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Vassilakopoulos TP, Piperidou A, Mellios Z, Verigou E, Katodritou E, Kalpadakis C, Papageorgiou SG, Chatzidimitriou C, Prassopoulos V, Siakantaris MP, Giatra H, Karantanis D, Papathanasiou N, Ligdi L, Kopsaftopoulou A, Leonidopoulou T, Xanthopoulos V, Karakatsanis S, Vrakidou E, Chatziioannou S, Drougkas D, Hatzimichael E, Gainaru G, Palassopoulou M, Tsirogianni M, Kotsopoulou M, Tsourouflis G, Skoura E, Mainta C, Terpos E, Poziopoulos C, Triantafyllou T, Zikos P, Koumarianou A, Liapi D, Pappa V, Verrou E, Tsirigotis P, Labropoulou V, Papadaki H, Datseris I, Symeonidis A, Bouzani M, Bakiri M, Karmiris T, Angelopoulou MK, Rondogianni P. PET for Response Assessment to R-da-EPOCH in Primary Mediastinal Large B-cell lymphoma: Who Is Worthy to be Irradiated? Hemasphere 2023; 7:e965. [PMID: 38027423 PMCID: PMC10631617 DOI: 10.1097/hs9.0000000000000965] [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] [Received: 04/24/2023] [Accepted: 08/28/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Greece
| | - Alexia Piperidou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Greece
| | - Zois Mellios
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Evgenia Verigou
- Department of Internal Medicine, Hematology Division, University of Patras, Rion, Greece
| | - Eirini Katodritou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | | | - Sotirios G. Papageorgiou
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit, National and Kapodistrian University of Athens, University General Hospital “Attikon,” Greece
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Greece
| | | | - Marina P. Siakantaris
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Greece
| | - Hara Giatra
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | | | | | - Loukia Ligdi
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Anastasia Kopsaftopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Greece
| | | | | | - Stamatios Karakatsanis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | | | - Sophia Chatziioannou
- Department of Nuclear Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Greece
| | - Dimitrios Drougkas
- Department of Nuclear Medicine and PET/CT, Vioiatriki, Thessaloniki, Greece
| | | | | | | | - Maria Tsirogianni
- Department of Hematology, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Gerassimos Tsourouflis
- Second Department of Surgery, Propedeutic, National and Kapodistrian University of Athens, Laikon General Hospital, Greece
| | - Evangelia Skoura
- Department of Nuclear Medicine and PET/CT, Vioiatriki, Athens, Greece
| | - Catherine Mainta
- Department of Nuclear Medicine and PET/CT, Athens Medical Center, Greece
| | - Evangelos Terpos
- Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | | | | | - Panayiotis Zikos
- Haematology Unit, General Hospital of Patras “Agios Andreas,” Greece
| | - Argyro Koumarianou
- First Department of Hematology, Metropolitan General Hospital, Athens, Greece
| | - Dimitra Liapi
- Department of Hematology, Venizelion Hospital, Iraklion, Crete, Greece
| | - Vassiliki Pappa
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit, National and Kapodistrian University of Athens, University General Hospital “Attikon,” Greece
| | - Evgenia Verrou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - Panayiotis Tsirigotis
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit, National and Kapodistrian University of Athens, University General Hospital “Attikon,” Greece
| | - Vassiliki Labropoulou
- Department of Internal Medicine, Hematology Division, University of Patras, Rion, Greece
| | - Helen Papadaki
- Department of Hematology, University of Crete, Iraklion, Greece
| | - Ioannis Datseris
- Department of Nuclear Medicine and PET/CT, Evangelismos General Hospital, Athens, Greece
| | - Argiris Symeonidis
- Department of Internal Medicine, Hematology Division, University of Patras, Rion, Greece
| | - Maria Bouzani
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Maria Bakiri
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Themis Karmiris
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Greece
| | - Phivi Rondogianni
- Department of Nuclear Medicine and PET/CT, Evangelismos General Hospital, Athens, Greece
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Brotis AG, Palassopoulou M, Kapsalaki EZ, Paschalis T, Papastergiou V, Fountas KN. Bing-Neel syndrome presenting with bilateral lumbar radiculopathy: A case report of a rare clinical entity. Neurocirugia (Astur : Engl Ed) 2022; 33:250-253. [PMID: 36084961 DOI: 10.1016/j.neucie.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/20/2021] [Indexed: 06/15/2023]
Abstract
The differential diagnosis of bilateral lower extremity weakness is broad. We present a very rare case of a 48-year old male patient, with walking difficulties due to Bing-Neel syndrome. On clinical examination, there was a significant loss of muscle power in all his lower extremities key-muscle groups. The lumbar spine magnetic resonance imaging (MRI) showed only mild degenerative changes, whereas the MRI of the head indicated a diffuse meningeal thickening at the right temporal region, characterized by significant enhancement after contrast administration. Serum protein electrophoresis detected an IgM-kappa monoclonal protein. The patient received intrathecal chemotherapy with methotrexate and cytarabine, and was started on oral ibrutinib 420mg daily. In conclusion, a past medical history of Waldenstrom macroglobulinemia in conjunction with neurological manifestations should alert the treating physician for Bing-Neel syndrome. A complete diagnostic imaging and serologic protocol helps in setting the final diagnosis. Steroids are part of the treatment, but should be given after the diagnosis is set. Neurosurgical intervention is indicated for histologic confirmation in the case of diagnostic uncertainty.
