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Kozma A, Meggyesi N, Hardi A, Ceglédi A, Tomán Á, Kapócs K, Mikala G. [Calreticulin: Pathophysiology of an unusual gain-of-function and its clinical consequences]. Magy Onkol 2022; 66:147-152. [PMID: 35724392] [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] [Received: 03/01/2022] [Accepted: 04/02/2022] [Indexed: 06/15/2023]
Abstract
One characteristic type of the common somatic mutations causing myeloproliferative neoplasias is the frameshift mutation of the calreticulin gene that leads to proteins of abnormal structure. The pathologic protein induces novel cell biological processes that are fundamental to the onset and maintenance of myeloproliferative diseases. In this review, an insight is provided into these processes, aiding better understanding of the underlining pathobiological processes and eventually to more effective therapy in the future.
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Affiliation(s)
- András Kozma
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Nóra Meggyesi
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Apor Hardi
- Hematológiai és Őssejt-transzplantációs Osztály, Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - Andrea Ceglédi
- Hematológiai és Őssejt-transzplantációs Osztály, Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - Ágnes Tomán
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Katalin Kapócs
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Gábor Mikala
- Hematológiai és Őssejt-transzplantációs Osztály, Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
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Szita VR, Mikala G, Kozma A, Fábián J, Hardi A, Alizadeh H, Rajnics P, Rejtő L, Szendrei T, Váróczy L, Nagy Z, Illés Á, Vályi-Nagy I, Masszi T, Varga G. Targeted Venetoclax Therapy in t(11;14) Multiple Myeloma: Real World Data From Seven Hungarian Centers. Pathol Oncol Res 2022; 28:1610276. [PMID: 35295611 PMCID: PMC8918485 DOI: 10.3389/pore.2022.1610276] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
Despite the introduction of novel agents, multiple myeloma remains incurable for most patients, necessitating further therapeutic options. Venetoclax, a selective BCL-2 inhibitor, had shown promising results in patients with translocation t(11;14), but questions remain open about its optimal use. We have contacted all Hungarian haematology centers for their experience treating t(11;14) myeloma patients with venetoclax. 58 patients were reported. 37 received venetoclax in the relapsed/refractory setting with few or no other therapeutic options available. 21 patients started venetoclax as salvage after failing to achieve satisfactory response to first line therapy. In the relapsed/refractory setting objective response rate (ORR) was 94%, median progression-free survival (PFS) 10.0 months and median overall survival (OS) 14.6 months. In reinduction patients, ORR was 100%, median PFS and OS were not reached. Importantly, we found no adverse effect of high risk features such as deletion 17p or renal failure, in fact renal failure ameliorated in 42% of the cases, including three patients who became dialysis independent. Our study also reports the highest number of plasma cell leukemia cases successfully treated with venetoclax published in literature, with refractory plasma cell leukemia patients achieving a median PFS of 10.0 and a median OS of 12.2 months.
