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Creignou M, Bernard E, Gasparini A, Tranberg A, Todisco G, Moura PL, Ejerblad E, Nilsson L, Garelius H, Antunovic P, Lorenz F, Rasmussen B, Walldin G, Mortera-Blanco T, Jansson M, Tobiasson M, Elena C, Ferrari J, Gallì A, Pozzi S, Malcovati L, Edgren G, Crowther MJ, Jädersten M, Papaemmanuil E, Hellström-Lindberg E. Early transfusion patterns improve the Molecular International Prognostic Scoring System (IPSS-M) prediction in myelodysplastic syndromes. J Intern Med 2024. [PMID: 38654517 DOI: 10.1111/joim.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND The Molecular International Prognostic Scoring System (IPSS-M) is the new gold standard for diagnostic outcome prediction in patients with myelodysplastic syndromes (MDS). This study was designed to assess the additive prognostic impact of dynamic transfusion parameters during early follow-up. METHODS We retrieved complete transfusion data from 677 adult Swedish MDS patients included in the IPSS-M cohort. Time-dependent erythrocyte transfusion dependency (E-TD) was added to IPSS-M features and analyzed regarding overall survival and leukemic transformation (acute myeloid leukemia). A multistate Markov model was applied to assess the prognostic value of early changes in transfusion patterns. RESULTS Specific clinical and genetic features were predicted for diagnostic and time-dependent transfusion patterns. Importantly, transfusion state both at diagnosis and within the first year strongly predicts outcomes in both lower (LR) and higher-risk (HR) MDSs. In multivariable analysis, 8-month landmark E-TD predicted shorter survival independently of IPSS-M (p < 0.001). A predictive model based on IPSS-M and 8-month landmark E-TD performed significantly better than a model including only IPSS-M. Similar trends were observed in an independent validation cohort (n = 218). Early transfusion patterns impacted both future transfusion requirements and outcomes in a multistate Markov model. CONCLUSION The transfusion requirement is a robust and available clinical parameter incorporating the effects of first-line management. In MDS, it provides dynamic risk information independently of diagnostic IPSS-M and, in particular, clinical guidance to LR MDS patients eligible for potentially curative therapeutic intervention.
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Affiliation(s)
- Maria Creignou
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Phase 1 Unit, Center for Clinical Cancer Studies, Karolinska University Hospital, Stockholm, Sweden
| | - Elsa Bernard
- Computational Oncology Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- INSERM U981 & Precision Medicine Cancer Center, Gustave Roussy, Villejuif, France
| | | | - Anna Tranberg
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Gabriele Todisco
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pedro Luis Moura
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Ejerblad
- Unit of Hematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Hege Garelius
- Department of Medicine, Section of Hematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Petar Antunovic
- Department of Hematology, University Hospital in Linköping, Linköping, Sweden
| | - Fryderyk Lorenz
- Department of Hematology, University Hospital of Umeå, Umeå, Sweden
| | - Bengt Rasmussen
- Department of Hematology, Örebro University Hospital, Örebro, Sweden
| | - Gunilla Walldin
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Teresa Mortera-Blanco
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Monika Jansson
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Tobiasson
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Chiara Elena
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Jacqueline Ferrari
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Anna Gallì
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Sara Pozzi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Luca Malcovati
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Gustaf Edgren
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | | | - Martin Jädersten
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Elli Papaemmanuil
- Computational Oncology Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Eva Hellström-Lindberg
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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2
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Larfors G, Moreno Berggren D, Garelius H, Nilsson L, Rasmussen B, Hellström-Lindberg E, Ejerblad E. MDS-Comorbidity Index using register data has prognostic impact in Swedish MDS patients. Leuk Res 2023; 134:107386. [PMID: 37690322 DOI: 10.1016/j.leukres.2023.107386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
Comorbidities influence the mortality in patients with myelodysplastic syndromes, and a growing body of evidence suggest that comorbidity history should be used in addition to established prognostic indices. A comorbidity index specific for MDS, the MDS-CI, was introduced a decade ago. In this study we aim to construct an MDS-CI version based on diagnoses from register data only, to expand its use beyond the clinical setting to retrospective and register based studies. We further test this version on a Swedish population-based MDS cohort of 2947 patients, and compare its prognostic accuracy to that of Charlson Comorbidity Index. Our register based MDS-CI divided patients into three risk groups of similar proportions as have been published for the original MDS-CI. Compared to low risk patients, intermediate and high risk patients had 50 % and 70 % higher mortality, respectively. The prognostic value of MDS-CI was equal to that of Charlson comorbidity index. Adding MDS-CI to the established prognostic factors IPSS-R and age increased the prognostic accuracy. In summary, we demonstrate that MDS-CI can be adequately estimated from diagnoses recorded in registers only, and that it is a useful tool in any future study on myelodysplastic syndromes with a need to adjust for comorbidities.
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Affiliation(s)
- Gunnar Larfors
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Daniel Moreno Berggren
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hege Garelius
- Section of Haematology and Coagulation, Department of Specialist Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Nilsson
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Bengt Rasmussen
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Hellström-Lindberg
- Centre for Haematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Ejerblad
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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3
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Moreno Berggren D, Garelius H, Willner Hjelm P, Nilsson L, Rasmussen B, Weibull CE, Lambe M, Lehmann S, Hellström-Lindberg E, Jädersten M, Ejerblad E. Therapy-related MDS dissected based on primary disease and treatment-a nationwide perspective. Leukemia 2023; 37:1103-1112. [PMID: 36928008 PMCID: PMC10169633 DOI: 10.1038/s41375-023-01864-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
In this population-based study, we aimed to characterize and compare subgroups of therapy-related Myelodysplastic syndromes (t-MDS) and define the implications of type of previous treatment and primary disease. We combined data from MDS patients, diagnosed between 2009 and 2017 (n = 2705), in the nationwide Swedish MDS register, with several health registers. Furthermore, using matched population controls, we investigated the prevalence of antecedent malignancies in MDS patients in comparison with the general population. This first ever nationwide study on t-MDS confirms a shorter median survival for t-MDS compared to de novo MDS (15.8 months vs 31.1 months, p < 0.001). T-MDS patients previously treated with radiation only had disease characteristics with a striking resemblance to de novo-MDS, in sharp contrast to patients treated with chemotherapy who had a significantly higher risk profile. IPSS-R and the WHO classification differentiated t-MDS into different risk groups. As compared with controls, MDS patients had a six-fold increased prevalence of a previous hematological malignancy but only a 34% increased prevalence of a previous solid tumor. T-MDS patients with a previous hematological malignancy had a dismal prognosis, due both to mortality related to their primary disease and to high-risk MDS.