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Affiliation(s)
- Alexandros G Brotis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece.
| | - Maria Palassopoulou
- Department of Haematology, General University Hospital of Larissa, Larissa, Greece
| | - Eftychia Z Kapsalaki
- Department of Radiology, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
| | - Thanos Paschalis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece
| | | | - Konstantinos N Fountas
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
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Karakatsanis SJ, Bouzani M, Symeonidis A, Angelopoulou MK, Papageorgiou SG, Michail M, Gainaru G, Kourti G, Sachanas S, Kalpadakis C, Katodritou E, Leonidopoulou T, Kotsianidis I, Hatzimichael E, Kotsopoulou M, Dimou M, Variamis E, Boutsis D, Kanellias N, Dimopoulou MN, Michali E, Karianakis G, Tsirkinidis P, Vadikolia C, Poziopoulos C, Pigaditou A, Vrakidou E, Economopoulos T, Kyriazopoulou L, Siakantaris MP, Kyrtsonis MC, Anargyrou K, Papaioannou M, Hatjiharissi E, Vervessou E, Tsirogianni M, Palassopoulou M, Stefanoudaki E, Zikos P, Tsirigotis P, Tsourouflis G, Assimakopoulou T, Verrou E, Papadaki H, Lampropoulou P, Dimopoulos MA, Pappa V, Konstantopoulos K, Karmiris T, Roussou P, Panayiotidis P, Pangalis GA, Vassilakopoulos TP. Real-life Experience With Rituximab-CHOP Every 21 or 14 Days in Primary Mediastinal Large B-cell Lymphoma. In Vivo 2022; 36:1302-1315. [PMID: 35478115 DOI: 10.21873/invivo.12831] [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: 03/01/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Primary mediastinal large B-cell lymphoma (PMLBCL) is an aggressive B-cell non-Hodgkin lymphoma (NHL), whose prognosis has greatly improved since the incorporation of the anti-CD20 monoclonal antibody rituximab into current therapeutic regimens. Evidence, however, on the optimal time interval between consecutive chemoimmunotherapy (CIT) cycles is still scarce. This study aimed to evaluate the efficacy outcomes of the more commonly administered 3-weekly regimens to the biweekly ones in a PMLBCL patients' population, who were mostly treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone every 21 days (R-CHOP-21) or R-CHOP-14. PATIENTS AND METHODS We retrospectively studied our cohort of consecutively treated PMLBCL patients, focusing on their treatment density, in order to determine possible differences in treatment outcomes. RESULTS CIT, in the form of both R-CHOP-21 as well as R-CHOP-14 (or similar regimens), is highly active in PMLBCL, with low rates of early treatment failure. In our cohort of patients, R-CHOP-14 did not result in a meaningful improvement of freedom from progression (FFP) or overall survival (OS). CONCLUSION Both R-CHOP-14 and R-CHOP-21 are probably equally effective in PMLBCL, yet further, prospective, randomized studies are warranted to clarify whether dose-dense regimens can be associated with better disease control and long-term results.
