1
|
Rajner M, Jasiński M, Karakulska-Prystupiuk E, Ambroziak U, Jędrzejczak WW, Basak GW. The role of antithyroid antibodies in thyroid dysfunction after allogeneic hematopoietic stem cell transplantation. Pol Arch Intern Med 2023; 133:16588. [PMID: 37874246 DOI: 10.20452/pamw.16588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Affiliation(s)
- Magdalena Rajner
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Jasiński
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland; Doctoral School, Medical University of Warsaw, Warsaw, Poland.
| | - Ewa Karakulska-Prystupiuk
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Urszula Ambroziak
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Wiesław W Jędrzejczak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz W Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
2
|
Szczygieł JA, Michałek P, Truszkowska G, Drozd-Sokołowska J, Wróbel A, Franaszczyk M, Gawor-Prokopczyk M, Mazurkiewicz Ł, Ziarkiewicz M, Waszczuk-Gajda A, Legatowicz-Koprowska M, Walczak E, Stawiński P, Lutyńska A, Płoski R, Jędrzejczak WW, Bilińska ZT, Grzybowski J. Clinical features, etiology, and survival in patients with restrictive cardiomyopathy: A single-center experience. Kardiol Pol 2023; 81:1227-1236. [PMID: 37937352 DOI: 10.33963/v.kp.97879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Numerous prognostic factors have been proposed for cardiac amyloidosis (CA). The knowledge about other subtypes of restrictive cardiomyopathy (RCM) is scant. AIMS This study aimed to elucidate the etiology and prognostic factors of RCM as well as assess cardiac biomarkers: high-sensitive troponin T (hs-TnT), growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and soluble suppression of tumorigenicity 2, as mortality predictors in RCM. METHODS We enrolled 36 RCM patients in our tertiary cardiac department. All patients were screened for CA. Genetic testing was performed in 17 patients without CA. RESULTS Pathogenic or likely pathogenic gene variants were found in 86% of patients, including 5 novel variants. Twenty patients died, and 4 had a heart transplantation during the study. Median overall survival was 29 months (8-55). The univariate Cox models analysis indicated that systolic and diastolic blood pressure, GDF-15, hs-TnT, NT-proBNP, left ventricular stroke volume, the ratio of the transmitral early peak velocity (E) estimated by pulsed wave Doppler over the early mitral annulus velocity (e'), tricuspid annulus plane systolic excursion, early tricuspid valve annular systolic velocity, the presence of pulmonary hypertension, and pericardial effusion influenced survival (P <0.05). A worse prognosis was observed in patients with GDF-15 >1316 pg/ml, hs-TnT >42 ng/l, NT-proBNP >3383 pg/ml, and pericardial effusion >3.5 mm (Kaplan-Meier analysis, log-rank test, P <0.001). CONCLUSIONS Genetic testing should be considered in every RCM patient where light-chain amyloidosis has been excluded. Survival remains poor regardless of etiology. Increased concentrations of GDF-15, hs-TNT, NT-proBNP, and pericardial effusion are associated with worse prognosis. Further studies are warranted.
Collapse
Affiliation(s)
- Justyna A Szczygieł
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland.
| | - Piotr Michałek
- Rapid Diagnosis Department, National Institute of Cardiology, Warszawa, Poland
| | - Grażyna Truszkowska
- Department of Medical Biology, Molecular Biology Laboratory, National Institute of Cardiology, Warszawa, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Aleksandra Wróbel
- Department of Medical Biology, National Institute of Cardiology, Warszawa, Poland
| | - Maria Franaszczyk
- Department of Medical Biology, Molecular Biology Laboratory, National Institute of Cardiology, Warszawa, Poland
- Department of Medical Genetics, Medical University of Warsaw, Warszawa, Poland
| | | | - Łukasz Mazurkiewicz
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland
| | - Mateusz Ziarkiewicz
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Marta Legatowicz-Koprowska
- Department of Pathomorphology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warszawa, Poland
| | - Ewa Walczak
- Department of Pathomorphology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warszawa, Poland
| | - Piotr Stawiński
- Department of Medical Genetics, Medical University of Warsaw, Warszawa, Poland
| | - Anna Lutyńska
- Department of Medical Biology, Molecular Biology Laboratory, National Institute of Cardiology, Warszawa, Poland
- Department of Medical Biology, National Institute of Cardiology, Warszawa, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, Warszawa, Poland
| | - Wiesław W Jędrzejczak
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Zofia T Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland
| |
Collapse
|
3
|
Osmola M, Gierej B, Kłosowicz A, Waszczuk-Gajda A, Basak GW, Jędrzejczak WW, Jurczyszyn A, Ziarkiewicz-Wróblewska B. Leukaemia cutis for clinicians, a literature review. Postepy Dermatol Alergol 2021; 38:359-365. [PMID: 34377113 PMCID: PMC8330858 DOI: 10.5114/ada.2021.107923] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022] Open
Abstract
Leukaemia cutis (LC) describes infiltration of the skin by leukaemia cells, resulting in clinically identifiable cutaneous lesions. LC has a wide range of clinical manifestations, which can make it difficult to distinguish LC from other skin changes. In a group of patients, LC can be the first manifestation of leukaemia, therefore skin biopsy is crucial for the diagnosis. In this mini review, we discuss various types of leukaemia most frequently represented in leukaemia cutis, in both children and adults and skin changes in multiple myeloma, focusing on the clinical presentation of LC and prognosis in patients.