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Affiliation(s)
- Daniel Moreno Berggren
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden.
| | - Hege Garelius
- Section of Hematology and Coagulation, Department of Specialist Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Lars Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Bengt Rasmussen
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Caroline E Weibull
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm and Regional Cancer Center Central Sweden, Uppsala, Sweden
| | - Sören Lehmann
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden.,Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Hellström-Lindberg
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Jädersten
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Ejerblad
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
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Nilsson C, Linde F, Hulegårdh E, Garelius H, Lazarevic V, Antunovic P, Cammenga J, Deneberg S, Eriksson A, Jädersten M, Björkvall CK, Möllgård L, Wennström L, Ölander E, Höglund M, Juliusson G, Lehmann S. Characterization of therapy-related acute myeloid leukemia: increasing incidence and prognostic implications. Haematologica 2022; 108:1015-1025. [PMID: 36005563 PMCID: PMC10071134 DOI: 10.3324/haematol.2022.281233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Indexed: 11/09/2022] Open
Abstract
Studies of therapy-related AML (t-AML) are usually performed in selected cohorts and reliable incidence rates are lacking. In this study, we characterized, defined the incidence over time and studied prognostic implications in all t-AML patients diagnosed in Sweden between 1997 and 2015. Data were retrieved from nationwide population-based registries. In total, 6779 AML patients were included in the study, of which 686 (10%) had t-AML. The median age for t-AML was 71 years and 392 (57%) patients were females. During the study period, the incidence of t-AML almost doubled with a yearly increase in t-AML of 4.5% (CI 2.8% - 6.2%), which contributed significantly to the general increase in AML incidence over the study period. t-AML solidly constituted over 10% of all AML cases during the later study period. Primary diagnoses with the largest increase in incidence and decrease in mortality rate during the study period (i.e. breast and prostate cancer) contributed significantly to the increased incidence of t-AML. In multivariable analysis, t-AML was associated with poorer outcome in cytogenetically intermediate and adverse risk but t-AML had no significant impact on outcome in favorable risk AML, including core binding leukemias, APL and AML with mutated NPM1 without FLT3-ITD. We conclude that t-AML displays a strong increase in incidence over time and that t-AML constitutes a successively larger proportion of the AML patients. Furthermore, we conclude that t-AML confer a poor prognosis in cytogenetically intermediate and adverse risk, but not in favorable risk AML.
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Affiliation(s)
- Christer Nilsson
- Department of Medicine, Huddinge, Division of Hematology, Karolinska Institutet, Stockholm.
| | - Fredrika Linde
- Department of Medical Sciences, Uppsala University, Uppsala
| | - Erik Hulegårdh
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | - Hege Garelius
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | - Vladimir Lazarevic
- Department of Hematology, Skåne University Hospital, Lund, and Department of Hematology, Stem Cell Center, Department of Laboratory Medicine, Lund University, Lund
| | - Petar Antunovic
- Department of Hematology, Linköping University Hospital, Linköping
| | - Jörg Cammenga
- Department of Hematology, Linköping University Hospital, Linköping
| | - Stefan Deneberg
- Department of Medicine, Huddinge, Division of Hematology, Karolinska Institutet, Stockholm
| | - Anna Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala
| | - Martin Jädersten
- Department of Medicine, Huddinge, Division of Hematology, Karolinska Institutet, Stockholm
| | | | - Lars Möllgård
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | - Lovisa Wennström
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | - Emma Ölander
- Department of Hematology, Sundsvall Hospital, Sundsvall
| | - Martin Höglund
- Department of Medical Sciences, Uppsala University, Uppsala
| | - Gunnar Juliusson
- Department of Hematology, Skåne University Hospital, Lund, and Department of Hematology, Stem Cell Center, Department of Laboratory Medicine, Lund University, Lund
| | - Sören Lehmann
- Department of Medicine, Huddinge, Division of Hematology, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Uppsala University, Uppsala
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5
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Rasmussen B, Göhring G, Bernard E, Nilsson L, Tobiasson M, Jädersten M, Garelius H, Dybedal I, Grønbaek K, Ejerblad E, Lorenz F, Flogegård M, Marcher CW, Öster Fernström A, Cavelier L, Papaemmanuil E, Ebeling F, Kittang AO, Nørgaard JM, Saft L, Möllgård L, Hellström-Lindberg E. “Randomized phase II study of azacitidine ± lenalidomide in higher-risk myelodysplastic syndromes and acute myeloid leukemia with a karyotype including Del(5q)”. Leukemia 2022; 36:1436-1439. [PMID: 35277655 PMCID: PMC9061286 DOI: 10.1038/s41375-022-01537-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 01/05/2022] [Accepted: 02/21/2022] [Indexed: 12/24/2022]
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6
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Larfors G, Moreno Berggren D, Garelius H, Jädersten M, Nilsson L, Rasmussen B, Ejerblad E. Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes. Eur J Haematol 2021; 107:219-228. [PMID: 34028869 DOI: 10.1111/ejh.13641] [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: 02/25/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To assess whether socioeconomic indices such as income and educational level can explain part of the variation in survival among patients with myelodysplastic syndromes, and further to assess whether these factors influence care and treatment decisions. METHODS Population-based cohort study on 2945 Swedish patients diagnosed between 2009 and 2018 and included in the Swedish MDS Register. Relative mortality was assessed by Cox regression, whereas treatment differences were assessed by Poisson regression. Regarding mortality, patients were also compared to a matched comparison group from the general population. RESULTS Mortality was 50% higher among patients in the lowest income category compared to the highest and 40% higher in patients with mandatory school education only compared to those with college or university education. Treatment with hypomethylating agents and allogeneic stem cell transplantation, as well as investigation with cytogenetic diagnostics were also linked to income and education. The findings were not explained by differences in risk class or comorbidity at the time of diagnosis. CONCLUSIONS Income and education are linked to survival among patients with myelodysplastic syndromes. Socioeconomic status also seems to influence treatment intensity as patients with less income and education to a lesser degree receive hypomethylating agents and transplants.
