophil pool system. PLoS One 2019; 14:e0215576. [PMID: 30998754 PMCID: PMC6472781 DOI: 10.1371/journal.pone.0215576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/04/2019] [Indexed: 12/23/2022] Open
Abstract
Most chemotherapy regimens cause neutropenic nadirs between days 10 and 14, and administration of granulocyte colony-stimulating factor (G-CSF) support relies on this timing. In docetaxel (DOC)-based chemotherapy, the frequency of febrile neutropenia (FN) and the G-CSF dose administered varied greatly between studies. Our study goal was to forecast the necessary dose of G-CSF by comparing day 8 neutropenia with putative changes within the neutrophil pool. We conducted a retrospective observational analysis of 242 early breast cancer patients who had received adjuvant DOC-based chemotherapy (DOC group) compared with 43 patients who had received FEC chemotherapy (FEC group). Patients who were given a standard dose and had a blood test on day 8 in the 1st cycle were eligible. In the DOC group, patients routinely received prophylactic administration of G-CSF (150 μg/body) on day 3 and received additional G-CSF based on a blood test on day 8. Results of the day 8 blood test showed that severe neutropenia (<500/mm3, average 494/mm3) was observed in 152 out of 242 (62.8%) patients in the DOC group, while in the FEC group (n = 43), neutropenia was ambiguous (average 1,741/mm3). In the FEC group, 9 out of 43 patients (20.9%) and in the DOC group, 27 out of 242 patients (11.1%) experienced FN. In the DOC group, day 8 neutropenia was predictive for FN in a logistic regression model (OR 0.79 [95% CI: 0.655-0.952], p = 0.013). Among 214 patients under 70 years old, the planned chemotherapy cycle was completed in 190 (88.8%) patients who also received the maximum dose of G-CSF (150 μg/body) four times, while 23 patients could not complete the planned chemotherapy cycle, but only five because of FN-related complications. Patients treated with DOC should be treated for primary prophylaxis with G-CSF support at an earlier time starting with a relatively small dose.
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Affiliation(s)
- Yoshihiko Furuya
- Department of Surgery, Saiseikai Osaka Nakatsu Hospital, Osaka, Japan
- * E-mail:
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Abstract
Periodic hematological diseases such as cyclical neutropenia or cyclical thrombocytopenia, with their characteristic oscillations of circulating neutrophils or platelets, may pose grave problems for patients. Likewise, periodically administered chemotherapy has the unintended side effect of establishing periodic fluctuations in circulating white cells, red cell precursors and/or platelets. These fluctuations, either spontaneous or induced, often have serious consequences for the patient (e.g. neutropenia, anemia, or thrombocytopenia respectively) which exogenously administered cytokines can partially correct. The question of when and how to administer these drugs is a difficult one for clinicians and not easily answered. In this paper we use a simple model consisting of a delay differential equation with a piecewise linear nonlinearity, that has a periodic solution, to model the effect of a periodic disease or periodic chemotherapy. We then examine the response of this toy model to both single and periodic perturbations, meant to mimic the drug administration, as a function of the drug dose and the duration and frequency of its administration to best determine how to avoid side effects.
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Affiliation(s)
- Daniel C De Souza
- Department of Mathematics and Statistics, McGill University, Montreal, QC, H3A 0B9, Canada.
- Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Labs, Edinburgh, EH9 3FL, Scotland.
| | - Michael C Mackey
- Departments of Physiology, Physics and Mathematics, McGill University, 3655 Promenade Sir William Osler, Montreal, QC, H3G 1Y6, Canada
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McMahon KE, Habeeb O, Bautista GM, Levin S, DeChristopher PJ, Glynn LA, Jeske W, Muraskas JK. The association between AB blood group and neonatal disease. J Neonatal Perinatal Med 2019; 12:81-86. [PMID: 30347622 DOI: 10.3233/npm-17115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Numerous studies have examined the association between ABO blood groups and adult disease states, but very few have studied the neonatal population. The objective of this study was to determine the relationship between AB blood group and the occurrence of common neonatal disorders such as neutropenia at birth, sepsis, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and patent ductus arteriosus (PDA) compared to all other blood groups. METHODS We performed a retrospective review on 3,981 infants born at 22 0/7 to 42 6/7 weeks' gestational age and compared the relative risk of neonatal diseases in infants with AB blood group to that of infants with all other blood groups (A, B, and O). RESULTS When compared to all other blood groups, AB infants demonstrated an increased risk for developing negative clinical outcomes. AB blood group was significantly associated with a 14-89% increased risk of neutropenia at birth, sepsis, RDS, and ROP. Risks for IVH and PDA were not significant. CONCLUSION We hypothesize that the phenotypic expression of A and B antigens, rather than the antigens themselves, in the AB group may reveal an enhanced susceptibility to injury at the endothelial level resulting in an increased risk for disease development.
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Affiliation(s)
- K E McMahon
- Loyola University Medical Center, Maywood, IL, USA
| | - O Habeeb
- New York University Langone Medical Center, New York, NY, USA
| | - G M Bautista
- Loyola University Medical Center, Maywood, IL, USA
| | - S Levin
- Loyola University Medical Center, Maywood, IL, USA
| | | | - L A Glynn
- Mercy Health Rockford, University of Illinois, Rockford, IL, USA
| | - W Jeske
- Loyola University Medical Center, Maywood, IL, USA
| | - J K Muraskas
- Loyola University Medical Center, Maywood, IL, USA
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Anisimova NY, Ustyuzhanina NE, Bilan MI, Donenko FV, Ushakova NA, Usov AI, Kiselevskiy MV, Nifantiev NE. Influence of Modified Fucoidan and Related Sulfated Oligosaccharides on Hematopoiesis in Cyclophosphamide-Induced Mice. Mar Drugs 2018; 16:E333. [PMID: 30216993 PMCID: PMC6164909 DOI: 10.3390/md16090333] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/04/2018] [Accepted: 09/08/2018] [Indexed: 12/20/2022] Open
Abstract
Immunosuppression derived after cytostatics application in cancer chemotherapy is considered as an adverse side effect that leads to deterioration of quality of life and risk of infectious diseases. A linear sulfated (1→3)-α-l-fucan M-Fuc prepared by chemical modification of a fucoidan isolated from the brown seaweed Chordaria flagelliformis, along with two structurally related synthetic sulfated oligosaccharides, were studied as stimulators of hematopoiesis on a model of cyclophosphamide immunosuppression in mice. Recombinant granulocyte colony-stimulating factor (r G-CSF), which is currently applied in medicine to treat low blood neutrophils, was used as a reference. Polysaccharide M-Fuc and sulfated difucoside DS did not demonstrate significant effect, while sulfated octasaccharide OS showed higher activity than r G-CSF, causing pronounced neutropoiesis stimulation. In addition, production of erythrocytes and platelets was enhanced after the octasaccharide administration. The assessment of populations of cells in blood and bone marrow of mice revealed the difference in mechanisms of action of OS and r G-CSF.
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Affiliation(s)
- Natalia Yu Anisimova
- N.N. Blokhin National Medical Research Center of Oncology, Kashirskoe shosse, 24, 115478 Moscow, Russia.
| | - Nadezhda E Ustyuzhanina
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia.
| | - Maria I Bilan
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia.
| | - Fedor V Donenko
- N.N. Blokhin National Medical Research Center of Oncology, Kashirskoe shosse, 24, 115478 Moscow, Russia.
| | - Natalia A Ushakova
- V.N. Orekhovich Research Institute of Biomedical Chemistry, Pogodinskaya str. 10, 119121 Moscow, Russia.
| | - Anatolii I Usov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia.
| | - Mikhail V Kiselevskiy
- N.N. Blokhin National Medical Research Center of Oncology, Kashirskoe shosse, 24, 115478 Moscow, Russia.
| | - Nikolay E Nifantiev
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia.
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Bizerea TO, Stroescu R, Rogobete AF, Marginean O, Ilie C. Pregnancy Induced Hypertension Versus Small Weight for Gestational Age: Cause of Neonatal Hematological Disorders. Clin Lab 2018; 64:1241-1248. [PMID: 30146849 DOI: 10.7754/clin.lab.2018.180302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pregnancy-induced hypertension (PIH) is a multifactorial disorder that increases the risk of morbidity and mortality in both mother and newborn. Although there are many studies that track the effects of PIH on maternal and neonatal outcome, the results are contradictory. This retrospective study focuses on the effect of maternal PIH on neonatal hematological changes (thrombocytopenia and neutropenia). It also tries to determine whether neonatal thrombocytopenia and neutropenia are direct consequences of maternal PIH, rather than of the small for gestational age (SGA) status of the newborn. METHODS A three year restrospective observational study was conducted, from 1st of January 2014 to 31st of December 2016, on 6,077 newborns registered at the Neonatology Department of the Clinic of Obstetrics, Gynecology, and Neonatology, Emergency County Hospital, Timișoara, România. Selection of newborns with maternal PIH was made using the case-mix records RO DRG v1., according to which PIH was classified in gestational hypertension, preeclampsia and eclampsia. Patients were divided into four study groups, according to birth weight for gestational age and presence or absence of maternal PIH: 5,867 appropriate for gestational age (AGA) neonates form healthy mothers (AGA-Controls), 152 small for gestational age neonates from healthy mothers (SGA-Controls), 40 AGA newborns with maternal PIH (AGA-PIH) and 18 SGA newborns with maternal PIH (SGA-PIH). Regression and correlation analysis using the XLSTAT Microsoft Excel® tool pack, was performed to compare data from the study groups of neonates from mothers with PIH and the control groups of neonates from normotensive mothers. RESULTS SGA-PIH neonates were the most affected with regard to the hematological abnormalities (33.3% neutropenic and 27.7% thrombocytopenic newborns) followed by AGA-PIH neonates (22.5% neutropenia and 17.5% thrombocytopenia). SGA-Controls had much lower percentages of both neutropenia and thrombocytopenia (2.63% and 1.97% respectively), whereas AGA-Controls had no record of any hematological changes. CONCLUSIONS Maternal PIH has a strong influence on the development of newborn hematologic abnormalities, such as neutropenia and thrombocytopenia. The incidence and severity of these hematological changes are increased in neonates of mothers with PIH, that are born preterm and/or SGA.
