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McComish JS, Slade CA, Buizen L, Paul SK, Chatelier JW, Unglik G, Nicholls KA, Spriggs K, Chan SS, Godsell J, Auyeung P, Tan ZH, DeLuca J, Patel M, Kuek LE, Tran Y, Kern JS, Scardamaglia L, Varigos GA, Juneja S, Grabek JA, Christie M, Mackay GA, Douglass JA. Randomized controlled trial of omalizumab in treatment-resistant systemic and cutaneous mastocytosis (ROAM). J Allergy Clin Immunol Pract 2023; 11:2248-2250.e3. [PMID: 37088371 DOI: 10.1016/j.jaip.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Affiliation(s)
| | - Charlotte A Slade
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Luke Buizen
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Melbourne EpiCentre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Sanjoy K Paul
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Melbourne EpiCentre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Josh W Chatelier
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Gary Unglik
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Kymble Spriggs
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha S Chan
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Walter and Eliza Hall Institute, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jack Godsell
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Priscilla Auyeung
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Zi Hao Tan
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Joseph DeLuca
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mittal Patel
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lin Eon Kuek
- Department of Biochemistry and Pharmacology, University of Melbourne, Melbourne, Victoria, Australia
| | - Yang Tran
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Johannes S Kern
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | | | - Graham A Mackay
- Department of Biochemistry and Pharmacology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jo A Douglass
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Walter and Eliza Hall Institute, Melbourne, Victoria, Australia; Melbourne EpiCentre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
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2
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Deepak GP, Juneja S, Wadehra A, Sandhu K, Walia BS. Pinch purpura; an acute presentation of systemic amyloidosis under general anaesthesia. Anaesth Rep 2023; 11:e12252. [PMID: 37869174 PMCID: PMC10589823 DOI: 10.1002/anr3.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- G. P. Deepak
- Department of Neuroanaesthesia and Critical CareMax Super Speciality HospitalDelhiIndia
| | - S. Juneja
- Department of Neuroanaesthesia and Critical CareMax Super Speciality HospitalDelhiIndia
| | - A. Wadehra
- Department of Neuroanaesthesia and Critical CareMax Super Speciality HospitalDelhiIndia
| | - K. Sandhu
- Department of Neuroanaesthesia and Critical CareMax Super Speciality HospitalDelhiIndia
| | - B. S. Walia
- Department of NeurosurgeryMax Super Speciality HospitalDelhiIndia
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3
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Nguyen PC, Shugg C, Juneja S. Dysplastic eosinophils erroneously counted as neutrophils in the automated analyser. Int J Lab Hematol 2023; 45:141-142. [PMID: 36716705 DOI: 10.1111/ijlh.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Phillip C Nguyen
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Clare Shugg
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Surender Juneja
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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4
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Nedumannil R, Leitinger E, Juneja S. Extreme Thrombocytosis in Refractory ITP Post-Splenectomy With Associated Fatal Thromboembolism. Clin Pathol 2022; 15:2632010X221083218. [PMID: 35284824 PMCID: PMC8905198 DOI: 10.1177/2632010x221083218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/01/2022] [Indexed: 12/31/2022]
Abstract
Thrombopoietin (TPO)-receptor agonists have heralded a paradigm shift in the treatment of refractory immune thrombocytopenia (ITP). Reactive thrombocytosis has been described as a secondary effect of such therapies. However, the phenomenon of extreme thrombocytosis with morphology mimicking a myeloproliferative neoplasm (MPN) followed by fatal thromboembolism is unusual in this setting. Caution is required in the diagnosis of refractory ITP as well as TPO-receptor agonist dosing in such cases.
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Affiliation(s)
- Rithin Nedumannil
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Emma Leitinger
- Department of Clinical Haematology, Monash Health, Clayton, VIC, Australia
| | - Surender Juneja
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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5
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Nedumannil R, Juneja S. Large granular lymphocytosis: A novel association with immunotherapy. Hematol Oncol 2021; 40:119-121. [PMID: 34713505 DOI: 10.1002/hon.2942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although reactive large granular lymphocytosis due to diverse etiologies is not an uncommon finding in clinical practice, isolated natural killer (NK)-cell lymphocytosis is unusual and its association with immunotherapy has not been described thus far. We provide a brief analysis of a patient with this unique hematological corollary of immunotherapy being increasingly used in the setting of both solid organ and hematological malignancies, and highlight this as an additional differential to consider in the diagnosis of large granular lymphocytosis. Also explored is the importance of recognizing and monitoring the potential hematological manifestations of experimental immunotherapies, as well as the possible implicated mechanisms of action. It is hypothesized that quantification of large granular lymphocytosis may potentially be used as a surrogate marker of therapeutic efficacy in this setting.
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Affiliation(s)
- Rithin Nedumannil
- Department of Haematopathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Surender Juneja
- Department of Haematopathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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6
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van de Berg SEJ, Pelzer PT, van der Land AJ, Abdrakhmanova E, Ozi AM, Arias M, Cook-Scalise S, Dravniece G, Gebhard A, Juneja S, Handayani R, Kappel D, Kimerling M, Koppelaar I, Malhotra S, Myrzaliev B, Nsa B, Sugiharto J, Engel N, Mulder C, van den Hof S. Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients. BMC Public Health 2021; 21:1404. [PMID: 34271884 PMCID: PMC8284025 DOI: 10.1186/s12889-021-11427-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND BPaL, a 6 month oral regimen composed of bedaquiline, pretomanid, and linezolid for treating extensively drug-resistant tuberculosis (XDR-TB) is a potential alternative for at least 20 months of individualized treatment regimens (ITR). The ITR has low tolerability, treatment adherence, and success rates, and hence to limit patient burden, loss to follow-up and the emergence of resistance it is essential to implement new DR-TB regimens. The objective of this study was to assess the acceptability, feasibility, and likelihood of implementing BPaL in Indonesia, Kyrgyzstan, and Nigeria. METHODS We conducted a concurrent mixed-methods study among a cross-section of health care workers, programmatic and laboratory stakeholders between May 2018 and May 2019. We conducted semi-structured interviews and focus group discussions to assess perceptions on acceptability and feasibility of implementing BPaL. We determined the proportions of a recoded 3-point Likert scale (acceptable; neutral; unacceptable), as well as the overall likelihood of implementing BPaL (likely; neutral; unlikely) that participants graded per regimen, pre-defined aspect and country. We analysed the qualitative results using a deductive framework analysis. RESULTS In total 188 stakeholders participated in this study: 63 from Kyrgyzstan, 51 from Indonesia, and 74 from Nigeria The majority were health care workers (110). Overall, 88% (146/166) of the stakeholders would likely implement BPaL once available. Overall acceptability for BPaL was high, especially patient friendliness was often rated as acceptable (93%, 124/133). In contrast, patient friendliness of the ITR was rated as acceptable by 45%. Stakeholders appreciated that BPaL would reduce workload and financial burden on the health care system. However, several stakeholders expressed concerns regarding BPaL safety (monitoring), long-term efficacy, and national regulatory requirements regarding introduction of the regimen. Stakeholders stressed the importance of addressing current health systems constraints as well, especially in treatment and safety monitoring systems. CONCLUSIONS Acceptability and feasibility of the BPaL regimen is high among TB stakeholders in Indonesia, Kyrgyzstan, and Nigeria. The majority is willing to start using BPaL as the standard of care for eligible patients despite country-specific health system constraints.