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Affiliation(s)
- Gunnar Larfors
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Daniel Moreno Berggren
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hege Garelius
- Section of Haematology and Coagulation, Department of Specialist Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Jädersten
- Department of Medicine Huddinge, Centre for Haematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Nilsson
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Bengt Rasmussen
- School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Elisabeth Ejerblad
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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7
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Hoeks M, Bagguley T, van Marrewijk C, Smith A, Bowen D, Culligan D, Kolade S, Symeonidis A, Garelius H, Spanoudakis M, Langemeijer S, Roelofs R, Wiegerinck E, Tatic A, Killick S, Panagiotidis P, Stanca O, Hellström-Lindberg E, Cermak J, van der Klauw M, Wouters H, van Kraaij M, Blijlevens N, Swinkels DW, de Witte T. Toxic iron species in lower-risk myelodysplastic syndrome patients: course of disease and effects on outcome. Leukemia 2020; 35:1745-1750. [PMID: 32948844 PMCID: PMC8179850 DOI: 10.1038/s41375-020-01022-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Marlijn Hoeks
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands. .,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Tim Bagguley
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Corine van Marrewijk
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alex Smith
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - David Bowen
- St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, UK
| | - Dominic Culligan
- Department of Hematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Seye Kolade
- Department of Hematology, Blackpool Victoria Hospital, Blackpool, Lancashire, UK
| | - Argiris Symeonidis
- Department of Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Hege Garelius
- Department of Medicine, Sect. of Hematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Michail Spanoudakis
- Department of Hematology, Airedale NHS Trust, Airdale, UK.,Department of Haematology, Warrington and Halton Teaching Hospitals NHS foundation Trust, Cheshire, UK
| | - Saskia Langemeijer
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rian Roelofs
- Department of Laboratory Medicine, Hepcidinanalysis.com, and Radboudumc Expertise Center for Iron Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erwin Wiegerinck
- Department of Laboratory Medicine, Hepcidinanalysis.com, and Radboudumc Expertise Center for Iron Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aurelia Tatic
- Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Sally Killick
- Department of Hematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Panagiotis Panagiotidis
- Department of Haematology, 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece
| | - Oana Stanca
- Department of Hematology, Coltea Clinical Hospital, Bucharest, Romania
| | - Eva Hellström-Lindberg
- Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Jaroslav Cermak
- Department of Clinical Hematology, Institute of Hematology and Blood Transfusion, Praha, Czech Republic
| | - Melanie van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hanneke Wouters
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marian van Kraaij
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Hepcidinanalysis.com, and Radboudumc Expertise Center for Iron Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theo de Witte
- Nijmegen Center for Molecular Life Sciences, Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
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8
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Moreno Berggren D, Kjellander M, Backlund E, Engvall M, Garelius H, Lorenz F, Nilsson L, Rasmussen B, Lehmann S, Hellström-Lindberg E, Jädersten M, Ungerstedt J, Ejerblad E. Prognostic scoring systems and comorbidities in chronic myelomonocytic leukaemia: a nationwide population-based study. Br J Haematol 2020; 192:474-483. [PMID: 32501529 DOI: 10.1111/bjh.16790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/04/2020] [Indexed: 01/07/2023]
Abstract
Outcomes in chronic myelomonocytic leukaemia (CMML) are highly variable and may be affected by comorbidity. Therefore, prognostic models and comorbidity indices are important tools to estimate survival and to guide clinicians in individualising treatment. In this nationwide population-based study, we assess comorbidities and for the first time validate comorbidity indices in CMML. We also compare the prognostic power of: the revised International Prognostic Scoring System (IPSS-R), CMML-specific prognostic scoring system (CPSS), MD Anderson Prognostic Scoring System (MDAPS) and Mayo score. In this cohort of 337 patients with CMML, diagnosed between 2009 and 2015, the median overall survival was 21·3 months. Autoimmune conditions were present in 25% of the patients, with polymyalgia rheumatica and Hashimoto's thyroiditis being most common. Of the tested comorbidity indices: the Charlson Comorbidity Index (CCI), Haematopoietic cell transplantation-specific Comorbidity Index (HCT-CI) and Myelodysplastic Syndrome-Specific Comorbidity Index (MDS-CI), CCI had the highest C-index (0·62) and was the only comorbidity index independently associated with survival in multivariable analyses. When comparing the prognostic power of the scoring systems, the CPSS had the highest C-index (0·69). In conclusion, using 'real-world' data we found that the CCI and CPSS have the best prognostic power and that autoimmune conditions are overrepresented in CMML.
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Affiliation(s)
- Daniel Moreno Berggren
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
| | - Matilda Kjellander
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital and PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ellen Backlund
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
| | - Marie Engvall
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Hege Garelius
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fryderyk Lorenz
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lars Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Bengt Rasmussen
- School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Sören Lehmann
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
| | - Eva Hellström-Lindberg
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital and PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Jädersten
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital and PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna Ungerstedt
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital and PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Ejerblad
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
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9
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Rochau U, Stojkov I, Conrads-Frank A, Borba HH, Koinig KA, Arvandi M, van Marrewijk C, Garelius H, Germing U, Symeonidis A, Sanz GF, Fenaux P, de Witte T, Efficace F, Siebert U, Stauder R. Development of a core outcome set for myelodysplastic syndromes - a Delphi study from the EUMDS Registry Group. Br J Haematol 2020; 191:405-417. [PMID: 32410281 PMCID: PMC8221029 DOI: 10.1111/bjh.16654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/18/2020] [Indexed: 12/11/2022]
Abstract
Treatment options for myelodysplastic syndromes (MDS) vary widely, depending on the natural disease course and patient‐related factors. Comparison of treatment effectiveness is challenging as different endpoints have been included in clinical trials and outcome reporting. Our goal was to develop the first MDS core outcome set (MDS‐COS) defining a minimum set of outcomes that should be reported in future clinical studies. We performed a comprehensive systematic literature review among MDS studies to extract patient‐ and/or clinically relevant outcomes. Clinical experts from the European LeukemiaNet MDS (EUMDS) identified 26 potential MDS core outcomes and participated in a three‐round Delphi survey. After the first survey (56 experts), 15 outcomes met the inclusion criteria and one additional outcome was included. The second round (38 experts) resulted in six included outcomes. In the third round, a final check on plausibility and practicality of the six included outcomes and their definitions was performed. The final MDS‐COS includes: health‐related quality of life, treatment‐related mortality, overall survival, performance status, safety, and haematological improvement. This newly developed MDS‐COS represents the first minimum set of outcomes aiming to enhance comparability across future MDS studies and facilitate a better understanding of treatment effectiveness.
