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Sehdev SR, Rawson NSB, Aseyev OI, Buick CJ, Butler MO, Edwards S, Gill S, Gotfrit JM, Hsia CC, Juergens RA, Manna M, McCarthy JS, Mukherjee SD, Snow SL, Spadafora S, Stewart DJ, Wentzell JR, Wong RPW, Zalewski PG. Access to Oncology Medicines in Canada: Consensus Forum for Recommendations for Improvement. Curr Oncol 2024; 31:1803-1816. [PMID: 38668039 PMCID: PMC11048816 DOI: 10.3390/curroncol31040136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Patient access to new oncology drugs in Canada is only possible after navigating multiple sequential systemic checkpoints for national regulatory approval, health technology assessment (HTA) and collective government price negotiation. These steps delay access and prevent health care providers from being able to prescribe optimal therapy. Eighteen Canadian oncology clinicians from the medicine, nursing and pharmacy professions met to develop consensus recommendations for defining reasonable government performance standards around process and timeliness to improve Canadian cancer patients' access to best care. A modified Delphi methodology was used to identify consensus on 30 questions involving five themes: accountability, disparities, endpoints, timeliness, and cost-effectiveness. It was agreed that greater transparency is required across regulatory and HTA processes. Health professionals in oncology are frustrated for their patients because they are unable to deliver the modern guideline-supported therapies they want to provide due to delays in approval or funding. Canadian health care providers request improvements in timely access to life-saving therapeutics in line with other comparator countries. Clinicians expect urgent improvements in Canadian health systems to give our patients their best chance of survival.
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Affiliation(s)
- Sandeep R. Sehdev
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | | | - Olexiy I. Aseyev
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON P7B 6V4, Canada
| | - Catriona J. Buick
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Canadian Association of Nurses in Oncology/Association Canadienne des Infirmières en Oncologie, Vancouver, BC V6A 1B6, Canada
| | - Marcus O. Butler
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Scott Edwards
- Dr H Bliss Murphy Cancer Centre, Eastern Health, St. John’s, NL A1B 3V6, Canada
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Sharlene Gill
- Department of Medicine, Division of Medical Oncology, University of British Columbia and BC Cancer, Vancouver, BC V5Z 1M9, Canada
| | - Joanna M. Gotfrit
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | - Cyrus C. Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | | | - Mita Manna
- Saskatoon Cancer Centre, Saskatoon, SK S7N 4H4, Canada
| | - Joy S. McCarthy
- Cancer Care Program, Newfoundland and Labrador Health Services, St. John’s, NL A1B 3V6, Canada
| | - Som D. Mukherjee
- Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada
| | | | - Silvana Spadafora
- Algoma District Cancer Program, Sault Area Hospital, Sault Ste Marie, ON P6B 0A8, Canada
- Northern Ontario School of Medicine University, Sudbury, ON P3E 2C6, Canada
| | - David J. Stewart
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | - Jason R. Wentzell
- Department of Pharmacy, the Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | - Ralph P. W. Wong
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Pawel G. Zalewski
- Lakeridge Health, Durham Regional Cancer Centre, Oshawa, ON L1G 8A2, Canada
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2
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Mortuza S, Chin-Yee B, James TE, Chin-Yee IH, Hedley BD, Ho JM, Saini L, Lazo-Langner A, Schenkel L, Bhai P, Sadikovic B, Keow J, Sangle N, Hsia CC. Myelodysplastic Neoplasms (MDS) with Ring Sideroblasts or SF3B1 Mutations: The Improved Clinical Utility of World Health Organization and International Consensus Classification 2022 Definitions, a Single-Centre Retrospective Chart Review. Curr Oncol 2024; 31:1762-1773. [PMID: 38668037 PMCID: PMC11049163 DOI: 10.3390/curroncol31040134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Myelodysplastic neoplasms (MDS) with ring sideroblasts (RS) are diagnosed via bone marrow aspiration in the presence of either (i) ≥15% RS or (ii) 5-14% RS and an SF3B1 mutation. In the MEDALIST trial and in an interim analysis of the COMMANDS trial, lower-risk MDS-RS patients had decreased transfusion dependency with luspatercept treatment. A total of 6817 patients with suspected hematologic malignancies underwent molecular testing using a next-generation-sequencing-based genetic assay and 395 MDS patients, seen at our centre from 1 January 2018 to 31 May 2023, were reviewed. Of these, we identified 39 evaluable patients as having lower-risk MDS with SF3B1 mutations: there were 20 (51.3%) males and 19 (48.7%) females, with a median age of 77 years (range of 57 to 92). Nineteen (48.7%) patients had an isolated SF3B1 mutation with a mean variant allele frequency of 35.2% +/- 8.1%, ranging from 7.4% to 46.0%. There were 29 (74.4%) patients with ≥15% RS, 6 (15.4%) with 5 to 14% RS, one (2.6%) with 1% RS, and 3 (7.7%) with no RS. Our study suggests that a quarter of patients would be missed based on the morphologic criterion of only using RS greater than 15% and supports the revised 2022 definitions of the World Health Organization (WHO) and International Consensus Classification (ICC), which shift toward molecularly defined subtypes of MDS and appropriate testing.
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Affiliation(s)
- Shamim Mortuza
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Benjamin Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Tyler E. James
- Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
| | - Ian H. Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Benjamin D. Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Jenny M. Ho
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Lalit Saini
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Laila Schenkel
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Pratibha Bhai
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Jonathan Keow
- Edmonton Base Lab, Alberta Precision Laboratories, Edmonton, AB T2N 1M7, Canada;
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Cyrus C. Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
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3
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Keow J, Kwan KF, Hedley BD, Hsia CC, Xenocostas A, Chin-Yee B. Merkel cell carcinoma mimicking acute leukemia. Int J Lab Hematol 2024. [PMID: 38477102 DOI: 10.1111/ijlh.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
Bone marrow aspirate showed diffuse infiltration by a population of monomorphic cells with scant cytoplasm, markedly increased nuclear-to-cytoplasmic ratio, and numerous indistinct nucleoli. Bone marrow biopsy confirmed extensive marrow infiltration by a malignant neoplasm with strong and diffuse expression of synaptophysin by immunohistochemistry, consistent with metastases from Merkel Cell carcinoma.
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Affiliation(s)
| | - Keith F Kwan
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Ben D Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Cyrus C Hsia
- Department of Medicine, Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Anargyros Xenocostas
- Department of Medicine, Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Benjamin Chin-Yee
- Department of Medicine, Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, Canada
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4
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Almanaseer A, Chin-Yee B, Ho J, Lazo-Langner A, Schenkel L, Bhai P, Sadikovic B, Chin-Yee IH, Hsia CC. An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis. Adv Hematol 2024; 2024:3056216. [PMID: 38375212 PMCID: PMC10876298 DOI: 10.1155/2024/3056216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
Background Thrombocytosis is a common reason for referral to Hematology. Differentiating between secondary causes of thrombocytosis and essential thrombocythemia (ET) is often clinically challenging. A practical diagnostic approach to identify secondary thrombocytosis could reduce overinvestigation such as next generation sequencing (NGS) panel. Methods and Results All adult patients with thrombocytosis (≥450 × 109/L) who underwent molecular testing at a single tertiary care centre between January 1, 2018 and May 31, 2021 were evaluated. Clinical and laboratory variables were compared between patients with secondary thrombocytosis vs. ET. Clinical variables included smoking, thrombosis, splenectomy, active malignancy, chronic inflammatory disease, and iron deficiency anemia. Laboratory variables included complete blood count (CBC), ferritin, and myeloid mutations detected by NGS. The overall yield of molecular testing was 52.4%; 92.1% of which were mutations in JAK2, CALR, and/or MPL. Clinical factors predictive of ET included history of arterial thrombosis (p < 0.05); active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency were associated with secondary thrombocytosis (p < 0.05). A diagnosis of ET was associated with higher hemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), and mean platelet volume (MPV), while secondary thrombocytosis was associated with higher body mass index, white blood cells, and neutrophils (p < 0.01). Conclusion A practical approach to investigating patients with persistent thrombocytosis based on clinical characteristics such as active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency may assist in accurately identifying patients more likely to have secondary causes of thrombocytosis and reduce overinvestigation, particularly costly molecular testing.
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Affiliation(s)
- Ala Almanaseer
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jenny Ho
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Laila Schenkel
- Molecular Diagnostic Division, Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H. Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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Pope V, Hsia CC. Safe utilization of ruxolitinib in simultaneous primary myelofibrosis and warm autoimmune hemolytic anemia. Ann Hematol 2024; 103:677-679. [PMID: 37930364 DOI: 10.1007/s00277-023-05535-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Victor Pope
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Cyrus C Hsia
- Department of Medicine, Division of Hematology,, London Health Sciences Centre, Room E6-219A, Victoria Hospital, 800 Commissioners Road East, London, Ontario, Canada.
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6
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Liu J, Chin-Yee B, Chin-Yee IH, Ho J, Sadikovic B, Hsia CC. Sodium-glucose cotransporter-2 inhibitor-associated erythrocytosis: A retrospective cohort study. J Intern Med 2024; 295:103-105. [PMID: 37729395 DOI: 10.1111/joim.13722] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Jessica Liu
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jenny Ho
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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7
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Keow J, Chin‐Yee B, Hsia CC, Robertson K. Urticaria pigmentosa and systemic mastocytosis. Clin Case Rep 2023; 11:e8302. [PMID: 38111510 PMCID: PMC10725995 DOI: 10.1002/ccr3.8302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
Key Clinical Message Additional investigations for systemic involvement should be initiated once the diagnosis of cutaneous mastocytosis has been established in an adult patient. A serum tryptase can serve as a screening test for systemic mastocytosis, and persistent elevations should prompt further investigations, such as bone marrow studies. Abstract Urticaria pigmentosa (UP) is the most common form of cutaneous mastocytosis, presenting as a wide variety of macroscopic appearances. Cutaneous mastocytosis in pediatric patients usually does not present with systemic involvement, but more than half of adult patients with cutaneous mastocytosis demonstrate systemic involvement. Currently, there is no guidance surrounding systemic testing in patients with UP. A 50-year-old Caucasian male was referred to the Clinical Immunology and Allergy clinic with a history of a rash. He initially presented to hospital 12 years prior with group A beta hemolytic streptococcus bacteremia treated with multiple different antibiotics. One week following discharge, he developed erythematous brown spots on his right leg which were flat, non-pruritic, and not painful. The rash later expanded to his trunk and extremities. A skin biopsy performed 2 years prior to referral to our clinic demonstrated urticaria pigmentosa. The CD117 immunohistochemical stain showed increased perivascular and interstitial mast cells in the superficial dermis. Darier's sign was negative on physical examination, and venom testing was also negative. Although he had no symptoms of systemic involvement, his serum tryptase was elevated at 47.6 ng/mL in the context of normal kidney and liver function. A skeletal survey was normal, and an abdominal ultrasound ruled out splenomegaly. Bone marrow biopsy demonstrated a mild increase in paratrabecular and perivascular atypical mast cells, in keeping with systemic mastocytosis. Adult patients with cutaneous mastocytosis have a high likelihood of having an underlying systemic mast cell disorder. Therefore, any patient presenting with characteristic skin findings should be investigated as having a cutaneous manifestation of systemic mastocytosis. This case demonstrates the utility of serum tryptase and its role in triggering additional investigations and guiding appropriate therapy.