Collapse
Affiliation(s)
- Małgorzata Osmola
- Department of Haematology, Oncology and Internal Diseases, University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - Beata Gierej
- Department of Pathomorphology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Kłosowicz
- Department of Dermatology, University Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Diseases, University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz W. Basak
- Department of Haematology, Oncology and Internal Diseases, University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - Wiesław W. Jędrzejczak
- Department of Haematology, Oncology and Internal Diseases, University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - Artur Jurczyszyn
- Department of Haematology, Jagiellonian University Medical College, Krakow, Poland
| | | |
Collapse
|
4
|
Dimopoulos MA, Grosicki S, Jędrzejczak WW, Nahi H, Gruber A, Hansson M, Gupta N, Byrne C, Labotka R, Teng Z, Yang H, Grzasko N, Kumar S. All-oral ixazomib, cyclophosphamide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma. Eur J Cancer 2018; 106:89-98. [PMID: 30471652 DOI: 10.1016/j.ejca.2018.09.011] [Citation(s) in RCA: 10] [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] [Received: 06/27/2018] [Revised: 09/07/2018] [Accepted: 09/15/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Novel efficacious treatments with long-term tolerability are needed for transplant-ineligible, newly diagnosed multiple myeloma (NDMM) patients. This phase 2 study evaluated the safety and efficacy of all-oral ixazomib-cyclophosphamide-dexamethasone (ICd) followed by single-agent ixazomib maintenance. PATIENTS AND METHODS Patients were randomised (1:1) to receive 4.0 mg of ixazomib, 300 (Arm A) or 400 (Arm B) mg/m2 of cyclophosphamide (days 1, 8, and 15), and 40 mg of dexamethasone (days 1, 8, 15, and 22) as induction (up to 13 × 28-day cycles), followed by single-agent ixazomib maintenance (28-day cycles) until progressive disease, death, or unacceptable toxicity. Primary end-point was complete response (CR) + very good partial response (VGPR) rate for ICd induction. RESULTS Seventy patients were enrolled (n = 36 Arm A; n = 34 Arm B); median age was 73 years (range, 61-87). At data cut-off, 66% of patients had completed 13 induction cycles followed by ixazomib maintenance. Median overall treatment duration was 19 cycles (range, 1-29); 21% of patients discontinued treatment during induction and 3% during maintenance due to adverse events (AEs). During induction, among 67 response-evaluable patients, CR+VGPR rate was 25%, and overall response rate (ORR) was 73%. Including the maintenance phase, CR+VGPR rate was 33%, and ORR was 76%. Median progression-free survival was 23.5 months (median follow-up: 26.1 months). The most common all-grade AE was neutropenia (31%). Grade ≥3 AEs were reported by 73% of patients. Five on-study deaths occurred (not treatment-related). CONCLUSIONS ICd treatment followed by ixazomib maintenance is tolerable and active in elderly, transplant-ineligible NDMM patients. TRIAL REGISTRATION NUMBER NCT02046070.
Collapse
Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Sebastian Grosicki
- Department of Cancer Prevention, Silesian Medical University, Katowice, Poland.
| | - Wiesław W Jędrzejczak
- Department of Haematology and Oncology, Medical University of Warsaw, Warsaw, Poland.
| | - Hareth Nahi
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Astrid Gruber
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Markus Hansson
- Hematology Clinic, Skåne University Hospital, Lund, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.
| | - Neeraj Gupta
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Catriona Byrne
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Richard Labotka
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Zhaoyang Teng
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Huyuan Yang
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
| | - Norbert Grzasko
- Department of Haematology, St. John's Cancer Centre, Lublin, Poland; Department of Experimental Haemato-oncology, Medical University of Lublin, Lublin, Poland(1).