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Affiliation(s)
- Ursula Rochau
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Igor Stojkov
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Helena H Borba
- Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil
| | - Karin A Koinig
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Marjan Arvandi
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Corine van Marrewijk
- Department of Hematology, Radboud university medical center, Nijmegen, the Netherlands
| | - Hege Garelius
- Department of Medicine, Section of Hematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Argiris Symeonidis
- Department of Internal Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Guillermo F Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Pierre Fenaux
- Service d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP) and Université Paris 7, Paris, France
| | - Theo de Witte
- Department of Tumor Immunology - Nijmegen Center for Molecular Life Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - Fabio Efficace
- Health Outcomes Research Unit, Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA), Rome, Italy
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
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10
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Smith F, Gunnarsdóttir KÁ, Genell A, McLinden D, Vaughn L, Garelius H, Nilsson-Ehle H, Lönqvist U, Björk-Eriksson T. Evaluating the implementation and use of the regional cancer plan in Western Sweden through concept mapping. Int J Qual Health Care 2020; 31:44-52. [PMID: 30576515 DOI: 10.1093/intqhc/mzy241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 12/09/2018] [Accepted: 11/21/2018] [Indexed: 11/13/2022] Open
Abstract
QUALITY PROBLEM OR ISSUE Within healthcare, policy documents are often used to strategically standardize, streamline or change how general health issues are managed for a specific patient group or treatment. Despite significant effort in developing policy and strategic planning documents, these may not have the intended impact and their value has long been questioned by practitioners. CHOICE OF SOLUTION To identify barriers and affordances for the implementation and use of a strategic plan for cancer care in the Western Sweden Healthcare Region, we used Concept Mapping; a participatory mixed method approach to inquiry consisting of both qualitative and quantitative tasks intended to elicit and integrate the diverse perspectives of multiple stakeholders. IMPLEMENTATION The study was carried out between April and October 2017 and consisted of several sequential data collection steps: idea generation, sorting and rating ideas for importance and feasibility. Stakeholders from different levels and professions in cancercare participated, but the number varied in the separate steps of data collection: idea generation (n = 112), sorting (n = 16) and rating (n = 38). EVALUATION A concept map visualized seven areas that stakeholders throughout the cancer-care process considered necessary to address in order to enable the implementation of the plan. Skills provision was considered the most important cluster but also rated as least feasible. A consistent theme emerged that information, or lack thereof, might be a barrier for the plan being put into action to a greater extent in the cancer-care units. Nine actionable ideas rated highly on both importance and feasibility were presented as a go-zone. LESSONS LEARNED Our results suggest that efforts might be better spent on ensuring information about and accessibility to strategic documents throughout the organization, rather than frequently updating them or producing new ones. Having sufficient skills provision seems to be the prerequisite for successful implementation.
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Affiliation(s)
- Frida Smith
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Chalmers University of Technology, Chalmersplatsen 4, Gothenburg, Sweden
| | | | - Anna Genell
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel McLinden
- University of Cincinnati College of Medicine, 3230 Eden Ave Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Division of General & Community Pediatrics, 3333 Burnet Ave Cincinnati, OH, USA
| | - Lisa Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave ML 2008 Cincinnati, OH, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave ML 2008 Cincinnati, OH, USA.,Educational Studies, University of Cincinnati College of Education, Criminal Justice, and Human Services, 3333 Burnet Ave ML 2008 Cincinnati, OH, USA
| | - Hege Garelius
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Section of Hematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Herman Nilsson-Ehle
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Section of Hematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ulf Lönqvist
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Oncology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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11
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Lennmyr E, Karlsson K, Ahlberg L, Garelius H, Hulegårdh E, Izarra AS, Joelsson J, Kozlowski P, Moicean A, Tomaszewska-Toporska B, Lübking A, Hallböök H. Survival in adult acute lymphoblastic leukaemia (ALL): A report from the Swedish ALL Registry. Eur J Haematol 2019; 103:88-98. [PMID: 31074910 PMCID: PMC6851994 DOI: 10.1111/ejh.13247] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 03/21/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES As new, effective therapies emerge for acute lymphoblastic leukaemia (ALL), the results of clinical trials need to relate to standard of care. METHODS We used the population-based Swedish ALL Registry to evaluate characteristics, treatment and long-term outcome in 933 patients with diagnosis between 1997 and 2015. RESULTS The median age was 53 years. The frequency of Philadelphia (Ph)-positive leukaemia was 34% of examined B-ALL with a peak incidence at 50-59 years. Five-year overall survival (OS) improved between 1997-2006 and 2007-2015; in patients 18-45 years from 50% (95% CI 43-57) to 65% (95% CI 58-72), 46-65 years from 25% (95% CI 18-32) to 46% (95% CI 37-55) and >65 years from 7% (95% CI 2.6-11) to 11% (95% CI 5.9-16) (P < 0.05). Men with Ph-neg B-ALL 46-65 years had inferior OS compared with women (P < 0.01). Standardised mortality ratio was 5.7 (95% CI 5.0-6.3) for patients who survived 5 years from diagnosis. In multivariable analysis, Ph-positive disease was not associated with impaired prognosis but with lower risk of death in 2007-2015. CONCLUSIONS In a population-based cohort, OS has improved in adult ALL, especially for Ph-positive disease but for middle-aged men with Ph-negative B-ALL outcome was poor. Cure without late toxicity or relapse is still desired.
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Affiliation(s)
- Emma Lennmyr
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Karlsson
- Department of Haematology, Oncology and Radiophysics, Skåne University Hospital, Lund, Sweden
| | - Lucia Ahlberg
- Department of Haematology, University Hospital of Linköping, Linköping, Sweden
| | - Hege Garelius
- Department of Medicine, Section of Haematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Erik Hulegårdh
- Department of Medicine, Section of Haematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Antonio S Izarra
- Department of Haematology, Cancer Centre, University Hospital of Umeå, Umeå, Sweden
| | - Joel Joelsson
- Division of Haematology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Piotr Kozlowski
- Department of Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Andreea Moicean
- Department of Medicine, Central Hospital Skövde, Skövde, Sweden
| | | | - Anna Lübking
- Department of Haematology, Oncology and Radiophysics, Skåne University Hospital, Lund, Sweden
| | - Helene Hallböök
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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12
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Moreno Berggren D, Folkvaljon Y, Engvall M, Sundberg J, Lambe M, Antunovic P, Garelius H, Lorenz F, Nilsson L, Rasmussen B, Lehmann S, Hellström-Lindberg E, Jädersten M, Ejerblad E. Prognostic scoring systems for myelodysplastic syndromes (MDS) in a population-based setting: a report from the Swedish MDS register. Br J Haematol 2018; 181:614-627. [PMID: 29707769 DOI: 10.1111/bjh.15243] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/16/2018] [Indexed: 01/22/2023]
Abstract
The myelodysplastic syndromes (MDS) have highly variable outcomes and prognostic scoring systems are important tools for risk assessment and to guide therapeutic decisions. However, few population-based studies have compared the value of the different scoring systems. With data from the nationwide Swedish population-based MDS register we validated the International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R) and the World Health Organization (WHO) Classification-based Prognostic Scoring System (WPSS). We also present population-based data on incidence, clinical characteristics including detailed cytogenetics and outcome from the register. The study encompassed 1329 patients reported to the register between 2009 and 2013, 14% of these had therapy-related MDS (t-MDS). Based on the MDS register, the yearly crude incidence of MDS in Sweden was 2·9 per 100 000 inhabitants. IPSS-R had a significantly better prognostic power than IPSS (P < 0·001). There was a trend for better prognostic power of IPSS-R compared to WPSS (P = 0·05) and for WPSS compared to IPSS (P = 0·07). IPSS-R was superior to both IPSS and WPSS for patients aged ≤70 years. Patients with t-MDS had a worse outcome compared to de novo MDS (d-MDS), however, the validity of the prognostic scoring systems was comparable for d-MDS and t-MDS. In conclusion, population-based studies are important to validate prognostic scores in a 'real-world' setting. In our nationwide cohort, the IPSS-R showed the best predictive power.