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Affiliation(s)
- Stamatis J Karakatsanis
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Maria Bouzani
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Argyris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras, Patras, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Sotirios G Papageorgiou
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Chaidari, Greece
| | - Michail Michail
- Department of Hematology, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Georgia Kourti
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece.,Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | | | | | - Eirini Katodritou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | | | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Maria Dimou
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine,Laikon General Hospital, Athens, Greece
| | | | - Nick Kanellias
- Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Maria N Dimopoulou
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Evridiki Michali
- Department of Clinical Hematology, G.Gennimatas Athens General Hospital, Athens, Greece
| | | | | | | | | | - Anna Pigaditou
- Department of Hematology, Athens Medical Center, Marousi, Greece
| | | | | | - Lydia Kyriazopoulou
- Department of Hematology, University of Ioannina, Medical School, Ioannina, Greece
| | - Marina P Siakantaris
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | | | | | - Maria Papaioannou
- Hematology Unit, 1 Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdoxia Hatjiharissi
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece.,Hematology Unit, 1 Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Tsirogianni
- Department of Hematology, Aghios Savvas Anticancer Hospital, Athens, Greece
| | | | | | | | - Panayiotis Tsirigotis
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Chaidari, Greece
| | | | | | - Evgenia Verrou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | - Helen Papadaki
- Department of Hematology,University Hospital of Heraklion, Heraklion, Greece
| | | | | | - Vassiliki Pappa
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Chaidari, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Themis Karmiris
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Paraskevi Roussou
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Gerassimos A Pangalis
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece.,Department of Hematology, Athens Medical Center, Psychikon, Greece
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Vassilakopoulos TP, Michail M, Papageorgiou S, Kourti G, Angelopoulou MK, Panitsas F, Sachanas S, Kalpadakis C, Katodritou E, Leonidopoulou T, Kotsianidis I, Hatzimichael E, Kotsopoulou M, Dimou M, Variamis E, Boutsis D, Terpos E, Dimopoulou MN, Karakatsanis S, Michalis E, Karianakis G, Tsirkinidis P, Vadikolia C, Poziopoulos C, Pigaditou A, Vrakidou E, Economopoulos T, Kyriazopoulou L, Siakantaris MP, Kyrtsonis MC, Symeonidis A, Anargyrou K, Papaioannou M, Hatjiharissi E, Vervessou E, Tsirogianni M, Palassopoulou M, Gainaru G, Stefanoudaki E, Zikos P, Tsirigotis P, Tsourouflis G, Assimakopoulou T, Konstantinidou P, A Papadaki H, Megalakaki K, Dimopoulos MA, Pappa V, Karmiris T, Roussou P, Panayiotidis P, Konstantopoulos K, Pangalis GA. Identification of Very Low-Risk Subgroups of Patients with Primary Mediastinal Large B-Cell Lymphoma Treated with R-CHOP. Oncologist 2021; 26:597-609. [PMID: 33870594 DOI: 10.1002/onco.13789] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/05/2020] [Accepted: 04/02/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND R-CHOP can cure approximately 75% of patients with primary mediastinal large B-cell lymphoma (PMLBCL), but prognostic factors have not been sufficiently evaluated yet. R-da- EPOCH is potentially more effective but also more toxic than R-CHOP. Reliable prognostic classification is needed to guide treatment decisions. MATERIALS AND METHODS We analyzed the impact of clinical prognostic factors on the outcome of 332 PMLBCL patients ≤65 years treated with R-CHOP ± radiotherapy in a multicenter setting in Greece and Cyprus. RESULTS With a median follow-up of 69 months, 5-year freedom from progression (FFP) was 78% and 5-year lymphoma specific survival (LSS) was 89%. On multivariate analysis, extranodal involvement (E/IV) and lactate dehydrogenase (LDH) ≥2 times upper limit of normal (model A) were significantly associated with FFP; E/IV and bulky disease (model B) were associated with LSS. Both models performed better than the International Prognostic Index (IPI) and the age-adjusted IPI by Harrel's C rank parameter and Akaike information criterion. Both models A and B defined high-risk subgroups (13%-27% of patients [pts]) with approximately 19%-23% lymphoma-related mortality. They also defined subgroups composing approximately one-fourth or one-half of the patients, with 11% risk of failure and only 1% or 4% 5-year lymphoma-related mortality. CONCLUSION The combination of E/IV with either bulky disease or LDH ≥2 times upper limit of normal defined high-risk but not very-high-risk subgroups. More importantly, their absence defined subgroups comprising approximately one-fourth or one-half of the pts, with 11% risk of failure and minimal lymphoma-related mortality, who may not need more intensive treatment such as R-da-EPOCH. IMPLICATIONS FOR PRACTICE By analyzing the impact of baseline clinical characteristics on outcomes of a large cohort of patients with primary mediastinal large B-cell lymphoma homogeneously treated with R-CHOP with or without radiotherapy, we developed novel prognostic indices which can aid in deciding which patients can be adequately treated with R-CHOP and do not need more intensive regimens such as R-da-EPOCH. The new indices consist of objectively determined characteristics (extranodal disease or stage IV, bulky disease, and markedly elevated serum lactate dehydrogenase), which are readily available from standard initial staging procedures and offer better discrimination compared with established risk scores (International Prognostic Index [IPI] and age-adjusted IPI).