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Affiliation(s)
| | - P T Pelzer
- KNCV Tuberculosis foundation, The Hague, The Netherlands.
| | | | | | - A Muhammad Ozi
- National Tuberculosis and Leprosy control Program Nigeria, Mabushi, Nigeria
| | - M Arias
- KNCV Tuberculosis foundation, The Hague, The Netherlands
| | | | - G Dravniece
- KNCV Tuberculosis foundation, The Hague, The Netherlands
- PATH, Kyiv, Ukraine
| | - A Gebhard
- KNCV Tuberculosis foundation, The Hague, The Netherlands
| | | | - R Handayani
- National TB Program Indonesia, Jakarta, Indonesia
| | | | - M Kimerling
- KNCV Tuberculosis foundation, The Hague, The Netherlands
| | - I Koppelaar
- KNCV Tuberculosis foundation, The Hague, The Netherlands
| | | | - B Myrzaliev
- KNCV country office Kyrgyzstan, Bishkek, Kyrgyzstan
| | - B Nsa
- KNCV country office Nigeria, Abuja, Nigeria
| | | | - N Engel
- Maastricht University, Maastricht, The Netherlands
| | - C Mulder
- KNCV Tuberculosis foundation, The Hague, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - S van den Hof
- KNCV Tuberculosis foundation, The Hague, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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7
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Jayasekara H, MacInnis RJ, Juneja S, Bassett JK, Bruinsma F, Lynch BM, Hodge AM, Hopper JL, English DR, Giles GG, Milne RL. Smoking, alcohol consumption, body fatness, and risk of myelodysplastic syndromes: A prospective study. Leuk Res 2021; 109:106593. [PMID: 34237503 DOI: 10.1016/j.leukres.2021.106593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Harindra Jayasekara
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Robert J MacInnis
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia
| | - Surender Juneja
- Melbourne Health Pathology, Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia; Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Julie K Bassett
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia
| | - Allison M Hodge
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, 3168, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, 3168, Australia
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8
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Steinberg AG, Fox LC, Bender S, Batrouney A, Juneja S, Sirac C, Touchard G, Blombery P, Finlay MJ, Bridoux F, Barbour TD. Proliferative Glomerulonephritis With Fibrils, Monoclonal κ Light Chain, and C3 Deposits. Am J Kidney Dis 2021; 78:459-463. [PMID: 33774080 DOI: 10.1053/j.ajkd.2021.01.014] [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: 07/06/2020] [Accepted: 01/07/2021] [Indexed: 11/11/2022]
Abstract
There is increasing recognition of monoclonal gammopathy as a cause of proliferative glomerulonephritis (GN), including cases in which glomerular deposition of monoclonal immunoglobulin is demonstrated. Recently, proliferative GN with monoclonal immunoglobulin deposits (PGNMID) has incorporated a light chain variant of the disease (termed PGNMID-LC). Intriguingly, glomerular co-deposition of C3 is found in addition to monotypic light chain, implying complement activation via the alternative pathway (AP). We present a unique case of proliferative GN in a 42-year-old man who presented with nephrotic syndrome and was found to have κ light chain multiple myeloma. Immune staining of the glomerulus was positive only for κ light chain and C3, with the striking appearance of nonamyloid fibrils on electron microscopy. Following clonally targeted therapy for myeloma, the renal clinical abnormalities resolved completely. We present detailed molecular studies for light chain and complement and consider local mechanisms whereby monoclonal κ light chain fibrils may have triggered AP activation within the glomerulus.
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Affiliation(s)
- Adam G Steinberg
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Lucy C Fox
- Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Sebastien Bender
- Centre National de la Recherche Scientifique UMR CNRS 7276/INSERM U1262, Université de Limoges, Limoges, France
| | - Ahida Batrouney
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Surender Juneja
- Department of Hematology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Christophe Sirac
- Centre National de la Recherche Scientifique UMR CNRS 7276/INSERM U1262, Université de Limoges, Limoges, France
| | - Guy Touchard
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, CIC INSERM 1402, Centre de référence pour l'amylose AL et autres maladies par dépôt d'immunoglobulines monoclonales, CHU Poitiers, Poitiers, France
| | - Piers Blombery
- Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Moira J Finlay
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Frank Bridoux
- Centre National de la Recherche Scientifique UMR CNRS 7276/INSERM U1262, Université de Limoges, Limoges, France; Service de Néphrologie, Hémodialyse et Transplantation Rénale, CIC INSERM 1402, Centre de référence pour l'amylose AL et autres maladies par dépôt d'immunoglobulines monoclonales, CHU Poitiers, Poitiers, France
| | - Thomas D Barbour
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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9
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Nedumannil R, Sim S, Westerman D, Juneja S. Identification and quantitation of blasts in myeloid malignancies with marrow fibrosis or marrow hypoplasia and CD34 negativity. Pathology 2021; 53:795-798. [PMID: 33612271 DOI: 10.1016/j.pathol.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Rithin Nedumannil
- Department of Haematopathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.