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Affiliation(s)
- Daniel Moreno Berggren
- Department of Medical Science, Section of Haematology, Uppsala University, Uppsala, Sweden
| | - Yasin Folkvaljon
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Marie Engvall
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Johan Sundberg
- Department of Medical Science, Section of Haematology, Uppsala University, Uppsala, Sweden
| | - Mats Lambe
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Petar Antunovic
- Department of Haematology, Linköping University Hospital, Linköping, Sweden
| | - Hege Garelius
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fryderyk Lorenz
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Lars Nilsson
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Bengt Rasmussen
- School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Sören Lehmann
- Department of Medical Science, Section of Haematology, Uppsala University, Uppsala, Sweden
| | - Eva Hellström-Lindberg
- Centre for Haematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Jädersten
- Centre for Haematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Ejerblad
- Department of Medical Science, Section of Haematology, Uppsala University, Uppsala, Sweden
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13
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de Swart L, Reiniers C, Bagguley T, van Marrewijk C, Bowen D, Hellström-Lindberg E, Tatic A, Symeonidis A, Huls G, Cermak J, van de Loosdrecht AA, Garelius H, Culligan D, Macheta M, Spanoudakis M, Panagiotidis P, Krejci M, Blijlevens N, Langemeijer S, Droste J, Swinkels DW, Smith A, de Witte T. Labile plasma iron levels predict survival in patients with lower-risk myelodysplastic syndromes. Haematologica 2017; 103:69-79. [PMID: 29122992 PMCID: PMC5777192 DOI: 10.3324/haematol.2017.171884] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/27/2017] [Indexed: 01/01/2023] Open
Abstract
Red blood cell transfusions remain one of the cornerstones in supportive care of lower-risk patients with myelodysplastic syndromes. We hypothesized that patients develop oxidant-mediated tissue injury through the formation of toxic iron species, caused either by red blood cell transfusions or by ineffective erythropoiesis. We analyzed serum samples from 100 lower-risk patients with myelodysplastic syndromes at six-month intervals for transferrin saturation, hepcidin-25, growth differentiation factor 15, soluble transferrin receptor, non-transferrin bound iron and labile plasma iron in order to evaluate temporal changes in iron metabolism and the presence of potentially toxic iron species and their impact on survival. Hepcidin levels were low in 34 patients with ringed sideroblasts compared to 66 patients without. Increases of hepcidin and non-transferrin bound iron levels were visible early in follow-up of all transfusion-dependent patient groups. Hepcidin levels significantly decreased over time in transfusion-independent patients with ringed sideroblasts. Increased soluble transferrin receptor levels in transfusion-independent patients with ringed sideroblasts confirmed the presence of ineffective erythropoiesis and suppression of hepcidin production in these patients. Detectable labile plasma iron levels in combination with high transferrin saturation levels occurred almost exclusively in patients with ringed sideroblasts and all transfusion-dependent patient groups. Detectable labile plasma iron levels in transfusion-dependent patients without ringed sideroblasts were associated with decreased survival. In conclusion, toxic iron species occurred in all transfusion-dependent patients and in transfusion-independent patients with ringed sideroblasts. Labile plasma iron appeared to be a clinically relevant measure for potential iron toxicity and a prognostic factor for survival in transfusion-dependent patients. clinicaltrials.gov Identifier: 00600860.
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Affiliation(s)
- Louise de Swart
- Department of Hematology, Radboud university medical center, Nijmegen, the Netherlands
| | - Chloé Reiniers
- Department of Hematology, University Medical Centre, Groningen, the Netherlands
| | - Timothy Bagguley
- Epidemiology and Cancer Statistics Group, University of York, UK
| | - Corine van Marrewijk
- Department of Hematology, Radboud university medical center, Nijmegen, the Netherlands
| | - David Bowen
- St. James's Institute of Oncology, Leeds Teaching Hospitals, UK
| | - Eva Hellström-Lindberg
- Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Aurelia Tatic
- Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Argiris Symeonidis
- Department of Medicine, Division of Hematology, University of Patras Medical School, Greece
| | - Gerwin Huls
- Department of Hematology, University Medical Centre, Groningen, the Netherlands
| | - Jaroslav Cermak
- Department of Clinical Hematology, Institute of Hematology & Blood Transfusion, Prague, Czech Republic
| | | | - Hege Garelius
- Department of Medicine, Section of Hematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Mac Macheta
- Department of Haematology, Blackpool Victoria Hospital, Lancashire, UK
| | | | - Panagiotis Panagiotidis
- Department of Hematology, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Marta Krejci
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Masaryk University, Czech Republic
| | - Nicole Blijlevens
- Department of Hematology, Radboud university medical center, Nijmegen, the Netherlands
| | - Saskia Langemeijer
- Department of Hematology, Radboud university medical center, Nijmegen, the Netherlands
| | - Jackie Droste
- Department of Hematology, Radboud university medical center, Nijmegen, the Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Hepcidinanalysis.com, and Radboudumc expertise center for iron disorders, Radboud university medical center, Nijmegen, the Netherlands and
| | - Alex Smith
- Department of Hematology, University Medical Centre, Groningen, the Netherlands
| | - Theo de Witte
- Nijmegen Center for Molecular Life Sciences, Department of Tumor Immunology, Radboud university medical center, the Netherlands
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14
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Lehmann S, Deneberg S, Antunovic P, Rangert-Derolf Å, Garelius H, Lazarevic V, Myhr-Eriksson K, Möllgård L, Uggla B, Wahlin A, Wennström L, Höglund M, Juliusson G. Early death rates remain high in high-risk APL: update from the Swedish Acute Leukemia Registry 1997-2013. Leukemia 2017; 31:1457-1459. [PMID: 28232742 DOI: 10.1038/leu.2017.71] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- S Lehmann
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Unit of Hematology, Department of Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - S Deneberg
- Unit of Hematology, Department of Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - P Antunovic
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Å Rangert-Derolf