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Affiliation(s)
- Virág Réka Szita
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Gábor Mikala
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - András Kozma
- Department of Molecular Genetics, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - János Fábián
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - Apor Hardi
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - Hussain Alizadeh
- 1st Department of Internal Medicine, University of Pécs, Pécs, Hungary
| | - Péter Rajnics
- Department of Haematology, Teaching Hospital Mór Kaposi, Kaposvár, Hungary
- Faculty of Health Sciences, Institute of Diagnostics, University of Pécs, Pécs, Hungary
| | - László Rejtő
- Jósa András Teaching Hospital, Nyíregyháza, Hungary
| | | | - László Váróczy
- Department of Haematology, Faculty of Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Zsolt Nagy
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Árpád Illés
- Department of Haematology, Faculty of Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - István Vályi-Nagy
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - Tamás Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Gergely Varga
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
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Hardi A, Varga G, Nagy Z, Kosztolányi S, Váróczy L, Plander M, Schneider T, Demeter J, Alizadeh H, Illés Á, Masszi T, Mikala G. Long-time progression-free survival in relapsed, refractory multiple myeloma with the oral ixazomib-lenalidomide-dexamethasone regime. Orv Hetil 2021; 162:1451-1458. [PMID: 34482291 DOI: 10.1556/650.2021.32179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/06/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: A myeloma multiplex mindmáig alapvetően gyógyíthatatlan betegség, ezért nagy klinikai jelentőségük van az eredményes mentő kezeléseknek. A szájon át adható első proteaszómagátlóval, az ixazomibbal kiegészített lenalidomid-dexametazon terápia jól tolerálható, csak orális szerekből álló kombináció, mely hazánkban 2015 áprilisától kezdődően a "Named Patient Program" keretén belül vált elérhetővé relabált, refrakter myeloma multiplexes betegek kezelésére. Célkitűzés: Kutatásunk célja az ixazomib-lenalidomid-dexametazon kezelés mellett a hosszú távon progressziómentes túlélők célzott vizsgálata. Módszer: A program keretében összesen 7 centrumban 80 visszaeső beteg részesült e triplet kezelésben, adataikat retrospektíven elemeztük. Leíró statisztikai és Kaplan-Meier-analízist végeztünk. Eredmények: A betegek nagyobb hányada reagált: 63,75%-os válaszarány mellett 14 (17,5%) betegnél nem volt terápiás válasz/stabil betegség alakult ki, és 15-nél (18,75%) a betegség a kezelés mellett is progrediált. A progressziómentes túlélés a teljes betegcsoportban 10,6 hónapnak adódott, ugyanakkor 16 beteg (18,75%) két éven túl progressziómentesnek bizonyult, sőt közülük 11-nél a betegség még 3 év után sem progrediált. Tanulmányunkban a fenti, hosszú távú túlélő betegcsoport tulajdonságait tárjuk fel. Megbeszélés: A folyamatos terápia a myeloma multiplex kezelésében meghatározóvá vált. Ezért fontos ismernünk, hogy kik lehetnek azok a betegek, akik különösen sokat profitálnak egy bizonyos terápiából. A hosszú távon progressziómentes túlélők között az immunglobulin-nehézláncot érintő transzlokációk vagy triszómiák közül (trend szintjén) az utóbbiak kedvezőbb progressziómentes túléléssel bírtak, de progressziómentes platót mindkét betegcsoportban észleltünk. A betegség tumortömegét mérő nemzetközi stádiumbeosztás (ISS) nem jelezte előre a hosszú túlélést. Gyógyszerelhagyáshoz vezető mellékhatást a hosszú távú túlélő csoportban egyet sem regisztráltunk; az észlelt mellékhatások nagy része enyhe volt. Következtetések: Munkánk során az ixazomib-lenalidomid-dexametazon kombinációt effektívnek és biztonságosnak találtuk relabált, refrakter myeloma multiplex kezelésére, mely a betegek mintegy hatodánál több éven át eredményesen alkalmazható. Cikkünkkel a hazai beteganyagon szerzett tapasztalatainkat szeretnénk megosztani a COVID-19-világjárvány alatt különösen aktuálissá vált, tisztán orális terápiás lehetőségről. Orv Hetil. 2021; 162(36): 1451-1458. SUMMARY INTRODUCTION Despite great advances in therapy, multiple myeloma is still a largely incurable disease, therefore the importance of salvage therapies is paramount. The first oral proteasome inhibitor ixazomib in combination with lenalidomide-dexamethasone is a tolerable, orally administered regime, which has become available for Hungarian relapsed, refractory multiple myeloma patients from April 2015 in the Named Patient Program. OBJECTIVE Our goal was to investigate the long-time progression-free surviving patient population treated with the ixazomib-lenalidomide-dexamethasone triplet. METHOD We retrospectively studied a total of 80 patients from 7 centers who received the triplet combination. Survival analyses were performed. RESULTS Two-third of the patients responded: the overall response rate was 63.75%. 