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
5
|
Waszczuk-Gajda A, Feliksbrot-Bratosiewicz M, Król M, Snarski E, Drozd-Sokołowska J, Biecek P, Król M, Lewandowski Z, Peradzyńska J, Jędrzejczak WW, Dwilewicz-Trojaczek J. Influence of Clonal Plasma Cell Contamination of Peripheral Blood Stem Cell Autografts on Progression and Survival in Multiple Myeloma Patients After Autologous Peripheral Blood Stem Cell Transplantation in Long-term Observation. Transplant Proc 2018; 50:2202-2211. [PMID: 30177137 DOI: 10.1016/j.transproceed.2018.02.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/19/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND High-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (auto-PBSCT) remains the mainstay of treatment of eligible patients diagnosed multiple myeloma. The role of clonal plasma cell (CPC) contamination was found as a reason for relapse, but results in terms of survival, progression, and purging were ambiguous. Therefore, the aim of the study was to explore the influence of CPC contamination in the autograft on survival and progression after auto-PBSCT. STUDY DESIGN The study included 59 patients diagnosed and treated for multiple myeloma in 1998-2004. Cells with coexpression of CD38+++CD138++CD56+ and lacking the expression of CD45, CD19, CD10, CD20, and CD23 were considered CPC in flow cytometry. RESULTS The risk of death and progression after auto-PBSCT increased significantly by 10% (P < .021) and 8% (P < .034) per 1 × 106/kg of the CPC number, respectively. For CPC number above 2.96 × 106/kg overall survival achieved clinical significance. Two years after auto-PBSCT, the risk of death was independent of CPC number among the patients who survived (P = .70). Analogous conclusions concerned results of progression-free survival at 1 year after auto-PBSCT. CONCLUSIONS High clonal plasma cell contamination (>2.96 ×1 06/kg; 90th percentile of CPC number) is associated with the worst progression-free survival and overall survival. Therefore purging in vitro might be considered for the patients with the highest CPC contamination. Negative consequences of CPC contamination on the risk of death are observed for only 2 years after auto-PBSCT. Thereafter only those patients who had lower CPC contamination survived.
Collapse
Affiliation(s)
- A Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland.
| | | | - M Król
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - E Snarski
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - J Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - P Biecek
- Faculty of Mathematics, Informatics, and Mechanics, University of Warsaw, Warsaw, Poland
| | - M Król
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Z Lewandowski
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
| | - J Peradzyńska
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
| | - W W Jędrzejczak
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - J Dwilewicz-Trojaczek
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| |
Collapse
|
6
|
Przybylski M, Rynans S, Waszczuk-Gajda A, Bilinski J, Basak GW, Jędrzejczak WW, Wróblewska M, Młynarczyk G, Dzieciątkowski T. Sequence typing of human adenoviruses isolated from Polish patients subjected to allogeneic hematopoietic stem cell transplantation – a single center experience. Hematology 2018; 23:633-638. [DOI: 10.1080/10245332.2018.1457308] [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] [Indexed: 10/17/2022] Open
Affiliation(s)
- Maciej Przybylski
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
- Department of Microbiology, Central Clinical Hospital in Warsaw, Warsaw, Poland
| | - Sylwia Rynans
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Bilinski
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz W. Basak
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Wiesław W. Jędrzejczak
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marta Wróblewska
- Department of Microbiology, Central Clinical Hospital in Warsaw, Warsaw, Poland
- Department of Dental Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Młynarczyk
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Dzieciątkowski
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
- Department of Microbiology, Central Clinical Hospital in Warsaw, Warsaw, Poland
| |
Collapse
|
7
|
Waszczuk-Gajda A, Kamiński MF, Koperski Ł, Kamińska A, Drozd-Sokołowska J, Lewandowski Z, Wasiutyński A, Górnicka B, Jędrzejczak WW. Heart infarct as the major cause of death of hematological patients as identified by autopsy. ADV CLIN EXP MED 2018. [PMID: 29521044 DOI: 10.17219/acem/65866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite progress in diagnostic procedures, clinical diagnosis is not always confirmed by an autopsy. An autopsy is a valuable tool in evaluating diagnostic accuracy. OBJECTIVES The aim of the study was to compare clinical diagnoses of immediate causes of death with autopsy findings in patients with hematological malignancies or aplastic anemia. MATERIAL AND METHODS In this study, the results of 154 autopsies (1993-2004) of patients with hematological diseases were reviewed and compared with clinical data. The most probable causes of death in the case of particular hematological diseases as well as the discordances between clinical and autopsy diagnoses and their relation to the clinical characteristic were identified in the studied cohort, which primarily included patients whose death at that particular time was not explained by the clinical course, and in 50% of cases was sudden. RESULTS Although various combined infections have been found to be responsible for the largest number of deaths (26.6%), the most common single cause was myocardial infarction (29 patients, 18.8%). The discordance between clinical and post-mortem diagnoses of immediate causes of death was found in 55 patients (35.7%; 95% CI 28.2-42.8%), with 50.9% of cases considered class I discrepancies according to Goldman's criteria. The myocardial infarction was found to be clinically undiagnosed in 69% of cases. In 41% of cases, it was a class I discrepant diagnosis. CONCLUSIONS This data suggests that hematological patients require special attention and probably preventive measures concerning coronary heart disease, particularly during the initiation of antineoplastic therapy.