| | - Shirlene Sim
- Department of Haematopathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - David Westerman
- Department of Haematopathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; University of Melbourne, Parkville, Vic, Australia
| | - Surender Juneja
- Department of Haematopathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; University of Melbourne, Parkville, Vic, Australia; Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Vic, Australia
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10
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Hong FS, Fox LC, Chai KL, Htun K, Clucas D, Morgan S, Cole-Sinclair MF, Juneja S. Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context. Intern Med J 2020; 49:850-854. [PMID: 30350441 DOI: 10.1111/imj.14147] [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: 07/08/2018] [Revised: 09/23/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone marrow biopsy (BMB) is an accepted investigation in fever of unknown origin (FUO) to uncover haematological malignancies, such as lymphoma, and sometimes infections. With the advance in imaging modalities, such as 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) to identify the focus of lymphoma, BMB may not contribute to the diagnosis when there are no other clinical features to suggest an underlying haematological disease. AIM To investigate the utility of BMB in determining the cause of FUO, when there are no other indications for BMB. METHODS Medical records of adult patients who had BMB performed for FUO or febrile illness from 1 January 2005 to 31 December 2014 in four metropolitan tertiary hospitals in Melbourne, Australia were reviewed. Patients with other concurrent indications for BMB, known human immunodeficiency virus infection and previously diagnosed connective tissue diseases were excluded. RESULTS Seventy-three patients were included in the study. Fifty-one patients had a final diagnosis for fever (systemic inflammatory diseases, infective, malignancy or other) while 22 patients had no diagnoses. In only 10 patients (13.7%) did BMB contribute to the diagnosis, finding either malignancy or granulomata. However, all these diagnoses could have been made without BMB. Two patients with diffuse large B-cell lymphoma had normal BMB. FDG-PET was helpful in making a diagnosis in eight (25%) out of 32 patients. CONCLUSION Performing BMB in patients with FUO and no other haematological abnormalities is of very limited value, and other investigations, such as FDG-PET, may be more likely to help establish a definitive diagnosis.
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Affiliation(s)
- Frank S Hong
- Department of Laboratory Haematology, Austin Health, Victoria, Australia
| | - Lucy C Fox
- Department of Laboratory Haematology, Austin Health, Victoria, Australia
| | - Khai Li Chai
- Laboratory Haematology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Kay Htun
- Laboratory Haematology, Alfred Health, Victoria, Australia
| | - Danielle Clucas
- Diagnostic Haematology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Susan Morgan
- Laboratory Haematology, Alfred Health, Victoria, Australia
| | | | - Surender Juneja
- Diagnostic Haematology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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11
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Maqbool MG, Tam CS, Morison IM, Simpson D, Mollee P, Schneider H, Chan H, Juneja S, Harvey Y, Nath L, Hissaria P, Prince HM, Wordsworth H, Opat S, Talaulikar D. A practical guide to laboratory investigations at diagnosis and follow up in Waldenström macroglobulinaemia: recommendations from the Medical and Scientific Advisory Group, Myeloma Australia, the Pathology Sub-committee of the Lymphoma and Related Diseases Registry and the Australasian Association of Clinical Biochemists Monoclonal Gammopathy Working Group. Pathology 2020; 52:167-178. [PMID: 31902622 DOI: 10.1016/j.pathol.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/26/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 01/30/2023]
Abstract
Waldenström macroglobulinaemia (WM) is an indolent non-Hodgkin lymphoma which usually presents with symptoms related to infiltration of bone marrow or other tissues like lymph nodes, liver or spleen and has certain unusual clinical manifestations, e.g., renal and central nervous system (CNS) involvement. It also has an array of laboratory features including hypersecretion of IgM, cryoglobulinaemia, increased plasma viscosity and identification of mutated MYD88L265P in more than 90% of cases. In this review, we aim to provide a guide to the laboratory investigations recommended for WM at initial diagnosis and at follow-up. A discussion on the nuances of diagnosis and differential diagnoses is followed by bone marrow (BM) assessment, measurement of paraprotein and other ancillary investigations. Recommendations are provided on laboratory work-up at diagnosis, in the asymptomatic follow-up phase, and during and post-treatment. Finally, we briefly discuss the implications of laboratory diagnosis in regard to recruitment and monitoring on clinical trials.
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Affiliation(s)
- M Gohar Maqbool
- Department of Haematology, ACT Pathology, Canberra Hospital, ACT, Australia; ANU Medical School, College of Medicine and Health, Australian National University, Canberra, ACT, Australia
| | - Constantine S Tam
- Peter MacCallum Cancer Center, St Vincent's Hospital and University of Melbourne, Melbourne, Vic, Australia
| | - Ian M Morison
- Southern Community Laboratories, Dunedin, New Zealand; Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia
| | - David Simpson
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Medical and Scientific Advisory Group, Myeloma Australia
| | - Peter Mollee
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Medical and Scientific Advisory Group, Myeloma Australia; Department of Haematology, Princess Alexandra Hospital and University of Queensland Medical School, Brisbane, Qld, Australia
| | - Hans Schneider
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Alfred Pathology Service and Monash University, Melbourne, Vic, Australia
| | - Henry Chan
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Medical and Scientific Advisory Group, Myeloma Australia
| | - Surender Juneja
- Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia
| | - Yasmin Harvey
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Lakshmi Nath
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Department of Haematology and Transfusion Medicine, Clinpath Pathology, Adelaide, SA, Australia
| | - Pravin Hissaria
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Royal Adelaide Hospital, University of Adelaide and SA Pathology, Adelaide, SA, Australia
| | - H Miles Prince
- Medical and Scientific Advisory Group, Myeloma Australia; Epworth Healthcare, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Vic, Australia
| | - Helen Wordsworth
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Stephen Opat
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Department of Haematology, Monash Health, Melbourne, Vic, Australia
| | - Dipti Talaulikar
- Department of Haematology, ACT Pathology, Canberra Hospital, ACT, Australia; ANU Medical School, College of Medicine and Health, Australian National University, Canberra, ACT, Australia; Medical and Scientific Advisory Group, Myeloma Australia; Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia.