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Affiliation(s)
| | - Benjamin Chin‐Yee
- Division of Hematology, Department of MedicineUniversity of Western OntarioLondonOntarioCanada
- Department of History and Philosophy of ScienceUniversity of CambridgeCambridgeUnited Kingdom
| | - Cyrus C. Hsia
- Division of Hematology, Department of MedicineUniversity of Western OntarioLondonOntarioCanada
| | - Kara Robertson
- Division of Clinical Immunology and Allergy, Department of MedicineUniversity of Western OntarioLondonOntarioCanada
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8
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Bastin DJ, Mount G, Hsia CC, Jarrar M, McCann K, Xenocostas A, Teriaky A, Deotare U. The tale of two organs: allogeneic hematopoietic stem cell transplantation following liver transplantation in a myelofibrosis patient. Hematol Transfus Cell Ther 2023; 45:502-504. [PMID: 34955451 PMCID: PMC10627999 DOI: 10.1016/j.htct.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/06/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Kit McCann
- Western University, London, ON, Canada; Windsor Regional Hospital, Windsor, ON, Canada
| | - Anargyros Xenocostas
- Western University, London, ON, Canada; Blood and Marrow Transplant Program, London Health Sciences Centre, London, ON, Canada
| | | | - Uday Deotare
- Western University, London, ON, Canada; Blood and Marrow Transplant Program, London Health Sciences Centre, London, ON, Canada; The Centre for Quality, Innovation and Safety, Department of Medicine, Western University, London, ON, Canada.
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9
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Chin-Yee B, Bhai P, Cheong I, Matyashin M, Hsia CC, Kawata E, Ho JM, Levy MA, Stuart A, Lin H, Chin-Yee I, Kadour M, Sadikovic B, Lazo-Langner A. A Rational Approach to JAK2 Mutation Testing in Patients with Elevated Hemoglobin: Results from the JAK2 Prediction Cohort (JAKPOT) Study. J Gen Intern Med 2023; 38:1828-1833. [PMID: 36451015 PMCID: PMC10271984 DOI: 10.1007/s11606-022-07963-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Erythrocytosis, most often measured as an increase in hemoglobin and/or hematocrit, is a common reason for referral to internal medicine and hematology clinics and a rational approach is required to effectively identify patients with polycythemia vera while avoiding over-investigation. AIM We aimed to develop and validate a simple rule to predict JAK2 mutation positivity based on complete blood count parameters to aid in the diagnostic approach to patients referred for elevated hemoglobin. SETTING Internal medicine and hematology clinics at an academic tertiary referral center. PARTICIPANTS The JAK2 Prediction Cohort (JAKPOT), a large retrospective cohort (n = 901) of patients evaluated by internal medicine and hematology specialists for elevated hemoglobin. DESIGN JAK2 mutation analysis was performed in all patients and clinical and laboratory variables were collected. Patients were randomly divided into derivation and validation cohorts. A prediction rule was developed using data from the derivation cohort and tested in the validation cohort. KEY RESULTS The JAKPOT prediction rule included three variables: (i) red blood cell count >6.45×1012/L, (ii) platelets >350×109/L, and (iii) neutrophils >6.2×109/L; absence of all criteria was effective at ruling out JAK2-positivity with sensitivities 94.7% and 100%, and negative predictive values of 98.8% and 100% in the derivation and validation cohorts, respectively, with an overall low false negative rate of 0.4%. The rule was validated for three different methods of JAK2 testing. Applying this rule to our entire cohort would have resulted in over 50% fewer tests. CONCLUSION In patients with elevated hemoglobin, the use of a simple prediction rule helps to accurately identify patients with a low likelihood of having a JAK2 mutation, potentially limiting costly over-investigation in this common referral population.
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Affiliation(s)
- Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Ian Cheong
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Maxim Matyashin
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Eri Kawata
- Division of Hematology, Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Jenny M Ho
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael A Levy
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Alan Stuart
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Hanxin Lin
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mike Kadour
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bekim Sadikovic
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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Yeung KCY, Kapitany C, Chargé S, Callum J, Cserti-Gazdewich C, D'Empaire PP, Khandelwal A, Lieberman L, Lee C, Pavenski K, Pendergrast J, Shehata N, Hsia CC, Lavoie M, Murphy MF, Prokopchuk-Gauk O, Rahmani M, Trudeau J, Zeller MP, Lin Y. Transfusion camp: A retrospective study of self-reported impact on postgraduate trainee transfusion practice. Transfusion 2023; 63:839-848. [PMID: 36811164 DOI: 10.1111/trf.17278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The optimal method of postgraduate transfusion medicine (TM) education remains understudied. One novel approach is Transfusion Camp, a longitudinal 5-day program that delivers TM education to Canadian and international trainees. The purpose of this study was to determine the self-reported impact of Transfusion Camp on trainee clinical practice. STUDY DESIGN AND METHODS A retrospective analysis of anonymous survey evaluations from Transfusion Camp trainees over three academic years (2018-2021) was conducted. Trainees were asked, "Have you applied any of your learning from Transfusion Camp into your clinical practice?". Through an iterative process, responses were categorized into topics according to program learning objectives. The primary outcome was the rate of self-reported impact of Transfusion Camp on clinical practice. Secondary outcomes were to determine impact based on specialty and postgraduate year (PGY). RESULTS Survey response rate was 22%-32% over three academic years. Of 757 survey responses, 68% of respondents indicated that Transfusion Camp had an impact on their practice, increasing to 83% on day 5. The most frequent areas of impact included transfusion indications (45%) and transfusion risk management (27%). Impact increased as PGY increased with 75% of PGY-4+ trainees reporting impact. In multivariable analysis, the impact of specialty and PGY varied depending on the objective. DISCUSSION The majority of trainees report applying learnings from Transfusion Camp to their clinical practice with variations based on PGY and specialty. These findings support Transfusion Camp as an effective means of TM education and help identify high-yield areas and gaps for future curriculum planning.
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Affiliation(s)
- Katie C Y Yeung
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | | | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada.,Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada
| | - Christine Cserti-Gazdewich
- Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Blood Transfusion Laboratory (Laboratory Medicine Program) and Blood Disorders Clinic (Division of Medical Oncology and Hematology), University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Perez D'Empaire
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aditi Khandelwal
- Canadian Blood Services, Ottawa, Ontario, Canada.,Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.,Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christie Lee
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Jacob Pendergrast
- Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Blood Transfusion Laboratory (Laboratory Medicine Program) and Blood Disorders Clinic (Division of Medical Oncology and Hematology), University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Nadine Shehata
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Marianne Lavoie
- Department of Medicine, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Michael F Murphy
- NHS Blood & Transplant and the Oxford University Hospitals, Oxford, UK.,Department of Medicine, University of Oxford, Oxford, UK
| | - Oksana Prokopchuk-Gauk
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Mahboubeh Rahmani
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Pathology and Lab Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.,Beatrice Hunter Cancer Research Institute Halifax, Nova Scotia, Canada
| | - Jacqueline Trudeau
- Departments of Anesthesiology, Pharmacology and Therapeutics and Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle P Zeller
- Canadian Blood Services, Ottawa, Ontario, Canada.,McMaster McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Yulia Lin
- Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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11
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Ahmad M, Chin-Yee B, Sangle N, Rizkalla K, Chin-Yee I, Hsia CC. Pericardial Extramedullary Hematopoiesis Associated with Metastatic Adenocarcinoma of Gastrointestinal or Pancreaticobiliary Origin: A Case Report. Case Rep Oncol 2023; 16:96-101. [PMID: 36820213 PMCID: PMC9938399 DOI: 10.1159/000529123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/19/2022] [Indexed: 02/19/2023] Open
Abstract
Extramedullary hematopoiesis (EMH) is a rare complication of solid tumor malignancies. We describe the first case of a patient who developed EMH in the pericardium secondary to metastatic gastrointestinal or pancreaticobiliary cancer. A 58-year-old man presented with recurrent episodes of fatigue and shortness of breath and was treated with thoracocentesis and pericardiocentesis for pleural and pericardial effusions, respectively. Owing to a markedly elevated alkaline phosphatase, a bone scan was performed and demonstrated diffuse sclerotic lesions. Evaluation of pleural effusion diagnosed metastatic adenocarcinoma, and cytospin morphology of the pericardial fluid demonstrated EMH. While EMH secondary to solid tumors is commonly suggested to be due to cytokine signaling, we propose the mechanism of EMH in this patient was due to extensive disruption of bone marrow hematopoiesis, similar to what is seen in myeloproliferative neoplasms.