- Department of Hematology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - H Garelius
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - V Lazarevic
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - K Myhr-Eriksson
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - L Möllgård
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - B Uggla
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - A Wahlin
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - L Wennström
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - M Höglund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - G Juliusson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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15
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Juliusson G, Abrahamsson J, Lazarevic V, Antunovic P, Derolf Å, Garelius H, Lehmann S, Myhr-Eriksson K, Möllgård L, Uggla B, Wahlin A, Wennström L, Höglund M. Prevalence and characteristics of survivors from acute myeloid leukemia in Sweden. Leukemia 2016; 31:728-731. [PMID: 27795559 PMCID: PMC5339425 DOI: 10.1038/leu.2016.312] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 11/21/2022]
Affiliation(s)
- G Juliusson
- Department of Hematology and Oncology, Skåne University Hospital, Lund, Sweden.,Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - J Abrahamsson
- Department of Pediatrics, Institution for Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - V Lazarevic
- Department of Hematology and Oncology, Skåne University Hospital, Lund, Sweden.,Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - P Antunovic
- Department of Hematology, University Hospital Linköping, Linköping, Sweden
| | - Å Derolf
- Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - H Garelius
- Department of Hematology, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - S Lehmann
- Department of Hematology, Academic Hospital, Uppsala, Sweden
| | | | - L Möllgård
- Department of Hematology, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - B Uggla
- School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - A Wahlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - L Wennström
- Department of Pediatrics, Institution for Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Hematology, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - M Höglund
- Department of Hematology, Academic Hospital, Uppsala, Sweden
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16
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Malmberg EB, Ståhlman S, Rehammar A, Samuelsson T, Alm SJ, Kristiansson E, Abrahamsson J, Garelius H, Pettersson L, Ehinger M, Palmqvist L, Fogelstrand L. Patient-tailored analysis of minimal residual disease in acute myeloid leukemia using next-generation sequencing. Eur J Haematol 2016; 98:26-37. [DOI: 10.1111/ejh.12780] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Erik B.R. Malmberg
- Department of Clinical Chemistry and Transfusion Medicine; Institute of Biomedicine; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Sara Ståhlman
- Department of Clinical Chemistry and Transfusion Medicine; Institute of Biomedicine; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Anna Rehammar
- Mathematical Sciences; Chalmers University of Technology and University of Gothenburg; Gothenburg Sweden
| | - Tore Samuelsson
- Department of Medical Biochemistry and Cell Biology; Institute of Biomedicine; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Sofie J. Alm
- Department of Clinical Chemistry and Transfusion Medicine; Institute of Biomedicine; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Erik Kristiansson
- Mathematical Sciences; Chalmers University of Technology and University of Gothenburg; Gothenburg Sweden
| | - Jonas Abrahamsson
- Department of Pediatrics; Institute of Clinical Sciences; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Hege Garelius
- Department of Medicine; Section of Hematology and Coagulation; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Louise Pettersson
- Department of Pathology; Hallands Hospital Halmstad; Halmstad Sweden
| | - Mats Ehinger
- Division of Oncology and Pathology; Lund University; Lund Sweden
| | - Lars Palmqvist
- Department of Clinical Chemistry and Transfusion Medicine; Institute of Biomedicine; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
- Department of Clinical Chemistry; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Linda Fogelstrand
- Department of Clinical Chemistry and Transfusion Medicine; Institute of Biomedicine; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
- Department of Clinical Chemistry; Sahlgrenska University Hospital; Gothenburg Sweden
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de Swart L, Reiniers C, Bagguley T, Van Marrewijk C, Bowen D, Cermak J, Hellström-Lindberg E, Tatic A, Symeonidis A, Huls G, Panagiotidis P, Garelius H, Culligan D, Krejci M, Droste J, Smith A, Swinkels D, de Witte T. 212 TRANSFUSIONS AND PRESENCE OF RINGSIDEROBLASTS INFLUENCE HEPCIDIN AND NTBI LEVELS IN PATIENTS WITH LOWER-RISK MYELODYSPLASTIC SYNDROMES (MDS) - A REPORT FROM THE EUROPEAN LEUKEMIANET MDS REGISTRY. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hulegårdh E, Nilsson C, Lazarevic V, Garelius H, Antunovic P, Rangert Derolf Å, Möllgård L, Uggla B, Wennström L, Wahlin A, Höglund M, Juliusson G, Stockelberg D, Lehmann S. Characterization and prognostic features of secondary acute myeloid leukemia in a population-based setting: a report from the Swedish Acute Leukemia Registry. Am J Hematol 2015; 90:208-14. [PMID: 25421221 DOI: 10.1002/ajh.23908] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 12/29/2022]
Abstract
Patients with secondary acute myeloid leukemia (AML) often escape inclusion in clinical trials and thus, population-based studies are crucial for its accurate characterization. In this first large population-based study on secondary AML, we studied AML with an antecedent hematological disease (AHD-AML) or therapy-related AML (t-AML) in the population-based Swedish Acute Leukemia Registry. The study included 3,363 adult patients of which 2,474 (73.6%) had de novo AML, 630 (18.7%) AHD-AML, and 259 (7.7%) t-AML. Secondary AML differed significantly compared to de novo AML with respect to age, gender, and cytogenetic risk. Complete remission (CR) rates were significantly lower but early death rates similar in secondary AML. In a multivariable analysis, AHD-AML (HR 1.51; 95% CI 1.26-1.79) and t-AML (1.72; 1.38-2.15) were independent risk factors for poor survival. The negative impact of AHD-AML and t-AML on survival was highly age dependent with a considerable impact in younger patients, but without independent prognostic value in the elderly. Although patients with secondary leukemia did poorly with intensive treatment, early death rates and survival were significantly worse with palliative treatment. We conclude that secondary AML in a population-based setting has a striking impact on survival in younger AML patients, whereas it lacks prognostic value among the elderly patients.