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12
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Handunnetti S, Lew T, Lin V, Anderson M, Carney D, Wolf M, Came N, Juneja S, Westerman D, Tam C, Roberts A, Seymour J. AN UNDETECTABLE PB MRD STATUS SHOULD BE THE THERAPEUTIC GOAL WITH VENETOCLAX THERAPY IN RELAPSED/ REFRACTORY CLL. Hematol Oncol 2019. [DOI: 10.1002/hon.70_2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- S.M. Handunnetti
- Department of Hematology; Peter MacCallum Cancer Centre and Royal Melbourne Hospital; Melbourne Australia
| | - T.E. Lew
- Blood Cells and Blood Cancers; Walter and Eliza Hall Institute of Medical Research; Melbourne Australia
| | - V.S. Lin
- Blood Cells and Blood Cancers; Walter and Eliza Hall Institute of Medical Research; Melbourne Australia
| | - M.A. Anderson
- Blood Cells and Blood Cancers; Walter and Eliza Hall Institute of Medical Research; Melbourne Australia
| | - D. Carney
- Department of Hematology; Peter MacCallum Cancer Centre and Royal Melbourne Hospital; Melbourne Australia
| | - M. Wolf
- Department of Hematology; Peter MacCallum Cancer Centre and Royal Melbourne Hospital; Melbourne Australia
| | - N. Came
- Department of Hematology; Peter MacCallum Cancer Centre and Royal Melbourne Hospital; Melbourne Australia
| | - S. Juneja
- Department of Hematology; Peter MacCallum Cancer Centre and Royal Melbourne Hospital; Melbourne Australia
| | - D. Westerman
- Department of Hematology; Peter MacCallum Cancer Centre and Royal Melbourne Hospital; Melbourne Australia
| | - C.S. Tam
- Department of Hematology; Peter MacCallum Cancer Centre and Royal Melbourne Hospital; Melbourne Australia
| | - A.W. Roberts
- Blood Cells and Blood Cancers; Walter and Eliza Hall Institute of Medical Research; Melbourne Australia
| | - J.F. Seymour
- Department of Hematology; Peter MacCallum Cancer Centre and Royal Melbourne Hospital; Melbourne Australia
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13
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Asha Madhavan A, Juneja S, Sen P, Ghosh Moulick R, Bhattacharya J. Gold Nanoparticle-Based Detection of Low Molecular Weight AGEs from In Vitro Glycated Haemoglobin A0 Samples. Nanoscale Res Lett 2018; 13:390. [PMID: 30511188 PMCID: PMC6277258 DOI: 10.1186/s11671-018-2812-y] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
Protein glycation is a major biochemical event that takes place in the plasma of diabetic patients due to increased sugar levels. Extensive glycation leads to the formation of advanced glycation end products (AGEs) that is well known for having detrimental effects on diabetic patients. In the current work, we have glycated the physiologically important protein Haemoglobin A0 in vitro to study AGE formation and activity by using them as a template for gold nanoparticle (GNPs) synthesis. It was found that the surface plasmon resonance of synthesised GNPs showed high correlation with the extent of glycation. On fractionation, the glycated Haemoglobin A0 segregated into two distinct population of products, one consisting of proteinaceous, cross-linked larger fragments of Haemoglobin A0 and a second population of non-proteinaceous low molecular weight AGEs. Only low molecular weight AGEs contributed to synthesis of GNPs upon using the fractions as a template, substantiating the principle of proposed GNP-based assay. Owing to its physiological importance, AGEs can be used as a diagnostic means for diabetes and its associated complications. In this study, we have employed the high reactivity of AGEs for the development of a GNP-based novel colorimetric sensor to enable their detection. Our proposed GNP-based sensing could have high clinical significance in detecting diabetes and its associated complexities.
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Affiliation(s)
- A. Asha Madhavan
- School of Biotechnology, Jawaharlal Nehru University, New Mehrauli Road, New Delhi, 110067 India
| | - S. Juneja
- School of Biotechnology, Jawaharlal Nehru University, New Mehrauli Road, New Delhi, 110067 India
| | - P. Sen
- School of Physical Sciences, Jawaharlal Nehru University, New Mehrauli Road, New Delhi, 110067 India
| | - R. Ghosh Moulick
- Amity Institute of Integrative sciences and Health, Amity University Gurgaon, Manesar, Haryana 122413 India
| | - J. Bhattacharya
- School of Biotechnology, Jawaharlal Nehru University, New Mehrauli Road, New Delhi, 110067 India
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14
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Chua CC, Omerod A, Wight J, Juneja S, Zantomio D. Correlation of mutation status and morphological changes in essential thrombocythaemia and myelofibrosis. Pathology 2018; 50:671-674. [PMID: 30097170 DOI: 10.1016/j.pathol.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Chong Chyn Chua
- Department of Laboratory Haematology, Austin Pathology, Vic, Australia.
| | - Amanda Omerod
- Department of Laboratory Haematology, Royal Melbourne Hospital, Vic, Australia
| | - Joel Wight
- Clinical Haematology, Austin Health, Vic, Australia
| | - Surender Juneja
- Department of Laboratory Haematology, Royal Melbourne Hospital, Vic, Australia
| | - Daniela Zantomio
- Department of Laboratory Haematology, Austin Pathology, Vic, Australia; Clinical Haematology, Austin Health, Vic, Australia
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15
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Butler LA, Juneja S. Intrasinusoidal pattern of bone marrow infiltration by hepatosplenic T-cell lymphoma. Clin Case Rep 2018; 6:756-757. [PMID: 29636955 PMCID: PMC5889222 DOI: 10.1002/ccr3.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/10/2018] [Accepted: 01/18/2018] [Indexed: 12/02/2022] Open
Abstract
Hepatosplenic T‐cell lymphoma is a rare, aggressive form of extranodal lymphoma, which frequently involves the bone marrow. An intrasinusoidal pattern of infiltration is characteristic of the disease and is often best appreciated on immunohistochemical staining. Bone marrow biopsy can be a useful diagnostic tool.