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Affiliation(s)
- Maud Ahmad
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kamilia Rizkalla
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ian Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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12
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Chin-Yee B, Suthakaran A, Hedley BD, Howlett C, Stuart A, Sadikovic B, Chin-Yee IH, Hsia CC. T-cell clonality testing for the diagnosis of T-cell large granular lymphocytic leukemia: Are we identifying pathology or incidental clones? Int J Lab Hematol 2022; 44:1115-1120. [PMID: 36380468 DOI: 10.1111/ijlh.13949] [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: 05/25/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION T-cell clonality testing by T-cell receptor (TCR) gene rearrangement is key to the diagnosis of T-cell lymphoproliferative disorders such as T-cell large granular lymphocytic (T-LGL) leukemia. Benign clonal T-cell expansions, however, are commonly found in patients without identifiable disease, a condition referred to as T-cell clones of uncertain significance (T-CUS). In practice, T-cell clonality testing is performed for a range of reasons and results are often challenging to interpret given the overlap between benign and malignant clonal T-cell proliferations and uncertainties in the management of T-CUS. METHODS We conducted a 5-year retrospective cohort study of 211 consecutive patients who underwent PCR-based T-cell clonality testing for suspected T-LGL leukemia at our institution to characterize the use of T-cell clonality testing and its impact on patient management. RESULTS Overall, 46.4% (n = 98) of individuals tested had a clonal T-cell population identified. Patients with a monoclonal T-cell population were more likely to be older, have rheumatoid arthritis and have higher lymphocyte counts compared to patients with polyclonal populations. The majority of patients eventually diagnosed and treated for T-LGL leukemia had rheumatoid arthritis and lower neutrophil counts compared to untreated patients with monoclonal T-cell populations. A diagnosis of T-LGL leukemia was made in only a minority of patients (n = 48, 22.7%), and only a small proportion were treated (n = 17, 8.1%). CONCLUSION Our study suggests that T-cell clonality testing most commonly identifies incidental T-cell clones with only a minority of patients receiving a diagnosis of T-LGL leukemia and fewer requiring active treatment. These finding indicate an opportunity to improve utilization of T-cell clonality testing in clinical practice to better target patients where the results of testing would impact clinical management.
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Affiliation(s)
- Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Abitha Suthakaran
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher Howlett
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alan Stuart
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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13
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Li N, Mahamad S, Parpia S, Iorio A, Foroutan F, Heddle NM, Hsia CC, Sholzberg M, Rimmer E, Shivakumar S, Sun HL, Refaei M, Hamm C, Arnold DM. Development and internal validation of a clinical prediction model for the diagnosis of immune thrombocytopenia. J Thromb Haemost 2022; 20:2988-2997. [PMID: 36121734 DOI: 10.1111/jth.15885] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/10/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is a diagnosis of exclusion that can resemble other thrombocytopenic disorders. OBJECTIVES To develop a clinical prediction model (CPM) for the diagnosis of ITP to aid hematogists in investigating patients presenting with undifferentiated thrombocytopenia. METHODS We designed a CPM for ITP diagnosis at the time of the initial hematology consultation using penalized logistic regression based on data from patients with thrombocytopenia enrolled in the McMaster ITP registry (n = 523) called the Predict-ITP Tool. The case definition for ITP was a platelet count less than 100 × 109 /L and a platelet count response after high-dose corticosteroids or intravenous immune globulin, defined as the achievement of a platelet count above 50 × 109 /L and at least a doubling of baseline. Internal validation was done using bootstrap resampling. Model discrimination was assessed by the c-statistic, and calibration was assessed by the calibration slope, calibration-in-the-large, and calibration plot. RESULTS The final model included the following variables: (1) platelet count variability (based on three or more platelet count values), (2) lowest platelet count value, (3) maximum mean platelet volume, and (4) history of major bleeding (defined by the ITP bleeding scale). The optimism-corrected c-statistic was 0.83, the calibration slope was 0.88, and calibration-in-the-large for all performance measures was <0.001 with standard error <0.001, indicating good discrimination and excellent calibration. CONCLUSIONS The Predict-ITP Tool can estimate the likelihood of ITP for a given patient with thrombocytopenia at the time of the initial hematology consultation. The tool had high predictive accuracy for the diagnosis of ITP.
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Affiliation(s)
- Na Li
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Syed Mahamad
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Hamilton, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Michelle Sholzberg
- Departments of Medicine and Laboratory Medicine and Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Emily Rimmer
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Sudeep Shivakumar
- Department of Medicine, Division of Hematology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Haowei Linda Sun
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammad Refaei
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Caroline Hamm
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
- Division of Oncology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University - Windsor Campus, Windsor, Ontario, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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14
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Beca BM, Radford MJ, Hedley BD, Chin-Yee IH, Lazo-Langner A, Hsia CC. Thrombolysis in the recovery of coagulated bone marrow aspirate samples. Int J Lab Hematol 2022; 44:e233-e235. [PMID: 35633199 DOI: 10.1111/ijlh.13901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Bogdan Mihai Beca
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael James Radford
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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15
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Szeto VG, Chin-Yee B, Dehghani M, Rizkalla K, Licskai C, Hsia CC. Successful treatment of Kimura disease with benralizumab. Ann Hematol 2022; 101:2099-2100. [PMID: 35622096 DOI: 10.1007/s00277-022-04873-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Vivian G Szeto
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Benjamin Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre and Western University, Room E6-219A, 800 Commissioners Road East London, London, ON, N6A 5W9, Canada
| | - Mina Dehghani
- Department of Medicine, Division of Hematology, London Health Sciences Centre and Western University, Room E6-219A, 800 Commissioners Road East London, London, ON, N6A 5W9, Canada
| | - Kamilia Rizkalla
- Department of Pathology, Victoria Hospital, London Health Sciences Centre and Western University, London, ON, Canada
| | - Christopher Licskai
- Department of Medicine, Division of Respirology, London Health Sciences Centre and Western University, London, ON, Canada
| | - Cyrus C Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre and Western University, Room E6-219A, 800 Commissioners Road East London, London, ON, N6A 5W9, Canada.
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16
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Bhai P, Hsia CC, Schenkel LC, Hedley BD, Levy MA, Kerkhof J, Santos S, Stuart A, Lin H, Broadbent R, Nan S, Yang P, Xenocostas A, Chin-Yee I, Sadikovic B. Clinical Utility of Implementing a Frontline NGS-Based DNA and RNA Fusion Panel Test for Patients with Suspected Myeloid Malignancies. Mol Diagn Ther 2022; 26:333-343. [PMID: 35381971 DOI: 10.1007/s40291-022-00581-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of molecular genetic biomarkers is rapidly advancing to aid diagnosis, prognosis, and clinical management of hematological disorders. We have implemented a next-generation sequencing (NGS) assay for detection of genetic variants and fusions as a frontline test for patients suspected with myeloid malignancy. In this study, we summarize the findings and assess the clinical impact in the first 1613 patients tested. METHODS All patients were assessed using NGS based Oncomine Myeloid Research Assay (ThermoFisher) including 40 genes (17 full genes and 23 genes with clinically relevant "hotspot" regions), along with a panel of 29 fusion driver genes (including over fusion 600 partners). RESULTS Among 1613 patients with suspected myeloid malignancy, 43% patients harbored at least one clinically relevant variant: 91% (90/100) in acute myeloid leukemia patients, 71.7% (160/223) in myelodysplastic syndrome (MDS), 77.5% (308/397) in myeloproliferative neoplasm (MPN), 83% (34/41) in MPN/MDS, and 100% (40/40) in chronic myeloid leukemia patients. Comparison of NGS and cytogenetics results revealed a high degree of concordance in gene fusion detection. CONCLUSIONS Our findings demonstrate clinical utility and feasibility of integrating a NGS-based gene mutation and fusion testing assay as a frontline diagnostic test in a large reported cohort of patients with suspected myeloid malignancy, in a clinical laboratory setting. Overlap with cytogenetic test results provides opportunity for testing reduction and streamlining.
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Affiliation(s)
- Pratibha Bhai
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Laila C Schenkel
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Michael A Levy
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Jennifer Kerkhof
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Stephanie Santos
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Alan Stuart
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Hanxin Lin
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Robert Broadbent
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Shirley Nan
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ping Yang
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Anargyros Xenocostas
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, Room E6-211, London, ON, N6A 5W9, Canada.
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada.
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17
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Chin‐Yee B, Cheong I, Matyashin M, Lazo‐Langner A, Chin‐Yee I, Bhayana V, Bhai P, Lin H, Sadikovic B, Hsia CC. Serum erythropoietin levels in 696 patients investigated for erythrocytosis with JAK2 mutation analysis. Am J Hematol 2022; 97:E150-E153. [PMID: 35045195 DOI: 10.1002/ajh.26471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Benjamin Chin‐Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
| | - Ian Cheong
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Maxim Matyashin
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
| | - Alejandro Lazo‐Langner
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
| | - Ian Chin‐Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division London Health Sciences Centre London Ontario Canada
- Verspeeten Clinical Genome Centre London Health Sciences Centre London Ontario Canada
| | - Hanxin Lin
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Molecular Diagnostic Division London Health Sciences Centre London Ontario Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Molecular Diagnostic Division London Health Sciences Centre London Ontario Canada
- Verspeeten Clinical Genome Centre London Health Sciences Centre London Ontario Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
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18
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Kawata E, Hedley BD, Chin-Yee B, Xenocostas A, Lazo-Langner A, Hsia CC, Howson-Jan K, Yang P, Levy MA, Santos S, Bhai P, Howlett C, Lin H, Kadour M, Sadikovic B, Chin-Yee I. Reducing cytogenetic testing in the era of next generation sequencing: Are we choosing wisely? Int J Lab Hematol 2021; 44:333-341. [PMID: 34713980 DOI: 10.1111/ijlh.13747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION In most laboratories, next generation sequencing (NGS) has been added without consideration for redundancy compared to conventional cytogenetics (CG). We tested a streamlined approach to genomic testing in patients with suspected myeloid and plasma cell neoplasms using next generation sequencing ("NGS first") as the primary testing modality and limiting cytogenetics (CG) to samples with morphologic abnormalities in the marrow aspirate. METHODS Based on morphologic interpretation of bone marrow aspirate and flow cytometry, samples were triaged into four groups: (a) Samples with dysplasia or excess blasts had both NGS and karyotyping; (b) Samples without excess blasts or dysplasia had NGS only; (c) Repeat samples with previous NGS and/or CG studies were not retested; (d) Samples for suspected myeloma with less than 5% plasma cell had CG testing cancelled. RESULTS Seven hundred eleven adult bone marrow (BM) samples met the study criteria. The NGS first algorithm eliminated CG testing in 229/303 (75.6%) of patients, primarily by reducing repeat testing. Potential cost avoided was approximately $124 000 per annum. Hematologists overruled the triage comment in only 11/303 (3.6%) cases requesting CG testing for a specific indication. CONCLUSIONS Utilizing NGS as the primary genomic testing modality NGS was feasible and well accepted, reducing over three quarters of all CG requests and improving the financial case for adoption of NGS. Key factors for the success of this study were collaboration of clinical and genomic diagnostic teams in developing the algorithm, rapid turnaround time for BM interpretation for triage, and communication between laboratories.