14 patients (17.5%) did not respond/had stable disease and 15 patients (18.75%) outright progressed upon therapy. Although progression-free survival was only 10.6 months for the entire patient cohort, the disease in a subgroup of 16 patients did not progress within two years. In fact, 11 of them were still in sustained remission after 3 years of therapy. Our goal was to analyze the characteristics of this subgroup. DISCUSSION The idea of long-term therapy of multiple myeloma is gaining widespread acceptance. Therefore it is important to know which patients may benefit the most from certain therapies. Among these 16 long-term responder patients, reciprocal translocation of the immunoglobulin heavy chain seemed to lack an adverse impact on progression-free survival; comparable to trisomies, both curves had a progression-free plateau. The International Staging System (ISS) score at the start of therapy did not predict long-term survivorship. Most of the side effects in this subgroup were mild, manageable, none led to therapy discontinuation. CONCLUSION Ixazomib-lenalidomide-dexamethasone was confirmed to be an effective and safe combination for relapsed, refractory multiple myeloma, and one-sixth of the treated patients were able to receive it for several years, effectively. This fully oral therapeutic option is at its best during the present COVID-19 pandemic. Orv Hetil. 2021; 162(36): 1451-1458.
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Affiliation(s)
- Apor Hardi
- 1 Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Hematológiai és Őssejt-transzplantációs Osztály, Budapest
| | - Gergely Varga
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika, Budapest, Szentkirályi u. 46., 1088
| | - Zsolt Nagy
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika, Budapest
| | - Szabolcs Kosztolányi
- 4 Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Pécs
| | - László Váróczy
- 5 Debreceni Egyetem, Általános Orvostudományi Kar, Belgyógyászati Intézet, Hematológiai Klinika, Debrecen
| | - Márk Plander
- 6 Markusovszky Egyetemi Oktatókórház, Szombathely
| | - Tamás Schneider
- 7 Országos Onkológiai Intézet, Hematológiai Osztály, Budapest
| | - Judit Demeter
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika, Budapest
| | - Hussain Alizadeh
- 4 Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Pécs
| | - Árpád Illés
- 5 Debreceni Egyetem, Általános Orvostudományi Kar, Belgyógyászati Intézet, Hematológiai Klinika, Debrecen
| | - Tamás Masszi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika, Budapest, Szentkirályi u. 46., 1088
| | - Gábor Mikala
- 1 Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Hematológiai és Őssejt-transzplantációs Osztály, Budapest
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Varga G, Dávid Tóth A, Réka Szita V, Csukly Z, Hardi A, Gaál-Weisinger J, Nagy Z, Altai E, Rencsik A, Plander M, Szendrei T, Kórád K, Radványi G, Rottek J, Deák B, Szaleczky E, Schneider T, Kohl Z, Kosztolányi S, Alizadeh H, Lengyel Z, Modok S, Borbényi Z, Lovas S, Váróczy L, Illés Á, Rajnics P, Masszi T, Mikala G. Beneficial Effect of Lenalidomide-Dexamethason Treatment in Relapsed/Refractory Multiple Myeloma Patients: Results of Real-Life Data From 11 Hungarian Centers. Pathol Oncol Res 2021; 27:613264. [PMID: 34257583 PMCID: PMC8262242 DOI: 10.3389/pore.2021.613264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/01/2021] [Indexed: 11/17/2022]
Abstract
In Hungary, the cost of lenalidomide-based therapy is covered only for relapsed multiple myeloma (MM) patients, therefore lenalidomide is typically used in the second-line either as part of a triplet with proteasome inhibitors or as a doublet. Lenalidomide-dexamethasone is a standard treatment approach for relapsed/refractory MM, and according to recent large randomized clinical trials (RCT, the standard arm of POLLUX, ASPIRE, TOURMALINE), the progression-free survival (PFS) is expected to be approximately 18 months. We surveyed ten Hungarian centers treating MM and collected data of 278 patients treated predominantly after 2016. The median age was 65 years, and patients were distributed roughly equally over the 3 international staging system groups, but patients with high risk cytogenetics were underrepresented. 15.8% of the patients reached complete response, 21.6% very good partial response, 40.6% partial response, 10.8% stable disease, and 2.5% progressed on treatment. The median PFS was unexpectedly long, 24 months, however only 9 months in those with high risk cytogenetics. We found interesting differences between centers regarding corticosteroid type (prednisolone, methylprednisolone or dexamethasone) and dosing, and also regarding the choice of anticoagulation, but the outcome of the various centers were not different. Although the higher equivalent steroid dose resulted in more complete responses, the median PFS of those having lower corticosteroid dose and methylprednisolone were not inferior compared to the ones with higher dose dexamethasone. On multivariate analysis high risk cytogenetics and the number of prior lines remained significant independent prognostic factors regarding PFS (p < 0.001 and p = 0.005). Our results show that in well-selected patients Lenalidomide-dexamethasone can be a very effective treatment with real-world results that may even outperform those reported in the recent RCTs. This real world information may be more valuable than outdated RCT data when treatment options are discussed with patients.