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Affiliation(s)
- Liesl Ann Butler
- Victorian Comprehensive Cancer Centre 305 Grattan Street Melbourne Victoria 3000 Australia.,Peter MacCallum Cancer Centre 305 Grattan Street Melbourne Victoria 3000 Australia
| | - Surender Juneja
- Victorian Comprehensive Cancer Centre 305 Grattan Street Melbourne Victoria 3000 Australia.,Peter MacCallum Cancer Centre 305 Grattan Street Melbourne Victoria 3000 Australia.,Royal Melbourne Hospital 300 Grattan Street Parkville Victoria 3050 Australia.,Department of Pathology University of Melbourne Building 181, Grattan Street Parkville Victoria 3052 Australia
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16
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Juneja S, Westerman D. Changing role of bone marrow examination in the diagnosis of hematological malignancies. Leuk Lymphoma 2018; 59:2018-2020. [PMID: 29431563 DOI: 10.1080/10428194.2018.1430798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Surender Juneja
- a Department of Haematology , The Royal Melbourne Hospital , Melbourne , Australia.,b Peter MaCallum Cancer Centre , Melbourne , Australia.,c Department of Pathology , University of Melbourne , Melbourne , Australia
| | - David Westerman
- b Peter MaCallum Cancer Centre , Melbourne , Australia.,c Department of Pathology , University of Melbourne , Melbourne , Australia
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17
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Rowsell L, Lade S, Kumar B, Juneja S, Morey A, Jain S, Kearney D, Ellis D, Nath L, Jessup P, Young E, Hitchins S, Lee K, Brown C, Leslie C, Parry J, Birch S, Norris D, Harvey Y, McQuilten Z, Wood E, Opat S, Talaulikar D. A national pathology review committee for the lymphoma and related diseases registry. Pathology 2018. [DOI: 10.1016/j.pathol.2017.12.302] [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: 11/15/2022]
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18
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Jayasekara H, Juneja S, Hodge AM, Room R, Milne RL, Hopper JL, English DR, Giles GG, MacInnis RJ. Lifetime alcohol intake and risk of non‐Hodgkin lymphoma: Findings from the Melbourne Collaborative Cohort Study. Int J Cancer 2017; 142:919-926. [PMID: 29055104 DOI: 10.1002/ijc.31123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/14/2017] [Accepted: 10/12/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Harindra Jayasekara
- Cancer Epidemiology & Intelligence DivisionCancer Council Victoria, 615 St Kilda RoadMelbourne VIC3004 Australia
- Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of PathologyThe University of MelbourneMelbourne VIC3010 Australia
- Centre for Alcohol Policy Research, La Trobe University, 215 Franklin StreetMelbourne VIC3000 Australia
| | - Surender Juneja
- Department of HaematologyMelbourne Health Pathology, Royal Melbourne HospitalMelbourne VIC3000 Australia
| | - Allison M. Hodge
- Cancer Epidemiology & Intelligence DivisionCancer Council Victoria, 615 St Kilda RoadMelbourne VIC3004 Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of Melbourne, 207 Bouverie StreetMelbourne VIC3010 Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, 215 Franklin StreetMelbourne VIC3000 Australia
- Centre for Health Equity, Melbourne School of Population and Global HealthThe University of Melbourne, 207 Bouverie StreetCarlton VIC3010 Australia
- Centre for Social Research on Alcohol and Drugs, Stockholm UniversityStockholm SE‐106 91 Sweden
| | - Roger L. Milne
- Cancer Epidemiology & Intelligence DivisionCancer Council Victoria, 615 St Kilda RoadMelbourne VIC3004 Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of Melbourne, 207 Bouverie StreetMelbourne VIC3010 Australia
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of Melbourne, 207 Bouverie StreetMelbourne VIC3010 Australia
| | - Dallas R. English
- Cancer Epidemiology & Intelligence DivisionCancer Council Victoria, 615 St Kilda RoadMelbourne VIC3004 Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of Melbourne, 207 Bouverie StreetMelbourne VIC3010 Australia
| | - Graham G. Giles
- Cancer Epidemiology & Intelligence DivisionCancer Council Victoria, 615 St Kilda RoadMelbourne VIC3004 Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of Melbourne, 207 Bouverie StreetMelbourne VIC3010 Australia
| | - Robert J. MacInnis
- Cancer Epidemiology & Intelligence DivisionCancer Council Victoria, 615 St Kilda RoadMelbourne VIC3004 Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of Melbourne, 207 Bouverie StreetMelbourne VIC3010 Australia
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19
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Affiliation(s)
- Surender Juneja
- Diagnostic Haematology, Royal Melbourne Hospital; Parkville Vic Australia
- University of Melbourne; Parkville Vic Australia
| | - Eric Wong
- University of Melbourne; Parkville Vic Australia
- Clinical Haematology and Bone Marrow Transplantation; Royal Melbourne Hospital; Parkville Vic Australia
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20
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Brotchie J, Chapple P, Came N, Liew D, Juneja S. Reference ranges of peripheral blood lymphoid subsets by 10-colour flow cytometry based on 69 healthy adults from Australia. Pathology 2016; 48:631-4. [PMID: 27596237 DOI: 10.1016/j.pathol.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/05/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
Affiliation(s)
- J Brotchie
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Australia.
| | - P Chapple
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Australia
| | - N Came
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Australia
| | - D Liew
- Department of Clinical Outcomes Research, Monash University, Melbourne, Vic, Australia
| | - S Juneja
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Australia
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21
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Abstract
Consider a circle with perimeter N > 1 on which k < N segments of length 1 are sampled in an independent and identically distributed manner. In this paper we study the probability π (k,N) that these k segments do not overlap; the density φ(·) of the position of the disks on the circle is arbitrary (that is, it is not necessarily assumed uniform). Two scaling regimes are considered. In the first we set k≡ a√N, and it turns out that the probability of interest converges (N→ ∞) to an explicitly given positive constant that reflects the impact of the density φ(·). In the other regime k scales as aN, and the nonoverlap probability decays essentially exponentially; we give the associated decay rate as the solution to a variational problem. Several additional ramifications are presented.
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22
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Came N, Westerman D, Juneja S. The denominator variable in the quantitation of MRD in acute myeloid leukemia. Am J Hematol 2015; 90:E213-5. [PMID: 26251233 DOI: 10.1002/ajh.24142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/28/2015] [Accepted: 08/03/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Neil Came
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Diagnostic Haematology, the Royal Melbourne Hospital, Parkville, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - David Westerman
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Surender Juneja
- Diagnostic Haematology, the Royal Melbourne Hospital, Parkville, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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23
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Agarwal R, Lade S, Liew D, Rogers TM, Byrne D, Feleppa F, Juneja S, Westerman DA. Role of immunohistochemistry in the era of genetic testing inMYC-positive aggressive B-cell lymphomas: a study of 209 cases. J Clin Pathol 2015; 69:266-70. [DOI: 10.1136/jclinpath-2015-203002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/04/2015] [Indexed: 12/12/2022]
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24
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Wong E, Ling V, Westerman D, Morgan S, Juneja S. How unique is pure erythroid leukaemia? A retrospective analysis of seven cases and review of the literature. J Clin Pathol 2015; 68:301-5. [PMID: 25609576 DOI: 10.1136/jclinpath-2014-202740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Pure erythroid leukaemia (PEL) is a rare subtype of acute myeloid leukaemia (AML) and its clinicopathological features are not well-defined. The aim of this study was to describe the immunophenotypic, cytogenetic and clinical features of PEL and to compare these with cases of AML with ≥ 50% erythroblasts. METHODS Cases of PEL according to WHO morphological criteria diagnosed at three institutions from 1997 to 2013 were included. A comparison cohort comprised of AML with ≥ 50% erythroblasts. The clinical, histopathology, immunophenotypic and cytogenetic features of cases were analysed. We also reviewed the existing literature on PEL, and combined our cohort with previously reported cases of PEL in a pooled analysis. RESULTS There were seven cases of PEL diagnosed at our institutions. There was a high incidence of either prior chemoradiotherapy exposure or evolution from pre-existing myelodysplastic syndrome (MDS) (71%). The leukaemic blasts frequently expressed glycophorin C (100%), CD117 (83%) and were myeloperoxidase negative (83%). Complex karyotypes were present in 83% of cases. Median overall survival was 2.9 months. Compared with AML with ≥ 50% erythroblasts, cases of PEL demonstrated a higher incidence of adverse-risk cytogenetics (p=0.01) and prior exposure to chemoradiotherapy (p=0.01). CONCLUSIONS PEL appears to be a unique entity that is often secondary or therapy related, commonly features a complex karyotype and has a poor prognosis. It is morphologically and immunophenotypically distinct from other cases of AML with erythroid hyperplasia.