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Marshall H. Estrogen-induced myelotoxicity in a 4-year-old golden retriever dog due to a Sertoli cell tumor. Can Vet J 2018; 59:425-427. [PMID: 29606731 PMCID: PMC5855222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 4-year-old, unilateral cryptorchid golden retriever dog was presented to the Ontario Veterinary College Health Sciences Centre with gynecomastia, dribbling urine, lethargy, neutropenia, and thrombocytopenia. A Sertoli cell tumor was diagnosed in a cryptorchid testicle with estrogen-induced myelotoxicity. The tumor was removed and bone marrow regenerated within 4 months.
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Affiliation(s)
- Hayden Marshall
- Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1
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Xin DS, Zhou L, Li CZ, Zhang SQ, Huang HQ, Qiu GD, Lin LF, She YQ, Zheng JT, Chen C, Fang L, Chen ZS, Zhang SY. TC > 0.05 as a Pharmacokinetic Parameter of Paclitaxel for Therapeutic Efficacy and Toxicity in Cancer Patients. Recent Pat Anticancer Drug Discov 2018; 13:341-347. [PMID: 29512471 DOI: 10.2174/1574892813666180305170439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/01/2017] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Paclitaxel (PTX) has remarkable anti-tumor activity, but it causes severe toxicities. There is an urgent need to seek an appropriate pharmacokinetic parameter of PTX to improve treatment efficacy and reduce adverse effects. OBJECTIVE To evaluate the association of pharmacokinetic parameter TC > 0.05 of paclitaxel (PTX) and its therapeutic efficacy and toxicity in patients with solid tumors. METHODS A total of 295 patients with ovarian cancer, esophageal cancer, breast cancer, and non-small cell lung cancer (NSCLC), who were admitted to the Tumor Hospital of Shantou University Medical College, China, were recruited for this study. Patients received 3 weeks of PTX chemotherapy. The plasma concentrations of PTX were examined using the MyPaclitaxel™ kit. The patients' PTX TC > 0.05 (the time during which PTX plasma concentration exceed 0.05µmol/L) were calculated based on pharmacokinetic analysis. RESULTS The results showed that: (1) the concentrations of PTX in these 295 patients ranged from 0.0358-0.127 µmol/L; (2) the PTX TC > 0.05 ranged from 14 to 38h with a median time of 27h; (3) among all treatment cycles, there was a statistically significant difference in the PTX TC > 0.05 between CR+PR and SD+PD; (4) with the increasing value of TC > 0.05, level of leukopenia and leukopenic fever increased; (5) high PTX TC > 0.05 led to the occurrence of neutropenia, neutropenic fever, severe anemia, and severe peripheral neurotoxicity. Taken together, our results indicated that the pharmacokinetic parameter PTX TC > 0.05 was an effective measure of treatment efficacy and toxicity in patients with solid tumors. Maintaining PTX TC > 0.05 at 26 to 30h could improve its efficacy and reduce the incidence of leukopenia, neutropenia, anemia, and peripheral neurotoxicity in these patients. CONCLUSION PTX TC > 0.05 is a key pharmacokinetic parameter of PTX which should be monitored to optimize individual treatment in patients with solid tumors.
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Affiliation(s)
- D S Xin
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - L Zhou
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - C Z Li
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - S Q Zhang
- Medical Oncology, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou, Guangdong, 515041, China
| | - H Q Huang
- Department of Ultrasound, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - G D Qiu
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
- Clinical Pharmacy Research Center, Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - L F Lin
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - Y Q She
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
- Clinical Pharmacy Research Center, Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - J T Zheng
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - C Chen
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - L Fang
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
| | - Z S Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John`s University, 8000 Utopia Parkway, Queens, NY 11439, United States
| | - S Y Zhang
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
- Clinical Pharmacy Research Center, Shantou University Medical College, Raoping Rd, Shantou 515041, Guangdong, China
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14
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Viscoli C. A step towards precision medicine in management of fever and neutropenia in haematology. Lancet Haematol 2017; 4:e563-e564. [PMID: 29195599 DOI: 10.1016/s2352-3026(17)30217-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Claudio Viscoli
- Ospedale Policlinico San Martino, IRCCS per l'Oncologia and Università di Genova (DISSAL), Genova 16132, Italy.
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15
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Lee JA, Sauer B, Tuminski W, Cheong J, Fitz-Henley J, Mayers M, Ezuma-Igwe C, Arnold C, Hornik CP, Clark RH, Benjamin DK, Smith PB, Ericson JE. Effectiveness of Granulocyte Colony-Stimulating Factor in Hospitalized Infants with Neutropenia. Am J Perinatol 2017; 34:458-464. [PMID: 27649291 PMCID: PMC5359073 DOI: 10.1055/s-0036-1593349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective The objective of this study was to determine the time to hematologic recovery and the incidence of secondary sepsis and mortality among neutropenic infants treated or not treated with granulocyte colony-stimulating factor (G-CSF). Study Design We identified all neutropenic infants discharged from 348 neonatal intensive care units from 1997 to 2012. Neutropenia was defined as an absolute neutrophil count ≤ 1,500/µL for ≥ 1 day during the first 120 days of life. Incidence of secondary sepsis and mortality and number of days required to reach an absolute neutrophil count > 1,500/µL for infants exposed to G-CSF were compared with those of unexposed infants. Results We identified 30,705 neutropenic infants, including 2,142 infants (7%) treated with G-CSF. Treated infants had a shorter adjusted time to hematologic recovery (hazard ratio: 1.36, 95% confidence interval [CI]: 1.30-1.44) and higher adjusted odds of secondary sepsis (odds ratio [OR]: 1.50, 95% CI: 1.20-1.87), death (OR: 1.33, 95% CI: 1.05-1.68), and the combined outcome of sepsis or death (OR: 1.41, 95% CI: 1.19-1.67) at day 14 compared with untreated infants. These differences persisted at day 28. Conclusion G-CSF treatment decreased the time to hematologic recovery but was associated with increased odds of secondary sepsis and mortality in neutropenic infants. G-CSF should not routinely be used for infants with neutropenia.
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Affiliation(s)
- Jin A. Lee
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Seoul National University Boramae Hospital, Seoul, South Korea
- Seoul National University College of Medicine, Seoul, South Korea
| | - Brooke Sauer
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - William Tuminski
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Jiyu Cheong
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - John Fitz-Henley
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Megan Mayers
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Chidera Ezuma-Igwe
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Christopher Arnold
- Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, VA
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department, of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department, of Pediatrics, Duke University School of Medicine, Durham, NC
| | - P. Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department, of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Jessica E. Ericson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
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16
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Abstract
In patients with cancer and myeloproliferative disorders, leukocytosis has been associated with an increased venous thromboembolic (VTE) risk. Our goal was to determine whether persistent neutrophilia (PN), not associated with known causes such as malignancies, infections or steroids, is independently associated with VTE. All adult patients with >3 outpatient complete blood counts (CBCs) within 3 years were included. PN was defined as having an absolute neutrophil count >95 % (>2SD) of the population (≥7.8 × 10(9)/L) on at least three CBCs, at least 2 months apart. Separate analyses for neutrophil counts ≥9 × 10(9)/L and ≥10 × 10(9)/L were also performed. Blood counts from inpatients were excluded. Primary outcome was diagnosis of VTE, as determined by ICD-9 codes. Odds ratios were adjusted for diabetes, smoking, obesity, gender, and age. Charlson score was utilized as a morbidity measure. Data on 43,538 outpatients were collected. Although there was no association of VTE with neutrophil counts ≥7.8 × 10(9)/L, patients with ≥9.0 × 10(9)/L neutrophils were twice as likely to be diagnosed with VTE compared to those with normal neutrophil counts (OR 2.0, 95 % CI 1.3, 3.1; p = 0.003). Patients with neutrophil counts ≥10.0 × 10(9)/L were at an even higher risk (OR 2.3, 95 % CI 1.2, 4.8; p = 0.019). Charlson scores significantly modified this risk when incorporated into analysis. Elevated neutrophil counts are associated with an increased risk of venous thrombosis even when they are not due to cancer, infection or steroids. In patients with significant comorbidities, neutrophilia may be a marker of VTE risk.
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Affiliation(s)
- Margarita Kushnir
- Division of Hematology, Department of Oncology, Montefiore Medical Center and The Albert Einstein College of Medicine, 3411 Wayne Avenue, Bronx, NY, 10467, USA.
