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Girard L, Koh YJ, Koh LP, Chee YL, Chan HL, Lee J, de Mel S, Poon LM, Samuel M. Role of upfront autologous transplant for peripheral T-cell lymphoma patients achieving a complete remission with first-line therapy: a systematic review and meta-analysis. Bone Marrow Transplant 2024:10.1038/s41409-024-02254-x. [PMID: 38443704 DOI: 10.1038/s41409-024-02254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/12/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
There is currently no consensus on the role of upfront autologous transplantation (ASCT) for patients with peripheral T-cell lymphomas (PTCL), especially in patients achieving first complete remission (CR1) following chemotherapy, and data in the literature is conflicting. A systematic review and meta-analysis was performed to address this question. We searched key databases from January 2000 to February 2022. Six prospective and eleven retrospective studies were included among 2959 unique records. Median follow up in these studies ranged from 22 to 94 months. There was a trend towards benefit in PFS (HR = 0.80, 95% CI 0.62-1.05, p = 0.11) and OS (HR = 0.79, 95% CI 0.57-1.09, p = 0.15) in the ASCT compared to chemotherapy only group. Importantly, in transplant eligible patients in CR1, a significant benefit was demonstrated in both OS (HR = 0.59, 95% CI 0.36-0.95, p = 0.03) and PFS (HR = 0.61, 95% CI 0.47-0.81, p = 0.0004) in the ASCT group. Amongst the nodal PTCL subgroups, ASCT showed a significant PFS benefit for the AITL subgroup (HR = 0.43, 95% CI 0.20-0.94, p < 0.03) but not PTCL-NOS or ALK-ve ALCL subgroups. Our findings support upfront ASCT for transplant eligible PTCL patients achieving CR1 post chemotherapy. In particular, patients with AITL exhibited a significantly better PFS after upfront ASCT.
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Affiliation(s)
- L Girard
- Aberdeen Royal Infirmary, National Health Service Grampian, Aberdeen, UK
| | - Y J Koh
- University College London Medical School, London, UK
| | - L P Koh
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - Y L Chee
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - H L Chan
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - J Lee
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - S de Mel
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - L M Poon
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore.
| | - M Samuel
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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2
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De Mel S, Goh J, Rashid MBMA, Zhang XY, Jaynes P, Liu X, Poon L, Chan E, Lee J, Chee YL, Koh LP, Tan LK, Soh TG, Yuen YC, Loi H, Ng S, Goh X, Tan D, Cheah DMZ, Pang WL, Huang D, Chan JY, Somasundaram N, Tang T, Lim ST, Ong CK, Chng W, Chow EK, Jeyasekharan AD. CLINICAL APPLICATION OF AN EX‐VIVO PLATFORM TO GUIDE THE CHOICE OF DRUG COMBINATIONS IN RELAPSED/REFRACTORY LYMPHOMA; A PROSPECTIVE STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.147_2880] [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: 11/06/2022]
Affiliation(s)
- S De Mel
- National University Health System Department of Haematology‐Oncology National University Cancer Institute, Singapore Singapore Singapore
| | - J Goh
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | | | - X. Y Zhang
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - P Jaynes
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - X Liu
- National University Health System Department of Haematology‐Oncology National University Cancer Institute, Singapore Singapore Singapore
| | - L Poon
- National University Health System Department of Haematology‐Oncology National University Cancer Institute, Singapore Singapore Singapore
| | - E Chan
- National University Health System Department of Haematology‐Oncology National University Cancer Institute, Singapore Singapore Singapore
| | - J Lee
- National University Health System Department of Haematology‐Oncology National University Cancer Institute, Singapore Singapore Singapore
| | - Y. L Chee
- National University Health System Department of Haematology‐Oncology National University Cancer Institute, Singapore Singapore Singapore
| | - L. P Koh
- National University Health System Department of Haematology‐Oncology National University Cancer Institute, Singapore Singapore Singapore
| | - L. K Tan
- National University Hospital Department of Laboratory Medicine Singapore Singapore
| | - T. G Soh
- National University Hospital Department of Laboratory Medicine Singapore Singapore
| | - Y. C Yuen
- National University Health System Department of Pharmacy Singapore Singapore
| | - Hoi‐Y Loi
- National University Hospital Singapore Department of Diagnostic Imaging Singapore Singapore