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Affiliation(s)
- Eric Wong
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Victoria Ling
- Department of Diagnostic Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - David Westerman
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Morgan
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Surender Juneja
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Melbourne, Victoria, Australia University of Melbourne, Melbourne, Victoria, Australia
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25
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Juneja S, Chaitanya NB, Agarwal M. Immunohistochemical expression of Bcl-2 in oral epithelial dysplasia and oral squamous cell carcinoma. Indian J Cancer 2015; 52:505-10. [DOI: 10.4103/0019-509x.178411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Agarwal R, Chapple P, Brown M, Szer J, Juneja S. Analysis of abnormal clones by the fluorescent aerolysin method in paroxysmal nocturnal haemoglobinuria and other marrow disorders. Int J Lab Hematol 2014; 37:14-21. [PMID: 24702736 DOI: 10.1111/ijlh.12207] [Citation(s) in RCA: 10] [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: 08/16/2013] [Accepted: 02/10/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Flow cytometry is the most sensitive and specific diagnostic modality for the assessment of clone size in paroxysmal nocturnal haemoglobinuria (PNH) and other bone marrow failure states. In this study, we attempt to distinguish PNH from aplastic anaemia (AA) and myelodysplastic syndromes (MDS) associated with PNH clones at diagnosis by clone size, clinical and laboratory features. METHODS A total of 29 samples included 19 PNH cases and 10 AA/MDS cases with PNH clones. Flow cytometry was performed using fluorescent aerolysin (FLAER)-based assay and comparison of clinical features, laboratory parameters and PNH clone size was carried out at diagnosis. RESULTS The PNH clone size on granulocytes varied from 0.4% to 99.2% and correlated with the clone size on monocytes (r = 0.966; P < 0.001). Paroxysmal nocturnal haemoglobinuria clone size on granulocytes (median = 34.6%) and monocytes (median = 49.9%) was always larger than erythrocytes (median = 10.9%). The median clone size in PNH (median granulocytes = 74.9%, monocytes = 71.8%) was significantly greater than in AA/MDS associated with PNH clone (median granulocytes = 2.9%, monocytes = 6%). In PNH patients, a significant negative correlation was seen between PNH clone on monocytes and the haemoglobin concentration. CONCLUSION In our small study using the FLAER method, the clone size was >70% in majority of PNH cases. In other marrow disorders like AA/MDS, the clone size was usually <10%.
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Affiliation(s)
- R Agarwal
- Department of Diagnostic, Royal Melbourne Hospital, Parkville, Vic., Australia
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28
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Wong E, Juneja S. Myelodysplastic syndrome with ider(20q) and prominent emperipolesis. Ann Hematol 2013; 93:341-2. [DOI: 10.1007/s00277-013-1798-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
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29
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Affiliation(s)
- Edward Chew
- Royal Melbourne Hospital, Melbourne, VIC, Australia
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30
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Grigoriadis G, Gilbertson M, Came N, Westerman D, Fellepa F, Jene N, Chapple P, Juneja S. Is CD20 positive plasma cell myeloma a unique clinicopathological entity? A study of 40 cases and review of the literature. Pathology 2013; 44:552-6. [PMID: 22935987 DOI: 10.1097/pat.0b013e3283583f5d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS A number of clinicopathological features have been attributed to the CD20 positive subset of plasma cell myeloma (PCM). CD20 is an appealing therapeutic target given the success with monoclonal antibody regimens in a spectrum of B cell lymphomas. To date, a small number of reports have described CD20 PCM as a unique subset, and these are not conclusive, especially taking into consideration reporting bias. This study aims to further identify the clinicopathological features of CD20 PCM. METHODS A retrospective analysis of all newly diagnosed PCM between 2003 and 2010 was undertaken. Trephine material was retrieved and reviewed for CD20, and for positive cases an extended immunohistochemical (IHC) panel including cyclin D1 was subsequently performed. RESULTS The review of our 40 cases and those described in the literature demonstrated that these are heterogeneous with regard to clinical features, morphology, biochemical features, immunophenotype, and cytogenetics. CONCLUSION Based on our study and review of the literature, CD20 PCM cases represent a heterogeneous disease and not a unique clinicopathological entity.
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Affiliation(s)
- George Grigoriadis
- Department of Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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31
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Pasricha JM, Juneja S, Manitta J, Whitehead S, Maxwell E, Goh WK, Pasricha SR, Eisen DP. Is serial testing required to diagnose imported malaria in the era of rapid diagnostic tests? Am J Trop Med Hyg 2012. [PMID: 23208885 DOI: 10.4269/ajtmh.2012.11-0674] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Exclusion of malaria traditionally requires three negative serial thick and thin blood films. However, many clinical laboratories now routinely perform rapid diagnostic tests (RDTs) in addition to blood films when malaria is suspected. We sought to determine whether serial testing is necessary in this setting. We examined 388 cases of malaria diagnosed during 1999-2010 at three laboratories in Melbourne, Australia. For each case, we ascertained whether the diagnosis was made on initial or follow-up testing. Nine cases (3.5%) were diagnosed after a negative initial blood film and RDT: 7 Plasmodium vivax, 1 P. ovale, and 1 P. falciparum. Of four case-patients with P. vivax in which clinical data were available, all had recent exposure to antimalarial medication. Our data suggest that among patients who have not received recent anti-malarial therapy, and when RDTs are performed and blood films are prepared, most malaria diagnoses are made by using the first set of tests.