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Affiliation(s)
- Gergely Varga
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - András Dávid Tóth
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Virág Réka Szita
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Zoltán Csukly
- National Institute for Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, Budapest, Hungary
| | - Apor Hardi
- National Institute for Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, Budapest, Hungary
| | - Júlia Gaál-Weisinger
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Zsolt Nagy
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Elvira Altai
- Veszprém-Csolnoky Ferenc County Hospital, Hematology, Veszprém, Hungary
| | - Annamária Rencsik
- Veszprém-Csolnoky Ferenc County Hospital, Hematology, Veszprém, Hungary
| | - Márk Plander
- Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Tamás Szendrei
- Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Krisztina Kórád
- Borsod-Abaúj- Zemplén Central County University Teaching Hospital, Miskolc, Hungary
| | - Gáspár Radványi
- Borsod-Abaúj- Zemplén Central County University Teaching Hospital, Miskolc, Hungary
| | - János Rottek
- National Institute of Oncology, Budapest, Hungary
| | - Beáta Deák
- National Institute of Oncology, Budapest, Hungary
| | | | | | - Zoltán Kohl
- 1st Department of Internal Medicine, University of Pécs, Pécs, Hungary
| | | | - Hussain Alizadeh
- 1st Department of Internal Medicine, University of Pécs, Pécs, Hungary
| | - Zsuzsanna Lengyel
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Szabolcs Modok
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Zita Borbényi
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Szilvia Lovas
- Department of Hematology, Institute for Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - László Váróczy
- Department of Hematology, Institute for Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Árpád Illés
- Department of Hematology, Institute for Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Péter Rajnics
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Tamás Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Gábor Mikala
- National Institute for Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, Budapest, Hungary
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Tasnády S, Karászi É, Szederjesi A, Bihari G, Juhász Z, Hardi A, Kriván G, Kállay K, Reményi P, Sinkó J, Mikala G, Réti M, Masszi T. Identification of the best-suited donor for generating virus-specific T cells. Vox Sang 2019; 115:18-26. [PMID: 31667887 DOI: 10.1111/vox.12857] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Administration of virus-specific T cells (VSTs) is a viable antiviral treatment strategy after allogeneic HSCT, even if conventional therapies fail. Third-party donors are often chosen for the generation of the VST product. The eligibility of the donor has to be tested in a rigorous donor screening procedure, since the isolation technology only targets pre-existing VSTs. MATERIALS AND METHODS In a period of 3 years, we performed 32 VST treatments for 28 patients. Targeting four different viruses, 284 healthy individuals underwent 417 donor screening procedures. VSTs were counted by flow cytometry detecting interferon-gamma (IFN-γ) producing T cells. Generation of the VSTs was performed from leukapheresis products in a fully automated and closed system using magnetic cell separation. RESULTS The mean circulating VST frequencies ranged from 0·006% to 0·328%. The average yield of viable VSTs in the product was 1·83·106 cells, while the average VST dose calculated for the patient's body weight was 4·63·104 /kg. The mean purity - percentage of VSTs within the T cells - of all T-cell products was 62·9%. Correlation was identified between the frequency of the VSTs in the peripheral blood of the donor and the VST numbers of the end product; the strongest correlation was seen for CMV. CONCLUSION This paper focuses on the T-cell donors, highlighting some key points on the donor selection process. Based on the findings in connection with the CMV therapies, peripheral VST seems to be the best predictor of the VST content of the final product administered to the patient.