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Henny H Billett
- Division of Hematology, Department of Oncology, Montefiore Medical Center and The Albert Einstein College of Medicine, 3411 Wayne Avenue, Bronx, NY, 10467, USA
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17
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Kawazoe H, Yano A, Ishida Y, Takechi K, Katayama H, Ito R, Yakushijin Y, Moriguchi T, Tanaka M, Tanaka A, Araki H. Non-steroidal anti-inflammatory drugs induce severe hematologic toxicities in lung cancer patients receiving pemetrexed plus carboplatin: A retrospective cohort study. PLoS One 2017; 12:e0171066. [PMID: 28158216 PMCID: PMC5291448 DOI: 10.1371/journal.pone.0171066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/16/2017] [Indexed: 01/13/2023] Open
Abstract
Purpose As the major toxicity induced by pemetrexed plus carboplatin is severe hematologic toxicities, the aim of this study was to determine the risk factors for severe hematologic toxicities in lung cancer patients. Methods We retrospectively investigated data from lung cancer patients who had received pemetrexed plus carboplatin, with or without bevacizumab. This observational study was carried out at Ehime University Hospital using electronic medical records dating from July 2009 to March 2015. Severe hematologic toxicities were defined as grade 3 or 4, according to the Common Terminology Criteria for Adverse Events, version 4.0. Results Forty-two patients were included in the study. The incidence of grade 3 or 4 hematologic toxicities during the first cycle of chemotherapy and during all cycles was 19.0% and 16.1%, respectively. Multivariate time-depend generalized estimating equations logistic regression analysis revealed that regular use of non-steroidal anti-inflammatory drugs (NSAIDs) was significantly associated with an increased risk of severe hematologic toxicities during all cycles (adjusted odds ratio (OR): 8.32, 95% confidence interval (CI): 1.27–54.38; p = 0.03), whereas creatinine clearance of <45 mL/min was not significantly associated with an increased risk of severe hematologic toxicities during all cycles (adjusted OR: 0.91, 95% CI: 0.25–3.34; p = 0.88). Conclusions The results suggest that severe hematologic toxicities in patients receiving carboplatin-based pemetrexed may be significantly induced by the inhibition of renal tubular pemetrexed secretion through drug–drug interactions between NSAIDs and pemetrexed rather than through glomerular filtration of pemetrexed, even with moderate to sufficient renal function.
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Affiliation(s)
- Hitoshi Kawazoe
- Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan
| | - Akiko Yano
- Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan
| | - Yuri Ishida
- Division of Pharmacy, Komazawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Kenshi Takechi
- Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan
| | - Hitoshi Katayama
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Ryoji Ito
- Department of Respiratory Medicine, National Hospital Organization Ehime Medical Center, Toon, Ehime, Japan
| | | | | | - Mamoru Tanaka
- Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan
| | - Akihiro Tanaka
- Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan
- * E-mail:
| | - Hiroaki Araki
- Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan
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18
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Hsiao SH, Chang CM, Tsai JC, Lin CY, Liao LH, Lin WL, Wu TJ. Glycopeptide-Induced Neutropenia: Cross-Reactivity Between Vancomycin and Teicoplanin. Ann Pharmacother 2016; 41:891-4. [PMID: 17426073 DOI: 10.1345/aph.1h633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To report teicoplanin-related neutropenia that developed after an episode of neutropenia induced by vancomycin therapy. Case Summary: A 57-year-old female suffered from osteomyelitis of the left humerus, with a white blood cell (WBC) count of 2.8 × 103/mm3 and absolute neutrophil count (ANC) of 0.28 × 103/mm3, occurring after 24 days of vancomycin therapy. Vancomycin was changed to teicoplanin and the agranulocytosis resolved 4 days later. However, a new episode of neutropenia, with a WBC count of 2.8 × 103/mm3 and ANC of 0.448 × 103/mm3, occurred 11 days after teicoplanin initiation. Agranulocytosis resolved 4 days following withdrawal of teicoplanin. Discussion: Because of the close time relationship between drug administration and the development of symptoms and signs, as well as between drug withdrawal and changes in WBC count and ANC, the episodes of neutropenia were suspected to be drug related. Teicoplanin-induced agranulocytosis that followed vancomycin-induced agranulocytosis suggests a possible cross-reactivity between the 2 drugs. Both reactions were categorized as probable according to the Naranjo probability scale. Conclusions: For all patients with vancomycin-induced neutropenia, possible cross-reactivity of teicoplanin should be monitored.
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Affiliation(s)
- Shu-Hwa Hsiao
- Department of Pharmacy, National Cheng Kung University Hospital, Taiwan, Republic of China
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19
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Pai MP, Mercier RC, Koster SA. Epidemiology of Vancomycin-Induced Neutropenia In Patients Receiving Home Intravenous Infusion Therapy. Ann Pharmacother 2016; 40:224-8. [PMID: 16434560 DOI: 10.1345/aph.1g436] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Vancomycin is frequently used to manage serious resistant gram-positive Infections. Neutropenia, whose epidemiology has not been well characterized, is a potentially serious adverse event associated with the use of vancomycin. Objective: To characterize the incidence and risk factors for development of vancomycin-induced neutropenia in patients treated with home intravenous vancomycin therapy. Methods: A retrospective chart review was conducted of adult patients receiving vancomycin therapy through the University of New Mexico Home Intravenous Infusion Clinic between January 1998 and December 2004. Data collection included demographics, comorbid conditions, dose and duration of vancomycin therapy, indications for vancomycin use, vancomycin concentrations, all concurrent medications, laboratory data, culture and susceptibility data, reasons for antibiotic alteration or discontinuations, all other recorded adverse events, management of adverse events, and outcomes of adverse events. Results: A total of 372 charts of patients managed through the clinic were reviewed and 114 patients treated with vancomycin were identified. Fourteen (12%) cases of vancomycin-induced neutropenia were identified; 4 (3.5%) cases included a reduction in absolute neutrophil count to 500 cells/mm3 or less. The mean ± SD duration of vancomycin therapy and time to neutropenia were 32 ± 29 and 26 ± 15 days, respectively. Laboratory monitoring was performed on a weekly basis and resolution of vancomycin-induced neutropenia occurred promptly after discontinuation. Total vancomycin doses used and serum concentrations were not associated with the development of neutropenia. Conclusions: Vancomycin-induced neutropenia may occur at a higher frequency than previously reported. Clinicians should monitor hematologic parameters at least weekly in patients receiving home intravenous vancomycin therapy.
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Affiliation(s)
- Manjunath P Pai
- College of Pharmacy, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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20
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Okoye HC, Eweputanna LI, Korubo KI, Ejele OA. Effects of maternal hypertension on the neonatal haemogram in southern Nigeria: A case-control study. Malawi Med J 2016; 28:174-178. [PMID: 28321281 PMCID: PMC5348610 DOI: 10.4314/mmj.v28i4.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypertension in pregnancy is a leading cause of maternal and neonatal morbidity and mortality. This study aimed to compare the hematological parameters in neonates of hypertensive mothers with those of normotensive mothers, and also to compare the incidence of polycythaemia, neutropenia and thrombocytopenia in both groups. METHODS This was a hospital-based case control study. Three milliliters of cord blood from neonates of women with hypertension in pregnancy and those of normotensive pregnant women were sampled for haemogram parameters using a 3-part autoanalyser. Haematocrit and white blood cell differentials were done manually. Data were analysed using SPSS version 16. RESULTS A total of 200 neonates were recruited, comprising 100 neonates of mothers with hypertensive disorders of pregnancy and 100 neonates of normotensive mothers. The mean haematocrit was significantly higher in neonates of hypertensive mothers than those of normotensive mothers. The neutrophil and platelet counts of neonates of hypertensive mothers were significantly lower than those of normotensive mothers. The incidences of polycythaemia, neutropenia, and thrombocytopenia were found to be 8%, 15%, and 38% among neonates of hypertensive mothers and 0%, 2%, and 8% among neonates of normotensive mothers, respectively. These incidences were significantly different between the groups. CONCLUSIONS There was a positive association between hypertension in pregnancy and neonatal polycythaemia, neutropenia, and thrombocytopenia. Haematological parameters of neonates of mothers with hypertension in pregnancy should be properly evaluated and monitored to reduce the chances of developing complications associated with these abnormalities.
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Affiliation(s)
- Helen C Okoye
- Department of Haematology and Immunology, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Lisa I Eweputanna
- Department of Radiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Kaladada I Korubo
- Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Oseikhuemen A Ejele
- Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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21
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Sameshima T, Iwatani S, Fukushima S, Taniguchi-Ikeda M, Hashimoto M, Yurugi K, Iijima K, Morioka I. Periomphalitis with Delayed Umbilical Cord Separation due to Alloimmune Neonatal Neutropenia. Clin Lab 2016; 62:2249-2252. [PMID: 28164680 DOI: 10.7754/clin.lab.2016.160422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In a preterm infant, small-for-gestational age, neutropenia persisted from the birth, and periomphalitis symptoms appeared at 23 days of age. Upon administration of granulocyte colony-stimulating factor, the neutrophil count increased, and periomphalitis was recovered. At the same time, the umbilical cord separated at 44 days of age. The human neutrophil antigen (HNA) of the infant was 1a/1b, and antineutrophil antibody for HNA-1b was present in both serums of the mother and the infant at birth, indicating a diagnosis of alloimmune neutropenia. This case demonstrated a definite relationship between the number of neutrophils and the separation of umbilical cord.