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Affiliation(s)
- Janet M Pasricha
- Victorian Infectious Diseases Service, and Diagnostic Haematology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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Chew E, Mason KD, Juneja S. Marked eosinophilia with abnormal basophilic granules in acute graft-versus-host disease post-allogeneic haemopoietic stem cell transplant for acute myeloid leukaemia without CBFB-MYH11 mutation. Eur J Haematol 2012; 90:175-6. [PMID: 23106290 DOI: 10.1111/ejh.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Edward Chew
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Juneja S. Optimising laboratory diagnostic and prognostic investigations in lymphoma. Pathology 2012. [DOI: 10.1016/s0031-3025(16)32681-2] [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: 11/29/2022]
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Blombery PA, Wong SQ, Hewitt CA, Dobrovic A, Maxwell EL, Juneja S, Grigoriadis G, Westerman DA. Detection of BRAF mutations in patients with hairy cell leukemia and related lymphoproliferative disorders. Haematologica 2011; 97:780-3. [PMID: 22133769 DOI: 10.3324/haematol.2011.054874] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hairy cell leukemia has been shown to be strongly associated with the BRAF V600E mutation. We screened 59 unenriched archived bone marrow aspirate and peripheral blood samples from 51 patients with hairy cell leukemia using high resolution melting analysis and confirmatory Sanger sequencing. The BRAF V600E mutation was detected in 38 samples (from 36 patients). The BRAF V600E mutation was detected in all samples with disease involvement above the limit of sensitivity of the techniques used. Thirty-three of 34 samples from other hematologic malignancies were negative for BRAF mutations. A BRAF K601E mutation was detected in a patient with splenic marginal zone lymphoma. Our data support the recent finding of a disease defining point mutation in hairy cell leukemia. Furthermore, high resolution melting with confirmatory Sanger sequencing are useful methods that can be employed in routine diagnostic laboratories to detect BRAF mutations in patients with hairy cell leukemia and related lymphoproliferative disorders.
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Affiliation(s)
- Piers A Blombery
- Peter MacCallum Cancer Centre, Division of Cancer Medicine, East Melbourne, Victoria, Australia
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35
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Cargo CA, Westerman DA, Gambell P, Juneja S, Szer J, Ritchie D. Flow-cytometric minimal residual disease monitoring for chronic lymphocytic leukemia in the post-allogeneic transplant period. Leuk Lymphoma 2011; 52:2185-7. [PMID: 21718135 DOI: 10.3109/10428194.2011.585530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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Unglik G, Juneja S, Chapel P, Varigos G, Bleasel K. Flow cytometry for systemic mastocytosis. Pathology 2011. [DOI: 10.1016/s0031-3025(16)33174-9] [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: 10/22/2022]
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37
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Chowdhary A, Randhawa HS, Khan ZU, Ahmad S, Juneja S, Sharma B, Roy P, Sundar G, Joseph L. First isolations in India of Candida nivariensis, a globally emerging opportunistic pathogen. Med Mycol 2010; 48:416-20. [PMID: 19626545 DOI: 10.1080/13693780903114231] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We randomly screened 363 yeast isolates during 2008 for their ability to form white colonies on CHROM agar Candida medium. Two of these isolates (0.5%) were identified as Candida nivariensis based on detailed phenotypic characterization and DNA sequencing. One was recovered from the sputum of an HIV-positive patient with a pneumonic lesion and the second from the blood of a diabetic with oropharyngeal lesions. Direct DNA sequencing of the D1/D2 region of 28S rRNA gene and/or the internal transcribed spacer (ITS) regions of rDNA confirmed that both of the isolates were C. nivariensis. The carbohydrate assimilation profiles with the ID 32 C and VITEK 2 yeast identification systems revealed only glucose assimilation. In vitro antifungal susceptibility profiles by broth microdilution and Etest methods revealed susceptibility of both isolates to fluconazole, itraconazole, voriconazole, amphotericin B and 5-flucytosine, with low MICs for posaconazole and caspofungin. These results document the occurrence of Candida nivariensis for the first time in India and focus on its potential as an opportunistic human pathogen.
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Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Underhill C, Koschel A, Szer J, Steer C, Clarke K, Grigg A, Juneja S, Stella D, Francis H, Josselyn K. Mentoring in the management of hematological malignancies. Asia Pac J Clin Oncol 2010; 6:28-34. [PMID: 20398035 DOI: 10.1111/j.1743-7563.2010.01274.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The Mentoring in Management of Haematological Malignancies (MMHM) project aimed to improve treatment outcomes, coordinate care and provide best practice for patients with hematological cancers, by developing a program of mentoring and multidisciplinary care between a regional and a metropolitan centre. METHODS A regular multidisciplinary meeting conducted by teleconference was established between a tertiary metropolitan site and a regional practice to discuss cases of patients with hematological malignancies. Information from multidisciplinary team meetings was recorded to capture adherence to process and clinician outcomes. An educational program was developed. A gap analysis was performed to identify differences in routine practice between the two centers. Clinician satisfaction with mentoring and educational interventions was assessed by structured survey. RESULTS The MMHM project developed a formal mentoring system to improve the management of patients by building on established links and developing an innovative model of web-based multidisciplinary care. The project established a novel multidisciplinary meeting between a metropolitan and regional site. Common treatment policies were adopted between the two sites. Development of an educational framework and mentoring for health-care professionals in regional areas was achieved by tutorials and workshops. Most participating clinicians indicated their high level of satisfaction with the mentoring project. CONCLUSION The MMHM project was a successful pilot of a mentoring program in hematological cancers between metropolitan and regional centers that resulted in improved referral links, facilitated better care coordination, updated treatment policies and guidelines and increased clinician satisfaction and knowledge.
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Chowdhary A, Randhawa HS, Khan ZU, Ahmad S, Juneja S, Sharma B, Roy P, Sundar G, Joseph L. First isolations in India ofCandida nivariensis, a globally emerging opportunistic pathogen. Med Mycol 2010. [DOI: 10.3109/13693780903114231] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jayasekara H, Karahalios A, Juneja S, Thursfield V, Farrugia H, English DR, Giles GG. Incidence and survival of lymphohematopoietic neoplasms according to the World Health Organization classification: a population-based study from the Victorian Cancer Registry in Australia. Leuk Lymphoma 2010; 51:456-68. [PMID: 20141433 DOI: 10.3109/10428190903552104] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brickwedel J, Vaid AK, Juneja S, Biswal S, Meharwal ZS, Saraf N, Reichenspurner H, Mishra YK. Coronary endarterectomy in off-pump coronary bypass grafting: angiographic midterm results. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246636] [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: 10/19/2022]
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Vaid AK, Brickwedel J, Juneja S, Biswal S, Reichenspurner H, Mishra YK. Late spontaneous leaflet embolisation of a St. Jude aortic prosthetic heart valve. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246743] [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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Affiliation(s)
- Anna Kalff
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Melbourne, Australia.