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Affiliation(s)
- Erik Hulegårdh
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
| | - Christer Nilsson
- Hematology Centre; Karolinska University Hospital, Huddinge, Stockholm and Regional Tumor Registry; Stockholm Sweden
| | - Vladimir Lazarevic
- Department of Hematology and Regional Tumor Registry; Skåne University Hospital and Lund University; Lund Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Hege Garelius
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Petar Antunovic
- Swedish Acute Myeloid Leukemia Group
- Department of Hematology and Regional Tumor Registry; Linköping University Hospital; Linköping Sweden
| | - Åsa Rangert Derolf
- Swedish Acute Myeloid Leukemia Group
- Center of Hematology and Regional Tumor Registry; Karolinska University Hospital; Solna Stockholm Sweden
| | - Lars Möllgård
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Bertil Uggla
- Swedish Acute Myeloid Leukemia Group
- Department of Medicine; Örebro University Hospital; Örebro Sweden
| | - Lovisa Wennström
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Anders Wahlin
- Swedish Acute Myeloid Leukemia Group
- Department of Radiation Sciences; University of Umeå and Regional Tumor Registry, Norrland University Hospital; Umeå Sweden
| | - Martin Höglund
- Swedish Acute Myeloid Leukemia Group
- Department of Hematology and Regional Tumor Registry; Academic Hospital, Uppsala; Sweden
| | - Gunnar Juliusson
- Department of Hematology and Regional Tumor Registry; Skåne University Hospital and Lund University; Lund Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Dick Stockelberg
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Sören Lehmann
- Hematology Centre; Karolinska University Hospital, Huddinge, Stockholm and Regional Tumor Registry; Stockholm Sweden
- Swedish Acute Myeloid Leukemia Group
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Garelius H, Grund S, Stockelberg D. Induction with azacytidine followed by allogeneic hematopoietic stem cell transplantation in a Jehovah's Witness with acute monocytic leukemia. Clin Case Rep 2015; 3:287-90. [PMID: 25984306 PMCID: PMC4427369 DOI: 10.1002/ccr3.212] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 10/18/2014] [Accepted: 12/07/2014] [Indexed: 11/12/2022] Open
Abstract
We have used a hypomethylating agent instead of conventional chemotherapy to induce remission in a young Jehovah's Witness with acute monocytic leukemia to avoid severe myelosuppression and blood product support. The treatment was consolidated with reduced intensity allogeneic stem cell transplantation. This could be an alternative when transfusions must be avoided.
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Affiliation(s)
- Hege Garelius
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital Gothenburg, Sweden
| | - Sofia Grund
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital Gothenburg, Sweden
| | - Dick Stockelberg
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital Gothenburg, Sweden
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Svensson T, Chowdhury O, Garelius H, Lorenz F, Saft L, Jacobsen SE, Hellström-Lindberg E, Cherif H. A pilot phase I dose finding safety study of the thrombopoietin-receptor agonist, eltrombopag, in patients with myelodysplastic syndrome treated with azacitidine. Eur J Haematol 2014; 93:439-45. [DOI: 10.1111/ejh.12383] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Tobias Svensson
- Department of Medical Sciences; Section of Hematology; Uppsala University Hospital; Uppsala Sweden
| | - Onima Chowdhury
- Haematopoietic Stem Cell Laboratory and MRC Molecular Haematology Unit; Weatherall Institute of Molecular Medicine; Oxford University; Oxford UK
| | - Hege Garelius
- Department of Medicine; Section of Hematology and Coagulation; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Fryderyk Lorenz
- Department of Hematology; Umeå University Hospital; Umeå Sweden
| | - Leonie Saft
- Department of Pathology; Division of Hematopathology; Karolinska University Hospital; Solna Sweden
| | - Sten-Eirik Jacobsen
- Haematopoietic Stem Cell Laboratory and MRC Molecular Haematology Unit; Weatherall Institute of Molecular Medicine; Oxford University; Oxford UK
| | - Eva Hellström-Lindberg
- Center for Hematology and Regenerative Medicine; Karolinska Institutet; Karolinska University Hospital; Huddinge Sweden
| | - Honar Cherif
- Department of Medical Sciences; Section of Hematology; Uppsala University Hospital; Uppsala Sweden
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Tobiasson M, Dybedahl I, Holm MS, Karimi M, Brandefors L, Garelius H, Grövdal M, Högh-Dufva I, Grønbæk K, Jansson M, Marcher C, Nilsson L, Kittang AO, Porwit A, Saft L, Möllgård L, Hellström-Lindberg E. Limited clinical efficacy of azacitidine in transfusion-dependent, growth factor-resistant, low- and Int-1-risk MDS: Results from the nordic NMDSG08A phase II trial. Blood Cancer J 2014; 4:e189. [PMID: 24608733 PMCID: PMC3972706 DOI: 10.1038/bcj.2014.8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/24/2014] [Accepted: 01/29/2014] [Indexed: 02/08/2023] Open
Abstract
This prospective phase II study evaluated the efficacy of azacitidine (Aza)+erythropoietin (Epo) in transfusion-dependent patients with lower-risk myelodysplastic syndrome (MDS). Patients ineligible for or refractory to full-dose Epo+granulocyte colony stimulation factors for >8 weeks and a transfusion need of 4 units over 8 weeks were included. Aza 75 mg m(-2) d(-1), 5/28 days, was given for six cycles; non-responding patients received another three cycles combined with Epo 60 000 units per week. Primary end point was transfusion independence (TI). All patients underwent targeted mutational screen for 42 candidate genes. Thirty enrolled patients received one cycle of Aza. Ten patients discontinued the study early, 7 due to adverse events including 2 deaths. Thirty-eight serious adverse events were reported, the most common being infection. Five patients achieved TI after six cycles and one after Aza+Epo, giving a total response rate of 20%. Mutational screening revealed a high frequency of recurrent mutations. Although no single mutation predicted for response, SF3A1 (n=3) and DNMT3A (n=4) were only observed in non-responders. We conclude that Aza can induce TI in severely anemic MDS patients, but efficacy is limited, toxicity substantial and most responses of short duration. This treatment cannot be generally recommended in lower-risk MDS. Mutational screening revealed a high frequency of mutations.