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Affiliation(s)
- Eri Kawata
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Hematology, Panasonic Health Insurance Organization Matsushita Memorial Hospital, Moriguchi, Japan.,Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anargyros Xenocostas
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada
| | - Kang Howson-Jan
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ping Yang
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Cytogenetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Michael A Levy
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Santos
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher Howlett
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Hanxin Lin
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Mike Kadour
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada
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19
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Madrazo L, Jones E, Hsia CC. Anémie grave induite par l’azathioprine et potentialisée par l’emploi concomitant d’allopurinol. CMAJ 2021; 193:E460-E463. [PMID: 33782177 PMCID: PMC8099162 DOI: 10.1503/cmaj.201022-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Lorenzo Madrazo
- Département de médecine (Madrazo, Jones) et division d'hématologie (Hsia), Département de médecine, Centre des sciences de la santé de London, Université Western Ontario, London, Ont.
| | - Emily Jones
- Département de médecine (Madrazo, Jones) et division d'hématologie (Hsia), Département de médecine, Centre des sciences de la santé de London, Université Western Ontario, London, Ont
| | - Cyrus C Hsia
- Département de médecine (Madrazo, Jones) et division d'hématologie (Hsia), Département de médecine, Centre des sciences de la santé de London, Université Western Ontario, London, Ont
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20
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Affiliation(s)
- Lorenzo Madrazo
- Department of Medicine (Madrazo, Jones) and Division of Hematology (Hsia), Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ont.
| | - Emily Jones
- Department of Medicine (Madrazo, Jones) and Division of Hematology (Hsia), Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - Cyrus C Hsia
- Department of Medicine (Madrazo, Jones) and Division of Hematology (Hsia), Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ont
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21
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Kawata E, Lazo-Langner A, Xenocostas A, Hsia CC, Howson-Jan K, Deotare U, Saini L, Yang P, Broadbent R, Levy M, Howlett C, Stuart A, Kerkhof J, Santos S, Lin H, Sadikovic B, Chin-Yee I. Clinical value of next-generation sequencing compared to cytogenetics in patients with suspected myelodysplastic syndrome. Br J Haematol 2020; 192:729-736. [PMID: 32588428 DOI: 10.1111/bjh.16891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
Next-generation sequencing (NGS) increasingly influences diagnosis, prognosis and management of myelodysplastic syndrome (MDS). In addition to marrow morphology and flow cytometry, our institution performs cytogenetics (CG) and NGS-based testing routinely in patients with suspected MDS. We evaluated the relative value of NGS in the assessment of patients with suspected MDS. We initially compared the diagnostic and prognostic information derived from CG and NGS in 134 patients. NGS enhanced the diagnostic yield compared to CG for clonal myeloid disorders (sensitivity 77% vs. 42·2%; specificity 90·2% vs. 78%; positive predictive value 92·8% vs. 76%; and negative predictive value 70·8% vs. 45·5%). The identification of poor prognosis mutations by NGS altered risk category in 27/39 (69·2%) patients with MDS with good/intermediate risk CG. Subsequently, we prospectively evaluated 70 patients with suspected MDS using an 'NGS-first approach' with CG restricted to samples with morphological abnormalities. We rarely identified mutations or CG abnormalities in patients without dysplastic features. NGS has a superior diagnostic performance compared to CG in patients with suspected MDS. We estimate that by using an 'NGS-first approach' we could reduce karyotyping by approximately 30%.
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Affiliation(s)
- Eri Kawata
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Hematology, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan.,Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulish School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anargyros Xenocostas
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulish School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulish School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kang Howson-Jan
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulish School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Uday Deotare
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulish School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lalit Saini
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulish School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ping Yang
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Cytogenetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Robert Broadbent
- Cytogenetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Levy
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Molecular Genetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher Howlett
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Molecular Genetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Alan Stuart
- Molecular Genetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Kerkhof
- Molecular Genetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Santos
- Molecular Genetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Hanxin Lin
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Molecular Genetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Molecular Genetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulish School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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22
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Lin Y, Tilokee E, Chargé S, Alam A, Cserti-Gazdewich C, Lau W, Lee C, Lieberman L, Nixon P, Owens W, Pavenski K, Pendergrast J, Saidenberg E, Shehata N, Skeate R, Yi QL, Conrad D, Dudebout J, Hsia CC, Murphy M, Prokopchuk-Gauk O, Shah A, Solh Z, Trudeau J, Zeller MP, Callum J. Transfusion Camp: a prospective evaluation of a transfusion education program for multispecialty postgraduate trainees. Transfusion 2019; 59:2141-2149. [PMID: 30946497 DOI: 10.1111/trf.15284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/25/2019] [Accepted: 02/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The optimal method of providing transfusion medicine (TM) education has not been determined. Transfusion Camp was established in 2012 at the University of Toronto as a centrally delivered TM education program for postgraduate trainees. The impact of Transfusion Camp on knowledge, attitudes, and self-reported behavior was evaluated. METHODS Didactic lectures (delivered locally, by webinar, or recorded) and locally facilitated team-based learning seminars were delivered over 5 days during the academic year to 8 sites: 7 in Canada and 1 in the United Kingdom. Knowledge assessment using a validated 20-question multiple-choice exam was conducted before and after Transfusion Camp. Attitudes and self-reported behavior were collected through a survey. RESULTS Over 2 academic years (July 2016 to June 2018), 390 trainees from 16 different specialties (predominantly anesthesia, 41%; hematology, 14%; and critical care, 7%) attended at least 1 day of Transfusion Camp. The mean pretest score was 10.3 of 20 (±2.9; n = 286) compared with posttest score of 13.0 (±2.8; n = 194; p < 0.0001). Lower pretest score and greater attendance (4-5 days compared with 1-3 days) were associated with larger improvement in posttest score; delivery format, specialty, and postgraduate year were not. Trainees reported an improvement in self-rated abilities to manage TM scenarios; 95% rated TM knowledge as very or extremely important in providing patient care; and 81% indicated that they had applied learning from Transfusion Camp into clinical practice. CONCLUSIONS Transfusion Camp increased TM knowledge, fostered a positive attitude toward TM, and enabled a self-reported positive impact on transfusion practice in postgraduate trainees. It is a novel and scalable approach to delivering TM education.
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Affiliation(s)
- Yulia Lin
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada
| | - Everad Tilokee
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Sophie Chargé
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Asim Alam
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Department of Anesthesia, North York General Hospital, Toronto, Canada
| | - Christine Cserti-Gazdewich
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - Wendy Lau
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Christie Lee
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - Paula Nixon
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada
| | - Wendy Owens
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Ontario Regional Blood Coordinating Network, Ontario, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,St. Michael's Hospital, Toronto, Canada
| | - Jacob Pendergrast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - Elianna Saidenberg
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Hematology and Transfusion Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Nadine Shehata
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Department of Medicine, Division of Hematology, Mount Sinai Hospital, Toronto, Canada
| | - Robert Skeate
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Qi-Long Yi
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - David Conrad
- Division of Hematopathology, Dalhousie University & Nova Scotia Health Authority Central Zone, Halifax, Canada
| | | | - Cyrus C Hsia
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - Oksana Prokopchuk-Gauk
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Akshay Shah
- Oxford University Hospitals, Oxford, United Kingdom
| | - Ziad Solh
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Jacqueline Trudeau
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Michelle P Zeller
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Canada.,Canadian Blood Services, Ancaster, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada
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23
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Jia S, Jae J, Hsia CC. Case report of granular acute lymphoblastic leukemia and review of the literature. Clin Case Rep 2019; 7:123-127. [PMID: 30656024 PMCID: PMC6333071 DOI: 10.1002/ccr3.1866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/15/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022] Open
Abstract
Granular acute lymphoblastic leukemia (ALL) is a rare variant of the disease that is associated with a lower remission rate to standard induction chemotherapy. Flow immunophenotyping, cytogenetics, and molecular diagnostics should be utilized to confirm the diagnosis of ALL versus acute myeloid leukemia (AML) in order to provide appropriate management.
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Affiliation(s)
- Sangyang Jia
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - James Jae
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Cyrus C. Hsia
- Department of Medicine, Division of HematologyLondon Health Sciences CentreLondonOntarioCanada
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24
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Russell SA, Sholzberg M, Mangel J, Keeney M, Hedley B, Bode M, Gob A, Lam S, Phua C, Hsia CC. Gaucher disease screening at a general adult hematology tertiary care centre: A prospective study. Int J Lab Hematol 2018; 41:e66-e69. [DOI: 10.1111/ijlh.12960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Steven A. Russell
- Department of Internal Medicine Western University London Ontario Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto London Ontario Canada
| | - Joy Mangel
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Michael Keeney
- MLT London Laboratory Services Group London Ontario Canada
| | - Ben Hedley
- MLT London Laboratory Services Group London Ontario Canada
| | - Margo Bode
- MLT London Laboratory Services Group London Ontario Canada
| | - Alan Gob
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Selay Lam
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Chai Phua
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine Western University London Ontario Canada
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25
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Abstract
Progressive multifocal leukoencephalopathy (pml) is a rare demyelinating disease of the central nervous system that most often affects immunocompromised individuals. It is caused by the reactivation of the John Cunningham virus (jcv), which is found in latent form in the majority of adults. We describe a 59-year-old man with multiple myeloma who developed severe neurological deficits during treatment with ixazomib-based chemotherapy. A diagnosis of pml was established with gadolinium-enhanced magnetic resonance imaging (mri) and by detection of jcv in the cerebrospinal fluid. Despite cessation of chemotherapy and treatment with mirtazapine, he had an inexorable neurological decline and died two months after presenting to hospital. Multiple myeloma and its treatments can predispose patients to opportunistic infections including pml. Although there have been case reports of pml in patients with multiple myeloma treated with bortezomib (a different proteosome inhibitor), this is, to our knowledge, the first documented case of pml in a patient treated with a regimen that includes ixazomib.