Collapse
Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland
| | - Michał F Kamiński
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland
- Department of Gastroenterology, Hepatology and Oncology, Medical Centre for Postgraduate Education, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warszawa, Poland
| | - Łukasz Koperski
- Department of Pathology, Medical University of Warsaw, Poland
| | - Anna Kamińska
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland
- II Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Poland
| | - Aleksander Wasiutyński
- Department of Pathomorphology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warszawa, Poland
| | | | - Wiesław W Jędrzejczak
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland
| |
Collapse
|
8
|
Chacińska W, Brzostowska M, Nojszewska M, Podlecka-Piętowska A, Jędrzejczak WW, Snarski E. "Cure" for multiple sclerosis (MS)-Evolving views of therapy goals in patients on different stages of the disease: A pilot study in a cohort of Polish MS patients. Brain Behav 2017; 7:e00701. [PMID: 28638709 PMCID: PMC5474707 DOI: 10.1002/brb3.701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION New aggressive treatments promise improvement of results in the treatment of multiple sclerosis (MS), however, with high risk of serious complications. In this study, we analyzed patients' acceptance for risks connected with the MS treatment. METHODS The study was designed as a prospective nonanonymous online questionnaire. Responders were asked about the definition of the "cure" for MS and crucial goals in the treatment. RESULTS One hundred and eighty patients filled in the questionnaire (129 women and 51 men), and the mean age was 33 years (SD = 10.29). The MS forms were as follows: relapsing-remitting (65%), secondary progressive (14%), primary progressive (10%), and other (11%), with mean EDSS score of 3 points (SD = 2.6). For 50% of the patients, relief of symptoms such as fatigue (72%), paresis (66%), and balance disorders (65%) was synonymous with "cure." The patients with faster progression of the disease were likely to accept risky "curative" treatments-with average 68% accepted mortality risk (p = .003). Over 81% of patients accepted mortality rates over 1% for the treatment that achieves self-defined cure. CONCLUSION The study shows that the MS patients are likely to accept even very risky treatments as long as they promise patient-defined "cure."