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Affiliation(s)
- M Tobiasson
- Division of Hematology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - I Dybedahl
- Department of Hematology, Rikshospitalet, Oslo, Norway
| | - M S Holm
- Department of Hematology, Århus University Hospital, Århus, Denmark
| | - M Karimi
- Karolinska Institutet, Institution for Medicine, Stockholm, Sweden
| | - L Brandefors
- Department of Medicine, Sunderbyn Hospital, Luleå, Sweden
| | - H Garelius
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Grövdal
- Department of Medicine, SöDersjukhuset, Stockholm, Sweden
| | - I Högh-Dufva
- Department of Hematology, Herlev University Hospital, Copenhagen, Denmark
| | - K Grønbæk
- Department of Hematology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - M Jansson
- Karolinska Institutet, Institution for Medicine, Stockholm, Sweden
| | - C Marcher
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - L Nilsson
- Department of Hematology, Lund University Hospital, Lund, Sweden
| | - A O Kittang
- Department of Medicine and University of Bergen, K2 Clinical Institute 2, Haukeland University Hospital, Bergen, Norway
| | - A Porwit
- Division of Hematology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - L Saft
- Division of Hematology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - L Möllgård
- Division of Hematology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - E Hellström-Lindberg
- Division of Hematology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Garelius H, Johnston W, Van de Loosdrecht A, Park S, De Swart L, Stauder R, Symeonidis A, Sanz G, Cermak J, Georgescu O, Skov-Holm M, Germing U, Fenaux P, MacKenzie M, Malcovati L, Madry K, Almeida AAM, Bowen D, De Witte T, Smith A, Hellström-Lindberg E. O-027 European distribution of usage and impact on outcome for treatment with erythropoietic stimulating agents within the EUMDS lower-risk registry programme. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Möllgård L, Saft L, Treppendahl MB, Dybedal I, Nørgaard JM, Astermark J, Ejerblad E, Garelius H, Dufva IH, Jansson M, Jädersten M, Kjeldsen L, Linder O, Nilsson L, Vestergaard H, Porwit A, Grønbæk K, Hellström-Lindberg E, Lindberg EH. Clinical effect of increasing doses of lenalidomide in high-risk myelodysplastic syndrome and acute myeloid leukemia with chromosome 5 abnormalities. Haematologica 2011; 96:963-71. [PMID: 21719884 DOI: 10.3324/haematol.2010.039669] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients with chromosome 5 abnormalities and high-risk myelodysplastic syndromes or acute myeloid leukemia have a poor outcome. We hypothesized that increasing doses of lenalidomide may benefit this group of patients by inhibiting the tumor clone, as assessed by fluorescence in situ hybridization for del(5q31). DESIGN AND METHODS Twenty-eight patients at diagnosis or with relapsed disease and not eligible for standard therapy (16 with acute myeloid leukemia, 12 with intermediate-risk 2 or high-risk myelodysplastic syndrome) were enrolled in this prospective phase II multicenter trial and treated with lenalidomide up to 30 mg daily for 16 weeks. Three patients had isolated del(5q), six had del(5q) plus one additional aberration, 14 had del(5q) and a complex karyotype, four had monosomy 5, and one had del(5q) identified by fluorescence in situ hybridization only. RESULTS Major and minor cytogenetic responses, assessed by fluorescence in situ hybridization, were achieved in 5/26 (19%) and 2/26 (8%) patients, respectively, who received one or more dose of lenalidomide, while two patients achieved only a bone marrow response. Nine of all 26 patients (35%) and nine of the ten who completed the 16 weeks of trial responded to treatment. Using the International Working Group criteria for acute myeloid leukemia and myelodysplastic syndrome the overall response rate in treated patients with acute myeloid leukemia was 20% (3/15), while that for patients with myelodysplastic syndrome was 36% (4/11). Seven patients stopped therapy due to progressive disease and nine because of complications, most of which were disease-related. Response rates were similar in patients with isolated del(5q) and in those with additional aberrations. Interestingly, patients with TP53 mutations responded less well than those without mutations (2/13 versus 5/9, respectively; P=0.047). No responses were observed among 11 cases with deleterious TP53 mutations. CONCLUSIONS Our data support a role for higher doses of lenalidomide in poor prognosis patients with myelodysplastic syndrome and acute myeloid leukemia with deletion 5q. (Clinicaltrials.gov identifier NCT00761449).
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Affiliation(s)
- Lars Möllgård
- Hematology Center, Karolinska University Hopsital Huddinge, 14186 Stockholm, Sweden.
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Nilsson-Ehle H, Birgegård G, Samuelsson J, Antunovic P, Astermark J, Garelius H, Engström LM, Kjeldsen L, Nilsson L, Olsson A, Skov-Holm M, Wallvik J, Gulbrandsen N, Hellström-Lindberg E. Quality of life, physical function and MRI T2* in elderly low-risk MDS patients treated to a haemoglobin level of ≥120 g/L with darbepoetin alfa ± filgrastim or erythrocyte transfusions. Eur J Haematol 2011; 87:244-52. [PMID: 21623919 DOI: 10.1111/j.1600-0609.2011.01654.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Anaemia in low-risk myelodysplastic syndromes (MDS) is associated with reduced quality of life (QoL). Response to treatment with erythropoietin ± granulocyte colony-stimulating factor (G-CSF) is associated with improved QoL, but whether transfusion therapy with higher haemoglobin (Hb) target levels has similar effects is unknown. The objective for this prospective phase II Nordic multicentre trial was to assess QoL, response rate and physical function in elderly anaemic MDS patients treated to a target Hb level of >120 g/L. METHODS Thirty-six elderly patients with low- and intermediate-1 risk MDS received darbepoetin (DA) 300 μg/wk, with the addition of G-CSF if no response. If the Hb target was reached at 16 wk, treatment was maintained until week 26. Remaining patients were transfused to reach the target level for at least 8 wk. RESULTS Twenty-seven patients completed the study. Response rate to DA ± G-CSF was 67% in evaluable patients and 56% according to intention to treat. Eighteen patients reached the target Hb level according to protocol. QoL scores for fatigue, dyspnoea, constipation, and physical, role and social functioning improved significantly during study, with similar results for transfused and untransfused patients. Maintaining Hb >120 g/L did not confer a higher transfusion rate, once the target was reached. In two of fourteen patients, magnetic resonance imaging T2* indicated cardiac iron overload, however, without association with ferritin levels. CONCLUSIONS In elderly anaemic MDS patients, an increment in haemoglobin is associated with improved QoL, whether induced by growth factor treatment or transfusion therapy.
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Affiliation(s)
- Herman Nilsson-Ehle
- Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Jadersten M, Saft L, Garelius H, Hast R, Nilsson L, Samuelsson J, Porwit A, Hellström-Lindberg E. C014 Expression of p53 or cytoplasmic nucleophosmine associated with increased risk of disease progression in myelodysplastic syndrome with isolated del(5q). Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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