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Affiliation(s)
- C P Sawicki
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of Toronto, Toronto, ON, Canada
| | - S A Climans
- Division of Hematology, Department of Medicine, Western University, London, ON, Canada; and
| | - C C Hsia
- Department of Ophthalmology, Western University, London, ON, Canada
| | - J A Fraser
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.,Department of Ophthalmology, Western University, London, ON, Canada
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26
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Chen YL, Wu YT, Hsia CC, Chang ST, Chiang SL. Nontraumatic Acute Anterior Cord Syndrome Caused by Cervical Disc Herniation after Napping with Neck Extension. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nontraumatic acute anterior cord syndrome caused by disc herniation occurring in the cervical spine is rare. A 39-year-old man presented with a sharp burning pain in bilateral upper limbs and progressive paraplegia after a nap with neck extension. He had impaired sensation of pain and temperature with preservation of proprioception and light touch below the C6 level. The magnetic resonance imaging showed focal hyperintensity of the anterior cord at the C5-C7 level and central herniation of C5-6 and C6-7 discs. An anterior discectomy of C5-6 and C6-7 was conducted because of the poor response to a high dose of steroid. A postoperative intensive rehabilitation treatment was also performed. The patient showed significant improvement in motor and sensory function three months postoperatively. Long-term repetitive neck extension should be avoided because it may be a risk for degenerative spondylotic change and cord compression disorders. Surgical intervention should be considered in a patient with anterior cord syndrome associated with nontraumatic cervical disc herniation. (Hong Kong j.emerg.med. 2013;20:389-391)
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Affiliation(s)
| | | | - CC Hsia
- Tri-Service General Hospital, Department of Neurosurgery, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan
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27
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Jian C, Hsia CC. A Unique Hairy Cell Leukemia Variant. Case Rep Oncol 2016; 9:312-6. [PMID: 27462230 PMCID: PMC4939668 DOI: 10.1159/000446696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
A 65-year-old woman presented with easy bruising, left upper quadrant pain, decreased appetite, and weight loss. She had splenomegaly and lymphocytosis (lymphocyte count of 11.6 × 10(9)/l), with remarkably abnormal appearing morphology. Her hemoglobin and platelet counts were normal. Peripheral blood flow cytometry revealed a monoclonal B-cell population expressing CD11c, CD25, CD19, CD20, and CD103. An initial diagnosis of hairy cell leukemia (HCL) was made, and the patient was treated with a standard 5-day course of cladribine. However, her lymphocytosis improved transiently, with a relapse 4 months later. There was no improvement in her splenomegaly. An HCL variant (HCL-v) was considered based on her resistance to treatment with a purine nucleoside analog. A subsequent splenectomy improved symptoms. Two years after, the patient suffered a relapse and underwent 6 cycles of CHOP-R (cyclophosphamide, hydroxydaunomycin, oncovin, prednisone, and rituximab), achieving partial remission. While under observation, she progressed with lymphocytosis 6 months later and was treated with pentostatin. There was no significant improvement in her disease, and she died 8 weeks following treatment initiation. HCL-v is a clinically more aggressive mature B-cell lymphoma than HCL with worse splenomegaly, higher lymphocyte counts, and resistance to typical HCL therapy with purine nucleoside analogs. Early recognition of HCL-v in the history, physical examination, and investigations with morphology and flow cytometry is key to patient management. Further, as in our case of HCL-v, cell morphology can be distinctly atypical, with large nucleoli and extremely convoluted nuclei. The distinction between HCL and HCL-v is important as HCL-v patients require more aggressive therapy and closer follow-up.
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Affiliation(s)
- Charles Jian
- Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ont., Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ont., Canada
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28
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Heddle NM, Arnold DM, Acker JP, Liu Y, Barty RL, Eikelboom JW, Webert KE, Hsia CC, O'Brien SF, Cook RJ. Red blood cell processing methods and in-hospital mortality: a transfusion registry cohort study. The Lancet Haematology 2016; 3:e246-54. [DOI: 10.1016/s2352-3026(16)00020-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 11/27/2022]
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Louzada ML, Hsia CC, Al-Ani F, Ralley F, Xenocostas A, Martin J, Connelly SE, Chin-Yee IH, Minuk L, Lazo-Langner A. Randomized double-blind safety comparison of intravenous iron dextran versus iron sucrose in an adult non-hemodialysis outpatient population: A feasibility study. BMC Hematol 2016; 16:7. [PMID: 26973791 PMCID: PMC4788943 DOI: 10.1186/s12878-016-0046-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/08/2016] [Indexed: 11/15/2022]
Abstract
Background Intravenous iron therapy is a treatment option for iron deficient patients who are intolerant to oral iron or where oral iron is ineffective, but with possible adverse effects. Currently, prospective studies comparing different intravenous iron formulations are needed to determine safety and efficacy of these agents. Methods We conducted a prospective, double-blind, randomized controlled trial (RCT) to assess the feasibility of a trial comparing the safety of high molecular weight intravenous iron dextran, Infufer®, with intravenous iron sucrose, Venofer®, in non-hemodialysis adult outpatients. Primary outcome was the occurrence of immediate severe drug reactions. Results We enrolled 143 patients in a one-year period. Overall, 45/143 (31.5 %) patients (20 iron dextran, 25 iron sucrose) developed 48 infusion reactions (14 immediate, 28 delayed, and 3 both). The risk of an immediate reaction was similar in both groups, 9/73 (12.3 %) iron dextran versus 8/70 (11.4 %) iron sucrose, RR = 0.93 (95 % CI; 0.38 to 2.27). The risk of a delayed reaction was significantly higher in the iron sucrose group 22/70 (31.4 %) versus the iron dextran group 9/73 (12.3 %), RR = 2.55 (95 % CI; 1.26 to 5.15; p = 0.0078). Conclusion In this limited feasibility study, no major differences in immediate reactions were seen, but a significantly higher number of delayed reactions were seen in the iron sucrose group. Further, under our assumptions and design a full RCT to evaluate the safety of different intravenous iron preparations is not feasible. Future studies should consider modifying the clinical outcomes, utilize multiple centers, and consider other emerging parenteral iron formulations. (ClinicalTrials.gov NCT005936197 January 3, 2008).
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Affiliation(s)
- Martha L Louzada
- Department of Medicine, Division of Hematology, London, ON Canada ; University of Western Ontario, London, ON Canada
| | - Cyrus C Hsia
- Department of Medicine, Division of Hematology, London, ON Canada ; University of Western Ontario, London, ON Canada ; London Health Sciences Centre, Department of Medicine, Division of Hematology. Rm E6-219A, Victoria Hospital, 800 Commissioners Road E., London, ON N6A 5W9 Canada
| | | | - Fiona Ralley
- University of Western Ontario, London, ON Canada ; Department of Anesthesia and Perioperative Medicine, London, ON Canada
| | - Anargyros Xenocostas
- Department of Medicine, Division of Hematology, London, ON Canada ; University of Western Ontario, London, ON Canada
| | - Janet Martin
- University of Western Ontario, London, ON Canada ; Department of Pharmacy, London Health Sciences Centre, London, ON Canada
| | - Sarah E Connelly
- University of Western Ontario, London, ON Canada ; Department of Pharmacy, London Health Sciences Centre, London, ON Canada
| | - Ian H Chin-Yee
- Department of Medicine, Division of Hematology, London, ON Canada ; University of Western Ontario, London, ON Canada
| | - Leonard Minuk
- Department of Medicine, Division of Hematology, London, ON Canada ; University of Western Ontario, London, ON Canada
| | - Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, London, ON Canada ; University of Western Ontario, London, ON Canada ; Department of Epidemiology & Biostatistics, London, ON Canada
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Hsia CC, Mahon JL, Seitelbach M, Chia J, Zou G, Chin-Yee IH. Use of n-of-1 (single patient) trials to assess the effect of age of transfused blood on health-related quality of life in transfusion-dependent patients. Transfusion 2016; 56:1192-200. [PMID: 26840915 DOI: 10.1111/trf.13484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/21/2015] [Accepted: 11/17/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The impact of age of red blood cells on health-related quality of life (HRQL) in patients who require chronic transfusions is not known. We assessed this using n-of-1 trials in patient populations where large randomized trials have not been done to date. STUDY DESIGN AND METHODS Chronically transfusion-dependent adult patients were randomly assigned over time to four fresh (<7 days of storage) and four standard-issue (up to 42 days of storage) blood transfusions in prospective double-blinded multicrossover studies (n-of-1 trials). HRQL questionnaires were completed before and at 24 hours after each transfusion. Hemoglobin (Hb) levels were measured before each subsequent transfusion. RESULTS Twenty transfusion-dependent patients were enrolled, of whom nine (five myelodysplastic syndromes, two myelofibrosis, one β-thalassemia major, one Diamond-Blackfan anemia) completed at least six transfusions. Mean ages of fresh and standard-issue blood transfused were 4.0 and 23.2 days, respectively. There were no significant differences in the effect of standard and fresh blood on follow-up Hb levels or the eight HRQL dimensions assessed in all analyses. CONCLUSIONS In chronically transfused patients, there were no significant differences in HRQL or Hb levels between fresh versus standard blood. While larger trials are needed, these results support current practices in hospital blood transfusion laboratories using a first-in, first-out model of blood utilization for these transfusion-dependent patients. Use of n-of-1 trials to determine the benefits of transfusions in single patients appears to be feasible.