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Affiliation(s)
- Szabolcs Tasnády
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Éva Karászi
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Attila Szederjesi
- Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - György Bihari
- Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zsófia Juhász
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Apor Hardi
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Gergely Kriván
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Krisztián Kállay
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Péter Reményi
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - János Sinkó
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Gábor Mikala
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Marienn Réti
- National Institute of Hematology and Infectious Diseases, Central Hospital of Southern Pest, Budapest, Hungary
| | - Tamás Masszi
- Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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Eskew A, Bedrick B, Stoll C, Hardi A, Tuuli M, Colditz G, Jungheim E. Letrozole versus clomiphene citrate for unexplained infertility: a systematic review and meta-analysis of randomized, controlled trials. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hardi A, Ravichandran S, Halford B, Ross I, Patel R. Innovative multi-pronged library resource model to enhance academic
global health education among residency programs. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Boots CE, Meister M, Cooper AR, Hardi A, Jungheim ES. Ovarian stimulation in the luteal phase: systematic review and meta-analysis. J Assist Reprod Genet 2016; 33:971-80. [PMID: 27146151 PMCID: PMC4974222 DOI: 10.1007/s10815-016-0721-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate whether outcomes are different if controlled ovarian stimulation (COS) is started in the luteal phase rather than the follicular phase. METHODS A systematic review and meta-analysis was performed. Sixteen studies were included in the qualitative analysis, and eight studies with a total of 338 women were included in the quantitative analysis. RESULTS Cycles initiated in the luteal phase were slightly longer (WMD 1.1 days, 95 % CI 0.39-1.9) and utilized more total gonadotropins (WMD 817 IU, 95 % CI 489-1144). However, no differences were noted in peak estradiol levels (WMD -411 pg/ml, 95 % CI -906-84.7) or in the total number of oocytes retrieved (WMD 0.52 oocytes, 95 % CI -0.74-1.7). There were slightly more mature oocytes retrieved in the luteal phase (WMD 0.77 oocytes, 95 % CI 0.21-1.3), and fertilization rates were significantly higher (WMD 10 %, 95 % CI 0.03-0.18). While only three studies reported pregnancy outcomes, no difference was noted in the FET pregnancy rates after COS in the luteal versus follicular phase (RR 0.95, 95 % CI 0.56-1.7). A post hoc power analysis revealed that a sample of this size was sufficient to detect a clinically meaningful difference of 2 oocytes retrieved with 93 % power. CONCLUSION Although initiating COS in the luteal phase requires a longer stimulation and a higher dose of total gonadotropin, these differences are not clinically significant. Furthermore, COS initiated in the luteal phase does not compromise the quantity or quality of oocytes retrieved compared to outcomes of traditional stimulation in the follicular phase.
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Affiliation(s)
- C E Boots
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA.
| | - M Meister
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
| | - A R Cooper
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
| | - A Hardi
- Washington University, 660 Euclid Avenue, St. Louis, MO, 63110, USA
| | - E S Jungheim
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
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