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Tam CS, Prince HM, Westerman D, Seymour JF, Juneja S. Leukaemic Subtype of Marginal Zone Lymphoma: A Presentation of Three Cases and Literature Review. Leuk Lymphoma 2009; 45:705-10. [PMID: 15160943 DOI: 10.1080/10428190310001615657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The recent World Health Organization (WHO) classification recognizes three subtypes of marginal zone lymphoma (MZL): extranodal MZL of mucosa-associated lymphoid tissue (MALT), splenic MZL and nodal MZL. As a group, MZL share morphological and immunophenotypic features similar to that of the marginal zone B-cell in secondary B-follicles, the postulated common cell of origin. There is, however, increasing information about molecular heterogeneity between the types of MZL, suggesting different aetiology and highlighting our current incomplete understanding of this evolving entity. We describe the presentation and clinical course of three patients with MZL who do not fit the currently recognized WHO categories, and best fit the putative category of MZL, leukaemic subtype. We review the current literature on this newly described entity, highlighting the importance of its recognition.
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Affiliation(s)
- Constantine S Tam
- Haematology Service, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia
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Saravanan L, Juneja S. Immunohistochemistry is a more sensitive marker for the detection of myeloperoxidase in acute myeloid leukemia compared with flow cytometry and cytochemistry. Int J Lab Hematol 2008; 32:e132-6. [PMID: 19077157 DOI: 10.1111/j.1751-553x.2008.01124.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Myeloperoxidase (MPO) is an unequivocal marker of myeloid differentiation which is routinely detected using cytochemistry (CC), flow cytometry (FC) and immunohistochemistry (IH). Several studies have compared the use of two of these methods, but to our knowledge none has compared all three techniques. We compared the performance of these three modalities in the detection of MPO in 158 cases of acute myeloid leukaemia (AML). Discrepancies were noted in a total of 28 cases. Of 110 cases in which all three modalities were performed, 23 cases showed discrepancies. CC was the least sensitive marker, being negative in 11 of 23 cases in the presence of positive IH and/or FC. IH was the most sensitive marker with only one case being negative in the presence of a positive result by FC and/or CC. The results highlight the necessity of employing more than one method in determining the presence of MPO and confirm the important role of IH in the diagnosis of AML particularly in cases where MPO is not detected by CC and FC.
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Affiliation(s)
- L Saravanan
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Victoria, Australia.
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Tan AYC, Westerman DA, Carney DA, Seymour JF, Juneja S, Dobrovic A. Detection of NPM1 exon 12 mutations and FLT3 - internal tandem duplications by high resolution melting analysis in normal karyotype acute myeloid leukemia. J Hematol Oncol 2008; 1:10. [PMID: 18664261 PMCID: PMC2517593 DOI: 10.1186/1756-8722-1-10] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [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: 05/20/2008] [Accepted: 07/29/2008] [Indexed: 12/28/2022] Open
Abstract
Background Molecular characterisation of normal karyotype acute myeloid leukemia (NK-AML) allows prognostic stratification and potentially can alter treatment choices and pathways. Approximately 45–60% of patients with NK-AML carry NPM1 gene mutations and are associated with a favourable clinical outcome when FLT3-internal tandem duplications (ITD) are absent. High resolution melting (HRM) is a novel screening method that enables rapid identification of mutation positive DNA samples. Results We developed HRM assays to detect NPM1 mutations and FLT3-ITD and tested diagnostic samples from 44 NK-AML patients. Eight were NPM1 mutation positive only, 4 were both NPM1 mutation and FLT3-ITD positive and 4 were FLT3-ITD positive only. A novel point mutation Y572C (c.1715A>G) in exon 14 of FLT3 was also detected. In the group with de novo NK-AML, 40% (12/29) were NPM1 mutation positive whereas NPM1 mutations were observed in 20% (3/15) of secondary NK-AML cases. Sequencing was performed and demonstrated 100% concordance with the HRM results. Conclusion HRM is a rapid and efficient method of screening NK-AML samples for both novel and known NPM1 and FLT3 mutations. NPM1 mutations can be observed in both primary and secondary NK-AML cases.
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Affiliation(s)
- Angela Y C Tan
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia.
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Haeusler M, Hogan C, Juneja S, Bartlett J, Suter A. New Transport System for Maintaining Temperature of Blood Products in Emergency Situations. Transfus Med 2008. [DOI: 10.1111/j.1365-3148.2005.00554s.x] [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: 12/01/2022]
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Affiliation(s)
- Kylie D Mason
- Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Melbourne, Australia
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Manoharan A, Reynolds J, Matthews J, Baxter H, Di Iulio J, Leahy M, Juneja S. Flexible low-intensity combination chemotherapy for elderly patients with acute myeloid leukaemia: a multicentre, phase II study. Drugs Aging 2007; 24:481-8. [PMID: 17571913 DOI: 10.2165/00002512-200724060-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a flexible low-intensity combination chemotherapy (FLICC) protocol in a multicentre, phase II study of elderly patients with acute myeloid leukaemia (AML). METHOD Twenty-five patients aged 61-78 years (median 70 years) with de novo (n = 17) or secondary (n = 8) AML (cytogenetic risk: favourable 2, intermediate 18, adverse 2, unknown 3) from eight Australian centres were enrolled. Treatment comprised mitoxantrone 6 mg/m(2) intravenously daily for 3 days, cytarabine 10mg/m(2) subcutaneously every 12 hours for 7-14 days and etoposide 100mg orally for 7-14 days. RESULTS The treatment was generally well tolerated, and 13 patients (52%) achieved a complete remission (CR). One patient achieved a partial remission but died on day 28 due to pneumonia. Five patients (20%) had no response, whilst six (24%) died on or before day 30 and so were not evaluable. The median overall survival (OS) was 6.5 months, and the median remission duration was 7.7 months. Estimated 1-year survival was 32%, but patients achieving CR had an estimated 1-year survival of 64%, whereas none in the non-CR group survived to 1 year. Two of the CR patients have survived beyond 2 years. OS was significantly shorter in the adverse cytogenetic risk group of patients compared with the favourable- and intermediate-risk groups, with the rates of death relative to the adverse group being 0.02 and 0.08 in the favourable- and intermediate-risk groups, respectively. There was no significant association between CR rate and pre-existing myelodysplasia or the presence of multilineage dysplasia. The median durations of significant neutropenia (<0.5 x 10(9)/L) and thrombocytopenia (<20 x10(9)/L) with the first course of treatment in the 19 evaluable patients were 19 days (range 12-26) and 11 days (range 1-25), respectively. The median duration of stay in the hospital was 27 days (range 14-42). These values were much shorter for the second course of treatment: 6 days, 5 days and 15 days, respectively. CONCLUSION The findings of this multicentre, phase II study validate the previously reported single-institution experience with the FLICC protocol in elderly patients with AML. The clinical outcome with this protocol is comparable to those reported with more aggressive anti-leukaemia protocols.
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