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Affiliation(s)
- Cyrus C Hsia
- Department of Medicine, Division of Hematology, Western University, London Health Sciences Centre, London, Ontario.,Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
| | - Jeffrey L Mahon
- Department of Medicine, Western University, London Health Sciences Centre, London, Ontario.,Department of Epidemiology & Biostatistics, Western University, London Health Sciences Centre, London, Ontario
| | - Maayan Seitelbach
- Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
| | - Justin Chia
- Department of Medicine, Western University, London Health Sciences Centre, London, Ontario.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Western University, London Health Sciences Centre, London, Ontario
| | - Ian H Chin-Yee
- Department of Medicine, Division of Hematology, Western University, London Health Sciences Centre, London, Ontario.,Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
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Bharath V, Eckert K, Kang M, Chin-Yee IH, Hsia CC. Incidence and natural history of intravenous immunoglobulin-induced aseptic meningitis: a retrospective review at a single tertiary care center. Transfusion 2015; 55:2597-605. [PMID: 26095012 DOI: 10.1111/trf.13200] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/03/2015] [Accepted: 05/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aseptic meningitis is a rare but significant complication of intravenous immunoglobulin (IVIG) therapy. The majority of literature is limited to case reports, so the true incidence of this complication is uncertain. STUDY DESIGN AND METHODS A retrospective review of all cases of IVIG-associated adverse transfusion reactions was performed at London Health Sciences Centre (LHSC) from January 1, 2008, to December 31, 2013. All reported transfusion reactions were evaluated to identify cases of aseptic meningitis due to IVIG. All documented IVIG infusions and lumbar punctures performed during the study period were reviewed; patients with both interventions were identified and further chart review was performed to identify aseptic meningitis. RESULTS During our study period, 1324 unique patients received a total of 11,907 IVIG infusions (554,566 g) for various conditions. Eight cases of aseptic meningitis were identified, suggesting an overall incidence of 0.60% for all patients and 0.067% for all IVIG infusions. Patients presented with symptoms within 24 to 48 hours of the infusion and were treated with antibiotics initially. The reactions were self-limited, as symptoms self-resolved within 5 to 7 days. Treatment was supportive, with subsequent IVIG infusions likely requiring preinfusion medication or possibly a switch in product formulation. CONCLUSION This review of IVIG-induced aseptic meningitis over a 6-year period identifies a more robust estimate of incidence and risk of 0.60% and 0.067% for all patients and infusions, respectively. Given that this complication can mimic infectious meningitis and cause considerable morbidity, physicians need to be aware of this rare but important condition.
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Affiliation(s)
- Vighnesh Bharath
- Department of Medicine, London Health Sciences Centre, Victoria Hospital
| | - Kathleen Eckert
- Blood Transfusion Laboratory, London Health Sciences Centre, Victoria Hospital
| | - Matthew Kang
- Division of Hematology, Department of Medicine, London Health Sciences Centre, Victoria Hospital
| | - Ian H Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, Victoria Hospital.,Canadian Blood Services, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, Victoria Hospital
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Sanford D, Hsia CC. A case of transfusion independence in a patient with myelodysplastic syndrome using deferasirox, sustained for two years after stopping therapy. ACTA ACUST UNITED AC 2015; 22:e128-32. [PMID: 25908918 DOI: 10.3747/co.22.2100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patients with myelodysplastic syndrome (mds) experience clinical complications related to progressive marrow failure and have an increased risk of developing acute myeloid leukemia. Frequent red blood cell transfusion can lead to clinical iron overload and is associated with decreased survival in mds patients. Iron chelation therapy reduces markers of iron overload and prevents end-organ damage. Here, we present the case of a patient with low-risk mds with transfusional iron overload. He was treated for 2 years with an oral iron chelator, deferasirox, and after 12 months of treatment, he experienced a hemoglobin increase of more than 50 g/L, becoming transfusion-independent. He has remained transfusion-independent, with a normal hemoglobin level, for more than 2 years since stopping chelation therapy. Hematologic and erythroid responses have previously been reported in mds patients treated with iron chelation. The durability of our patient's response suggests that iron chelation might alter the natural history of mds in some patients.
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Affiliation(s)
- D Sanford
- Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, ON
| | - C C Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, ON
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Hedley BD, Llewellyn-Smith N, Lang S, Hsia CC, MacNamara N, Rosenfeld D, Keeney M. Combined accurate platelet enumeration and reticulated platelet determination by flow cytometry. Cytometry 2015; 88:330-7. [DOI: 10.1002/cyto.b.21245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/21/2015] [Accepted: 04/03/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Benjamin D. Hedley
- Pathology and Laboratory Medicine; London Health Sciences Centre and St. Joseph's Health Care London; London Ontario N6A 4G5 Canada
| | | | - Stephen Lang
- Liverpool Hospital; Elizabeth NSW 2170 Liverpool Australia
| | - Cyrus C. Hsia
- Department of Medicine; Division of Hematology; London Health Sciences Centre, Victoria Hospital; London Ontario N6A 5W9 Canada
| | - Neil MacNamara
- Liverpool Hospital; Elizabeth NSW 2170 Liverpool Australia
| | | | - Michael Keeney
- Pathology and Laboratory Medicine; London Health Sciences Centre and St. Joseph's Health Care London; London Ontario N6A 4G5 Canada
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Hsia CC, Liu Y, Eckert K, Monga N, Elia-Pacitti J, Heddle NM. Intravenous Immunoglobulin (IVIg) Utilization in Immune Thrombocytopenia (ITP): A Multi-Center, Retrospective Review. Drugs Real World Outcomes 2015; 2:35-42. [PMID: 27747610 PMCID: PMC4883208 DOI: 10.1007/s40801-015-0009-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Intravenous immunoglobulin (IVIg) is an immune thrombocytopenia (ITP) therapy, which is associated with toxicities, limited availability, increasing utilization, and high cost. This study aimed to assess short- and long-term IVIg utilization in patients with ITP at two tertiary care centers in Ontario, Canada, to determine the proportion of IVIg used in ITP compared with all usage, and to forecast IVIg demand in ITP. Methods Records from all adult ITP patients who received IVIg between January 1, 2003, and September 30, 2012, at Hamilton Health Sciences and London Health Sciences Centre were reviewed retrospectively. Results During the study period, 383 adult ITP patients (mean age 51.3 years) received a total of 2,098 IVIg infusions (London 547 infusions in 150 patients; Hamilton 1,551 infusions in 233 patients). ITP accounted for 5.6 and 9.1 % of all IVIg usage in London and Hamilton, respectively. The treatments included 264 (53.7 %) acute, 172 (35.0 %) short-term, and 56 (11.4 %) long-term treatments. The amounts of IVIg used for short- and long-term treatment of ITP are forecasted to be approximately 5,000 and 11,000 g per year, respectively, up to 2018. Together, these two centers represent 19.9 % of the provincial IVIg utilization. Assuming similar patient populations and practice patterns in Ontario, the overall provincial cost of IVIg use in ITP may be as high as $5 million annually. Conclusion Short- and long-term IVIg utilization for ITP will remain an expensive resource within the Ontario provincial health care system. Physicians and policy makers should reflect on the impact of treating ITP with IVIg and should consider alternatives, where appropriate, to improve patient quality of life and decrease economic costs. Electronic supplementary material The online version of this article (doi:10.1007/s40801-015-0009-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cyrus C Hsia
- London Health Sciences Centre, London, ON, Canada.
- Division of Hematology, Department of Medicine, London Health Sciences Centre, Room E6-219, Victoria Hospital, 800 Commissioners Road East, London, ON, N6A 4G5, Canada.
| | - Yang Liu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Nancy M Heddle
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Sanford D, Kyle R, Lazo-Langner A, Xenocostas A, Chin-Yee I, Howson-Jan K, Hsia CC. Response to "Need to minimize bias when surveying patient attitudes to stopping cml treatment". Curr Oncol 2014; 21:e803-4. [PMID: 25489271 DOI: 10.3747/co.21.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We thank Villemagne et al. for their comments, and we will address some of the issues that they raised.[...]
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Affiliation(s)
- David Sanford
- Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario
| | - Rachel Kyle
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario
| | - Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, London Health Sciences Centre, Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario
| | - Anargyros Xenocostas
- Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, Ontario
| | - Ian Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, Ontario
| | - Kang Howson-Jan
- Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, Ontario
| | - Cyrus C Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, Victoria Hospital, Room E6-219A, 800 Commissioners Road East, London, Ontario,
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Patriquin CJ, Chin-Yee IH, Kovacs MJ, Lazo-Langner A, Keeney M, Hsia CC. Study of Octaplex dosing accuracy: an in vitro analysis. Thromb Haemost 2011; 107:248-52. [PMID: 22186847 DOI: 10.1160/th11-09-0610] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 11/04/2011] [Indexed: 11/05/2022]
Abstract
Prothrombin complex concentrates (PCC) are recommended for urgent warfarin reversal. However, disagreement exists regarding the proper dosing strategy (i.e. fixed vs. weight-based). We measured the in vitro effect of PCC dosing on international normalised ratio (INR) and factor activity. Plasma from warfarin-anticoagulated patients with stable INRs was collected. PCC doses of 1,000, 2,000 and 3,000 IU were added to the samples, and INR and factor activity were analysed before and after PCC. Twenty-three of thirty subjects enrolled had complete data for analysis. INRs were below 1.5 in all samples post-1,000 IU, and decreased further with subsequent doses (p<0.001). Factors II, VII, and X increased with consecutive doses (p<0.01). Linear correlation was seen between INR and factors II, VII and X. Factor IX did not increase consistently nor show correlation with INR reversal. Weight-based dosing was then estimated; INRs were all <1.2 (0.9-1.2) and activity >0.50 IU for factors II, VII and X (0.96-1.52, 0.51-1.45 and 0.81-1.38, respectively). Factor IX did not uniformly correct above 0.50 IU (0.31-1.31). We confirm in vitro that 1,000 IU of Octaplex(®) is able to correct INR to <1.5 but factors were not uniformly >0.50 IU until 2,000 IU, and not >1.00 IU until 3,000 IU. This suggests that INR correction alone may not accurately reflect factor activity, and lends support for weight-based dosing.