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MESH Headings
- Adult
- Antibodies, Antineutrophil Cytoplasmic/blood
- Birth Weight
- Female
- Flow Cytometry
- Gestational Age
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/immunology
- Infant, Premature
- Infant, Small for Gestational Age
- Isoantigens/immunology
- Leukocyte Count
- Male
- Neutropenia/blood
- Neutropenia/diagnosis
- Neutropenia/immunology
- Pregnancy
- Umbilical Cord/immunology
- Umbilical Cord/pathology
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22
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Abstract
We report a 17 year-old male patient, who presented with chronic diarrhoea, progressive pallor, short stature, anaemia (haemoglobin of 4.9 g/dL) and neutropenia and was diagnosed as coeliac disease. His neutropenia did not respond to 8 months of gluten-free diet, iron, folic acid and vitamin B12 therapy. So we suspected copper deficiency and his serum copper levels were tested, which was low. His neutrophil counts normalised after 2 months of copper supplementation. Hence we concluded that the cause of neutropenia in our case was copper deficiency.
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Affiliation(s)
- Daisy Khera
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Baldev Sharma
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
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23
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Lesma E, Riva E, Giovannini M, Di Giulio AM, Gorio A. Amelioration of Neutrophil Membrane Function Underlies Granulocyte-Colony Stimulating Factor Action in Glycogen Storage Disease 1b. Int J Immunopathol Pharmacol 2016; 18:297-307. [PMID: 15888252 DOI: 10.1177/039463200501800212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Glycogen storage disease (GSD) 1b is a metabolic disorder characterized by a deficiency of glucose 6-phosphate transporter and neutrophil alterations, which are reduced in number and functionally impaired. The present study aimed at investigating neutrophil dysfunction correlating submembrane and cytoskeletal changes at different ages with or without granulocyte-colony stimulating factor (G-CSF) treatment. GSD1b neutrophils showed reduced expression and diffused localization of focal adhesion kinase (FAK) and actin. No abnormalities were observed in GSD1a patient neutrophils. Gelsolin was also slightly reduced in neutrophils of GSD1b patients. When patients were treated for at least 3 months with G-CSF, the neutrophil number and the expression of FAK and actin were significantly increased. Granulocyte colony-stimulating factor treatment was similarly effective when performed in 1 year old patients. FAK auto- and IL-8-mediated phosphorylations were already affected as early as 1 year of age. G-CSF treatment also improved this alteration. Our data suggest that neutrophil dysfunction in GSD1b patients might be related to functional impairment and disorganization of proteins of the sub-membrane apparatus, and that G-CSF treatment counteracts neutropenia and prevents the progressive alterations of neutrophil sub-membrane proteins.
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Affiliation(s)
- E Lesma
- Pharmacological Laboratories and Department of Medicine, Surgery and Dentistry, School of Medicine, University of Milano, Italy
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24
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Jantunen E, Juutilainen A, Hämäläinen S, Koivula I, Vänskä M, Purhonen AK, Pulkki K. Biomarkers of neutropenic sepsis. Duodecim 2016; 132:1946-1951. [PMID: 29190045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Neutropenic sepsis is a common clinical problem in hematological patients receiving intensive chemotherapy. Complications will develop in a minority of these patients. Biomarkers can be used for the recognition of infection as well as to estimate its severity and risk of complications and also to assess treatment response. Experience gained from other patient groups or sepsis patients treated in intensive care units cannot be directly extrapolated to hematological patients. Numerous biomarkers of infections have been investigated in hematological patients, but no optimal marker has been found. C-reactive protein is still the most commonly used biomarker in hematological patients, but procalcitonin may be a real challenger, although more studies are still needed.
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25
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Berkhout J, Melchers MJ, van Mil AC, Seyedmousavi S, Lagarde CM, Schuck VJ, Nichols WW, Mouton JW. Pharmacodynamics of Ceftazidime and Avibactam in Neutropenic Mice with Thigh or Lung Infection. Antimicrob Agents Chemother 2016; 60:368-75. [PMID: 26525790 PMCID: PMC4704241 DOI: 10.1128/aac.01269-15] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022] Open
Abstract
Avibactam is a new non-β-lactam β-lactamase inhibitor that shows promising restoration of ceftazidime activity against microorganisms producing Ambler class A extended-spectrum β-lactamases (ESBLs) and carbapenemases such as KPCs, class C β-lactamases (AmpC), and some class D enzymes. To determine optimal dosing combinations of ceftazidime-avibactam for treating infections with ceftazidime-resistant Pseudomonas aeruginosa, pharmacodynamic responses were explored in murine neutropenic thigh and lung infection models. Exposure-response relationships for ceftazidime monotherapy were determined first. Subsequently, the efficacy of adding avibactam every 2 h (q2h) or q8h to a fixed q2h dose of ceftazidime was determined in lung infection for two strains. Dosing avibactam q2h was significantly more efficacious, reducing the avibactam daily dose for static effect by factors of 2.7 and 10.1, whereas the mean percentage of the dosing interval that free drug concentrations remain above the threshold concentration of 1 mg/liter (%fT>C(T) 1 mg/liter) yielding bacteriostasis was similar for both regimens, with mean values of 21.6 (q2h) and 18.5 (q8h). Dose fractionation studies of avibactam in both the thigh and lung models indicated that the effect of avibactam correlated well with %fT>C(T) 1 mg/liter. This parameter of avibactam was further explored for four P. aeruginosa strains in the lung model and six in the thigh model. Parameter estimates of %fT>C(T) 1 mg/liter for avibactam ranged from 0 to 21.4% in the lung model and from 14.1 to 62.5% in the thigh model to achieve stasis. In conclusion, addition of avibactam enhanced the effect of ceftazidime, which was more pronounced at frequent dosing and well related with %fT>C(T) 1 mg/liter. The thigh model appeared more stringent, with higher values, ranging up to 62.5% fT>C(T) 1 mg/liter, required for a static effect.
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Affiliation(s)
- Johanna Berkhout
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Maria J Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anita C van Mil
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Claudia M Lagarde
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Virna J Schuck
- AstraZeneca Pharmaceuticals, Waltham, Massachusetts, USA
| | | | - Johan W Mouton
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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Tong MC, Tadros M, Vaziri H. Endoscopy in neutropenic and/or thrombocytopenic patients. World J Gastroenterol 2015; 21:13166-13176. [PMID: 26674926 PMCID: PMC4674736 DOI: 10.3748/wjg.v21.i46.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/08/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety of endoscopic procedures in neutropenic and/or thrombocytopenic cancer patients.
METHODS: We performed a literature search for English language studies in which patients with neutropenia and/or thrombocytopenia underwent endoscopy. Studies were included if endoscopic procedures were used as part of the evaluation of neutropenic and/or thrombocytopenic patients, yielding 13 studies. Two studies in which endoscopy was not a primary evaluation tool were excluded. Eleven relevant studies were identified by two independent reviewers on PubMed, Scopus, and Ovid databases.
RESULTS: Most of the studies had high diagnostic yield with relatively low complication rates. Therapeutic endoscopic interventions were performed in more than half the studies, including high-risk procedures, such as sclerotherapy. Platelet transfusion was given if counts were less than 50000/mm3 in four studies and less than 10000/mm3 in one study. Other thrombocytopenic precautions included withholding of biopsy if platelet count was less than 30000/mm3 in one study and less than 20000/mm3 in another study. Two of the ten studies which examined thrombocytopenic patient populations reported bleeding complications related to endoscopy, none of which caused major morbidity or mortality. All febrile neutropenic patients received prophylactic broad-spectrum antibiotics in the studies reviewed. Regarding afebrile neutropenic patients, prophylactic antibiotics were given if absolute neutrophil count was less than 1000/mm3 in one study, if the patient was undergoing colonoscopy and had a high inflammatory condition without clear definition of significance in another study, and if the patient was in an aplastic phase in a third study. Endoscopy was also withheld in one study for severe pancytopenia.
CONCLUSION: Endoscopy can be safely performed in patients with thrombocytopenia/neutropenia. Prophylactic platelet transfusion and/or antibiotic administration prior to endoscopy may be considered in some cases and should be individualized.
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Tong MC, Tadros M, Vaziri H. Endoscopy in neutropenic and/or thrombocytopenic patients. World J Gastroenterol 2015. [PMID: 26674926 DOI: pmid/26674926] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
AIM To evaluate the safety of endoscopic procedures in neutropenic and/or thrombocytopenic cancer patients. METHODS We performed a literature search for English language studies in which patients with neutropenia and/or thrombocytopenia underwent endoscopy. Studies were included if endoscopic procedures were used as part of the evaluation of neutropenic and/or thrombocytopenic patients, yielding 13 studies. Two studies in which endoscopy was not a primary evaluation tool were excluded. Eleven relevant studies were identified by two independent reviewers on PubMed, Scopus, and Ovid databases. RESULTS Most of the studies had high diagnostic yield with relatively low complication rates. Therapeutic endoscopic interventions were performed in more than half the studies, including high-risk procedures, such as sclerotherapy. Platelet transfusion was given if counts were less than 50000/mm(3) in four studies and less than 10000/mm(3) in one study. Other thrombocytopenic precautions included withholding of biopsy if platelet count was less than 30000/mm(3) in one study and less than 20000/mm(3) in another study. Two of the ten studies which examined thrombocytopenic patient populations reported bleeding complications related to endoscopy, none of which caused major morbidity or mortality. All febrile neutropenic patients received prophylactic broad-spectrum antibiotics in the studies reviewed. Regarding afebrile neutropenic patients, prophylactic antibiotics were given if absolute neutrophil count was less than 1000/mm(3) in one study, if the patient was undergoing colonoscopy and had a high inflammatory condition without clear definition of significance in another study, and if the patient was in an aplastic phase in a third study. Endoscopy was also withheld in one study for severe pancytopenia. CONCLUSION Endoscopy can be safely performed in patients with thrombocytopenia/neutropenia. Prophylactic platelet transfusion and/or antibiotic administration prior to endoscopy may be considered in some cases and should be individualized.