Collapse
Affiliation(s)
- Weronika Chacińska
- Department of Hematology Oncology and Internal Diseases Medical University of Warsaw Warsaw Poland
| | - Marta Brzostowska
- Department of Hematology Oncology and Internal Diseases Medical University of Warsaw Warsaw Poland
| | | | | | - Wiesław W Jędrzejczak
- Department of Hematology Oncology and Internal Diseases Medical University of Warsaw Warsaw Poland
| | - Emilian Snarski
- Department of Hematology Oncology and Internal Diseases Medical University of Warsaw Warsaw Poland
| |
Collapse
|
9
|
Waszczuk-Gajda A, Mądry K, Machowicz R, Drozd-Sokołowska J, Stella-Hołowiecka B, Mital A, Obara A, Szmigielska-Kapłon A, Sikorska A, Subocz E, Jędrzejczak WW, Dwilewicz-Trojaczek J. Red Blood Cell Transfusion Dependency and Hyperferritinemia Are Associated with Impaired Survival in Patients Diagnosed with Myelodysplastic Syndromes: Results from the First Polish MDS-PALG Registry. ADV CLIN EXP MED 2016; 25:633-41. [PMID: 27629836 DOI: 10.17219/acem/62397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 10/16/2015] [Revised: 12/13/2015] [Accepted: 03/30/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell disorders characterized by ineffective hematopoiesis, cytopenias and a risk of progression to acute myeloid leukemia (AML). Anemia is the most frequent cytopenia diagnosed in patients with MDS. Regular RBC transfusions are the only treatment option for about 40% of patients. Transfusion-dependent patients develop secondary iron overload. The influence of serum ferritin (SF) concentration on survival and acute myeloid leukemia transformation in MDS patients remains controversial. The data for the Central European population is scarce and so far there is no description for Poland. OBJECTIVES The aim of this study was to perform a retrospective analysis of the relationship of SF concentration with red blood cell transfusion dependency, survival and transformation to acute myeloid leukemia. MATERIAL AND METHODS We retrospectively evaluated the data of the 819 MDS patients (58% male; median age 70 years) included in the MDS Registry of the MDS Section of the Polish Adult Leukemia Group (PALG). RESULTS Analyses were performed on 190 patients diagnosed with MDS, maximal 6 months before inclusion to the registry in order to avoid selection bias (a shorter survival of higher risk MDS patients). Patients with hyperferritinemia higher than 1000 ng/L vs. patients with SF concentration lower than 1000 ng/L had a median survival of 320 days vs. 568 days, respectively (p log-rank = 0.014). The following factors were found to significantly worsen survival: RBC-transfusion dependence (p = 0.0033; HR 2.67L), platelet transfusion dependence (p = 0.0071; HR 3.321), hemoglobin concentration lower than 10 g/dL (p = 0.0036; HR 2.97), SF concentration higher than 1000 ng/L (p = 0.0023; HR = 2.94), platelet count lower than 10 G/L (p = 0.0081 HR = 5.04), acute leukemia transformation (p = 0.0081; HR 1.968). CONCLUSIONS Taking into account the relatively low number of patients in previous studies exploring hyperferritinemia in MDS, the results of the first Polish MDS Registry provide important insights. Hyperferritinemia higher than 1000 ng/L can be an important indicator of poor prognosis in MDS.
Collapse
Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Poland
| | - Krzysztof Mądry
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Poland
| | - Rafał Machowicz
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Poland
| | - Beata Stella-Hołowiecka
- Department of Hematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland
| | - Andrzej Mital
- Department of Hematology and Bone Marrow Transplantation, Medical University of Gdańsk, Poland
| | - Agata Obara
- Department of Hematology, Holycross Cancer Center, Kielce, Poland
| | | | - Anna Sikorska
- Department of Hematology, Institute of Hematology and Transfusiology, Warszawa, Poland
| | - Edyta Subocz
- Department of Hematology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland
| | - Wiesław W Jędrzejczak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Poland
| | | |
Collapse
|
10
|
De Paula Campos U, Hatzopoulos S, Śliwa LK, Skarżyński PH, Jędrzejczak WW, Skarżyński H, Carvallo RMM. Relationship Between Distortion Product - Otoacoustic Emissions (DPOAEs) and High-Frequency Acoustic Immittance Measures. Med Sci Monit 2016; 22:2028-34. [PMID: 27299792 PMCID: PMC4913870 DOI: 10.12659/msm.897157] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/25/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pathologies that alter the impedance of the middle ear may consequently modify the DPOAE amplitude. The aim of this study was to correlate information from 2 different clinical procedures assessing middle ear status. Data from DPOAE responses (both DP-Gram and DP I/O functions) were correlated with data from multi-component tympanometry at 1000 Hz. MATERIAL AND METHODS The subjects were divided into a double-peak group (DPG) and a single-peak group (SPG) depending on 1000 Hz tympanogram pattern. Exclusion criteria (described in the Methods section) were applied to both groups and finally only 31 ears were assigned to each group. The subjects were also assessed with traditional tympanometry and behavioral audiometry. RESULTS Compared to the single-peak group, in terms of the 226 Hz tympanometry data, subjects in the DPG group presented: (i) higher values of ear canal volume; (ii) higher peak pressure, and (iii) significantly higher values of acoustic admittance. DPOAE amplitudes were lower in the DPG group only at 6006 Hz, but the difference in amplitude between the DPG and SPG groups decreased as the frequency increased. Statistical differences were observed only at 1001 Hz and a borderline difference at 1501 Hz. In terms of DPOAE I/O functions, significant differences were observed only in 4 of the 50 tested points. CONCLUSIONS The 1000-Hz tympanometric pattern significantly affects the structure of DPOAE responses only at 1001 Hz. In this context, changes in the properties of the middle ear (as detected by the 1000 Hz tympanometry) can be considered as prime candidates for the observed variability in the DP-grams and the DP I/O functions.