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Abstract
Primary mediastinal choriocarcinoma is a rare extragonadal germ cell malignancy. We describe the first case of a patient who developed mediastinal choriocarcinoma after treatment for Hodgkin lymphoma (HL). A 25-year-old man with classic HL, nodular sclerosis subtype, underwent treatment with splenectomy followed by radiation therapy. Unfortunately, his disease relapsed with a paraspinal mass, and he was subsequently treated with MOPP (mechlorethamine, Oncovin, procarbazine, and prednisone) alternating with ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine). He achieved a complete remission after 6 cycles. Ten years after treatment, the patient presented with a persistent cough, haemoptysis, right supraclavicular lymphadenopathy, and weight loss. His chest X-ray showed opacification of the lower right hemithorax with a widened mediastinum. Given unresponsiveness to several antibiotics and lack of evidence for lung volume loss, there were concerns over lung infiltration with relapsed lymphoma. Transbronchial fine needle aspiration biopsy suggested recurrence of his HL. MOPP alternating with ABVD was again given. Due to disease progression, brachytherapy as well as a cocktail of dexamethasone, cytarabine, and cisplatin were also tried. However, on a subsequent excisional lymph node biopsy, it turned out that the tumour was in fact choriocarcinoma and not relapsed HL. Unfortunately, despite aggressive therapy, the patient's disease rapidly progressed, and he died within 2 weeks.
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Affiliation(s)
- Selay Lam
- Division of Haematology, Department of Medicine, London, Ont., Canada
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Hsia CC, Liou KJ, Aung APW, Foo V, Huang W, Biswas J. Analysis and comparison of sleeping posture classification methods using pressure sensitive bed system. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2009:6131-4. [PMID: 19965072 DOI: 10.1109/iembs.2009.5334694] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pressure ulcers are common problems for bedridden patients. Caregivers need to reposition the sleeping posture of a patient every two hours in order to reduce the risk of getting ulcers. This study presents the use of Kurtosis and skewness estimation, principal component analysis (PCA) and support vector machines (SVMs) for sleeping posture classification using cost-effective pressure sensitive mattress that can help caregivers to make correct sleeping posture changes for the prevention of pressure ulcers.
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Affiliation(s)
- C C Hsia
- ICT-Enabled Healthcare Program, Industrial Technology Research Institute, ITRI South, No. 31, Gongye 2nd Rd., Annan District, Tainan City 70955, Taiwan, R.O.C.
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Xiao W, Hong H, Kawakami Y, Kato Y, Wu D, Yasudo H, Kimura A, Kubagawa H, Bertoli LF, Davis RS, Chau LA, Madrenas J, Hsia CC, Xenocostas A, Kipps TJ, Hennighausen L, Iwama A, Nakauchi H, Kawakami T. Tumor suppression by phospholipase C-beta3 via SHP-1-mediated dephosphorylation of Stat5. Cancer Cell 2009; 16:161-71. [PMID: 19647226 PMCID: PMC2744338 DOI: 10.1016/j.ccr.2009.05.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [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: 12/24/2008] [Revised: 03/20/2009] [Accepted: 05/28/2009] [Indexed: 01/22/2023]
Abstract
Given its catalytic activity to generate diacylglycerol and inositol 1,4,5-trisphosphate, phospholipase C (PLC) is implicated in promoting cell growth. However, we found that PLC-beta3-deficient mice develop myeloproliferative disease, lymphoma, and other tumors. The mutant mice have increased numbers of hematopoietic stem cells with increased proliferative, survival, and myeloid-differentiative abilities. These properties are dependent on Stat5 and can be antagonized by the protein phosphatase SHP-1. Stat5-dependent cooperative transformation by active c-Myc and PLC-beta3 deficiency was suggested in mouse lymphomas in PLC-beta3(-/-) and in Emicro-myc;PLC-beta3(+/-) mice and human Burkitt's lymphoma cells. The same mechanism for malignant transformation seems to be operative in other human lymphoid and myeloid malignancies. Thus, PLC-beta3 is likely a tumor suppressor.
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Affiliation(s)
- Wenbin Xiao
- Division of Cell Biology, La Jolla Institute for Allergy and Immunology, La Jolla, CA, 92037, USA
| | - Hong Hong
- Division of Cell Biology, La Jolla Institute for Allergy and Immunology, La Jolla, CA, 92037, USA
| | - Yuko Kawakami
- Division of Cell Biology, La Jolla Institute for Allergy and Immunology, La Jolla, CA, 92037, USA
| | - Yuko Kato
- Department of Cellular and Molecular Medicine, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Dianqing Wu
- Program for Vascular Biology and Therapeutics and Department of Pharmacology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Hiroki Yasudo
- Division of Cell Biology, La Jolla Institute for Allergy and Immunology, La Jolla, CA, 92037, USA
| | - Akiko Kimura
- Laboratory of Genetics and Physiology, National Institutes of Health/NIDDK, Bethesda, MD 20892, USA
| | - Hiromi Kubagawa
- Department of Pathology, University of Alabama, Birmingham, AL, 35294, USA
| | - Luigi F. Bertoli
- Department of Medicine, University of Alabama, Birmingham, AL, 35294, USA
| | | | - Luan A. Chau
- Department of Microbiology and Immunology, University of Western Ontario, London, ON, N6A 5K8, Canada
| | - Joaquin Madrenas
- Department of Microbiology and Immunology, University of Western Ontario, London, ON, N6A 5K8, Canada
| | - Cyrus C. Hsia
- Department of Medicine, University of Western Ontario, London, ON, N6A4G5, Canada
| | - Anargyros Xenocostas
- Department of Medicine, University of Western Ontario, London, ON, N6A4G5, Canada
| | - Thomas J. Kipps
- Department of Internal Medicine, University of California at San Diego, La Jolla, CA, 92093, USA
| | - Lothar Hennighausen
- Laboratory of Genetics and Physiology, National Institutes of Health/NIDDK, Bethesda, MD 20892, USA
| | - Atsushi Iwama
- Department of Cellular and Molecular Medicine, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Hiromitsu Nakauchi
- Laboratory of Stem Cell Therapy, Center of Experimental Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Toshiaki Kawakami
- Division of Cell Biology, La Jolla Institute for Allergy and Immunology, La Jolla, CA, 92037, USA
- Correspondence: Toshiaki Kawakami, M.D., Ph.D., Division of Cell Biology, La Jolla Institute for Allergy and Immunology, 9420 Athena Circle, La Jolla, California 92037, USA Tel: (858) 752-6814; Fax: (858) 752-6986;
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Hsia CC, Zurawska JH, Tong MZY, Eckert K, McAlister VC, Chin-Yee IH. Recombinant activated factor VII in the treatment of non-haemophilia patients: physician under-reporting of thromboembolic adverse events. Transfus Med 2009; 19:43-9. [PMID: 19302454 DOI: 10.1111/j.1365-3148.2009.00913.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to determine if clinically important thromboembolic adverse events (TAEs) because of recombinant activated factor VII (rFVIIa) administration are being under-reported. rFVIIa is a potent haemostatic agent with a short half-life of 2.6 h that is increasingly used in 'off-label' situations. Retrospective review of 94 patients who received rFVIIa during 1 January 2003 to 30 June 2007 was carried out at a tertiary care centre. Sixty-nine patients, 32 females and 37 males, mean age 55 years (18-84 years), satisfied study criteria of off-label usage. This was a high-risk population with 33 (48%) deaths. A mean dose of 8.2 mg (2.4-19.2 mg) was administered in two average divided doses. Thirty-six potential TAEs were identified in 29 patients, and of these, 12 patients had TAEs deemed to be rFVIIa related and were identified on average 8.8 days after exposure to rFVIIa. Forty-eight (70%) physician questionnaires were completed; however, no TAEs were reported in these questionnaires or on chart review. Potential clinically significant TAEs are being under-reported by treating physicians. Until further evidence, we suggest the urgent need to develop consensus recommendations for utilization and required follow up to monitor the safety of rFVIIa and that at a minimum, all use of rFVIIa should be regulated through a gate-keeping mechanism that ensures adherence to these policies. Furthermore, prospective registries and trials are necessary to evaluate the efficacy and safety of rFVIIa in off-label settings.
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Affiliation(s)
- C C Hsia
- Division of Hematology, Department of MedicineUniversity of Western Ontario, London, Ontario, Canada
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Hsia CC, Howson-Jan K, Rizkalla KS. Hodgkin lymphoma with cutaneous involvement. Dermatol Online J 2009; 15:5. [PMID: 19624983] [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: 05/28/2023] Open
Abstract
We report a case of a 54-year-old previously healthy man with Hodgkin lymphoma who presented initially with a solitary cutaneous ulcer. Unlike non-Hodgkin lymphoma subtypes, skin involvement of Hodgkin lymphoma is extremely rare. Furthermore, the prognosis of Hodgkin lymphoma with skin infiltration is felt to be extremely poor. Contrary to other reports, this case demonstrates that a good response with standard therapy is possible.
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Affiliation(s)
- Cyrus C Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, Ontario, Canada.
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Hsia CC, Keeney M, Bosco AA, Xenocostas A. Treatment of acquired factor X inhibitor by plasma exchange with concomitant intravenous immunoglobulin and corticosteroids. Am J Hematol 2008; 83:318-20. [PMID: 17975806 DOI: 10.1002/ajh.21105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A patient with spontaneous hemorrhage from multiple body sites was found to have markedly prolonged international normalized ratio (INR) and activated partial thromboplastin times (aPTT) with incomplete correction of aPTT on mixing studies using normal plasma. The cause of this severe hemorrhage was due to a specific factor X inhibitor. No underlying or associated diseases were found. Initial treatment with fresh frozen plasma, vitamin K, and recombinant activated factor VII (rFVIIa) was unsuccessful. However, therapy utilizing plasma exchange with concomitant intravenous immunoglobulin and corticosteroids resulted in a rapid and sustained normalization of factor X levels with a clinical hemostatic response.
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Affiliation(s)
- Cyrus C Hsia
- Division of Hematology, Department of Medicine, University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada
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Lin JW, Tsai JT, Lin CM, Lee LM, Hung KS, Huang SJ, Hsiao SH, Chung WY, Tsai MD, Hsia CC, Hung CC, Chiu WT. Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury. Acta Neurochir Suppl 2008; 101:131-136. [PMID: 18642647 DOI: 10.1007/978-3-211-78205-7_22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability. In the 2000 guidelines, one of the suggestions for TBI treatment was to maintain cerebral perfusion pressure (CPP) < or = 70 mmHg. But in the 2003 guidelines, the suggestion was changed to < or = 60 mmHg. There have been some discrepancies of opinions about this recommendation in recent publications. In this study, we retrospectively reviewed 305 severe TBI (STBI) patients with Glasgow Coma Scales (GCS) < or = 8 between January 1, 2002 and March 31, 2003. The study group was stratified according to use or nonuse of intracranial pressure (ICP) monitoring, ICP levels, ages, and GCS levels in order to test the correlation between CCP and the prognosis. The patients < 50-year-old, with higher GCS level, with ICP monitoring, and with ICP levels < 20 mmHg had lower mortality rates and better prognosis (GOS) (p < 0.05 or 0.001). The patients in the GCS 3-5 subgroup had a significantly lower mortality and better prognosis if the CPP value was maintained higher than 70 mmHg (p < 0.05) The optimal CPP maintained < or = 60 mmHg did not fit in all STBI patients. Our study concludes that it is critical to maintain CPP substantially higher in lower GCS level patients.