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Michail Michail
- Department of Hematology, Nicosia General Hospital, Nicosia, Cyprus
| | - Sotirios Papageorgiou
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Georgia Kourti
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece.,Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Maria K Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Fotios Panitsas
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Sotirios Sachanas
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | | | - Eirini Katodritou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | | | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Evangelos Terpos
- Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Maria N Dimopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stamatios Karakatsanis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Eurydiki Michalis
- Department of Clinical Hematology, "G.Gennimatas" Athens General Hospital, Athens, Greece
| | | | | | | | | | - Anna Pigaditou
- Department of Hematology, Athens Medical Center, Amaroussion Branch, Athens, Greece
| | | | | | | | - Marina P Siakantaris
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Argyris Symeonidis
- Hematology Division, Dept of Internal Medicine, University of Patras, Patras, Greece
| | | | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdoxia Hatjiharissi
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece.,Hematology Unit, 1st Dept of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Tsirogianni
- Department of Hematology, Aghios Savvas Anticancer Hospital, Athens, Greece
| | | | | | | | | | - Panayiotis Tsirigotis
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Gerasimos Tsourouflis
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | - Helen A Papadaki
- Department of Hematology, University of Crete, Iraklion, Crete, Greece
| | | | | | - Vassiliki Pappa
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Themis Karmiris
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Paraskevi Roussou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Gerassimos A Pangalis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
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5
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Vassilakopoulos T, Ferhanoglu B, Horowitz N, Mellios Z, Kaynar L, Zektser M, Symeonidis A, Piperidou A, Kalpadakis C, Akay OM, Atalar AC, Katodritou E, Leonidopoulou T, Papageorgiou S, Tadmor T, Gutwein O, Karakatsanis S, Ganzel C, Karianakis G, Isenberg G, Gainaru G, Vrakidou E, Palassopoulou M, Ozgur M, Siakantaris M, Paydas S, Tsirigotis P, Tsirogianni M, Hatzimichael E, Tuglular T, Chatzidimitriou C, Megalakaki E, Kanellias N, Zikos P, Koumarianou A, Gafter‐Gvili A, Angelopoulou M, Karmiris T, Gurion R. RITUXIMAB‐DOSE‐ADJUSTED EPOCH (R‐DA‐EPOCH) IN PRIMARY MEDIASTINAL LARGE B‐CELL LYMPHOMA (PMLBCL): REAL‐LIFE EXPERIENCE ON 190 PATIENTS FROM 3 MEDITERRANEAN COUNTRIES. Hematol Oncol 2021. [DOI: 10.1002/hon.76_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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6
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Brotis AG, Palassopoulou M, Kapsalaki EZ, Paschalis T, Papastergiou V, Fountas KN. Bing-Neel syndrome presenting with bilateral lumbar radiculopathy: A case report of a rare clinical entity. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00045-2. [PMID: 34045126 DOI: 10.1016/j.neucir.2021.03.004] [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: 02/18/2021] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 11/23/2022]
Abstract
The differential diagnosis of bilateral lower extremity weakness is broad. We present a very rare case of a 48-year old male patient, with walking difficulties due to Bing-Neel syndrome. On clinical examination, there was a significant loss of muscle power in all his lower extremities key-muscle groups. The lumbar spine magnetic resonance imaging (MRI) showed only mild degenerative changes, whereas the MRI of the head indicated a diffuse meningeal thickening at the right temporal region, characterized by significant enhancement after contrast administration. Serum protein electrophoresis detected an IgM-kappa monoclonal protein. The patient received intrathecal chemotherapy with methotrexate and cytarabine, and was started on oral ibrutinib 420mg daily. In conclusion, a past medical history of Waldenstrom macroglobulinemia in conjunction with neurological manifestations should alert the treating physician for Bing-Neel syndrome. A complete diagnostic imaging and serologic protocol helps in setting the final diagnosis. Steroids are part of the treatment, but should be given after the diagnosis is set. Neurosurgical intervention is indicated for histologic confirmation in the case of diagnostic uncertainty.
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Affiliation(s)
- Alexandros G Brotis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece.