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Affiliation(s)
- Michelle C Tong
- Michelle C Tong, Micheal Tadros, Haleh Vaziri, Division of Gastroenterology, University of Connecticut School of Medicine, Farmington, CT 06030-8074, United States
| | - Micheal Tadros
- Michelle C Tong, Micheal Tadros, Haleh Vaziri, Division of Gastroenterology, University of Connecticut School of Medicine, Farmington, CT 06030-8074, United States
| | - Haleh Vaziri
- Michelle C Tong, Micheal Tadros, Haleh Vaziri, Division of Gastroenterology, University of Connecticut School of Medicine, Farmington, CT 06030-8074, United States
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Kyritsi EMA, Yiakoumis X, Pangalis GA, Pontikoglou C, Pyrovolaki K, Kalpadakis C, Mavroudi I, Koutala H, Mastrodemou S, Vassilakopoulos TP, Vaiopoulos G, Diamanti-Kandarakis E, Papadaki HA, Angelopoulou MK. High Frequency of Thyroid Disorders in Patients Presenting With Neutropenia to an Outpatient Hematology Clinic STROBE-Compliant Article. Medicine (Baltimore) 2015; 94:e886. [PMID: 26061308 PMCID: PMC4616464 DOI: 10.1097/md.0000000000000886] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Granulopoiesis abnormalities have been described in association with thyroid disorders (TD). However, data regarding systematic evaluation of adult neutropenia and concurrent or prior TD are scarce. To investigate the frequency of TD among patients presenting with neutropenia, and the immunophenotypic and immunologic profile of neutropenic patients with concomitant thyroidopathy. Two hundred eighteen consecutive neutropenic patients were prospectively evaluated in our outpatient Hematology Clinic, with a detailed laboratory screen, including thyroid function tests, antineutrophil antibodies, blood lymphocytes immunophenotyping, and detection of T-cell clonality by PCR. Among 218 patients with neutropenia, 95 (43.6%) had TD, 65 chronic immunologic neutropenia, 20 clonal proliferation of T-large granular lymphocytes (T-LGL), 5 autoimmune disorders, and 33 other diagnoses. TD-patients had an increased frequency of recurrent infections compared with other patients (P = 0.045). The following correlations were found: negative correlation between FT3 and absolute neutrophil count (ANC) (r² = -0.274, P = 0.007), negative correlation between TPO-Abs/TG-Abs and C4 (r² = -0.16, P = 0.045; r² = -0.266, P = 0.001), and CD4⁺ counts were inversely correlated to T4 and positively to TSH (r² = -0.274, P = 0.024; r² = 0.16, P = 0.045). In addition, TD-patients had significantly higher percentages of CD4⁺ lymphocytes (P = 0.003). Among TD-patients, 23.4% had Hashimoto thyroiditis (HT), 4.1%, Graves disease (GD), 8.2% nontoxic multinodular goiter (NTMG), 5% subclinical hypothyroidism, and 2.8% had undergone total thyroidectomy associated with nodules (TTM). Thirteen TD-patients displayed T-LGL. Patients with autoimmune thyroidopathy had an increased frequency of concomitant autoimmune manifestations (P = 0.03). Significant differences between the different thyroidopathies included: HT-patients had higher percentages of B-lymphocytes, while the opposite was evident for the TTM-subgroup (P = 0.009, 0.02); GD-patients showed an increase of the proportion of NK cells and a decrease in the percentage of TCRγδ+ lymphocytes (P = 0.001, 0.045); and NTMG-patients had significantly higher ANC (P = 0.004) compared to other thyroidopathies. Antineutrophil antibodies were found in 37.2% of TD-patients tested. Anti-TPO titers were significantly higher in patients with positive antineutrophil antibodies (P = 0.04). The frequency of TD among neutropenic patients may be higher than previously reported. The existence of antineutrophil antibodies, as well as the different distribution of lymphocyte subsets among patients with different TD, suggests both humoral and cellular mechanisms in the pathophysiology of thyroid disease-associated neutropenia.
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Affiliation(s)
- Eleni Magdalini A Kyritsi
- From the Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, University of Athens Medical School, "Aghia Sophia" Children's Hospital, (EMK); Hematology Clinic, Athens Medical Center, Psychiko Branch, Athens (XY, GAP); Department of Hematology, University of Crete School of Medicine, Heraklion, Crete (CP, KP, CK, IM, HK, SM, HAP); Department of Hematology and BMT, National and Kapodistrian University of Athens, Laikon General Hospital (TPV, MKA); First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital (GV); and Third Department of Internal Medicine, Medical School, University of Athens, Sotiria General Hospital, Athens, Greece (ED-K)
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Ahn SB, Jun DW, Kim SG, Lee SH, Shin HP, Choe WH, Kim JK, Jung KS, Kim DY, Shim JJ, Park SY, Seo YS, Kim W, Chung JI. Efficacy and safety of pegylated interferon base treatment in patients with chronic hepatitis C on dialysis. Eur J Intern Med 2015; 26:292-6. [PMID: 25877760 DOI: 10.1016/j.ejim.2015.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/07/2015] [Accepted: 03/28/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Patients with chronic hepatitis C (CHC) and end-stage renal disease (ESRD) on dialysis are difficult to treat and show higher dropout rates during treatment. The aim of this study was to analyze the treatment outcomes in patients with CHC and underlying end-stage renal disease on dialysis in Korea. METHODS A retrospective multi-center study of 35 patients with CHC and underlying ESRD on regular dialysis from 13 centers were analyzed. We investigated the tolerability and efficacy of pegylated interferon therapy with or without ribavirin on dialysis patients. RESULTS Twenty patients (57%) were genotype 1. Sixteen patients (46%) were treated with pegylated interferon monotherapy. Nineteen patients (54%) were treated with pegylated interferon and ribavirin. The overall sustained virological response (SVR) rate was 65.7% in all subjects. Thirteen patients (37%) dropped out before completion of treatment, and six patients (46.2%) showed SVR despite premature termination of treatment. Twenty patients (90.9%) achieved SVR among the 22 patients who completed the scheduled course. The most common side effects were anemia and neutropenia. The patients receiving ribavirin treatment showed a higher dropout rate (52.6% vs. 18.8%, p=0.04) and higher SVR rate (68.4% vs. 62.5%, p=0.07) compared to the pegylated interferon mono-treatment group. CONCLUSIONS The difficulty in treating HCV patients with ESRD was attributed to higher dropout rate. However, despite the high dropout rate (37%), the SVR rate in genotype 1 was 65% and in genotypes 2 and 3 was 66%. Patients who completed the treatment showed a high SVR rate of 89.5%.
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Affiliation(s)
- Sang Bong Ahn
- Department of Internal Medicine, Eulji University College of Medicine, Republic of Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Republic of Korea.
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University, Bucheon Hospital, Republic of Korea
| | - Sae Hwan Lee
- Department of Internal Medicine, Soonchunhyang University, Bucheon Hospital, Republic of Korea
| | - Hyun Phil Shin
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Republic of Korea
| | - Won Hyeok Choe
- Department of Internal Medicine, Konkuk University School of Medicine, Republic of Korea
| | - Ja Kyung Kim
- Department of Internal Medicine, Yonsei University School of Medicine, Republic of Korea
| | - Kyu Sik Jung
- Department of Internal Medicine, Yonsei University School of Medicine, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University School of Medicine, Republic of Korea
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University Hospital, Republic of Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University School of Medicine, Republic of Korea
| | - Won Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jae Il Chung
- Sahmyook Medical Center, Seoul, Republic of Korea
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Abstract
Neutropenia is defined as a neutrophil count lower than 1.5g/L, with categorization as mild, moderate, or severe when the count is 1.5-1g/L, 1-0.5g/L, or<0.5g/L, respectively. The main complication is infection, whose risk increases with the depth and duration of the neutropenia. Comprehensive etiological investigations are mandatory to determine the best treatment strategy. Constitutional neutropenia is rarely seen in everyday rheumatology practice. It predominantly affects patients of African descent and is usually moderate and well tolerated. Congenital neutropenia due to genetic abnormalities is severe and chiefly seen in the pediatric population. Most cases of neutropenia in patients with rheumatoid arthritis (RA) are acquired. Medications are the most common causes, making detailed history-taking crucial. Many medications used to treat RA can induce neutropenia. Folic acid deficiency should be sought routinely in patients taking methotrexate. A less common cause of neutropenia is an RA-related autoimmune reaction. Splenomegaly suggests Felty's syndrome, which is accompanied with large granular lymphocytic (LGL) leukemia in 40% of cases. The treatment depends on the depth of the neutropenia and findings from the etiological workup. A neutrophil count below 0.5g/L, a fever, and the presence of clinical signs indicate a life-threatening condition requiring emergent treatment. In other patients, the first step is immediate discontinuation of any possibly involved drugs, simultaneously with the etiological workup.