Collapse
Affiliation(s)
- Ualace De Paula Campos
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, University of São Paulo of Medicine, São Paulo, SP, Brazil
| | | | - Lech K. Śliwa
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Piotr H. Skarżyński
- World Hearing Center, Warsaw/Kajetany, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | | | - Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Warsaw/Kajetany, Poland
| | - Renata Mota Mamede Carvallo
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, University of São Paulo of Medicine, São Paulo, SP, Brazil
| |
Collapse
|
11
|
Jędrzejczak WW. Diffuse large B‑cell lymphoma: R‑CHOP forever? Pol Arch Intern Med 2015. [DOI: 10.20452/pamw.3101] [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: 11/23/2022]
|
12
|
Bogunia-Kubik K, Mizia S, Gronkowska A, Nowak J, Kyrcz-Krzemień S, Markiewicz M, Dzierżak-Mietła M, Koclęga A, Sędzimirska M, Suchnicki K, Duda D, Lange J, Mordak-Domagała M, Kościńska K, Węzik S, Jędrzejczak WW, Kaczmarek B, Hellmann A, Kucharska A, Kowalczyk J, Drabko K, Warzocha K, Mika-Witkowska R, Goździk J, Lange A. CCR5gene polymorphism affects the risk of GvHD after haematopoietic stem cell transplantation from an unrelated donor. Br J Haematol 2015; 171:285-288. [DOI: 10.1111/bjh.13387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Katarzyna Bogunia-Kubik
- L. Hirszfeld Institute of Immunology and Experimental Therapy; Polish Academy of Sciences; Wroclaw Poland
| | - Sylwia Mizia
- Lower Silesian Centre for Cellular Transplantation with National Bone Marrow Donor Registry; Wroclaw Poland
| | - Anna Gronkowska
- Department of Haematology, Oncology and Internal Medicine; Medical University of Warsaw; Warsaw Poland
| | - Jacek Nowak
- Institute of Haematology and Transfusion Medicine; Warsaw Poland
| | - Sławomira Kyrcz-Krzemień
- Department of Haematology and Bone Marrow Transplantation; Medical University of Silesia; Katowice Poland
| | - Mirosław Markiewicz
- Department of Haematology and Bone Marrow Transplantation; Medical University of Silesia; Katowice Poland
| | - Monika Dzierżak-Mietła
- Department of Haematology and Bone Marrow Transplantation; Medical University of Silesia; Katowice Poland
| | - Anna Koclęga
- Department of Haematology and Bone Marrow Transplantation; Medical University of Silesia; Katowice Poland
| | - Mariola Sędzimirska
- Lower Silesian Centre for Cellular Transplantation with National Bone Marrow Donor Registry; Wroclaw Poland
| | - Krzysztof Suchnicki
- Lower Silesian Centre for Cellular Transplantation with National Bone Marrow Donor Registry; Wroclaw Poland
| | - Dorota Duda
- Lower Silesian Centre for Cellular Transplantation with National Bone Marrow Donor Registry; Wroclaw Poland
| | - Janusz Lange
- Lower Silesian Centre for Cellular Transplantation with National Bone Marrow Donor Registry; Wroclaw Poland
| | - Monika Mordak-Domagała
- Lower Silesian Centre for Cellular Transplantation with National Bone Marrow Donor Registry; Wroclaw Poland
| | - Katarzyna Kościńska
- Lower Silesian Centre for Cellular Transplantation with National Bone Marrow Donor Registry; Wroclaw Poland
| | - Sławomir Węzik
- Lower Silesian Centre for Cellular Transplantation with National Bone Marrow Donor Registry; Wroclaw Poland
| | - Wiesław W. Jędrzejczak
- Department of Haematology, Oncology and Internal Medicine; Medical University of Warsaw; Warsaw Poland
| | - Beata Kaczmarek
- Department of Haematology, Oncology and Internal Medicine; Medical University of Warsaw; Warsaw Poland
| | - Andrzej Hellmann
- Department of Hematology and Transplantology; Medical University of Gdansk; Gdansk Poland
| | - Agnieszka Kucharska