| | - Maria Palassopoulou
- Department of Haematology, General University Hospital of Larissa, Larissa, Greece
| | - Eftychia Z Kapsalaki
- Department of Radiology, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
| | - Thanos Paschalis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece
| | | | - Konstantinos N Fountas
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
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Vassilakopoulos TP, Papageorgiou SG, Angelopoulou MK, Chatziioannou S, Prassopoulos V, Karakatsanis S, Arapaki M, Mellios Z, Sachanas S, Kalpadakis C, Katodritou E, Leonidopoulou T, Kotsianidis I, Hatzimichael E, Kotsopoulou M, Dimou M, Variamis E, Boutsis D, Terpos E, Michali E, Karianakis G, Tsirkinidis P, Vadikolia C, Poziopoulos C, Pigaditou A, Vrakidou E, Siakantaris MP, Kyrtsonis MC, Symeonidis A, Anargyrou K, Papaioannou M, Chatziharissi E, Vervessou E, Tsirogianni M, Palassopoulou M, Gainaru G, Mainta C, Tsirigotis P, Assimakopoulou T, Konstantinidou P, Papadaki H, Dimopoulos MA, Pappa V, Karmiris T, Roussou P, Datseris I, Panayiotidis P, Konstantopoulos K, Pangalis GA, Rondogianni P. Positron emission tomography after response to rituximab-CHOP in primary mediastinal large B-cell lymphoma: impact on outcomes and radiotherapy strategies. Ann Hematol 2021; 100:2279-2292. [PMID: 33523289 DOI: 10.1007/s00277-021-04421-2] [Citation(s) in RCA: 3] [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: 11/17/2020] [Accepted: 01/11/2021] [Indexed: 01/22/2023]
Abstract
End-of-treatment (EoT) PET/CT is used as a guide to omit radiotherapy (RT) patients with primary mediastinal large B-cell lymphoma (PMBCL). We present the mature and extended results of a retrospective study evaluating the prognostic significance of EoT-PET/CT after adequate response to R-CHOP. Among 231 consecutive PMLBCL patients, 182 underwent EoT-PET/CT and were evaluated according to the Deauville 5-point scale (D5PS) criteria. Freedom from progression (FFP) was measured from the time of PET/CT examination. Among 182 patients, 72 (40%) had D5PS score 1 (D5PSS-1), 33 (18%) had 2, 28 (15%) had 3, 29 (16%) had 4, and 20 (11%) had 5. The 5-year FFP was 97, 94, 92, 82, and 44% for D5PSS-1, D5PSS-2, D5PSS-3, D5PSS-4, and D5PSS-5, respectively. Among 105 patients with unequivocally negative PET/CT (D5PSS-1/D5PSS-2), 49 (47%) received RT (median dose 3420 cGy) and 56 (53%) did not with relapses in 0/49 vs. 4/56 patients (2 mediastinum and 2 isolated CNS relapses).The 5-year FFP for those who received RT or not was 100% versus 96%, when isolated CNS relapses were censored (p = 0.159). Among D5PSS-3 patients (27/28 irradiated-median dose 3600 cGy), the 5-year FFP was 92%. The 5-year FFP for D5PSS-4 and D5PSS-5 was 82 and 44%; 44/49 patients received RT (median dose 4000 and 4400 cGy for D5PSS-4 and D5PSS-5). Our study supports the omission of RT in a sizeable fraction of PET/CT-negative patients and definitely discourages salvage chemotherapy and ASCT in patients with PMLBCL who conventionally respond to R-CHOP, solely based on PET/CT positivity in the absence of documented progressive or multifocal disease. The persistence of positive PET/CT with D5PSS < 5 after consolidative RT should not trigger the initiation of further salvage chemotherapy in the absence of conventionally defined PD.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece.
| | - Sotirios G Papageorgiou
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece
| | - Sophia Chatziioannou
- Department of Nuclear Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | | | - Stamatios Karakatsanis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece
| | - Zois Mellios
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Sotirios Sachanas
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | | | - Eirini Katodritou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | | | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelos Terpos
- Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Evridiki Michali
- Department of Clinical Hematology, "G.Gennimatas" Athens General Hospital, Athens, Greece
| | | | | | | | | | - Anna Pigaditou
- Department of Hematology, Athens Medical Center, Amaroussion Branch, Athens, Greece
| | | | - Marina P Siakantaris
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras, Patras, Greece
| | | | - Maria Papaioannou
- Hematology Unit, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdoxia Chatziharissi
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece.,Hematology Unit, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Tsirogianni
- Department of Hematology, Aghios Savvas Anticancer Hospital, Athens, Greece
| | | | | | - Catherine Mainta
- Department of Nuclear Medicine and PET/CT, Athens Medical Center, Athens, Greece
| | - Panagiotis Tsirigotis
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Helen Papadaki
- Department of Hematology, University of Crete, Iraklion, Crete, Greece
| | | | - Vassiliki Pappa
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Themis Karmiris
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Paraskevi Roussou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Ioannis Datseris
- Department of Nuclear Medicine and PET/CT, Evangelismos General Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece
| | - Gerassimos A Pangalis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece.,Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Phivi Rondogianni
- Department of Nuclear Medicine and PET/CT, Evangelismos General Hospital, Athens, Greece
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Sevdali E, Katsantoni E, Smulski CR, Moschovi M, Palassopoulou M, Kolokotsa EN, Argentou N, Giannakoulas N, Adamaki M, Vassilopoulos G, Polychronopoulou S, Germenis AE, Eibel H, Speletas M. BAFF/APRIL System Is Functional in B-Cell Acute Lymphoblastic Leukemia in a Disease Subtype Manner. Front Oncol 2019; 9:594. [PMID: 31380267 PMCID: PMC6657364 DOI: 10.3389/fonc.2019.00594] [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: 11/26/2018] [Accepted: 06/17/2019] [Indexed: 11/13/2022] Open