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Affiliation(s)
- Estibaliz Lazaro
- Service de médecine interne, hôpital du Haut-Lévêque, université de Bordeaux, 33604 Pessac, France.
| | - Jacques Morel
- Service de médecine interne, hôpital du Haut-Lévêque, université de Bordeaux, 33604 Pessac, France; Département de rhumatologie, hôpital Lapeyronie, université de Montpellier 1, 34295 Montpellier cedex 5, France
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Kontoyiannis DP, Reddy BT, Hanna H, Bodey GP, Tarrand J, Raad II. Breakthrough Candidemia in Patients with Cancer Differs from De Novo Candidemia in Host Factors andCandidaSpecies But Not Intensity. Infect Control Hosp Epidemiol 2015; 23:542-5. [PMID: 12269454 DOI: 10.1086/502104] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives:To evaluate the risk factors associated with breakthrough candidemia in patients with cancer and to compare them with those of de novo candidemia in this patient population. DESIGN: Retrospective case series of 120 episodes of candidemia, 90 de novo and 30 breakthrough candidemias.Setting:University-affiliated, tertiary-care cancer center in Houston, Texas.Patients:All patients with cancer who acquired candidemia between January 1993 and December 1998 were included if they had non-catheter-related candidemia and information about quantitative blood cultures.Results:Although less frequent, breakthrough candidemia was seen more often in neutropenic patients with leukemia. The intensity of breakthrough candidemia was comparable to that of de novo candidemia. Most (70%) of the breakthrough candidemias were due toCandida glabrataorC. krusei.Conclusions:In breakthrough candidemia, the same risk factors seen in de novo candidemia were encountered, although more frequently.C. glabrataandC. kruseiare the leading causes of breakthrough candidemia in patients with cancer.
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Affiliation(s)
- Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD. Anderson Cancer Center, Houston 77030, USA
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Benites-Zapata VA, Hernandez AV, Nagarajan V, Cauthen CA, Starling RC, Tang WHW. Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure. Am J Cardiol 2015; 115:57-61. [PMID: 25456873 DOI: 10.1016/j.amjcard.2014.10.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 01/17/2023]
Abstract
Elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) and neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options from 2007 to 2010. Patients were divided according to low, intermediate, and high tertiles of NLR and were followed longitudinally for time to all-cause mortality or heart transplantation (primary outcome). The median NLR was 3.9 (interquartile range 2.5 to 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared with the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, compared with the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (hazard ratio [HR] = 1.61, 95% confidence interval [CI] 1.10 to 2.37 and HR = 1.55, 95% CI 1.02 to 2.36, respectively) and all-cause mortality (HR = 1.83, 95% CI 1.07 to 3.14 and HR = 2.16, 95% CI 1.21 to 3.83, respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF.
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Affiliation(s)
- Vicente A Benites-Zapata
- Unidad de Análisis y Generación de Evidencia en Salud Pública, Instituto Nacional de Salud, Lima, Peru
| | - Adrian V Hernandez
- Faculty of Health Sciences, Postgraduate and Medical Schools, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Health Outcomes and Clinical Epidemiology Section, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vijaiganesh Nagarajan
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Randall C Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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Songdej D, Sirachainan N, Wongwerawattanakoon P, Sasanakul W, Kadegasem P, Sungkarat W, Chuansumrit A. Combined chelation therapy with daily oral deferiprone and twice-weekly subcutaneous infusion of desferrioxamine in children with β-thalassemia: 3-year experience. Acta Haematol 2014; 133:226-36. [PMID: 25376266 DOI: 10.1159/000363210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/24/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To study the efficacy of combined treatment with oral and subcutaneous iron chelators. MATERIAL AND METHODS 50-100 mg/kg/day of oral deferiprone (DFP) combined with 40 mg/kg/dose s.c. desferrioxamine (DFO) twice weekly were given to transfusion-dependent β-thalassemia children. RESULTS Enrolled patients (9 with β-thalassemia major and 33 with β-thalassemia hemoglobin E), ranging from 3 to 18 years in age, were divided into 3 groups; group 1 ferritin ≥1,000-2,500 ng/ml (n = 10), group 2 ferritin >2,500-4,000 ng/ml (n = 23) and group 3 ferritin >4,000 ng/ml (n = 9). Of the 42 patients, 28 reached the 36-month follow-up. Ten patients whose ferritin declined <15% while receiving 100 mg/kg/day of DFP were considered nonresponders. The median age and previous transfusion duration before enrollment were significantly higher in nonresponders than responders (p = 0.04 and 0.003, respectively). The responders exhibited a significant fall in median ferritin levels from 2,954.6 to 936.6 ng/ml (p < 0.001). Time to a significant decrease in serum ferritin among responders was 6 months. In 13 patients, 16 episodes of adverse events occurred: hemophagocytosis with cytopenia (n = 1), neutropenia (n = 2), thrombocytopenia (n = 2), elevated alanine aminotransferase (n = 5), elevated serum creatinine (n = 1), proteinuria (n = 1) and gastrointestinal discomfort (n = 4). CONCLUSION Combination therapy with daily oral DFP and subcutaneous DFO twice weekly is a safe and effective alternative to chelation monotherapy in β-thalassemia children.
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Affiliation(s)
- Duantida Songdej
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Shaver A, Walkovich K, Boxer L. Chronic neutropenia. ACTA ACUST UNITED AC 2014; 19:431-2. [PMID: 25155521 DOI: 10.1179/1024533214z.000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chang JY, Jeong EG, Yu JH, Chung BH, Yang CW. Recurrent neutropenia induced by rifabutin in a renal transplant recipient. Korean J Intern Med 2014; 29:532-4. [PMID: 25045303 PMCID: PMC4101602 DOI: 10.3904/kjim.2014.29.4.532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/31/2013] [Accepted: 03/09/2014] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ji Yeun Chang
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Eun Gyo Jeong
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hyun Yu
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chul Woo Yang
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Iacobellis A, Cozzolongo R, Minerva N, Valvano MR, Niro GA, Fontana R, Palmieri O, Ippolito A, Andriulli A. Feasibility of pegylated interferon and ribavirin in hepatitis C-related cirrhosis with neutropenia or thrombocytopenia. Dig Liver Dis 2014; 46:621-4. [PMID: 24675038 DOI: 10.1016/j.dld.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/19/2014] [Accepted: 02/04/2014] [Indexed: 12/11/2022]
Abstract
AIM To investigate the feasibility of pegylated interferon plus ribavirin treatment in cirrhotic patients who presented with, or developed while on-treatment, platelet counts ≤ 80,000/μL and/or neutrophil counts ≤ 1,500/μL. METHODS A retrospective analysis of prospectively gathered data on 123 cirrhotic patients treated with pegylated interferon and ribavirin. Adverse effects and haematological changes were monitored: bleeding and infectious events were registered and related to platelet and absolute neutrophil counts. RESULTS Among the 58 patients (47.2%) with nadir platelets ≤ 50,000/μL during therapy, 6 (10.3%) experienced a bleeding episode; of the remaining 65 patients with platelets constantly >50,000/μL, 3 (4.6%) bled. Of the 11 bleedings, 3 manifested during an infection, while patients had platelets >50,000/μL. Nadir neutrophils ≤ 750/μL occurred in 45 patients (38.2%) during treatment, and 14 of them (29.8%) had an infectious event. Infections were also documented in 18 of the 76 patients (23.7%) with neutrophils constantly >750/μL. CONCLUSIONS The study reveals the feasibility of treating cirrhotic patients with cytopenia with pegylated interferon and ribavirin, as bleeding or infectious events under therapy were unrelated to platelet and neutrophil counts. Withdrawal of therapy or variations in the pre-assigned dosages of either pegylated interferon or ribavirin owing to abnormally low haematological parameters seems to no longer be tenable.