- Department of Hematology and Transplantology; Medical University of Gdansk; Gdansk Poland
| | - Jerzy Kowalczyk
- Department of Paediatric Haematology, Oncology and Transplantology; Medical University; Lublin Poland
| | - Katarzyna Drabko
- Department of Paediatric Haematology, Oncology and Transplantology; Medical University; Lublin Poland
| | | | | | - Jolanta Goździk
- Chair of Clinical Immunology and Transplantation Polish-American Institute of Pediatrics; Jagiellonian University Medical College; Department of Transplantation Children's University Hospital; Cracow Poland
| | - Andrzej Lange
- L. Hirszfeld Institute of Immunology and Experimental Therapy; Polish Academy of Sciences; Wroclaw Poland
- Lower Silesian Centre for Cellular Transplantation with National Bone Marrow Donor Registry; Wroclaw Poland
| | | |
Collapse
|
13
|
Jędrzejczak WW. Diffuse large B‑cell lymphoma: R‑CHOP forever? Pol Arch Med Wewn 2015; 125:713-714. [PMID: 26529335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
14
|
Rynans S, Dzieciątkowski T, Przybylski M, Basak GW, Rusicka P, Tomaszewska A, Hałaburda K, Jędrzejczak WW, Młynarczyk G. Incidence of Adenoviral DNAemia in Polish Adults Undergoing Allogeneic Haematopoietic Stem Cell Transplantation. Arch Immunol Ther Exp (Warsz) 2014; 63:79-84. [DOI: 10.1007/s00005-014-0320-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 08/12/2014] [Indexed: 11/29/2022]
|
15
|
Tomaszewska A, Kryśko A, Dzieciątkowski T, Przybylski M, Basak GW, Hałaburda K, Piekarska K, Sulowska A, Nasiłowska-Adamska B, Młynarczyk G, Jędrzejczak WW, Mariańska B. Co-infections with cytomegalovirus and human herpesvirus type 7 in adult Polish allogeneic haematopoietic stem cell transplant recipients. Arch Immunol Ther Exp (Warsz) 2013; 62:77-80. [PMID: 23955532 PMCID: PMC3898125 DOI: 10.1007/s00005-013-0252-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/05/2013] [Indexed: 11/29/2022]
Abstract
Human herpesvirus 7 (HHV-7) is widespread around the world and may also be a possible cofactor for cytomegalovirus (CMV) infection in haematopoietic stem cell transplant (HSCT) recipients. In case of viral diseases where specific treatment is available, real-time PCR assays constitute reliable diagnostic tools enabling timely initiation of appropriate therapy and rapid assessment of the efficacy of antiviral treatment strategies. The presence of CMV and HHV-7 was confirmed by the detection of viral DNA isolated from 1,027 plasma samples. A group of 69 allogeneic HSCT (alloHSCT) recipients was examined in early post-transplant period using quantitative real-time PCR methods. Within the study period, 62 % of patients had at least once CMV DNA-emia, while HHV-7 DNA was found in 43 % of subjects. Co-infection between these β-herpesviruses was detected in the plasma samples collected from 18 patients (26 %). Patients with concomitant HHV-7 DNA-emia had significantly higher number of CMV DNA copies compared with those without HHV-7 infection (1986 vs. 432 copies/ml, p < 0.001) but there was no difference in duration of CMV DNA-emia between these groups. On the other hand, while the load of HHV-7 DNA was comparable between patients with CMV DNA-emia and without CMV DNA-emia, the duration of HHV-7 DNA-emia was significantly longer in the first group (38.5 vs. 14 days, p < 0.001). HHV-7 DNA-emia is very frequently detected in Polish alloHSCT recipients. In those, who have subsequent CMV reactivation, the coexistence of the viruses may negatively affect the kinetics of infection with either of them. Therefore the investigation of concomitant HHV-7 DNA-emia could affect the prognosis of post-transplant patients suffering from CMV reactivation.