| | - Siok‐B Ng
- National University of Singapore Department of Pathology Yong Loo Lin School of Medicine Singapore Singapore
| | - X Goh
- National University Hospital, Department of Otorhinolaryngology Singapore Singapore
| | - D Tan
- Mt Elizabeth Hospital, Dr Daryl Tan Clinic for Lymphoma, Myeloma and Blood Disorders Singapore Singapore
| | - D. M. Z Cheah
- National Cancer Centre Singapore Lymphoma Genomic Translational Research Laboratory Division of Cellular and Molecular Research Singapore Singapore
| | - W. L Pang
- National Cancer Centre Singapore Lymphoma Genomic Translational Research Laboratory Division of Cellular and Molecular Research Singapore Singapore
| | - D Huang
- National Cancer Centre Singapore Lymphoma Genomic Translational Research Laboratory Division of Cellular and Molecular Research Singapore Singapore
| | - J. Y Chan
- National Cancer Centre Singapore Division of Medical Oncology Singapore Singapore
| | - N Somasundaram
- National Cancer Centre Singapore Division of Medical Oncology Singapore Singapore
| | - T Tang
- National Cancer Centre Singapore Division of Medical Oncology Singapore Singapore
| | - S. T Lim
- National Cancer Centre Singapore Division of Medical Oncology Singapore Singapore
| | - C. K Ong
- National Cancer Centre Singapore Division of Cellular and Molecular Research Singapore Singapore
| | - W.‐J Chng
- National University Health System Department of Haematology‐Oncology National University Cancer Institute, Singapore Singapore Singapore
| | - E. K Chow
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - A. D Jeyasekharan
- National University Health System Department of Haematology‐Oncology National University Cancer Institute, Singapore Singapore Singapore
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Hoppe MM, Fan S, Jaynes P, Peng Y, Liu X, De Mel S, Poon L, Chan E, Lee J, Chee YL, Ong CK, Tang T, Lim ST, Chng WJ, Grigoropoulos NF, VanSchoiack A, Bertolazzi G, Ng S, Tripodo C, Jeyasekharan AD. DIGITAL SPATIAL PROFILING OF DIFFUSE LARGE B‐CELL LYMPHOMAS REVEALS STING AS AN IMMUNE‐RELATED DETERMINANT OF SURVIVAL AFTER R‐CHOP THERAPY. Hematol Oncol 2021. [DOI: 10.1002/hon.8_2880] [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: 11/05/2022]
Affiliation(s)
- M. M Hoppe
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - S Fan
- National University of Singapore Department of Pathology Yong Loo Lin School of Medicine Singapore Singapore
| | - P Jaynes
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - Y Peng
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - X Liu
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - S De Mel
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - L Poon
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - E Chan
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - J Lee
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - Y. L Chee
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - C. K Ong
- National Cancer Centre Singapore Division of Cellular and Molecular Research Singapore Singapore
| | - T Tang
- National Cancer Centre Singapore Division of Medical Oncology Singapore Singapore
| | - S. T Lim
- National Cancer Centre Singapore Division of Medical Oncology Singapore Singapore
| | - W. J Chng
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - N. F Grigoropoulos
- Singapore General Hospital Department of Haematology Singapore Singapore
| | | | - G Bertolazzi
- University of Palermo Tumor Immunology Unit Palermo Italy
| | - Siok‐B Ng
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - C Tripodo
- University of Palermo Tumor Immunology Unit Palermo Italy
| | - A. D Jeyasekharan
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
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4
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Hoppe MM, Jaynes P, Fan S, Peng Y, Hoang PM, Liu X, De Mel S, Poon L, Chan E, Lee J, Chee YL, Ong CK, Tang T, Lim ST, Grigoropoulos NF, Tan S, Hue SS, Chang S, Chuang S, Li S, Khoury JD, Choi H, Farinha P, Mottok A, Scott DW, Chng W, Ng S, Tripodo C, Jeyasekharan AD. MYC, BCL2 AND BCL6 COEXPRESSION PATTERNS AT SINGLE‐CELL RESOLUTION RE‐DEFINE DOUBLE EXPRESSOR LYMPHOMAS. Hematol Oncol 2021. [DOI: 10.1002/hon.9_2880] [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)
- M. M Hoppe
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - P Jaynes
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - S Fan
- National University of Singapore Department of Pathology Yong Loo Lin School of Medicine Singapore Singapore
| | - Y Peng
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - P. M Hoang
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - X Liu
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - S De Mel