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Affiliation(s)
- Angelo Iacobellis
- Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy.
| | - Raffaele Cozzolongo
- Division of Gastroenterology, De Bellis Hospital, IRCCS, Castellana Grotte 70013, Italy
| | - Nicola Minerva
- Division of Internal Medicine, General Hospital, Canosa 76012, Italy
| | - Maria Rosa Valvano
- Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy
| | - Grazia Anna Niro
- Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy
| | - Rosanna Fontana
- Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy
| | - Orazio Palmieri
- Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy
| | - Antonio Ippolito
- Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy
| | - Angelo Andriulli
- Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy
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Goldschmidt N, Ganzel C, Attias D, Gatt M, Polliack A, Tadmor T. Pegfilgrastim prophylaxis for cladribine-induced neutropenia in patients with hairy-cell leukemia. Acta Haematol 2014; 132:118-21. [PMID: 24557414 DOI: 10.1159/000358293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/02/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Neta Goldschmidt
- Department of Hematology, Hadassah University Hospital and Hebrew University Medical School, Jerusalem, Israel
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Arndt PA, Leger RM. Introduction to immunohematology special edition on drug-induced immune cytopenias. Immunohematology 2014; 30:43. [PMID: 25350999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Crawford J. Prevention and treatment of chemotherapy-induced neutropenia. Clin Adv Hematol Oncol 2013; 11:514-517. [PMID: 24518423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Jeffrey Crawford
- George Barth Geller Professor for Research in Cancer Chief of Medical Oncology Duke Cancer Institute Durham, North Carolina
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Park KH, Sohn JH, Lee S, Park JH, Kang SY, Kim HY, Park IH, Park YH, Im YH, Lee HJ, Hong DS, Park S, Shin SH, Kwon HC, Seo JH. A randomized, multi-center, open-label, phase II study of once-per-cycle DA-3031, a biosimilar pegylated G-CSF, compared with daily filgrastim in patients receiving TAC chemotherapy for early-stage breast cancer. Invest New Drugs 2013; 31:1300-6. [PMID: 23677653 DOI: 10.1007/s10637-013-9973-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/07/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUNDS A pegylated form of recombinant granulocyte-colony stimulating factor (G-CSF) was developed for prophylactic use in breast cancer. The aim of this study was to evaluate the efficacy and safety of once-per-cycle DA-3031 in patients receiving chemotherapy for breast cancer. METHODS A total of 61 patients receiving docetaxel, doxorubicin, and cyclophosphamide (TAC) chemotherapy were randomized in cycle 1 to receive daily injections of filgrastim (100 μg/m(2)) or a single subcutaneous injection of pegylated filgrastim DA-3031 at a dose of either 3.6 mg or 6 mg. RESULTS The mean duration of grade 4 neutropenia in cycle 1 was comparable among the treatment groups (2.48, 2.20, and 2.05 days for filgrastim, DA-3031 3.6 mg and 6 mg, respectively; P=0.275). No statistically significant differences were observed in the incidence of febrile neutropenia between the treatment groups (9.5 %, 15.0 %, and 5.0 % for filgrastim, DA-3031 3.6 mg and 6 mg, respectively; P=0.681) in cycle 1. The incidences of adverse events attributable to G-CSF were similar among the treatment groups. CONCLUSIONS Fixed doses of 3.6 mg or 6 mg DA-3031 have an efficacy comparable to that of daily injections of filgrastim in ameliorating grade 4 neutropenia in patients receiving TAC chemotherapy.
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Affiliation(s)
- K H Park
- Division of Oncology/Hematology, Department of Internal medicine, Korea University College of Medicine, 97 Guro-dong Gil, Guro-gu, Seoul, Korea
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Vladimirova SG, Tarasova LN, Sokol'skaia OI, Cherepanova VV. [C-reactive protein as a marker of the severity of an infectious process in acute myeloid leukemia patients with neutropenia]. TERAPEVT ARKH 2013; 85:34-40. [PMID: 24432597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To determine C-reactive protein (CRP) levels as diagnostic markers of infection in acute myeloid leukemia (AML) patients with neutropenia. SUBJECTS AND METHODS Sixty-three AML patients (28 men and 35 women) aged 20 to 77 years (median 50 years) were examined. According to the French-American-British (FAB) classification, the types of AML were as follows: M0 (n = 3), M1 (n = 9), M2 (n = 35), M4 (n = 10), and M5 (n = 6). All the patients had chemotherapy-associated neutropenia (granulocytes, less than 0.5.10(9)/l). In different treatment steps, all the patients developed infectious complications (the study analyzed the data of 86 cases). RESULTS In patients with localized infections (such as mucositis, abscess, pneumonia, etc.) or fever of unknown origin (FUO), the levels of CRP were not statistically significant different, but were significantly higher than in those without infectious complications. The concentrations of CRP did not differ in patients with systemic inflammatory response syndrome (SIRS) and in those with sepsis. At the same time, the level of CRP in systemic infection (SIRS, sepsis) was significantly higher than that in localized infection (p < 0.001). In patients with neutropenia, the median CRP levels were as follows: 7 mg/l (range 0-37; 95% reference interval (RI) 0 to 32) for those without infection 56 mg/l (range 13-104; 95% RI 17 to 104) for those with localized infection or FUO; and 168 mg/l (range 103-399; 95% RI 105 to 362) for those with systemic infection. CONCLUSION CRP is a marker of the severity of an infectious process in AML patients with neutropenia. The increase of its level more than 32 mg/l serves a valid criterion for the presence of infection and more than 105 mg/l does for that of a systemic inflammatory response in these patients.
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Kim T, Choi SH, Kim SH, Jeong JY, Woo JH, Kim YS, Sung H, Kim MN, Yoon DH, Suh C, Lee SO. Point prevalence of Pneumocystis pneumonia in patients with non-Hodgkin lymphoma according to the number of cycles of R-CHOP chemotherapy. Ann Hematol 2012; 92:231-8. [PMID: 23053189 PMCID: PMC7080131 DOI: 10.1007/s00277-012-1592-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 10/01/2012] [Indexed: 11/26/2022]
Abstract
R-CHOP chemotherapy composed of rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone which might increase the risk of Pneumocystis pneumonia in patients with non-Hodgkin lymphoma. We estimated the point prevalence of Pneumocystis pneumonia in non-Hodgkin lymphoma patients according to the number of R-CHOP cycles and investigated whether cytoreduction by chemotherapy is associated with Pneumocystis pneumonia development. We retrospectively established a cohort of patients who received R-CHOP for non-Hodgkin lymphoma in our institution. Using this cohort, we estimated the incidence rate and point prevalence of definite and probable Pneumocystis pneumonia. To assess factors associated with Pneumocystis pneumonia development several clinical variables, including absolute neutrophil and lymphocyte count at the time of non-Hodgkin lymphoma diagnosis and when the last R-CHOP cycle was administered, were compared between patients with and without Pneumocystis pneumonia. Of 713 patients in the cohort, 14 and 18 patients were diagnosed with definite and probable Pneumocystis pneumonia, respectively. The overall incidence of definite and definite plus probable PCP in NHL patients receiving R-CHOP were 2.0 % (14/713; 95 % CI, 1.1–3.3 %) and 4.5 % (32/713; 95 % CI, 3.2–6.4 %), respectively. This corresponded to 3.8 (95 % CI, 2.2–6.4) and 8.4 (95 % CI, 5.9–11.9) per 1000 persons. Many cases of Pneumocystis pneumonia (22/32, 68.7 %) developed after administration of the fourth R-CHOP cycle. However, there was no statistical difference in Pneumocystis pneumonia prevalence between patients receiving four or more cycles of R-CHOP and fewer than. Higher absolute neutrophil count (4,742/mm3 vs. 2,627/mm3; p < 0.01) was associated with Pneumocystis pneumonia development at the last R-CHOP cycle, while absolute lymphocyte count at the time of NHL diagnosis was not. Contrary to expectations, Pneumocystis pneumonia is not a frequent complication of R-CHOP treatment for non-Hodgkin lymphoma. Cytoreduction of R-CHOP might not be a risk factor of Pneumocystis pneumonia development. Universal prophylaxis against Pneumocystis pneumonia during R-CHOP treatment could not be strongly recommended.
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Affiliation(s)
- Tark Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Jin-Yong Jeong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736 Republic of Korea
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Mastrodemou S, Vazgiourakis V, Velegraki M, Pavlaki K, Goulielmos GN, Papadaki HA. Clonal patterns of X-chromosome inactivation in peripheral blood cells of female patients with chronic idiopathic neutropenia. Haematologica 2012; 97:1931-3. [PMID: 22875614 DOI: 10.3324/haematol.2012.069310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Purhonen AK, Vänskä M, Hämäläinen S, Pulkki K, Lehtikangas M, Kuittinen T, Nousiainen T, Koivula I, Jantunen E, Juutilainen A. Plasma copeptin in the assessment of febrile neutropenia. Peptides 2012; 36:129-32. [PMID: 22580173 DOI: 10.1016/j.peptides.2012.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 05/02/2012] [Accepted: 05/02/2012] [Indexed: 01/25/2023]
Abstract
Copeptin, the surrogate marker of arginine vasopressin (AVP), has been suggested to be a useful biomarker in monitoring sepsis reflecting hemodynamic imbalance and stress state. This prospective study conducted at a hematology ward in a Finnish University Hospital aimed to investigate whether plasma copeptin predicts the development of complicated course of neutropenic fever (bacteremia or need for treatment at intensive care unit) in 100 hematological patients experiencing their first neutropenic fever episode after intensive chemotherapy for hematological malignancy. Contrary to study presumptions, not elevated copeptin but the lack of a proper initial increase of plasma copeptin (<0.02 ng/mL from day 0 to day 1) predicted blood culture positive sepsis (p=0.023) and gram-negative bacteremia (p=0.045). No correlation was observed with plasma sodium, blood pressure or evaluated osmolality. Plasma copeptin correlated inversely with the same day pentraxin 3 on day 0-day 2 (all p-values <0.001) and with C-reactive protein on day 1 (p=0.015). In conclusion, copeptin did not correlate with disease severity, but the lack of a proper initial increase was associated with bacteremic complications of febrile neutropenia in hematological patients. The findings suggest the possibility of central dysregulation of AVP release and do not support the use of copeptin as a biomarker of septic complications in this patient group.