Abstract
BAFF, APRIL and their receptors regulate the survival, maturation and homeostasis of mature B-cells. Despite the lack of a functional role of BAFF/APRIL system during normal early B-cell development, previous studies indicated a contribution of these molecules in the pathogenesis of B-lineage acute lymphoblastic leukemia (B-ALL). Here, we evaluated the expression of this system in B-ALL and its involvement in spontaneous and drug-induced apoptosis of B-lymphoblasts, taking into consideration the distinct disease subtypes. We found that BAFFR is the most predominant aberrantly expressed receptor in B-ALL and that its expression, along with BCMA and APRIL, positively correlates with the maturation stage of B-lymphoblasts. Moreover, the binding of the E2A-PBX1 chimeric protein to the BAFFR promoter suggests that the transcriptional activator promotes the increase in BAFFR expression observed in about 50% of pre-B-ALL patients carrying the t (1, 19) translocation. BAFF binding to BAFFR led to the processing of NF-κB2 p100 in pre-B ALL cells suggesting that BAFFR can activate the NF-κB2 pathway in pre-B ALL cells. Surprisingly, we found that BAFF treatment promotes the cell death of primary BCR-ABL+ BAFFR+ pre-B-lymphoblasts in adult B-ALL. It also enhances glucocorticoid-induced apoptosis in the E2A-PBX1+ pre-B-ALL cell line 697. These data suggest that BAFF/BAFFR signaling in B-ALL cells differs from normal B cells and that it may affect the pathogenesis of the disease.
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Affiliation(s)
- Eirini Sevdali
- Department of Immunology and Histocompatibility, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni Katsantoni
- Basic Research Center, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Cristian R Smulski
- Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Maria Moschovi
- Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Maria Palassopoulou
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni-Nefeli Kolokotsa
- Department of Immunology and Histocompatibility, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Nikoletta Argentou
- Department of Immunology and Histocompatibility, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Nikolaos Giannakoulas
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Adamaki
- Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Georgios Vassilopoulos
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology/Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Anastasios E Germenis
- Department of Immunology and Histocompatibility, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Hermann Eibel
- Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Matthaios Speletas
- Department of Immunology and Histocompatibility, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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9
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Angelopoulou MK, Vassilakopoulos TP, Batsis I, Sakellari I, Gkirkas K, Pappa V, Giannoulia P, Apostolidis I, Apostolopoulos C, Roussou P, Panayiotidis P, Dimou M, Kyrtsonis M, Palassopoulou M, Vassilopoulos G, Moschogiannis M, Kalpadakis C, Margaritis D, Spyridonidis A, Michalis E, Anargyrou K, Repousis P, Hatzimichael E, Bousiou Z, Poulakidas E, Grentzelias D, Harhalakis N, Pangalis GA, Anagnostopoulos A, Tsirigotis P. Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma. The Hellenic experience. Hematol Oncol 2018; 36:174-181. [PMID: 28219112 PMCID: PMC5836920 DOI: 10.1002/hon.2383] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/02/2016] [Accepted: 12/09/2016] [Indexed: 01/24/2023]
Abstract
This retrospective study aimed to describe the Hellenic experience on the use of brentuximab vedotin (BV) in relapsed/refractory (R/R) Hodgkin lymphoma (HL) given within its indication. From June 2011 to April 2015, ninety-five patients with R/R HL, who received BV in 20 centers from Greece, were analyzed. Their median age was 33 years, and 62% were males. Sixty-seven patients received BV after autologous stem cell transplantation failure, whereas 28 patients were treated with BV without a prior autologous stem cell transplantation, due to advanced age/comorbidities or chemorefractory disease. The median number of prior treatments was 4 and 44% of the patients were refractory to their most recent therapy. The median number of BV cycles was 8 (range, 2-16), and the median time to best response was the fourth cycle. Fifty-seven patients achieved an objective response: twenty-two (23%), a complete response (CR), and 35 patients (37%), a partial, for an overall response rate of 60%. Twelve patients (13%) had stable disease, and the remaining twenty-six (27%) had progressive disease as their best response. At a median follow-up of 11.5 months, median progression-free survival and overall survival were 8 and 26.5 months, respectively. Multivariate analysis showed that chemosensitivity to treatment administered before BV was associated with a significantly increased probability of achieving response to BV (P = .005). Bulky disease (P = .01) and response to BV (P <.001) were significant for progression-free survival, while refractoriness to most recent treatment (P = .04), bulky disease (P = .005), and B-symptoms (P = .001) were unfavorable factors for overall survival. Among the 22 CRs, 5 remain in CR with no further treatment after BV at a median follow-up of 13 months. In conclusion, our data indicate that BV is an effective treatment for R/R HL patients even outside clinical trials. Whether BV can cure a fraction of patients remains to be seen.