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Affiliation(s)
- J W Lin
- Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
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Momosaki S, Hsia CC, Nakashima Y, Kojiro M, Tabor E. Integration of hepatitis B virus containing mutations in the core promoter/X gene in patients with hepatocellular carcinoma. Dig Liver Dis 2003; 35:795-800. [PMID: 14674670 DOI: 10.1016/s1590-8658(03)00462-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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] [Indexed: 12/11/2022]
Abstract
UNLABELLED Integration of hepatitis B virus is thought to be an essential step in hepatitis B virus associated hepatocarcinogenesis. Mutations at nucleotides 1762 and 1764 in the hepatitis B virus, within a sequence encoding both the core promoter gene and the X gene, have been found frequently in patients with hepatocellular carcinoma. However, integration of these mutant sequences has not been reported to date. METHODS A 228-base pair segment of the hepatitis B virus core promoter gene was amplified from hepatocellular carcinomas and adjacent non-tumourous liver tissue by nested PCR and sequenced. Integration of hepatitis B virus into human genomic DNA was investigated using the 'genome walking' method. RESULTS Point mutations were found in both hepatitis B virus nucleotides 1762 and 1764 in 8 of 14 hepatocellular carcinoma tissues (57%) and in 11 of 14 adjacent non-tumourous liver tissues (79%). Three patients were evaluated using the 'genome walking' method; all were found to have hepatitis B virus DNA integrated in their hepatocellular carcinoma (two patients) and/or in their non-tumourous liver tissue (three patients). Integration occurred in all tissues near host genomic sites that are prone to integration. Hepatitis B virus was integrated at or near the hepatitis B virus DR1 site in all samples, and all contained truncated X gene sequences that have been reported to be capable of producing fusion transcripts with transactivation potential. CONCLUSIONS Integrated hepatitis B virus DNA containing core promoter mutations at nucleotides 1762 and 1764 was found in hepatocellular carcinoma and/or adjacent non-tumourous liver tissue of three patients. These findings leave open the possibility that insertional mutagenesis or transactivation by fusion transcripts resulting from hepatitis B virus integration could play a role in hepatocarcinogenesis in some patients.
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Affiliation(s)
- S Momosaki
- Division of Emerging and Transfusion Transmitted Diseases, Food and Drug Administration, Center for Biologics Evaluation and Research, 1401 Rockville Pike, HFM-300, Rockville, MD 20852-1448, USA
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Hsia CC, Scudamore CH, Di Bisceglie AM, Tabor E. Molecular and serological aspects of HBsAg-negative hepatitis B virus infections in North America. J Med Virol 2003; 70:20-6. [PMID: 12629639 DOI: 10.1002/jmv.10353] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A few hepatitis B virus (HBV) infections are characterized by the presence of HBV DNA in serum or liver tissue, or both, in the absence of detectable hepatitis B surface antigen (HBsAg) in serum. However, such infections have rarely been described previously in North American patients. In the present study, 31 hepatocellular carcinoma (HCC) patients from the United States and Canada who had no detectable HBsAg in their serum were studied. In these 31 HBsAg-negative HCC patients, HBV DNA was detected in HCC and/or in adjacent nontumorous liver tissue using nested polymerase chain reaction (PCR) in 5/9 (56%) patients from the United States and in 12/22 (55%) from Canada. The 17 HBV DNA-positive/HBsAg-negative patients from the United States and Canada included 9 without any serological markers for HBV and 8 with detectable antibodies to hepatitis B core antigen. In these patients, HBV genotype C was the most prevalent genotype (11/17; 64%). HBV genotypes have not been previously reported in HCC patients from North America. Replicative intermediate forms of HBV (covalently closed circular HBV DNA) were detected in 2/17 (12%) HBV DNA-positive/HBsAg-negative patients, indicating that at least two of these patients had actively replicating HBV infections. The use of tests to detect HBV DNA permitted the identification of HBV infections in HBsAg-negative HCC patients from North America. Among these patients, those with antibody to hepatitis C virus (HCV) would otherwise have been designated "HCV-associated HCCs" based on serological tests alone. These findings provide a new perspective on determining the possible viral etiologies of HCCs in North America.
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Affiliation(s)
- C C Hsia
- Division of Emerging and Transfusion Transmitted Diseases, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland, USA
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Abstract
STUDY OBJECTIVES To validate lung diffusing capacity for nitric oxide (DLNO) as an index of conductance of the alveolar-capillary membrane during exercise, we compared DLNO to lung diffusing capacity for carbon monoxide (DLCO) and pulmonary membrane diffusing capacity for carbon monoxide (DMCO), and compared pulmonary capillary blood volume (Vc) calculated by two methods. SETTING AND PARTICIPANTS The study was performed at a university medical center involving 12 nonsmoking healthy volunteers (age range, 23 to 79 years). DLCO, DLNO, cardiac output (c), and lung volume were measured simultaneously at rest and during graded ergometer exercise by a rebreathing technique. Pulmonary membrane diffusing capacity and Vc were compared by (1) the classic technique of Roughton and Forster from DLCO measured at two alveolar oxygen tension (PAO(2)) levels, and (2) from DLNO and DLCO assuming negligible erythrocyte resistance to nitric oxide (NO) uptake, ie, DLNO approximately equal to pulmonary membrane diffusing capacity for nitric oxide. RESULTS In all subjects, DLNO increased linearly from rest to exercise; age, c, and lung volume were the major determinants of DLNO by stepwise regression analysis. The DLNO/DLCO ratio averaged 3.98 +/- 0.38 (+/- SD) and the DLNO/DMCO ratio averaged 2.49 +/- 0.28 irrespective of exercise intensity. Changing PAO(2) did not alter DLNO. Brief exposure to 40 ppm of inhaled NO during 16 s of rebreathing did not alter either DLCO or c. Estimates of pulmonary membrane diffusing capacity and Vc by the two methods showed a strong correlation. CONCLUSION Results support DLNO as a direct measure of pulmonary membrane diffusing capacity, allowing the estimation of Vc in a single rebreathing maneuver during exercise. The DLNO-DLCO rebreathing technique can be applied clinically in the investigation of pulmonary microvascular regulation.
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Affiliation(s)
- R M Tamhane
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9034, USA
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Hsia CC, Wu EY, Wagner E, Weibel ER. Preventing mediastinal shift after pneumonectomy impairs regenerative alveolar tissue growth. Am J Physiol Lung Cell Mol Physiol 2001; 281:L1279-87. [PMID: 11597921 DOI: 10.1152/ajplung.2001.281.5.l1279] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [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] [Indexed: 11/22/2022] Open
Abstract
To examine the effects of mechanical lung strain on regenerative growth of alveolar septal tissue after pneumonectomy (PNX), we replaced the right lungs of adult dogs with a custom-shaped inflatable silicone prosthesis. The prosthesis was either inflated (Inf) to maintain the mediastinum at the midline or deflated to allow mediastinal shift. The animals were euthanized approximately 15 mo later, and the lungs were fixed at a constant distending pressure. With the Inf prostheses, lung expansion, alveolar septal tissue volumes, surface areas, and diffusing capacity of the tissue-plasma barrier were significantly lower than with the deflated prostheses; the expected post-PNX tissue responses were impaired by 30-60%. Capillary blood volume was significantly higher with Inf prostheses, consistent with microvascular congestion. Measurements in the Inf group remained consistently and significantly higher than those expected for a normal left lung, indicating persistence of partial compensation. In one dog, delayed deflation of the prosthesis 9-10 mo after PNX led to vigorous lung expansion and septal tissue growth, particularly of type II epithelial cells. We conclude that mechanical lung strain is a major signal for regenerative lung growth; however, other signals are also implicated, accounting for a significant fraction of the compensatory response to PNX.
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Affiliation(s)
- C C Hsia
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9034, USA.
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Affiliation(s)
- C C Hsia
- Dept of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9034, USA.
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Hsia CC, Takeda SI, Wu EY, Glenny RW, Johnson RL. Adaptation of respiratory muscle perfusion during exercise to chronically elevated ventilatory work. J Appl Physiol (1985) 2000; 89:1725-36. [PMID: 11053319 DOI: 10.1152/jappl.2000.89.5.1725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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] [Indexed: 11/22/2022] Open
Abstract
Pneumonectomy (PNX) leads to chronic asymmetric ventilatory loading of respiratory muscles (RM). We measured RM energy requirements during exercise from RM blood flow (Q) using a fluorescent microsphere technique in dogs that had undergone right PNX as adults (adult R-PNX) or as puppies (puppy R-PNX), compared with dogs subjected to right thoracotomy without PNX as puppies (Sham) and to left PNX as adults (adult L-PNX). Ventilatory work (W) was measured during exercise. RM weight was determined post mortem. After adult and puppy R-PNX, the right hemidiaphragm becomes grossly distorted, but W and right costal muscle mass increased only after adult R-PNX. After adult L-PNX, the diaphragm was undistorted; W and left hemidiaphragm RM Q were elevated, but muscle mass did not increase. Mass of parasternal muscle did not increase after adult R-PNX, despite increased Q. Thus muscle mass increased only in response to the combination of chronic stretch and dynamic loading. There was a dorsal-to-ventral gradient of increasing Q within the diaphragm, but the distribution was unaffected by anatomic distortion, hypertrophy, or workload, suggesting a fixed pattern of neural activation. The diaphragm and parasternals were the primary muscles compensating for the asymmetric loading from PNX.
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Affiliation(s)
- C C Hsia
- Department of Medicine, University of Texas Southwestern Medical School, Dallas, Texas 75390-9034, USA
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