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Affiliation(s)
- Anna-Kaisa Purhonen
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, FI-70211 Kuopio, Finland
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Khan TH, Shahidullah M, Mannan MA, Nahar N. Effect of recombinant human granulocyte colony stimulating factor (rhG-CSF) for the treatment of neonates in presumed sepsis with neutropenia. Mymensingh Med J 2012; 21:469-474. [PMID: 22828545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bacterial sepsis continues to be an important cause of morbidity and mortality in neonates. In newborn with presumed sepsis, short-term treatment with rhG-CSF increased the neutrophil count and more importantly improved survival. The objective of the study was to evaluate the effect of rhG-CSF for the treatment of neonates in presumed sepsis with neutropenia. This interventional study was conducted in the Department of Neonatology, BSMMU, Dhaka during July 2009 to May 2010. Total 30 neonates of presumed sepsis with absolute neutrophil count ≤5000/cumm, age<28 days and birth weight 1000-2000g were included in the study. A subcutaneous injection of rhG-CSF (10μgm/kg/day) was administered to 15 neonates for 5 consecutive days (study group) and 15 neonates did not receive it (control group) in addition to standard antibiotic protocol for neonatal sepsis. Baseline characteristics of 30 neonates shows male/female ratio, weight on admission, gestational age were similar in both groups. Among 30 neonates of clinically presumed sepsis 7(23%) were culture proven. E. coli was the most common organism. After 24 hours of treatment mean ANC was increased more in study group (p<0.05) compared to control group. Mean ANC after 72 hours of treatment was increased significantly in study group than control group: 5940.00 versus 5706.00 (p=0.01). At the end of treatment, the mean ANC was higher than that of control (p=0.001). Twelve neonates in study group and ten neonates in control group survived to hospital discharge. The mortality rate in the study group 3/15(20%) and in control group 5/15(33%) were not significant. Duration of hospital stay was less in study group but not significant. The study concluded that before routine use of rhG-CSF in neonatal sepsis with neutropenia further large scale, multi-centre, randomized, placebo controlled trial are needed to validate the beneficial effect.
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Affiliation(s)
- T H Khan
- Department of Neonatology, Dhaka Medical College Hospital, Dhaka, Bangladesh.
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Soysal DE, Karakus V, Seren AR, Tatar E, Celik M, Hızar S. Evaluation of transient hyperglycemia in non-diabetic patients with febrile neutropenia. Eur J Intern Med 2012; 23:342-6. [PMID: 22560382 DOI: 10.1016/j.ejim.2011.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 12/14/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND We aimed to examine the effect of transient hyperglycemia in non-diabetic patients with febrile neutropenia. METHODS A total of 86 patients with febrile neutropenia were evaluated between June 2006 and December 2009. After measuring random blood glucose level at admission, cases with stress hyperglycemia were included in the study. Stress hyperglycemia was defined as documented random blood glucose level of 140 mg/dl and above without known diabetes mellitus, impaired glucose tolerance and impaired fasting glucose. A Multinational Association for Supportive Care in Cancer (MASCC) scoring system was used for the prediction of low and high risk patients according to medical complications at the onset of the febrile episode. RESULTS There were more patients with stress hyperglycemia than the patients with normoglycemia in the high risk group (p = 0.001). The growth of gram negative bacteria and fungi was higher in patients with stress hyperglycemia than with normoglycemia (p = 0.001). The patients receiving antifungal therapy had a higher rate of stress hyperglycemia than the patients without receiving antifungal therapy (p = 0.009). The patients with stress hyperglycemia had higher mortality rates than the patients with normoglycemia (p = 0.007). According to the MASCC risk-index, stress hyperglycemia increased 3.35 fold in the high risk patients compared to the low risk patients (p = 0.046) and 4.14 fold in the patients treated with antibacterial and antifungal agents compared to the patients treated with only antibacterial agents (p = 0.038). CONCLUSION Patients with stress hyperglycemia had more adverse clinical outcomes than patients with normoglycemia. We think further studies are needed to evaluate the relationship between stress hyperglycemia and febrile neutropenia.
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Affiliation(s)
- Dilek Ersil Soysal
- 1st Department of Internal Medicine, Ataturk Research and Training Hospital, Izmir, Turkey.
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Rabin KR, Smith J, Kozinetz CA. Myelosuppression and infectious complications in children with Down syndrome and acute lymphoblastic leukemia. Pediatr Blood Cancer 2012; 58:633-5. [PMID: 22106003 PMCID: PMC3279631 DOI: 10.1002/pbc.23371] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 09/02/2011] [Indexed: 11/08/2022]
Abstract
Children with Down syndrome (DS) bear an increased risk of acute lymphoblastic leukemia (ALL) and treatment complications. We compared blood counts and toxicities in 22 DS and 44 non-DS ALL patients. Patients with DS had deeper, longer neutrophil and monocyte count nadirs; more toxicities (HR 2.0, P = 0.0005); longer hospitalizations (HR 1.4, P < 0.0001); and more frequent microbiologically documented infections (HR 5.7, P = 0.0019), mucositis (HR 29.0, P = 0.0006), and cellulitis (HR 3.0, P = 0.033). Severe neutropenia, monocytopenia, and increased cellulitis in DS-ALL suggest the importance of skin hygiene, vigilance and aggressive treatment of cutaneous infections.
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Affiliation(s)
- Karen R Rabin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
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Visser G, de Jager W, Verhagen LP, Smit GPA, Wijburg FA, Prakken BJ, Coffer PJ, Buitenhuis M. Survival, but not maturation, is affected in neutrophil progenitors from GSD-1b patients. J Inherit Metab Dis 2012; 35:287-300. [PMID: 21863279 DOI: 10.1007/s10545-011-9379-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 07/04/2011] [Accepted: 07/22/2011] [Indexed: 12/14/2022]
Abstract
Glycogen storage disease type 1b (GSD 1b) is caused by mutations in the Glucose-6-phosphate transporter and is characterized by impaired glucose homeostasis. In addition, GSD-1b is associated with chronic neutropenia resulting in recurrent infections and inflammatory bowel disease. It is unclear whether the neutropenia is solely due to enhanced apoptosis of mature neutrophils or whether aberrant neutrophil development may also contribute. Here we demonstrate that hematopoietic progenitors from GSD-1b patients are not impaired in their capacity to develop into mature neutrophils. However, optimal survival of neutrophil progenitors from GSD-1b patients requires high glucose levels (> 200 mg dl(-1)), suggesting that even under normoglycemic conditions these cells are more prone to apoptosis. Furthermore, analysis of cytokine levels in peripheral blood suggests an inflammatory state with an inverse correlation between the level of inflammation and the number of neutrophils. Finally, in some patients, with low numbers of peripheral blood neutrophils, high numbers of neutrophils were observed in the intestine. Together, these results suggest that the neutropenia observed in GSD-1b patients is not caused by impaired maturation, but may be caused by both increased levels of apoptosis and egress of neutrophils from the blood to the inflamed tissues.
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Affiliation(s)
- Gepke Visser
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Ameye L, Paesmans M, Thiel S, Jensenius JC, Aoun M. M-ficolin levels are associated with the occurrence of severe infections in patients with haematological cancer undergoing chemotherapy. Clin Exp Immunol 2012; 167:303-8. [PMID: 22236007 PMCID: PMC3278697 DOI: 10.1111/j.1365-2249.2011.04512.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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] [Accepted: 10/21/2011] [Indexed: 11/28/2022] Open
Abstract
The pattern recognition molecules H-ficolin, L-ficolin and M-ficolin bind to micro-organisms. They activate the lectin pathway of complement through mannan-binding lectin (MBL)-associated serine proteases (MASPs). Association between low MBL levels and infections in patients undergoing chemotherapy for haematological diseases has been observed previously. We now examine for MASP-2, MASP-3 and ficolin levels. We assessed the concentration of lectin pathway molecules as risk factors for infection in patients with haematological malignancy undergoing chemotherapy. Samples taken before the initiation of chemotherapy covering 117 chemotherapy cycles in 105 patients were available. MASPs and ficolins were measured by time-resolved immunoflourometric assays and the levels related to parameters of infections. End-points included febrile neutropenia, documented infections, bacteraemia or severe infections. Lower M-ficolin concentrations were found in patients who developed a severe infection: median 0·27 µg/ml compared to 0·47 µg/ml in patients who did not develop a severe infection (P = 0·01). Conversely, MASP-2 was higher in these patients: median 0·53 µg/ml compared to 0·37 µg/ml, respectively (P = 0·008). When considering M-ficolin levels below 0·36 µg/ml as deficient, the time to development of severe infection was shorter in the M-ficolin deficient group: the hazard ratio was 2·60 (95% confidence interval: 1·23-5·49). No associations were revealed between infections and H-ficolin, L-ficolin or MASP-3. Patients with low M-ficolin are more likely to develop severe infections, whereas MASP-2 showed the opposite.
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Affiliation(s)
- L Ameye
- Jules Bordet Institute, Brussels, Belgium
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Laan WJDM, Ramlal D. [A case study; ethnicity and clozapine, a risky combination?]. Tijdschr Psychiatr 2012; 54:829-833. [PMID: 22961282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Agranulocytosis is a very serious side-effect of treatment with clozapine. For this reason, the Dutch guidelines state the specific values of leukocyte and neutrophil counts at which treatment with clozapine should be discontinued. We focus on a patient with a benign ethnic neutropenia who, despite a low neutrophil count, was allowed to continue taking clozapine. We discuss a number of important practical considerations that can affect the way in which leukocyte and neutrophil counts are interpreted in relation to the use of clozapine.
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