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Affiliation(s)
- Maria K. Angelopoulou
- Department of Hematology, Laikon General HospitalNational and Kapodistrian University of AthensAthensGreece
| | | | - Ioannis Batsis
- Hematology and Bone Marrow Transplantation DepartmentGeneral Hospital of Thessaloniki PapanikolaouThessalonikiGreece
| | - Ioanna Sakellari
- Hematology and Bone Marrow Transplantation DepartmentGeneral Hospital of Thessaloniki PapanikolaouThessalonikiGreece
| | - Konstantinos Gkirkas
- 2nd Department of Internal Medicine, Faculty of Medicine, ATTIKON General University HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Vasiliki Pappa
- 2nd Department of Internal Medicine, Faculty of Medicine, ATTIKON General University HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | | | | | - Christos Apostolopoulos
- Third Department of Medicine, “Sotiria” General Hospital of Thoracic Diseases, Hematology UnitNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Paraskevi Roussou
- Third Department of Medicine, “Sotiria” General Hospital of Thoracic Diseases, Hematology UnitNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Panayiotis Panayiotidis
- 1st Department of Propedeutic Internal Medicine, Laikon General HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Maria Dimou
- 1st Department of Propedeutic Internal Medicine, Laikon General HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Marie‐Christine Kyrtsonis
- 1st Department of Propedeutic Internal Medicine, Laikon General HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Maria Palassopoulou
- Department of Hematology, Larissa University HospitalUniversity of ThessaliaLarissaGreece
| | - Georgios Vassilopoulos
- Department of Hematology, Larissa University HospitalUniversity of ThessaliaLarissaGreece
| | | | - Christina Kalpadakis
- Department of Hematology, Heraklion University HospitalUniversity of CreteHeraklionGreece
| | - Dimitrios Margaritis
- Department of HematologyDemocritus University of Thrace Medical SchoolAlexandroupolisGreece
| | | | - Eurydiki Michalis
- Department of Clinical Hematology“G.Gennimatas” Athens General HospitalAthensGreece
| | | | | | | | - Zoi Bousiou
- Hematology and Bone Marrow Transplantation DepartmentGeneral Hospital of Thessaloniki PapanikolaouThessalonikiGreece
| | - Elias Poulakidas
- Department of Hematology401 Military Hospital of AthensAthensGreece
| | | | | | - Gerassimos A. Pangalis
- Department of HematologyDemocritus University of Thrace Medical SchoolAlexandroupolisGreece
| | - Achilles Anagnostopoulos
- Hematology and Bone Marrow Transplantation DepartmentGeneral Hospital of Thessaloniki PapanikolaouThessalonikiGreece
| | - Panagiotis Tsirigotis
- 2nd Department of Internal Medicine, Faculty of Medicine, ATTIKON General University HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
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Bouliaris K, Christodoulidis G, Koukoulis G, Mamaloudis I, Ioannou M, Bouronikou E, Palassopoulou M, Tepetes K. A primary hepatic lymphoma treated with liver resection and chemotherapy. Case Rep Surg 2014; 2014:749509. [PMID: 25165610 PMCID: PMC4137734 DOI: 10.1155/2014/749509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 05/04/2014] [Revised: 07/12/2014] [Accepted: 07/13/2014] [Indexed: 11/17/2022] Open
Abstract
Primary hepatic lymphoma (PHL) is a rare malignancy, which is frequently misdiagnosed. Although chemotherapy is the treatment of choice there are reports that a combination of surgery and adjuvant chemotherapy can offer better results. Herein we present an interesting case of a large primary non-Hodgkin lymphoma originating from liver was treated with a liver which resection and chemotherapy.