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - L Poon
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - E Chan
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - J Lee
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - Y. L Chee
- National University Health System Department of Haematology‐Oncology Singapore Singapore
| | - C. K Ong
- National Cancer Centre Singapore Division of Cellular and Molecular Research Singapore Singapore
| | - T Tang
- National Cancer Centre Singapore Division of Medical Oncology Singapore Singapore
| | - S. T Lim
- National Cancer Centre Singapore Division of Medical Oncology Singapore Singapore
| | - N. F Grigoropoulos
- Singapore General Hospital Department of Haematology Singapore Singapore
| | - S.‐Y Tan
- National University of Singapore Department of Pathology Yong Loo Lin School of Medicine Singapore Singapore
| | - S. S.‐S Hue
- National University of Singapore Department of Pathology Yong Loo Lin School of Medicine Singapore Singapore
| | - S.‐T Chang
- Chi‐Mei Medical Center Department of Pathology Tainan Taiwan
| | - S.‐S Chuang
- Chi‐Mei Medical Center Department of Pathology Tainan Taiwan
| | - S Li
- The University of Texas MD Anderson Cancer Center Department of Hematopathology, Division of Pathology and Laboratory Medicine Houston USA
| | - J. D Khoury
- The University of Texas MD Anderson Cancer Center Department of Hematopathology, Division of Pathology and Laboratory Medicine Houston USA
| | - H Choi
- National University of Singapore Department of Medicine, Yong Loo Lin School of Medicine Singapore Singapore
| | - P Farinha
- BC Cancer Research Centre Department of Lymphoid Cancer Research Vancouver Canada
| | - A Mottok
- University Medical Center and University of Ulm, Institute of Human Genetics Ulm Germany
| | - D. W Scott
- BC Cancer Research Centre Department of Lymphoid Cancer Research Vancouver Canada
| | - Wee‐J Chng
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - S.‐B Ng
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
| | - C Tripodo
- University of Palermo Tumor Immunology Unit Palermo Italy
| | - A. D Jeyasekharan
- National University of Singapore Cancer Science Institute of Singapore Singapore Singapore
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Abstract
The haemostatic system comprises four compartments: the vasculature, platelets, coagulation factors, and the fibrinolytic system. There is presently no laboratory or near-patient test capable of reproducing the complex regulated interaction between these four compartments. The prothrombin time (PT) and activated partial thromboplastin time (APTT) only test the coagulation protein compartment of the system and results have to be carefully interpreted in the context of the clinical presentation and assay limitations. This article will give a general overview of the limitations of PT and APTT and discuss specific issues that need to be considered when the tests are requested, in the context of anticoagulant monitoring, bleeding symptoms, and routine preoperative screening. Of these indications, routine preoperative screening is the most controversial and is generally not warranted in the absence of an abnormal bleeding history.
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Affiliation(s)
- Y L Chee
- YL Chee Consultant Haematologist Department of Haematology-Oncology NUHS Tower Block Level 7 1E Kent Ridge Road Singapore 119228 e-mail
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Abstract
It is not clear whether von Willebrand disease (VWD) is associated with an increased risk of postpartum haemorrhage (PPH). We assessed the effect of VWD on PPH in a case-control study. Logistic regression was used to test for differences in the odds of PPH in deliveries to women with and without VWD, before and after adjustment for known risk factors. A total of 62 deliveries in 33 women with VWD were compared with controls matched for age, year of delivery and parity. Primary PPH was observed in 12/62 (19.4%) deliveries in women with VWD and 16/124 (12.9%) controls. The unadjusted odds ratio (OR) for VWD as a risk factor for PPH was 1.62 (95% CI 0.75-3.49, P = 0.22). After adjustment for other risk factors for PPH, the OR for VWD as a risk factor for PPH was 1.31 (95% CI 0.48-3.60, P = 0.60). PPH was observed in 7/24 (29%) deliveries in women known prepregnancy to have VWD. The unadjusted odds for VWD as a risk factor for PPH in this group was significantly greater than the control group (OR 2.78 (95% CI 1.03-7.49) P = 0.043) and remained significant after adjusting for other significant risk factors (OR 3.41 (95% CI 1.07-10.9) P = 0.038). VWD in itself may not be a significant risk factor for PPH, however, women known to have VWD predelivery may represent an at risk sub-group.