Collapse
Affiliation(s)
- Agnieszka Tomaszewska
- Department of Haematopoetic Stem Cell Transplantation, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Fabijańska A, Smurzyński J, Hatzopoulos S, Kochanek K, Bartnik G, Raj-Koziak D, Mazzoli M, Skarżynski PH, Jędrzejczak WW, Szkiełkowska A, Skarżyński H. The relationship between distortion product otoacoustic emissions and extended high-frequency audiometry in tinnitus patients. Part 1: normally hearing patients with unilateral tinnitus. Med Sci Monit 2012; 18:CR765-70. [PMID: 23197241 PMCID: PMC3560797 DOI: 10.12659/msm.883606] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [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: 03/08/2012] [Accepted: 05/30/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate distortion product otoacoustic emissions (DPOAEs) and extended high-frequency (EHF) thresholds in a control group and in patients with normal hearing sensitivity in the conventional frequency range and reporting unilateral tinnitus. MATERIAL/METHODS Seventy patients were enrolled in the study: 47 patients with tinnitus in the left ear (Group 1) and 23 patients with tinnitus in the right ear (Group 2). The control group included 60 otologically normal subjects with no history of pathological tinnitus. Pure-tone thresholds were measured at all standard frequencies from 0.25 to 8 kHz, and at 10, 12.5, 14, and 16 kHz. The DPOAEs were measured in the frequency range from approximately 0.5 to 9 kHz using the primary tones presented at 65/55 dB SPL. RESULTS The left ears of patients in Group 1 had higher median hearing thresholds than those in the control subjects at all 4 EHFs, and lower mean DPOAE levels than those in the controls for almost all primary frequencies, but significantly lower only in the 2-kHz region. Median hearing thresholds in the right ears of patients in Group 2 were higher than those in the right ears of the control subjects in the EHF range at 12.5, 14, and 16 kHz. The mean DPOAE levels in the right ears were lower in patients from Group 2 than those in the controls for the majority of primary frequencies, but only reached statistical significance in the 8-kHz region. CONCLUSIONS Hearing thresholds in tinnitus ears with normal hearing sensitivity in the conventional range were higher in the EHF region than those in non-tinnitus control subjects, implying that cochlear damage in the basal region may result in the perception of tinnitus. In general, DPOAE levels in tinnitus ears were lower than those in ears of non-tinnitus subjects, suggesting that subclinical cochlear impairment in limited areas, which can be revealed by DPOAEs but not by conventional audiometry, may exist in tinnitus ears. For patients with tinnitus, DPOAE measures combined with behavioral EHF hearing thresholds may provide additional clinical information about the status of the peripheral hearing.
Collapse
Affiliation(s)
- Anna Fabijańska
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Jacek Smurzyński
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, U.S.A
| | | | - Krzysztof Kochanek
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Grażyna Bartnik
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Danuta Raj-Koziak
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Manuela Mazzoli
- Department of Audiology and ENT, University of Ferrara, Ferrara, Italy
| | - Piotr H. Skarżynski
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Wiesław W. Jędrzejczak
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Agata Szkiełkowska
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| |
Collapse
|
17
|
Hatzopoulos S, Petruccelli J, Śliwa L, Jędrzejczak WW, Kochanek K, Skarżyński H. Hearing threshold prediction with Auditory Steady State Responses and estimation of correction functions to compensate for differences with behavioral data, in adult subjects. Part 1: Audera and CHARTR EP devices. Med Sci Monit 2012; 18:MT47-53. [PMID: 22739744 PMCID: PMC3560776 DOI: 10.12659/msm.883195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The objective of the study was the evaluation and comparison of hearing threshold values extrapolated from Auditory Steady State Responses, using 2 commercial systems and the estimation of correction factors applicable to the ASSR data. Material/Methods One hundred ten subjects participated to the study. All subjects were initially examined with otoscopy, pure-tone audiometry and admittance. Data were acquired by 2 clinical systems the Audera (Viasys) and the CHARTR EP (ICS), using identical protocols. The acoustic stimuli consisted of single carrier frequencies at 1000, 2000 and 4000 Hz modulated at 40 Hz. Results The data show that the threshold estimates from both devices differ significantly from the measured behavioral thresholds. The ICS device presented significantly larger mean-ASSR estimated hearing level values at the tested frequencies, implying an underestimation of the hearing threshold. Both sets of prediction errors overestimated hearing levels for the normal group. The prediction errors were in all cases greater for the Audera than for the ICS. Conclusions The errors encountered in the estimates of the 2 widely-used commercial devices suggest that the current ASSR protocols are not ready for a wide-range use and that significant developments in the area of threshold prediction / precision are necessary. If, on the other-hand, the ASSR predicted threshold is used on a purely consulting basis, as in hearing-aid fitting, then such errors might be acceptable in a clinical setting.
Collapse
|
18
|
Jędrzejczak WW. XXXIII Zimowy Kongres ARO w Anaheim. Otolaryngol Pol 2010. [DOI: 10.1016/s0030-6657(10)70620-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: 11/29/2022]
|