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Affiliation(s)
- Konstantinos Bouliaris
- Surgical Department, University Hospital of Larissa, 41335 Mezourlo, Larissa, Thessaly, Greece
| | | | - Georgios Koukoulis
- Surgical Department, University Hospital of Larissa, 41335 Mezourlo, Larissa, Thessaly, Greece
| | - Ioannis Mamaloudis
- Surgical Department, University Hospital of Larissa, 41335 Mezourlo, Larissa, Thessaly, Greece
| | - Maria Ioannou
- Pathology Department, University Hospital of Larissa, 41335 Mezourlo, Larissa, Thessaly, Greece
| | - Eleni Bouronikou
- Hematology Department, University Hospital of Larissa, 41335 Mezourlo, Larissa, Thessaly, Greece
| | - Maria Palassopoulou
- Hematology Department, University Hospital of Larissa, 41335 Mezourlo, Larissa, Thessaly, Greece
| | - Konstantinos Tepetes
- Surgical Department, University Hospital of Larissa, 41335 Mezourlo, Larissa, Thessaly, Greece
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Bouronikou E, Georgoulias P, Giannakoulas N, Valotassiou V, Palassopoulou M, Vassilopoulos G, Papadoulis N, Matsouka P. Metabolism-related cytokine and hormone levels in the serum of patients with myelodysplastic syndromes. Acta Haematol 2013; 130:27-33. [PMID: 23392079 DOI: 10.1159/000345427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 10/23/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND A number of cytokines secreted from the bone marrow stromal cells and circulating hormones related to bone, adipose tissue and glucose metabolism might be involved in the pathogenesis of myelodysplastic syndromes (MDS). METHODS Serum levels of cytokines related to the metabolism of bone tissue [osteocalcin and parathyroid hormone (PTH)], adipose tissue (adiponectin, leptin and ghrelin) and glucose [insulin and insulin-like growth factor-1 (IGF-1)] were determined in 72 patients suffering from MDS, mostly of the low-risk group according to FAB classification, and 41 healthy individuals (controls). RESULTS Adiponectin and osteocalcin serum levels were significantly elevated in the MDS patients. Leptin, insulin and IGF-1 serum levels were reduced. No difference was found in the serum levels of PTH and ghrelin. Leptin levels were reversibly associated with patient blast count. CONCLUSION Increased serum levels of adiponectin and low levels of IGF-1 in MDS patients may counterbalance the increased rate of apoptosis in the pool of hematopoietic progenitors. Osteocalcin secreted by osteoblasts regulates the renewal and proliferation of hematopoietic stem cells. Hormones and cytokines either secreted by the cells of the bone marrow stroma or transferred by the microcirculation act on hematopoietic progenitors and may regulate their differentiation, apoptosis and proliferation rate in MDS.
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Affiliation(s)
- Eleni Bouronikou
- Department of Hematology, University Hospital of Larissa, Larissa, Greece
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12
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Giannakoulas NC, Terpos E, Palassopoulou M, Zolota V, Lampropoulou P, Symeonidis A, Matsouka P. Increased RANKL and IL-6 levels might result in high bone turnover in a case of a CD34+/CD117+/myeloperoxidase(+dim) acute myeloid leukemia presenting with severe hypercalcemia and lumbar spine fractures. Leuk Res 2011; 35:e188-9. [PMID: 21802729 DOI: 10.1016/j.leukres.2011.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/14/2011] [Accepted: 07/04/2011] [Indexed: 10/17/2022]
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13
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Koumati E, Palassopoulou M, Matsouka P, Polyzos A, Dalekos GN, Zachou K. Multiple autoimmune propensity and B-non-hodgkin lymphoma: cause or effect? Autoimmune Dis 2011; 2011:841325. [PMID: 21687651 PMCID: PMC3112510 DOI: 10.4061/2011/841325] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 03/01/2011] [Indexed: 11/24/2022] Open
Abstract
We report a case of multiple autoimmunity consisting of the presence of autoimmune haemolytic anaemia (AIHA), antimitochondrial antibodies (AMAs), and antiphospholipid antibodies (APLAbs) as the presenting manifestations of an extrahepatic B-non-Hodgkin lymphoma (B-NHL) in a 63-year-old woman. The patient presented with fatigue attributed to severe AIHA. Due to increased serum IgM and γ-GT levels, an investigation for AMA was performed, which proved positive with anti-M2 specificity. A prolongation of activated partial thromboplastin time (aPTT) led to the determination of APLAbs (lupus anticoagulant and other APLAbs) which were also positive. Bone marrow biopsy in combination with immmunohistochemical studies established the diagnosis of lymphoplasmacytic B-NHL. Ten months later, B-NHL was in remission while AMA and APLAbs were still positive. In conclusion, we documented the coexistence of multiple autoimmune reactions together with B-NHL highlighting the possible common pathogenetic pathways of the two entities.
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Affiliation(s)
- E Koumati
- Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Biopolis, Mezourlo, 41110 Larissa, Greece
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