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Affiliation(s)
- Y L Chee
- Department of Haematology, Foresterhill Health Campus, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
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Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. Br J Haematol 2008; 140:496-504. [DOI: 10.1111/j.1365-2141.2007.06968.x] [Citation(s) in RCA: 291] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Chee YL, Vickers MA, Stevenson D, Holyoake TL, Culligan DJ. Fatal myelodysplastic syndrome developing during therapy with imatinib mesylate and characterised by the emergence of complex Philadelphia negative clones. Leukemia 2003; 17:634-5. [PMID: 12646955 DOI: 10.1038/sj.leu.2402842] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Accurate diagnosis of the cause of bleeding is a prerequisite for determination of the optimal therapeutic response. Clinicians are generally aware of the more prevalent hemorrhagic syndromes but some rare acquired conditions are also of importance. In many of these, inhibitors of coagulation factors or of platelet adhesion/aggregation cause bleeding. These inhibitors are generally, but not always, immunoglobulins. In this review, the less common inhibitors of coagulation and hemostasis, as well as some important but rare nutritional, iatrogenic and disease associated hemorrhagic disorders, are described.
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Affiliation(s)
- H G Watson
- Department of Medicine and Therapeutics, University of Aberdeen, Polworth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
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10
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Abstract
Conditions which result in hypercoagulable blood or venous stasis may predispose to the development of deep vein thrombosis (DVT). Most of the recently described risk factors for DVT induce a hypercoagulable state. Over a 3-year period we have observed anomaly of the inferior vena cava (IVC) in four young patients presenting with spontaneous unprovoked DVT. This is a greater than expected rate (5% observed versus 0.5% expected). Further, bilateral DVT, which constitutes less than 10% of cases in most series, was present in three of the four cases. Anomaly of the IVC is a rare example of a prevalent congenital condition that predisposes to DVT, presumably by favouring venous stasis. This diagnosis should be considered in young patients with spontaneous and bilateral DVT.
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Affiliation(s)
- Y L Chee
- Department of Haematology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
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11
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Abstract
Varicella zoster virus (VZV) infection involving the posterior segment of the eye after fludarabine treatment has not previously been described. Two patients, who had completed fludarabine treatment 3 and 18 months previously, presented with visual loss that had been preceded by a recent history of cutaneous zoster. The use of the polymerase chain reaction (PCR) for VZV DNA from ocular specimens allowed rapid confirmation of clinical diagnosis and treatment with a good outcome in one patient. With the increasing use of fludarabine and other purine analogues, an awareness of such complications is important because of their potentially sight-threatening consequences.
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Affiliation(s)
- Y L Chee
- Department of Haematology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
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Culligan DJ, Stevenson D, Chee YL, Grimwade D. Acute promyelocytic leukaemia with t(11;17)(q23;q12-21) and a good initial response to prolonged ATRA and combination chemotherapy. Br J Haematol 1998; 100:328-30. [PMID: 9488621 DOI: 10.1046/j.1365-2141.1998.00575.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [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: 02/06/2023]
Abstract
Acute myeloid leukaemia (AML) of FAB subtype M3 is associated with t(15;17)(q22;q21) and a relatively good prognosis when treated with all-trans retinoic acid (ATRA) and combination chemotherapy. Rarely, alternative balanced translocations have been described in this subtype of AML. The translocation t(11;17)(q23;q21) leading to a PLZF/RARalpha rearrangement has been described in a very small number of cases and has been associated with a poor response to ATRA and an adverse prognosis. We describe a case of AML FAB type M3 with this translocation who entered morphological and cytogenetic complete remission after concurrent prolonged ATRA and one course of induction chemotherapy and remains in morphological and molecular remission at 10 months after presentation. This diagnosis therefore may not always be associated with a poor initial response to treatment.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 17/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Middle Aged
- Translocation, Genetic
- Tretinoin/administration & dosage
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Affiliation(s)
- D J Culligan
- Department of Haematology, Aberdeen Royal Infirmary, Foresterhill
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Currie J, Chee YL, Culligan DJ. Central nervous system relapse in acute promyelocytic leukaemia treated with ATRA. Br J Haematol 1997; 99:469. [PMID: 9375778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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